#179 - What Pharmacists Around the World Recommend for Allergies

The pharmacist is often the first person you talk to about allergies. So what are they thinking about when they hand you that box of antihistamines? Dr. Gupta and pharmacist Dr. Suzanne Soliman went to the World Congress of Pharmacy in Montreal. They asked pharmacists from the UK, Ghana, Portugal, Argentina, Uruguay, and Malaysia about three patients they might meet at the counter. Kortney joins Dr. G to talk through what the pharmacists shared: check that it’s really allergies, skip the older antihistamines, and look at the whole person. What we cover in this episode about pharmacist recommendations for allergy medicine Allergies or a cold? Pharmacists ask three questions: Is there a fever? Is it itchy? Does it keep coming back? Itch and symptoms that return every season point to allergies. When to see a doctor. A fever, pain on one side of your face, or coughing and wheezing can mean an infection. You may need a medicine the pharmacist can't give you. Old vs. new antihistamines. Older antihistamines can make you sleepy and slow your reaction time. Pharmacists around the world now choose the newer, non-drowsy ones, like fexofenadine and loratadine. Anticholinergic side effects. Older antihistamines can also cause dry mouth, constipation, trouble peeing, blurry vision, and confusion. These side effects hit older adults harder. Bring your medicine list. If you have kidney or liver disease or take other medicines, your pharmacist can still help. Bring a list of everything you take, including what you buy yourself. Thank you to the pharmacists who shared their thoughts with us: Ahuti Lakhani (UK), Bernard Opoku Ware (Ghana), Adwoa Mensah (Ghana), David Pires (Portugal), Romina Takesyan (Argentina), Cecilia Maldonado (Uruguay), and Susan YH Pan (Malaysia). More resources Ep. 151: What Allergists Think About Antihistamines Ep. 150: What Allergists Really Think About Your Allergy Nasal Spray Ep. 116: Why Fexofenadine Is Considered a Truly Non-Sedating Antihistamine Ep. 116 infographic: Which antihistamines cross into the brain ************ Made in partnership with The Allergy & Asthma Network. Thanks to Opella for supporting today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Hereditary angioedema (HAE) is a rare genetic condition that causes attacks of swelling in the skin, the belly, and sometimes the throat. Because it looks like an allergic reaction, it is often missed for years. Kortney and Dr. Payel Gupta are joined by Dr. Marc Riedl, Professor of Medicine and Clinical Director of the US HAEA Angioedema Center at UC San Diego, to set the stage for our three-part series on HAE. We cover what HAE is, what is happening in the body, and symptoms that tell you it is HAE and not an allergy. What we cover in this episode about hereditary angioedema Why HAE is not an allergy. HAE swelling comes from a different system in the body. That's why antihistamines, steroids, and epinephrine don't stop it. HAE is genetic. HAE comes from a change in one gene, and it can be passed from parent to child. Each child of a parent with HAE has a 50-50 chance of having it. About 1 in 4 people are the first in their family to have it, so family testing matters.  What happens in the body. People with HAE don't have enough working C1 inhibitor, the "brakes" on a chemical called bradykinin. Too much bradykinin makes tiny blood vessels leak fluid, and that fluid is the swelling.  HAE swelling and where it happens. It usually doesn't itch or come with hives, and it can last two to five days. It can show up in the hands, face, feet, belly, or throat. Belly attacks can be very painful, and throat swelling needs emergency care. Triggers and warning signs. Injury, dental work, estrogen, and stress can set off attacks. Some people notice a red rash that doesn't itch, or tingling, before the swelling starts. ************ Made in partnership with The Allergy & Asthma Network. Thanks to Phavaris for supporting today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Chronic hives guidelines give doctors a roadmap for treatment, but not everyone fits the same path. Pregnancy, breastfeeding, menopause, childhood, getting older, and living with more than one chronic condition can all change how chronic spontaneous urticaria (CSU) is treated. Kortney and Dr. Payel Gupta are joined by Dr. Allison Ramsey, an allergist and immunologist, to walk through the special populations section of the chronic urticaria guidelines.  