#131 - What Is a BTK Inhibitor?

For decades, allergists have focused on blocking what happens outside the mast cell: histamine, IgE, and interleukins. But now, there’s a new way to stop allergic inflammation before it even starts: by targeting what happens inside the cell with BTK Inhibitors. Dr. Payel Gupta and Kortney are joined by Dr. Matthew Giannetti to unpack what BTK actually does and why inhibiting it represents an exciting breakthrough in allergy and immunology. Together, they explore how BTK inhibitors work, why this inside-the-cell approach is different from anything before, and what it could mean for people living with chronic spontaneous urticaria (CSU). What the episode covers about BTK inhibitors: BTK explained: Bruton’s tyrosine kinase is a pivotal “last step” before mast-cell degranulation. How BTK inhibitors work: Blocking BTK can stop histamine release downstream of many outside triggers. The science: Why BTK binding is irreversible for each molecule and how the body “re-makes” BTK over time. Safety in brief: A look at petechiae (small pinpoint spots), what to monitor, and how shared decision-making guides treatment choices. The future of BTK inhibitors: Exploring their potential role in other allergic conditions.    ____ 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.

Seeing your allergist on a screen instead of in the office might feel strange at first, but for many people with allergies, telehealth isn’t just convenient.  it’s effective. In this episode, we sit down with telemedicine pioneer Dr. Jay Portnoy to explore how virtual allergy care works, what it can and can’t do, and how it’s helping patients get the care they need without the wait or the long drive. Dr. Portnoy shares over two decades of experience leading allergy telemedicine programs in rural areas and explains how remote care has grown from a fringe idea into a standard part of allergy care. He and Dr. G also discuss the benefits for both patients and clinicians. So how do you know when telehealth is enough and when it’s not? What we cover in our episode about virtual allergy care and telemedicine: How does telemedicine work for allergy patients? Learn how video visits and asynchronous tools are making care faster and easier, especially in rural or underserved areas. Telemendine limitations. We break down when in-person care is still needed, like for food challenges, skin tests, or urgent symptoms. Privacy and safety in virtual care. From HIPAA-compliant platforms to quiet spaces at home or in schools, we talk about how to keep your virtual visit just as private as a clinic one. How testing works with telemedicine. Telehealth doesn’t mean skipping tests. Many can be ordered remotely and done at a local lab or clinic near you. The future of allergy care. Hear how virtual care is shifting toward patient choice, whether you want to video call, send a message, or still come in. ___ 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.

Multiple food allergies are a daily stressor for millions of families. From avoiding social events to fearing accidental exposures, it can feel like living in a constant state of alert. Until recently, there were no FDA-approved treatments that targeted more than one allergen at a time. In this episode, we break down the study: “Omalizumab for the Treatment of Multiple Food Allergies,” published in 2024 in the New England Journal of Medicine. Known as the OUtMATCH trial, it’s the first large-scale study to show that omalizumab (Xolair), a biologic already used for asthma and hives, may help people with multiple food allergies by raising the threshold for reactions. We explain how omalizumab works by blocking IgE, the antibody that triggers allergic reactions, and how the study measured changes in reaction thresholds (the amount of an allergen a person can ingest before reacting). We also explore the trial design, results, safety profile, and what all of this means for the day-to-day management of food allergies. What we cover in our episode about OUtMATCH trial How omalizumab works to prevent allergic reactions: Learn how blocking IgE increases the amount of allergen needed to trigger symptoms, offering protection from small, accidental exposures. Who qualified for the OUtMATCH trial and why: Find out which patients were included and how eligibility impacted outcomes. What success looked like in this study: Understand how researchers defined protection across multiple allergens. Why not everyone responded the same to omalizumab: Explore the variability in results and what it means for clinical care. What else the study found beyond food challenges: Hear about safety findings, quality of life data, and the open-label extension. 📌 INFOGRAPHIC to follow along  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 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.  

When people get hives or swelling, they often think it’s caused by an allergy. But in the case of chronic spontaneous urticaria (CSU), the culprit is often your own immune system. CSU isn’t your typical allergic reaction, instead, it’s frequently an autoimmune condition, where the immune system misfires and activates mast cells without any external trigger. In this episode, Dr. Payel Gupta and Kortney unpack what it means for CSU to be autoimmune and autoallergic. They explain how IgE and IgG antibodies can trigger histamine release, leading to hives and swelling. You’ll also learn why allergy testing isn’t useful for diagnosing CSU, and how tests like IgG food sensitivity panels can do more harm than good by leading to unnecessary food avoidance and confusion. What we cover in our episode about autoimmune CSU and chronic hives: Is CSU an allergy? Why CSU is often mistaken for an allergic reaction—and why standard allergy tests rarely provide helpful answers. How the immune system works in CSU: What mast cells are, how they release histamine, and their central role in chronic spontaneous urticaria. Understanding autoimmune CSU: Learn how the immune system can trigger hives from within, including the roles of IgE and IgG antibodies. Autoimmune hives explained: We explore how CSU can be autoimmune, why the immune system may attack itself, and what Type I and Type IIb autoimmune CSU really mean. ____ 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.

