The Itch: Allergies, Asthma, Eczema & Immunology

#59 - What is anaphylaxis, and when to use epinephrine?

Have you ever wondered if it's anaphylaxis or just a severe allergic reaction? And how do you know when to use epinephrine? Diagnosing anaphylaxis can be challenging, and in this episode, we dive into this topic with our guest, Dr. David Golden.

What we cover in this episode:

• What is anaphylaxis
• When to use an Epinephrine device?
• How to determine if it is an allergic reaction or an anaphylactic reaction?
• How safe is it to use Epinephrine?
  • Why is epinephrine used to treat anaphylaxis?
  • Does epinephrine always work to treat anaphylaxis? Why would it not work?
  • What are the side effects of Epinephrine?
  • Do you have to go to the hospital after using Epinephrine?
• How does Epinephrine work?
• Why antihistamines do not work to treat anaphylaxis or a severe asthma attack
• Other treatments that are in the pipeline for anaphylaxis?
• Epinephrine dosing - how to know the right dose for kids and adults.
• When do you need a second dose of Epinephrine?
• Carrying two epinephrine devices
• Will the next anaphylactic reaction be worse?
• Why should we encourage having stock Epinephrine in schools, on planes, etc?

Helpful links:

• More about our guest Dr. David Golden
• More about Anaphylaxis: https://allergyasthmanetwork.org/anaphylaxis/
• More about Epinephrine: https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/
• What if I can’t afford my epinephrine? Learn more here: https://allergyasthmanetwork.org/anaphylaxis/what-if-i-cant-afford-my-epinephrine/

#58: What is controlled Asthma? Everything you need to know!

In the second episode of the Allergy, Asthma & Immunology Innovations Podcast Series, Dr. G and Kortney dive into the critical topic of controlled and uncontrolled asthma. They shed light on various aspects of asthma, including its types, severity levels, medications, and the importance of asthma action plans.

This episode is especially important to our hosts as asthma has personally impacted them.

What we cover about controlled asthma:

• A quick review of asthma

• Types and severity levels of asthma

• Asthma can manifest in various forms, including:

  • Allergic asthma (triggered by allergens).

  • Non-allergic asthma (triggered by factors other than allergens).

  • Occupational asthma (caused by workplace exposure).

  • Exercise-induced asthma.

  • Cough-variant asthma (primarily chronic cough).

  • Aspirin-exacerbated respiratory disease (AERD).

  • Late-onset asthma (developing in adulthood).

  • Eosinophilic asthma (inflammation-related).

  • Asthma can be categorized as mild, moderate, or severe based on symptoms and lung function tests. Severity impacts treatment strategies.

• Medications for asthma management

  • Rescue or emergency medication (for mild asthma).

  • Controller medication (for moderate to severe asthma). Controller medications include inhaled steroids, other medications, and biologics for severe cases.

• Assessing asthma control

• Asthma control is evaluated based on the "Rule of 2s". If you have two or more of the following, your asthma may not be controlled;

  • Symptoms more than two days a week.

  • Quick-relief medication usage more than two times a week.

  • Nighttime awakenings due to asthma more than two times a month.

  • Asthma exacerbations require oral steroids twice a year.

• What is good asthma control, and why is this important

• The long-term effects of uncontrolled asthma

• Asthma Peak Week.

• Creating an asthma action plan

• Working with healthcare providers and asthma coaches

Resources to help you with your asthma control:

Asthma Management and Control: https://allergyasthmanetwork.org/what-is-asthma/asthma-management-and-control/ 

Asthma Action Plan: https://allergyasthmanetwork.org/what-is-asthma/asthma-action-plan/  This page is great because it has multiple types of Asthma Action Plans.

Infographic about asthma peak in September: https://allergyasthmanetwork.org/images/Asthma/September_Asthma_Peak_July2023v1.pdf

Asthma Coach: www. AsthmaCoach.org and https://allergyasthmanetwork.org/free-asthma-coach-program/.

Lifestyle Changes to Manage Asthma: https://allergyasthmanetwork.org/what-is-asthma/lifestyle-changes-to-manage-asthma/

Biologic medications: www.BiologicMeds.org

Type 2 Inflammation: eosasthma.org https://allergyasthmanetwork.org/news/when-asthma-more-than-asthma-type-inflammation/

#57 - What are ocular allergies? Unpacking allergies of the eyes and more!