What we cover in this episode about chronic hives in special populations Why it's not your fault. Dr. Ramsey explains how she "absolves" patients of hunting for a trigger, because CSU starts with the immune system, not with anything outside the body. Why women are more burdened by chronic hives. About 70% of people with CSU are women. Estrogen can push the immune system toward autoimmunity, and hives can shift with the menstrual cycle and become less common after menopause. Pregnancy and breastfeeding. Non-drowsy antihistamines are considered safe, and pregnancy data from asthma suggest omalizumab (Xolair) and dupilumab (Dupixent) are too. Adults 65 and older. Higher antihistamine doses can cause sleepiness and raise the risk of falls, so share every medication you take. Biologics don't interact with other medicines. Living with more than one condition. People with CSU are more likely to have other autoimmune conditions. If you also have asthma, eczema, nasal polyps, or food allergy, one medication may treat more than one condition, so tell your doctor about everything. Chronic hives in children. Most hives in kids come from viruses and go away quickly. When kids do have CSU, they often respond better to antihistamines than adults. More resources What is Chronic Urticaria? Chronic Idiopathic Urticaria – CIU Allergy & Asthma Network Chronic Urticaria Toolkit More episodes about urticaria Ep. 164: New Chronic Hives Guidelines: A Look at What's Changing Ep. 128: Is Chronic Spontaneous Urticaria an Autoimmune Disease? Ep. 122: Mortality in adult patients with chronic spontaneous urticaria - A real-world cohort study Ep. 80: Chronic Spontaneous Urticaria Myths & Misconceptions Ep. 78: Chronic Spontaneous Urticaria Treatments Ep. 75: Understanding Chronic Spontaneous Urticaria: Hives Demystified ************ Made in partnership with The Allergy & Asthma Network. Thanks to Genentech and Novartis for supporting today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

We hear a lot about the struggles patients face on their systemic mastocytosis journey, the years of normal labs, the feeling of not being believed. But have you ever wondered what that feels like from the doctor's side? Kortney and Dr. Payel Gupta are joined by Dr. Alexander Kim, an allergist and immunologist who co-directs the Mast Cell Disorders Program at UC San Diego, for an honest look at what it's like to sit on the other side of the exam table and untangle a diagnosis of this complex condition. What we cover in this episode about treating systemic mastocytosis Why "your labs look fine" doesn't mean nothing's wrong. Dr. Kim explains why this journey can be challenging for doctors when labs are normal, but symptoms are severe.  Why systemic mastocytosis is still hard to diagnose, even with better tools. SM has a clearer testing path than mast cell activation syndrome (MCAS) does, but the overlap between the two still creates real diagnostic uncertainty in practice. What “dismissiveness” looks like from a doctor's side. From time constraints and busy schedules to the gap between meaning to listen and actually making a patient feel heard. Practical fixes for short appointments. Asking for a double appointment slot, bringing a written summary instead of hundreds of pages of records, and scheduling shorter, more frequent follow-ups instead of one long visit. What each side wants the other to understand. What it takes to build a trusting, lasting relationship with a healthcare provider when you're living with systemic mastocytosis. More resources about mast cell disease About the PIONEER Trial for Avapritinib Mast Cell Disease Toolkit What is Mastocytosis? What is Mast Cell Activation Syndrome (MCAS)? ************ Made in partnership with The Allergy & Asthma Network. Thanks to Blueprint Medicines for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Mast cell disorders can feel confusing, especially with so much information floating around online and on social media. In this episode, we cut to the chase and tackle the most common mast cell disorder FAQs, straight from the community. Dr. Dareen Siri joins us to work through community questions on mast cell disorders one by one, from what a mast cell actually is to testing, treatment, diet, and long-term outlook. What we cover in this episode about mast cell disorders What is a mast cell. Dr. Siri breaks down what mast cells do in the body and why an overactive one causes symptoms. The different mast cell disorders. Allergies, autoimmune activation, and clonal disorders like indolent systemic mastocytosis each work differently. Which tests actually matter. Blood tests, the KIT D816V mutation test, and when a bone marrow biopsy comes into play. Plus, should you consider a urine test? Treatment and long-term outlook. What targeted treatment (avapritinib) looks like now, and whether a mast cell disorder shortens your lifespan. Diet, supplements, and bone health. Whether a low-histamine diet helps, what the evidence says about supplements, and why bone density matters long term. More resources about mast cell diseases All of our mast cell disease episodes About the PIONEER Trial for Avapritinib Mast Cell Disease Toolkit Mental Health and Mast Cell Disorders Symptoms, Diagnosis & Treatment Options for Mast Cell Disorders (Recording) ************ Made in partnership with The Allergy & Asthma Network. Thanks to Blueprint Medicines for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.

