#148 - How Do You Know Your Chronic Hives Are Under Control?

Chronic hives that come and go without warning are exhausting physically and emotionally. But here is something many patients don't realize: feeling "okay" is not the same as being well controlled. Kortney and Dr. Gupta are joined by Dr. Tom Chacko, a board-certified allergist and immunologist based in Atlanta, to discuss what good hives control actually looks like and what to do when you are not there yet. From "just living with" your condition to managing a bad flare, tracking your symptoms, and preparing for your follow-up appointment, this episode gives you the tools to stop just coping and start getting better care. What we cover in our episode about what chronic hives control looks like: Chronic spontaneous urticaria. The plain-language definition of CSU, including why hives appear without a clear trigger and what angioedema is. The trap of normalizing symptoms. Why patients adjust their lives around hives without realizing it, and how to spot the signs that your condition is not actually controlled. How to track your hives. Why symptom tracking helps with diagnosis and better care, and how to use tools like the UAS7 score. What to bring to your follow-up appointment. The concrete information your doctor needs to work with you to find the best treatment plan. This includes information about sleep, daily activity, and medication side effects. How to ask for more help. What to say when antihistamines are not enough, and what newer treatment options exist for CSU patients today. More resources about chronic hives UAS-7 Urticaria Activity Score worksheet Allergy & Asthma Network chronic urticaria resources More episodes about hives *********** Made in partnership with The Allergy & Asthma Network. Thanks to Novartis for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

If you have chronic hives and antihistamines aren't helping, there's a new treatment option to know about. In this episode of The Itch Review, we spotlight "Remibrutinib in Chronic Spontaneous Urticaria" published in The New England Journal of Medicine, March 2025. This article looks at the REMIX trials, which tested whether remibrutinib, a BTK inhibitor, can help adults whose chronic spontaneous urticaria (CSU) is not controlled by antihistamines alone. Remibrutinib works differently from antihistamines. Instead of blocking histamine after it's released, it stops mast cells from releasing those itch-causing chemicals in the first place. The FDA approved remibrutinib in September 2025.  What we cover in our episode about the REMIX trial: Understanding CSU: Chronic spontaneous urticaria causes itchy hives and swelling for more than 6 weeks with no clear trigger, and antihistamines don't work for everyone. How remibrutinib works: This BTK inhibitor stops mast cells from releasing chemicals like histamine, rather than blocking histamine after it's already released. Why do two identical trials: Running the same study twice (REMIX-1 and REMIX-2) with different patients helps prove the results are real, not a fluke. Key results: About half of patients reached well-controlled disease, and about 1 in 3 became completely clear of hives and itch. Safety and side effects: Petechiae (tiny dots of bleeding under the skin) were the main thing to watch for, but most cases were mild and went away on their own. DOWNLOAD THE INFOGRAPHIC More resources about chronic hives Chronic Spontaneous Urticaria - Allergy & Asthma Network Chronic Urticaria Toolkit What are hives? All episodes on urticaria *********** The Itch Review, hosted by Dr. Gupta, Kortney, and Dr. Blaiss, explores allergy and immunology studies, breaking down complex research in conversations accessible to clinicians, patients, and caregivers. Each episode provides key insights from journal articles and includes a one-page infographic in the show notes for easy reference. *********** Made in partnership with The Allergy & Asthma Network. Thanks to Novartis for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