Itchy, watery eyes? It may be an allergy that only impacts your eyes!

Dr. Luk joins Dr. G and Kortney to discuss ocular allergies, which are allergic reactions that affect the eyes. 

Ocular allergies are common and can cause significant discomfort and impaired vision. However, many people are unaware of the different types of ocular allergies, the treatments available, or the importance of prevention. If you always find yourself with itchy, red and watery eyes or around certain things, this episode is for you!

What we cover about ocular allergies:

• The difference between an ophthalmologist and an optometrist

• Ocular allergy - what is this, and how is it different from systemic allergies? 

• The different types of ocular allergies: 

  • Seasonal allergic conjunctivitis

  • Perennial allergic conjunctivitis

  • Vernal keratoconjunctivitis

  • Atopic keratoconjunctivitis

• Treatment options for ocular allergies

• The dangers of rubbing your eyes and what to do instead

• All you need to know about eye drops

More about ocular eye allergy expert: Dr. Janice Luk

Dr. Janice Luk is a Toronto native who graduated with honors from the Doctor of Optometry and Bachelor of Science programs at the University of Waterloo. She is passionate about expanding her knowledge and bridging the gap between ocular aesthetics and dry eye disease. Janice communicates openly with her patients and volunteers with organizations like VOSH and Fighting Blindness Canada. She is an active member of multiple optometry associations.

Connect with her: https://www.instagram.com/ilukateyes/

#56 - Biologic Therapies for Asthma

Part of the series: Allergy, Asthma & Immunology Innovations Podcast

This podcast was made in partnership with Allergy & Asthma Network, with funding support from AstraZeneca.

In this episode, we explore a new form of asthma treatment, Biologics. These innovative treatments offer targeted relief by addressing the underlying causes of asthma, leading to improved symptom control and a better quality of life. Dr. G and Kortney discuss the current biologics on the market for asthma treatment. 

As this is a true deep dive, we have provided some more information about the Biologics discussed to help you build a better understanding. We have included images and graphs you can use when listening to the episode. 

What we cover in this episode:

• A background on how Biologic treatments work.
• The Biologics available for asthma - discuss who is a candidate, how they each work, how they are taken and some side effects. 
  • Omalizumab (Xolair)
  • Mepolizumab
  • Reslizumab
  • Benralizumab
  • Dupilumab
  • Tezepelumab

Helpful links:

Images and graphs discussed in this episode: www.itchpodcast.com/episodes/56-asthma-biologics

A look at biologics in more depth: www.biologicmeds.org

More about type 2 inflammation: https://allergyasthmanetwork.org/news/when-asthma-more-than-asthma-type-inflammation/

#55 - What is a venom allergy?

Breaking down the facts behind a bee sting allergy and more!

In this episode, we delve into the world of venom allergies, focusing on allergic reactions caused by flying insects and fire ants. Our hosts are joined by Dr. Farah Khan, who shares her valuable expertise, in explaining the underlying mechanisms of allergic reactions to venom allergies. 

What we cover in this episode:

• What types of insects can cause a venom allergy and lead to anaphylaxis; honey bees, bumble bees, wasps, hornets, yellow jackets and fire ants.
• Why mosquitos are not a concern for anaphylaxis.
• What a normal versus an allergic reaction to venom looks like.Local versus systemic reactions. What is the difference, and when do you need to worry that you will potentially have an anaphylaxic reaction.
• When should you see a doctor regarding your insect bite.
• Why testing is not straightforward for insect stings (venom allergy): insect sting allergies are rare, and we do not want to over-test. What happens after you have reacted a venom and how to work with your allergist.
• Only test people who have had an allergic reaction to a sting. Types of tests that would be used once you have reacted to venom. 
• How to determine whether you are a candidate for immunotherapy. 
• Why allergist test for systemic mastocytosis when talking about venom allergies.
• What to do when you get stung and the best medications to take.
• How to best prepare yourself to avoid getting stung.
• Advice to someone afraid of a stinging insect.

More information about this episode can be found here: www.itchpodcast.com/episodes/55-venom-allergy

#54 - Early Introduction of Allergens in Babies

What is early allergen introduction for babies?

