#151 - What Allergists Think About Antihistamines

If you have ever taken an antihistamine labeled "non-drowsy" and still ended up foggy and tired, you are not imagining it. Allergists have a lot to say about that label and about the foggy feeling that comes with allergy season in general. In part two of our live recordings from the AAAAI conference in Philadelphia, Kortney and Dr. Payel Gupta talk to allergists from across the US about what they actually think about antihistamines. What we cover in this episode about antihistamines: Non-drowsy does not mean the same thing for every antihistamine. Zyrtec, Claritin, and Allegra are all labeled non-drowsy, but some are more likely to make you sleepy than others. Why allergists have moved away from Benadryl. First-generation antihistamines cross into the brain more easily, causing drowsiness and a range of other side effects that are far less common with newer antihistamines. The foggy feeling might not be your medication. Congestion from untreated allergies disrupts your sleep, and poor sleep creates its own fog. Sometimes it is the disease, not the drug. Timing your antihistamine makes a real difference. Taking it before you head out gives it the best chance to work. And if it makes you drowsy, switching to a nighttime dose is a simple fix. Not all second-generation antihistamines are approved for pilots. Fexofenadine has the lowest penetration into the brain of any antihistamine tested, which is why the FAA cleared it as the only option pilots can take while flying. Second-generation antihistamines (non-sedating or minimally sedating) Cetirizine — Zyrtec Loratadine — Claritin, Alavert Fexofenadine — Allegra Levocetirizine — Xyzal Desloratadine — Clarinex (prescription only) First-generation antihistamines (sedating) Diphenhydramine — Benadryl, ZzzQuil, Unisom Chlorpheniramine — Chlor-Trimeton Brompheniramine — Dimetapp Dimenhydrinate — Dramamine Hydroxyzine — Atarax, Vistaril (prescription only) Thank you to our allergists A huge thank you to every allergist who stopped what they were doing at the AAAAI conference to talk to us. We could not make this episode without you. Dr. Mansi Kotwal, Instagram Dr. Lauren Davidson, Instagram Dr. Joel Brooks, LinkedIn Dr. Pratibha Vakharia, allergyv.com Dr. Rathika Gupta Dr. David Wertheim Thanks to Opella 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.  

Ep. 150: What Allergists Really Think About Your Allergy Nasal Spray If you have ever grabbed a nasal spray off the pharmacy shelf, used it for a few days, and given up because nothing seemed to be happening, you are not alone. And according to the allergists we spoke to at the AAAAI conference in Philadelphia, that is not uncommon. In this episode, Kortney and Dr. Payel Gupta share real conversations with allergists from across the US about what they actually think about allergy nasal sprays. What we cover in this episode about allergy nasal sprays Why allergists love nasal steroid sprays. They work at the source of the problem by calming swelling inside the nose before your symptoms have a chance to take hold, and you can pick them up at the grocery store without a prescription. You may not feel the nasal spray work right away. Nasal steroid sprays need about two weeks of consistent daily use before you feel a difference. The medication is working, you just cannot feel it yet. Do not give up early. When to start before allergy season. Starting your spray a couple of weeks before your season hits means you go in with as little swelling inside your nose as possible, giving the medication the best chance to work. Why so many patients stop using their spray. Incorrect technique causes irritation and nosebleeds, and means the medication is not landing where it needs to. Not all nasal sprays smell or feel the same. If the smell or taste of your spray puts you off, there are options without it, and that is worth a conversation with your allergist or pharmacist. Thank you to our allergists A huge thank you to every allergist who stopped what they were doing at the AAAAI conference to talk to us. We could not make this episode without you. Dr. Jessica Hui, Instagram | LinkedIn Dr. Jamie Rutland, Instagram | Instagram: The Health Exchange Podcast Dr. Juan Carlos Murillo, Instagram | LinkedIn Dr. Tobi Olayiwola  Dr. Jake Rosenblum, LinkedIn Dr. David Wertheim Dr. Sonali Majmudar, Instagram | LinkedIn Thanks to Opella 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 sinusitis without nasal polyps is the most common form of chronic sinusitis. Even so, most patients spend years without a clear explanation, cycling through antibiotics that do not address what is actually going on. In this episode, Kortney and Dr. Payel Gupta are joined by Dr. Michael Blaiss and Dr. Anju Peters, an allergist and immunologist at Northwestern University who co-authored the 2025 Adult Sinusitis Clinical Practice Guideline. Together, they break down what chronic sinusitis without nasal polyps (CRSsNP) actually is, what the real quality-of-life impact looks like, and how a proper diagnosis is confirmed. What we cover in this episode about chronic rhinosinusitis without nasal polyps Not an infection. Chronic sinusitis without nasal polyps is driven by inflammation lasting 12 weeks or more, not by bacteria or a virus, which is why antibiotics often do not help. The hidden quality of life burden. Beyond congestion and sinus pressure, patients commonly experience fatigue, poor sleep, anxiety, depression, and social isolation. Why so many patients go years without a correct diagnosis. Symptoms overlap significantly with conditions like allergic rhinitis or migraines. Many patients adapt to feeling unwell rather than seeking answers. How doctors confirm the diagnosis. A diagnosis requires objective evidence of inflammation, as seen on nasal endoscopy or a CT scan of the sinuses, not symptoms alone. The connection between sinusitis and asthma. The nose, sinuses, and lungs share one connected airway, and about 60% of people with this condition also have asthma, with each capable of making the other worse. *********** Made in partnership with The Allergy & Asthma Network. Thanks to Insmed 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 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.