#134 - How Dupilumab Reduces Mucus Burden in Asthma - VESTIGE Trial

Mucus plugging is a challenge in asthma care. It’s thick, sticky mucus that blocks the airways and doesn’t respond to regular inhalers. Even when inflammation improves, these plugs can lower lung function, limit how well medicine works, and make asthma harder to control. In this episode, we break down the study: “Effect of Dupilumab on Mucus Burden in Patients with Moderate-to-Severe Asthma,” published October 28, 2025. The analysis looks at whether dupilumab (Dupixent), a biologic that blocks IL-4 and IL-13, can lower mucus burden and improve lung function, especially in people who start with a high “mucus plug score.” What we cover in our episode about dupilumab and mucus plugging Why mucus plugging matters in asthma: Discover how thick, sticky mucus can block airways, make it harder to breathe, and why standard inhalers and steroids don’t clear these plugs. How dupilumab may help: Learn how this biologic blocks IL-4 and IL-13, two key drivers of type 2 inflammation that increase mucus production and thickness. Inside the VESTIGE study: Hear how researchers measured mucus burden using CT scans and “mucus plug scores” to see if dupilumab could reduce plugging in moderate-to-severe asthma. What the results showed: Find out how dupilumab lowered mucus plug scores, reduced airway inflammation, and improved lung function (FEV₁), especially in people with high mucus burden. What this means for patients: Learn why identifying and treating mucus plugging may help improve breathing, reduce flare-ups, and make asthma easier to manage day to day. 📌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. ___ A special collaboration with the American Thoracic Society.  This podcast was made in partnership with Allergy & Asthma Network. This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.    

Living with constant congestion, facial pressure, or a loss of smell can make daily life exhausting. For many people, these symptoms are more than just allergies or a lingering cold. They may be signs of chronic rhinosinusitis with nasal polyps (CRSwNP). Dr. Rohit Katial joins Kortney and Dr. G to unpack what CRSwNP really is, how it develops, and why type 2 inflammation plays such a key role. Together, they explain what’s happening inside the sinuses, what symptoms to look for, and when it’s time to see a specialist. What we cover about CRSwNP: What CRSwNP means: Chronic rhinosinusitis with nasal polyps is long-term inflammation of the nose and sinuses that lasts 12 weeks or more. What nasal polyps are: Soft, fluid-filled sacs (often “grape” or “pea” sized) that block airflow and lead to congestion and smell loss. Why it happens: Type 2 inflammation drives CRSwNP. Immune messengers like IL-4, IL-5, and IL-13 cause swelling and fluid buildup in the nasal lining. Who it affects: CRSwNP often overlaps with asthma, allergies, or aspirin sensitivity (AERD or Samter’s Triad), making symptoms worse. When to seek help: If congestion, pressure, or loss of smell lasts more than 12 weeks, see an allergist or an ENT specialist. Early care can prevent sinus damage and improve breathing and quality of life. More episodes to support CRSwNP Ep. 101: What is Type 2 Inflammation? Ep. 102: Comorbidities of Type 2 Inflammation -  Connecting the Dots Between Multiple Allergic Conditions Ep. 109: Tezepelumab & Nasal Polyps - Inside the WAYPOINT Phase III 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 professional medical advice. Always consult with your healthcare provider for any medical concerns.

Navigating food allergies is tough enough, but adding family dynamics to the mix can make things even more complicated. When loved ones don’t understand you or your child’s allergies or dismiss the rules meant to keep them safe, it can lead to conflict, hurt feelings, and stress for everyone involved. Kortney and Dr. Payel Gupta sit down with psychologist Dr. Amanda Whitehouse to talk about how families can find common ground when emotions run high. Together, they unpack what it means to stay regulated in difficult conversations, how to set healthy boundaries with family members, and why understanding different coping styles can help prevent conflict before it starts. What we cover about communication and boundary-setting for food allergy families: Coping styles and conflict: Learn how different stress responses, such as “fight” versus “flight,” shape how partners, parents, and relatives react to food allergy challenges. Staying calm and regulated: Understand how your body reacts to stress and how recognizing those signals can help you stay grounded during tough conversations. Setting and holding boundaries: Get practical tips for explaining what feels safe, keeping communication clear, and responding calmly when others push back. Working together as a team: Whether it’s with your partner, kids, or extended family, learn how to support each other and stay united when emotions rise. Bridging family differences: Explore ways to include children and siblings in allergy safety, and approach older relatives with patience and compassion when views or communication styles differ. ___ 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.

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.