Are you still confused about when to feed your baby allergens? Over the past few decades, there has been quite a shift in thinking about the early introduction of food allergens for babies, so your confusion is wholly justified. Dr. G dives into this exact topic and talks to two professionals, Meenal Lele and Dr. Katie Marks-Cogan, in the field of early introduction. She explores why the guidelines for introducing allergens have changed and how to introduce allergens safely and consistently. 

What we cover in this podcast about the early introduction of food allergens:

What inspired Meenal and Katie to develop products to help parents with early allergen introduction?

What is early food introduction? Why are we no longer avoiding food allergens in babies? 

What studies have shaped the protocol change around introducing allergens to babies? How does this impact 'high-risk' children?

The challenges for the studies and compliance hurdles parents faced.  

Why do babies develop food allergies? What hypotheses point to the increase in food allergies in children over the past three decades?

The guidelines for early introduction of allergens. How to feed allergens to infants safely?

Why do you want to consider the early introduction of allergens with your babies? 

The role of food allergies in a baby's eczema: if your baby has eczema, will they develop food allergies? When to see an allergist for your baby?

What is the best practice for diagnosing a baby's allergies, and why is testing not always appropriate? How to work with your medical team and rely on something other than online information. 

Fundamental studies about the early introduction of allergens: The LEAP study, EAT study, PETIT study

Guest Bios

Meenal Lele is the founder of Lil Mixins, an allergy prevention company for babies. With experience as a food allergy parent and clinical knowledge, she created the company to provide options for parents introducing allergenic foods to their babies. Meenal holds an engineering and business degree from the University of Pennsylvania. She is the author of The Baby and the Biome, a book exploring the connection between a child's microbiome and their health.

Dr. Katie Marks-Cogan, MD, FAAAAI, FACAAI, specializes in allergies, asthma, and sinus disease. She is the head allergist at Ready.Set.Food and provides top-notch care to both kids and adults at Clear Allergy in Downtown Culver City, CA. As a mom of two, Dr. Marks-Cogan was inspired to work with Ready.Set.Food. Originally from Cleveland, OH, she graduated with honors from the University of Maryland School of Medicine after earning a Bachelor of Science Degree in Physiology and Neurobiology from the University of Maryland College Park.

#53 - Shared Decision Making for Atopic Dermatitis & Your Health Care Team

Tips on how to make the best of your atopic dermatitis management and care plan.

 

Atopic dermatitis is not a diagnosis that you should go at alone. Your care team can consist of multiple health care professionals, from your GP to a nurse, a therapist, and even your pharmacist. Additionally, you should be an active member in creating your healthcare plan since you are the one who needs to follow through with it day in and day out. 

In this final episode of our Atopic Dermatitis in Skin of Color series, Dr. G and Kortney talk to Tonya Winders, the president of Allergy Asthma Network, to discuss the nurse's role in AD management and shared decision-making. Tonya also shares her experiences of having a daughter with atopic dermatitis and the psychological toll the disease can have on patients. 

 

What we cover in this episode:

- Who can all be a part of your healthcare team

- Telehealth for atopic dermatitis

- Why decision aids are essential to use

 

Interview with Tonya Winters: 

- Nurses in an outpatient setting - understanding their role in patients with atopic dermatitis.

- Nurse versus a nurse practitioner

- Developing an atopic dermatitis plan - asking what your goals are.

- Allergy and Asthma Network is working to help more nurses and physician assistants to become certified in managing atopic dermatitis.

- Shared decision making - what is it, and how can you be sure you are practicing this with your healthcare team

- How to talk to your doctor about your financial situation when making your treatment plan

- Using shared decision aids to help with shared decision making and as a guide to talking with your care team.

- The importance of addressing psychological health for people with atopic dermatitis

 

Helpful Links:

The role of the nurse in the care and management of patients with atopic dermatitis - Paper co-authored by Tonya: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-00494-y

Shared Decision Making Aids: www.ithcpodcast.com

#52 - Medications for treating atopic dermatitis in all skin colors

You have been diagnosed with atopic dermatitis or you are experiencing an eczema flare, now what can you do to treat it? 

In the fourth part of the series on atopic dermatitis in skin of color, Dr. G and Kortney discuss all medications available to treat AD, from topicals (creams) to oral medication and injections. 

They also discuss how other strategies to treat AD that is more budget-conscious if your insurance does not cover certain medications. 