Chronic rhinosinusitis with nasal polyps, or CRSwNP, is a condition driven by ongoing inflammation. That is why treatment is not a one-time fix and why polyps can come back even after surgery. In this episode, Dr. Payel Gupta and Kortney are joined by Dr. Maeve O'Connor, a board-certified allergist and immunologist, to walk through CRSwNP treatment options. This episode is released around World Anosmia Day because loss of smell is one of the most frustrating and most common symptoms of CRSwNP, and one that treatment can actually help with. What we cover in this episode about nasal polyps treatment Nasal therapies as your base management: Saline rinses and nasal steroid sprays are the foundation of CRSwNP treatment. They need to be used consistently as part of your daily routine, not just when symptoms flare. Why nasal polyps keep coming back: CRSwNP is driven by ongoing inflammation, not just the polyps themselves, so removing them does not address the root cause. When surgery is the right choice: Sinus surgery can open blocked passages and help nasal sprays reach deeper into the sinuses, but works best as part of a long-term plan, not a one-time fix. What biologic medications actually do: Biologics target the underlying inflammation causing CRSwNP. Four are currently approved for CRSwNP: dupilumab, omalizumab, mepolizumab, and tezepelumab. Why follow-up care matters even when you feel better: Inflammation can return before symptoms become noticeable, so regular check-ins with your allergist or ENT are key to catching early signs of polyp regrowth. About our guest  Dr. Maeve O'Connor, MD, FACAAI, FAAAAI, is a board-certified allergist and immunologist and founder of Allergy Asthma & Immunology Relief (AAIR) of Charlotte, North Carolina. She treats patients of all ages, practices integrative medicine, and has been named a Top Doctor by Charlotte Magazine since 2007. More resources What is Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)? What are nasal polyps? What is AERD? Biologics for Allergic Disease What to know before starting a biologic  Oral Corticosteroid Stewardship   ********* Made in partnership with The Allergy & Asthma Network. Thanks to Sanofi-Regeneron for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

We spend about 90% of our time indoors. But what's actually in that air we breathe, and why does it matter so much for people with asthma, allergies, and eczema? This is part two of our series about indoor air quality. We discuss how you can improve your indoor air quality. Kortney shares her experience living in Germany, where ventilating your home isn't just a suggestion, it's practically a lifestyle. We also go room by room with practical tips you can actually use, from washing your sheets in hot water to why that scented candle might need to go. Part one covered what causes bad indoor air quality and what causes health problems for people with asthma and allergic diseases. What we cover in part two about indoor air quality The art of Lüften, aka house burping: Fully opening your windows for 5 to 10 minutes is better than cracking them all day, but skip it during peak pollen season. How to reduce dust mites in your bedroom: Hot water washes, dust mite covers, humidity control between 30 and 50 percent, and keeping stuffed animals off the bed. What to know about air purifiers: HEPA filters catch particles, carbon filters catch chemicals, and size matters for your room. Some cleaning products may make things worse: Choose fragrance-free products, avoid aerosols and scented candles, and wear a mask while cleaning. Kitchen and bathroom tips: Run exhaust fans during and after cooking or showering, check for leaks, and watch your shower curtain for mold. Advocating for better air at school and work: Ask about ventilation and MERV filters, and pay attention if your symptoms improve on weekends. More resources Allergy & Asthma Network: Healthy at Home Allergy & Asthma Network: Healthy at Work EPA Indoor Air Quality Tools for Schools EPA Safer Choice Cleaning Products EXHALE Resources Listen: Ep. 144: What is Indoor Air Quality and Allergic Disease (Part 1 of 2) This series is part of the EXHALE project, a set of six evidence-based strategies designed to help people with asthma achieve better health and improved quality of life. This series supports the last "E" in EXHALE by reducing asthma triggers in indoor environments. This podcast is made in partnership with Allergy & Asthma Network

We spend about 90% of our time indoors. But what's actually in that air we breathe, and why does it matter so much for people with asthma, allergies, and eczema? This is a two-part series about indoor air quality. In the first part, we break down the three main categories of indoor air pollutants: particulate matter (PM2.5 and PM10), volatile organic compounds (VOCs), and biological allergens like dust mites and mold. Dr. G explains how each one affects the body differently and why people with allergic disease are especially vulnerable. In part two, we discuss how you can improve your indoor air quality. What we cover in part one about indoor air quality What's actually in your indoor air: The three main categories are particulate matter (PM), VOCs, and biological allergens. Why PM2.5 is more dangerous than PM10: PM2.5 is small enough to enter your lungs and bloodstream, while PM10 mostly irritates your nose and throat. How we create particulate matter: PM2.5 comes from burning things like cooking, candles, and gas stoves. PM10 comes from dust, construction, and dirt tracked in on shoes. The difference between particles and gases: PM2.5 is like tiny specks of dust or smoke. VOCs are invisible gases that cause smells, like that "new car" scent. Indoor allergens: Dust mites, mold, pet dander, and cockroach allergens are biological triggers that can cause allergic reactions and worsen asthma. More resources Allergy & Asthma Network: Healthy at Home Allergy & Asthma Network: Healthy at Work EPA Indoor Air Quality Tools for Schools EPA Safer Choice Cleaning Products EXHALE Resources This series is part of the EXHALE project, a set of six evidence-based strategies designed to help people with asthma achieve better health and improved quality of life. This series supports the last "E" in EXHALE by reducing asthma triggers in indoor environments. This podcast is made in partnership with Allergy & Asthma Network