How do you decide what is the right medication for you after antihistamines are not working to manage your chronic hives? Dr. David Lang, one of the authors of the new chronic urticaria guidelines (still in review), walks through every advanced treatment option the way he would if he had as much time as possible with a patient in his office. Along with Dr. Gupta, they cover the three treatments available when antihistamines are not enough, what each one asks of you week to week, and how to walk into your appointment ready to choose. Dr. Lang’s patient guide: Choosing an Advanced Treatment for Chronic Hives  What we cover in our episode about  chronic hives treatment What to think about when choosing a medication: benefit, harm, and burden. Dr. Lang explains why these are three different things, and why the one most patients are never asked about is what a treatment costs them in time, appointments, and schedule. The three advanced options side by side. Omalizumab (Xolair), dupilumab (Dupixent), and remibrutinib (Rhapsido) compared on how often you take them, how fast they work, and what the side effects really are. What the scary side effects actually mean. Dr. Lang walks through the anaphylaxis, cancer, and heart risks tied to omalizumab, and explains how likely each one really is. When blood tests for chronic hives come into the picture. Testing will not tell you why you have hives, but it may hint at which of the three treatments is more likely to work for you. Insurance may choose your starting point. All three treatments are approved for chronic hives, so if your plan covers one over another, that is a reasonable place to start, not a compromise. ************ Made in partnership with The Allergy & Asthma Network. Thanks to Genentech & Novartis for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.  

Starting a biologic can feel intimidating, especially if you are worried it means being on medication forever, or wondering if it will actually replace your inhaler or your next sinus surgery. After this episode, we hope your biggest biologics questions are answered. Kortney and Dr. Payel Gupta are joined by Dr. Giselle Mosnaim, an allergist and immunologist, to walk through the united airway, what uncontrolled disease really means, and the most common questions patients have before starting a biologic. What we cover in this episode about biologics for asthma, COPD, and nasal polyps The united airway. Why the nose and lungs share the same lining, and why the same biologics can treat conditions in both. What a biologic actually is. How it targets one specific part of the immune system instead of suppressing the whole thing like steroids. What uncontrolled disease means. Why taking your medication as prescribed does not always mean your asthma, COPD, or nasal polyps are under control. The goal of starting a biologic. What results to expect, how biologics work alongside your inhaler or nasal spray instead of replacing it, and how they can reduce the need for repeat sinus surgery. Common myths and fears. Answers to real patient worries about weight gain, needles, side effects, pregnancy, and being on a biologic long term. ________ 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 for professional medical advice. Always consult with your healthcare provider for any medical concerns.  