What we cover in this atopic dermatitis in skin of color episode:

- Topical steroids: what are they, how to use them and their side effects

- Topical steroid withdrawal

- Other topicals that do not contain steroids

- Oral medication that may be prescribed for atopic dermatitis: oral steroids, antibiotics and antihistamines

- Biologics: what are they and their side effects

- Wet wrapping

- Phototherapy

From Shiv

- How to wet wrap and why she likes this form of treatment

Helpful atopic dermatitis in skin of color resources:

Non-Steroidal Topicals

1. Calcineurin inhibitors - tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel)
2. Phosphodiesterase 4 inhibitor - crisaborole (Eucrisa)
3. JAK inhibitors. 

Bleach bath recipe from the American Academy of Allergy, Asthma and Immunology (AAAAI)

• Add ¼ - ½ cup of common 5% household bleach to a bathtub full of water (40 gallons). 
• Soak your torso or just the affected part of your skin for about 10 minutes
• Limit diluted bleach baths to no more than twice a week. 

 

More information about AD in skin of color: https://eczemainskinofcolor.org/eczema-diagnosis-skin-of-color/

#51 - Skincare strategies and lifestyle changes for atopic dermatitis in all skin colors

Practical tips about skin care maintenance for atopic dermatitis

In the third part of our 5 part series in collaboration with the Allergy & Asthma Network on atopic dermatitis in skin of color we are talking all about taking care of your skin and how to make your living environment more atopic dermatitis friendly.

 

Dr. G and Kortney the importance of skin hydration; the best ways to moisturize and shower. They also share ways to ensure your living environment is optimized for good skin conditions, from cleaning products to carpets. Finally, they go over the psychological side of atopic dermatitis and how to maintain balance in the body and the mind. 

 

What we cover in this atopic dermatitis in skin of color episode:

Understanding the importance of keeping atopic skin hydrated.

How to break the itch-scratch-rash cycle.

Skincare: bathing and moisturizing - the preferred types of cleansers and moisturizers to use.

How to make your living environment atopic dermatitis friendly.

Sleep hygiene for atopic dermatitis.

Managing stress to help control eczema - some things that can help you.

Strategies to stop scratching.

 

From Shiv

How moving helped her flares.

Seeking therapy was important to her mental health and skin healing.

 

Helpful atopic dermatitis in skin of color resources:

Resource for AD in skin of color:  https://eczemainskinofcolor.org/eczema-diagnosis-skin-of-color/

Dr G and Kortney discuss yoga for asthma - many of the tips can also apply to atopic dermatitis:https://allergyasthmanetwork.org/news/does-yoga-benefit-asthma/ 

More eczema episodes: https://www.itchpodcast.com/eczema

Yoga for asthma podcast: https://www.itchpodcast.com/episodes/48-yoga-asthma

Meet Shiv on Instagram: https://www.instagram.com/shivaika/ 

#50 - Diagnosing AD in patients with skin of color

How do doctors diagnose atopic dermatitis in skin of color?

In the second part of our 5 part series in collaboration with the Allergy & Asthma Network  on atopic dermatitis in skin of color we are talking about diagnosis!

Dr. G and Kortney discuss all of the tests involved in diagnosing atopic dermatitis (AD) in people with skin color. They also cover all of the skin conditions that are ruled out when a doctor is making a diagnosis and the importance of patient history in diagnosis. 

 

What we cover in this episode:

• A quick overview of what AD looks like in skin of color

• Skin conditions that may look like atopic dermatitis and common misdiagnosis

• The symptoms doctors look for when diagnosing atopic dermatitis

• Explanations of the  tests doctors use to diagnose atopic dermatitis- IgE blood test, component blood test, skin prick test, patch testing,and  skin biopsy

• How to diagnose eczema in babies and the link to food allergies

• The other factors that doctors take into account when diagnosing AD - the importance of patient history

 

From Shiv:

• Shiv shares her experiences with being diagnosed with atopic dermatitis and her experiences with different doctors.

 

Helpful Links:

• Link to images of AD in skin of color: https://eczemainskinofcolor.org/image-library/

• “What is eczema” from Allergy & Asthma Network: https://allergyasthmanetwork.org/what-is-eczema/

• More about Shiv: https://www.instagram.com/shivaika/