We continue our tradition of interviewing the incoming president of the American College of Allergy, Asthma & Immunology to learn what is top of mind for the field and what it means for patients and families. Dr. Cherie Zachary joins us to share her personal journey into allergy and immunology as both a lifelong patient and clinician. She explains what the ACAAI does and why increasing representation in medicine is critical for improving allergy outcomes. The conversation also tackles the allergist shortage, how physicians are trained, and what is being done to expand fellowship opportunities and improve access to care. What we cover in our episode about Dr. Zachary & ACAAI What the ACAAI actually does for allergy care: How the College supports clinicians and provides patients with trusted, evidence-based education. How lived experience shapes leadership: How Dr. Zachary’s own allergic diseases influenced her path into allergy and immunology. Why representation matters for allergy outcomes: How culturally responsive care and physician diversity improve trust and health outcomes. Why there are not enough allergists: How training bottlenecks contribute to long wait times and limited access to care. Historically Black Colleges and Universities (HBCUs): Her focus on expanding exposure to allergy through HBCUs and the ACAAI SPARK program. More resources about what we discussed American College of Allergy, Asthma, and Immunology Listen: Ep. 77: Food Allergy and Its Impact on the Black Community Listen: Ep. 108: Interview with Dr. James Tracy Listen: Ep. 66: Interview with Dr. Gailen D. Marshall, Jr. -- Made in partnership with The Allergy & Asthma Network. We thank the American College of Allergy, Asthma, and Immunology for their support of Allergy & Asthma Network and this podcast. 

Allergy & Asthma Network has spent more than four decades helping people living with asthma, allergies, and related immune conditions navigate care, access trustworthy education, and make their voices heard. In this episode, we talk with Lynda Mitchell, CEO of Allergy & Asthma Network. Lynda shares how becoming a food allergy and asthma mom in the early 1990s shaped her career and led her into patient advocacy work. We get into how Allergy & Asthma Network supports patients and families through four mission pillars: education, outreach, advocacy, and research. What we cover in our episode about Allergy & Asthma Network Trusted Messengers and culturally responsive education, and why information is more effective when it comes from people who reflect and understand the community Free virtual asthma coaching, and how one-on-one self-management education helps people improve daily asthma control and reduce emergency care Patient voice research, what it is, how it differs from clinical trials, and why diversity in clinical trial participation matters Advocacy efforts like Capitol Hill Day and PALI, and how patient stories influence laws and policies that affect asthma and allergy care Ways to get involved, including resources for patients, caregivers, and healthcare providers who want to support or participate in Allergy & Asthma Network’s work More resources about Allergy & Asthma Network Allergy & Asthma Network  Sign-up for the Allergy & Asthma Network’s Newsletter  Get involved with clinical trials and research  More about the PALI information session (February 18, 2026) Advocacy information Virtual asthma coaching program (free asthma self-management education) *********** Made in partnership with The Allergy & Asthma Network.