Needing oral steroids for your asthma is a signal, not just a setback. It could be a sign that your asthma is not actually under control, even if you feel like you're managing it day to day. Dr. Wes Sublett joins us to talk about why relying on steroid bursts is a warning sign, not a solution. Dr. Sublett breaks down what actually counts as an asthma exacerbation, the real risks of frequent oral steroid use, and the treatment options available so patients can avoid repeat trips to the ER. What we cover in this episode about oral steroids and asthma control Steroid bursts as a warning sign. Needing oral steroids for asthma is a signal your maintenance treatment may not be working. What actually counts as an exacerbation. Dr. Sublett explains the difference between a flare and a true asthma exacerbation, and why that distinction matters. The real risks of oral steroids. Repeated courses are linked to bone loss, diabetes, cataracts, and other long-term health risks. Why your specialist doesn't automatically know. ERs and urgent cares don't notify your asthma specialist when you're treated, so you have to share that history. Treatment options beyond steroid bursts. Triple therapy and biologics can reduce or eliminate the need for oral steroids for many patients. More resources Oral Corticosteroids (OCS) for Asthma, a deeper explainer from Allergy & Asthma Network What if I Can't Afford My Asthma Medication? ________ 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 for professional medical advice. Always consult with your healthcare provider for any medical concerns.

For decades, the rescue inhaler was simple: feel tight, take a puff, breathe easier. But the newest asthma guidelines have changed what's actually recommended inside that inhaler, shifting away from plain albuterol toward a combination inhaler that treats symptoms and inflammation at the same time. Kortney and Dr. Payel Gupta are joined by Dr. Bill McCann, allergist and CEO of Allergy Partners, to break down why this combo inhaler approach is now preferred, what it actually contains, and why auto-refilling your old rescue inhaler might be working against you. What we cover in this episode about rescue inhalers Understanding asthma: the boiling pot analogy. Dr. McCann explains asthma inflammation using a pot of water on the stove, and why a bronchodilator alone never turns down the heat. Why a combo inhaler is now preferred. The newest guidelines recommend a single inhaler containing both a fast-acting bronchodilator and a low dose of anti-inflammatory steroid. AIR and MART, explained simply. Two ways doctors are using this combo inhaler: either as-needed only, or as a daily plus as-needed routine. The myth of "mild" asthma. Why intermittent or infrequent symptoms don't mean you're free from risk. The auto-refill trap. Why an automatic pharmacy refill on your old rescue inhaler can quietly hide worsening asthma control from your doctor. More resources GINA 2026 Strategy Report (official source) What is asthma? Listen to the BATURA Trial ________ 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 for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Most asthma peak week coverage focuses on kids heading back to school. But adults with asthma are just as much at risk, and often don't realize it until they're already in trouble.  Kortney and Dr. Payel Gupta are joined by allergist Dr. Ashwin Shankar to talk about why asthma peak week hits adults hard, how normalizing symptoms can quietly put you at risk, and what steps to take before the season catches up with you. What we cover in this episode about adult asthma peak week What asthma peak week is, and why fall hits so hard. The third week of September brings the highest asthma-related ER visits and hospitalizations of the year. Where fall triggers hide. Teachers and school staff face mold in buildings that sat closed all summer, outdoor workers get hit with ragweed and sudden cold mornings, and farm workers stir up mold and dust during harvest. Why even controlled asthma can slip during peak week. Trigger load stacks up fast this time of year, and a flare during peak week doesn't mean you're doing something wrong. The adult habit of normalizing symptoms. Skipping hikes, avoiding stairs, or accepting a lingering cough are signs asthma isn't controlled, not just signs of getting older. How to get ahead of peak week before it hits. Confirm your asthma action plan, track how often you're reaching for your rescue inhaler, and get your flu shot at least two weeks before September ramps up. Resources Do You Have an Asthma Action Plan? A Comprehensive Guide for Asthma Treatments & Medication 10 Ways to Stay Healthy During the September Asthma Peak Week Lifestyle Changes to Manage Asthma ________ Made in partnership with The Allergy & Asthma Network. Thanks to AstraZeneca and Amgen for sponsoring today’s episode.  This podcast is for informational purposes only and does not substitute for professional medical advice. Always consult with your healthcare provider for any medical concerns.