Indolent Systemic Mastocytosis (ISM) is a rare but often underrecognized clonal mast cell disorder. From random hives to gut pain and brain fog, ISM can feel like a medical mystery. We continue our review of “Management of indolent mastocytosis and mast cell activation syndrome - A clinical yardstick,” published in June 2025 in The Annals of Allergy, Asthma & Immunology. This is Part 2 of our discussion, with a focus on indolent systemic mastocytosis. We look at what causes it, how it’s diagnosed, and how to manage symptoms and improve quality of life. In this episode, we break down this complex mast cell disease and how doctors use baseline serum tryptase, KIT D816V testing, and HaT screening to find answers. Plus, we explain how treatments like antihistamines, mast cell stabilizers, and avapritinib can help people live better with ISM. 📌 INFOGRAPHIC to follow along What we cover in our episode about indolent systemic mastocytosis (ISM): Yardsticks explained: Why the ACAAI uses yardsticks as practical, interim guidelines before full consensus statements are available. Understanding mast cell diseases: The difference between primary (clonal), secondary (allergic), and idiopathic mast cell disorders. Diagnosing ISM: KIT D816V mutation, WHO/ICC criteria, baseline serum tryptase, and when to test for hereditary alpha-tryptasemia (HaT). Symptoms of ISM: Why symptoms vary and how they can involve multiple systems, including skin, GI tract, cardiovascular, and even neuropsychiatric. Management strategies: Trigger avoidance, antihistamines, leukotriene blockers, sodium cromolyn, aspirin therapy, and, when venom immunotherapy is appropriate. Targeted treatment: How avapritinib works and what the PIONEER study shows about its role in ISM. 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 Blueprint Medicines 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.

Mast cell activation syndrome (MCAS) is a confusing and often misunderstood condition. If you’ve ever wondered about MCAS symptoms, serum tryptase testing, or how treatments like antihistamines, sodium cromolyn, and even omalizumab fit in, this episode is here to help. We review the findings from “Management of indolent mastocytosis and mast cell activation syndrome - A clinical yardstick,” published in June 2025 in The Annals of Allergy, Asthma & Immunology. Because the paper covers both diseases, we’ve split it into two parts. This episode focuses on mast cell activation syndrome (MCAS). GET THE INFOGRAPHIC - summary of this episode What we cover in our episode about mast cell activation syndrome: Yardsticks explained: Why the ACAAI uses yardsticks as practical, interim guidelines before full consensus statements are available. Classifying mast cell disorders: Primary (clonal), secondary (allergy/autoimmune), and idiopathic (MCAS). MCAS diagnosis criteria: Symptoms in 2 or more organ systems, objective evidence (serum tryptase or urinary metabolites tests), and positive response to therapy. Treatment strategies: Include trigger avoidance, H1/H2 antihistamines, leukotriene blockers, mast cell stabilizers (such as cromolyn and aspirin), off-label biologics like omalizumab, and epinephrine. Neuropsychiatric symptoms: Brain fog, anxiety, and depression are common and require multidisciplinary management. 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 Blueprint Medicines 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.

As September approaches, many families notice asthma symptoms getting worse. Ragweed pollen, viral infections, cooler nights, and the stress of back-to-school routines all combine to create Asthma Peak Week, a time when asthma attacks and ER visits spike across the country. Asthma mom, Sherrina Gibson, joins us to share how her family prepares her 11-year-old daughter for fall asthma challenges. She talks about cleaning routines, school planning, and teaching her daughter self-awareness and empowerment. Dr. Payel Gupta adds medical guidance on asthma action plans and seasonal medication adjustments. You’ll learn how to spot asthma triggers, prepare your home and school, and teach children to recognize symptoms early so they can act before a flare gets worse. What we cover in our episode about preparing for asthma peak week: Parenting with asthma: Sherrina Gibson shares her family’s journey and how they prepare their home and routines each fall. Asthma management strategies: Cleaning, decluttering, updating medications, and coordinating with schools and coaches. Asthma Peak Week explained: Why symptoms spike in September and how to get ahead of it. Asthma action plans: Why every family needs one and how to keep copies at home, school, and on the go. Empowering kids with asthma: Teaching children to recognize symptoms, use their inhaler properly, and advocate for themselves at school and in sports. More episodes about asthma Ep. 81: Why asthma attacks rise in September peak week Ep. 58: What is controlled Asthma? - Everything you need to know! Ep. 117: As-Needed Albuterol–Budesonide in Mild Asthma (BATURA Trial) Ep. 124: Asthma peak week and understanding triggers 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 professional medical advice. Always consult with your healthcare provider for any medical concerns.