Asthma is one of the most common long-term conditions in children. It is a leading cause of missed school and emergency room visits. Doctors use tools (validated questionnaires) to assess how well a child’s asthma is controlled and whether their medicine is helping. Some tools only ask about symptoms, which can miss children who are still at risk for asthma attacks. The lead author, Dr. Kevin Murphy, joins us to talk about “Pediatric Asthma Impairment and Risk Questionnaire: A Control Assessment for Children Aged 5 to 11 Years,” published July 2025 in Journal of Allergy and Clinical Immunology: In Practice. The Peds-AIRQ was designed to improve how doctors identify uncontrolled asthma in children by asking about both current symptoms and past asthma attacks. This approach helps avoid missing children who may seem okay day to day but are at higher risk for future flare-ups. What we cover in this episode Why asthma control in children can be hard to measure What “controlled asthma” really means Why past asthma attacks matter, even when symptoms seem mild What the Peds-AIRQ is and how it works How this tool may support better conversations between families and doctors DOWNLOAD THE INFOGRAPHIC More asthma in kids resources  Take the Peds-AIRQ questionnaire  What is asthma? Asthma in Babies and Children Childhood Asthma: A Complex Condition That Doesn’t Have to Be So Complicated - video *********** The Itch Review, hosted by Dr. Gupta, Kortney, and Dr. Blaiss, explores allergy and immunology studies, breaking down complex research in conversations accessible to clinicians, patients, and caregivers. Each episode provides key insights from journal articles and includes a one-page infographic in the show notes for easy reference. *********** Made in partnership with The Allergy & Asthma Network. Thanks to AstraZeneca for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

Sleep plays a critical role in managing allergies, asthma, and eczema, yet it is often overlooked in conversations about allergic disease. Sleep affects mood, focus, immune function, and inflammation, all of which influence how allergic conditions show up day to day. Poor sleep can worsen asthma symptoms, increase allergy flares, and make eczema harder to control. At the same time, allergies and asthma can disrupt sleep, creating a cycle that is difficult to break. Dr. Carol Yuan-Duclair, a sleep specialist, joins us to explore how sleep impacts allergic conditions and overall health. She breaks down what good sleep actually looks like, how to know if you are getting enough rest, and how sleep quality can directly affect allergies, asthma, and eczema. This conversation focuses on practical guidance for patients and families, including environmental changes, medication considerations, and when it may be time to seek help from a sleep specialist. What we cover in this episode about sleep and allergic disease Why sleep is essential for health and immune function: How sleep affects inflammation, mood, and overall health, and why poor sleep can worsen allergic disease. What good quality sleep actually looks like: The difference between sleep quality and sleep quantity, and how to tell if your sleep is truly restorative. The two-way relationship between sleep and allergies: How allergies can disrupt sleep, and how poor sleep can worsen allergy symptoms, creating a difficult cycle. Practical ways to improve sleep when you have allergies: Sleep hygiene basics, exercise timing, and creating a healthier bedroom environment. When medications or symptoms mean it is time to see a specialist: How allergy medications can affect sleep, how eczema fits into the picture, and when ongoing sleep issues may signal the need for a sleep specialist.

Reading food labels can feel like a full-time job when you or your child has food allergies. Even when you know what to avoid, labels can still be confusing, especially when you run into “may contain” warnings. Marion Groetch, a registered dietitian with decades of experience in food allergy care and education, joins us to unpack all things food labels. Together, we break down U.S. allergen labeling laws, what parts of the package actually matter, and why “may contain” statements are a much grayer area than most people realize. We also share practical tips for navigating so-called “mystery ingredients” like natural flavors and oils, when it is worth contacting a manufacturer, and how to avoid being more restrictive than necessary while still staying safe. What we cover in our episode about food labels: What U.S. labeling laws require: How FALCPA and the FASTER Act protect families by requiring clear disclosure of the Top 9 major allergens. Where allergy information actually lives on a label: Why the ingredients list and “Contains” statement matter most, and why front-of-package claims should be ignored. What “may contain” actually means: Why these statements are voluntary and unregulated, and what that means for real-world decision-making. Foods that fall outside labeling laws: Common situations where allergen labeling is not required, including deli foods, restaurant meals, airline meals, and alcohol. How to avoid over-restricting your diet: Practical guidance on mystery ingredients, higher-risk products, and when contacting a manufacturer actually makes sense. ___ Made in partnership with The Allergy & Asthma Network. Thanks to Genentech for sponsoring today’s episode. This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.