As summer winds down and September approaches, many people with asthma notice their symptoms getting worse. This is no coincidence as more asthma triggers appear during this time of year, from pollen and viruses to stress and weather changes. This combination peaks during Asthma Peak Week, a time when asthma attacks and ER visits spike across the country. Allergist Dr. Kristin Sokol joins us to discuss seasonal asthma triggers, why fall can be especially risky, and how you can prepare to keep your asthma under control. You’ll learn how to identify your personal triggers, steps to reduce your exposure, and why staying consistent with your medication routine is critical. We also cover tools like an asthma action plan, preparing for school, and making sure caregivers and teachers know how to respond to an asthma flare. What we cover in our episode about managing asthma triggers during the fall: Understanding asthma: learn why even mild asthma should be reviewed before the fall. Identifying triggers: from indoor allergens to seasonal pollen and surprising emotional triggers, know what can set off your asthma. Preparing for Asthma Peak Week: discover how viruses, ragweed pollen, and stress combine into a dangerous flare period and how to get ahead of it. Staying in control: strategies to avoid or reduce asthma trigger exposure, prepare for school, and keep your asthma action plan up to date. Supporting everyone with asthma: special considerations for adults, caregivers, and teachers to stay healthy and ready year-round. More episodes about asthma Ep. 81: Why asthma attacks rise in September peak week Ep. 58: What is controlled Asthma? - Everything you need to know! Ep. 117: As-Needed Albuterol–Budesonide in Mild Asthma (BATURA Trial) 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 professional medical advice. Always consult with your healthcare provider for any medical concerns.

Parenting a child with food allergies can feel overwhelming and isolating. We're joined by licensed therapist and food allergy mom Tamara Hubbard, MA, LCPC, to talk about her new book, May Contain Anxiety, and the often overlooked mental health challenges that food allergy parents face. We explore how chronic stress, fear, and anxiety can affect parenting, relationships, and family dynamics. Plus, why supporting the mental health of allergy parents is crucial for the entire family’s well-being. Tamara breaks down evidence-based tools from Acceptance and Commitment Therapy (ACT) to help parents manage food allergy anxiety, build confidence, and feel less alone on this lifelong journey. What we cover in this episode about food allergy anxiety in parents: Tamara’s journey from substance abuse counselor to food allergy mental health advocate Why she wrote May Contain Anxiety and how it’s different from typical self-help books A breakdown of Acceptance and Commitment Therapy (ACT) and how it supports allergy parents The impact of food allergy anxiety on the whole family system, from parenting dynamics to sibling relationships Why this book is valuable for every stage of the allergy journey and helpful for allergists and extended family, too May Contain Anxiety is available worldwide in English on September 30th, 2025. Get 30% off by buying it at Hopkins Press and using the code: HMCA25

Do adults with chronic spontaneous urticaria (CSU) have a higher risk of death over time compared to people without hives? We review the findings from “Mortality in adult patients with chronic spontaneous urticaria: A real-world cohort study,” published in April 2025, in The Journal of Allergy and Clinical Immunology. While CSU is often considered a non-life-threatening condition, this large study found something surprising: people with CSU had a significantly higher risk of death, especially from suicide. Dr. G and Dr. Blaiss walk through key takeaways from a dataset of over 272,000 CSU patients and nearly 13 million matched controls. They explore what the results mean for mortality risk, clinical care, mental health screening, and the importance of proper, guideline-based treatment. What we cover in our episode about CSU and mortality risk: What is CSU? Chronic hives are an unpredictable, itchy, and sometimes painful condition. It lasts for 6 weeks or longer and can continue for years. Mental health connection: CSU affects more than skin. Anxiety, depression, and suicidal thoughts are common and serious concerns. Study findings: CSU was associated with higher mortality at 3 months, 1 year, and 5 years. Suicide risk was over 3 times higher than in people without CSU. Demographics: Younger and White patients with CSU had the highest increase in risk. Treatment impact: Patients using guideline-recommended treatments like second-generation antihistamines or omalizumab had lower death rates. INFOGRAPHIC 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.