#163 - Understanding Chronic Spontaneous Urticaria: Hives Demystified

Chronic rhinosinusitis without nasal polyps (CRSsNP) is the type that makes up most chronic sinusitis cases. It's often mistaken for allergies, a lingering cold, or migraines, which can delay a proper diagnosis for years. Dr. Gupta and Kortney sit down with Dr. Anju Peters, an allergist at Northwestern University's Feinberg School of Medicine, to unpack how this condition is actually diagnosed, why it can take patients years to get an answer, and which treatments have real evidence behind them. What we cover in this episode about chronic sinusitis without nasal polyps Two types of chronic sinusitis. About 75% of chronic sinusitis patients do not have nasal polyps, and about 20 to 25% do, and the treatment path differs depending on which type you have. Getting the right diagnosis. Doctors confirm chronic sinusitis without nasal polyps by combining at least 12 weeks of symptoms with objective proof of inflammation. Ruling out look-alikes. Allergies, colds, and migraines can all cause similar congestion and pressure, so doctors pay close attention to how long symptoms last and whether inflammation is actually confirmed. Building a treatment toolkit. Nasal steroid sprays are the backbone of treatment. When to consider surgery. When sinus surgery becomes the next step in sinus care. Resources: Ep. 133 What Is Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)? Ep. 149 What is Chronic Rhinosinusitis without Nasal Polyps Allergy & Asthma Network: chronic rhinosinusitis overview How is chronic rhinosinusitis diagnosed Treatment and management of chronic rhinosinusitis What is chronic rhinosinusitis with nasal polyps How to use the FDA-approved nasal spray *********** 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 for professional medical advice. Always consult with your healthcare provider for any medical concerns.

Food allergy prevention is something most families think about once a baby starts eating. But the gut microbiome begins developing before birth, and what happens during pregnancy matters for the development of food allergies. This is a bonus episode from our conversation with Dr. Carina Venter. The clip did not make it into Episode 165, but it was too good not to share. Dr. Payel Gupta and Kortney dig into what Dr. Venter shared about pregnancy, the gut microbiome, and what families can do in that critical first year of life. What we cover in this episode about pregnancy and food allergy prevention How the gut microbiome develops before and after birth. From pregnancy through the first year of life, several key factors shape your baby's gut microbiome, including mode of delivery, breastfeeding, and the introduction of solid foods. What happens if things do not go as planned. A difficult pregnancy, a C-section, or not being able to breastfeed does not mean you have missed your chance to help your baby develop a healthy gut microbiome.  What the research on pregnancy diet actually shows. A look at how maternal diet during pregnancy and breastfeeding may affect a child's risk of allergies. Early introduction and why it matters. Introducing allergenic foods between four and six months of age and keeping them in the diet consistently may reduce the risk of food allergy by ten to thirty percent. What to feed your baby to support a healthy gut. Diversity, whole foods, and sustained exposure to allergens are the key takeaways for families starting solids. More Resources: Webinar: The Microbiome and Its Role in Asthma & Allergies Podcast episode: Did I Cause My Child’s Food Allergy? Podcast episode: Early Allergen Introduction What is a food allergy? Tips for Saving Money on Allergy-Friendly Food Shopping Dr. Venter’s Studies: Study 1: The Healthy Start Study Study 2: The MEDALLION Study Study 3: Systematic Review of Maternal Dietary Patterns During Pregnancy and Offspring Allergy __________ This podcast is made in partnership with the Allergy & Asthma Network 

You have probably heard the word "microbiome", but what does it actually mean for someone living with a food allergy? Dr. Carina Venter, a registered dietitian, joins us to break down the gut’s role in food allergies. She explains what the microbiome is, how it connects to the immune system, and what families can realistically do right now to support a healthier gut. What we cover in this episode about gut health and food allergies What the microbiome actually is. Understanding the bacteria living in your gut, why diversity matters, and what happens when that balance gets disrupted. The connection between gut bacteria and food allergy. Research consistently shows that children with food allergies have lower levels of two key bacteria, and that gap may affect how the immune system responds to food. Leaky gut and ultra-processed foods. What leaky gut actually means and research on emulsifiers. Should you be taking probiotics? Which strains have the most research behind them, what to look for on the label, and why diet diversity may matter more than any supplement. Practical steps for families. From a diverse diet to when to use supplements. About our guest, Dr. Carian Venter: https://www.carinaventer.com/ __ This podcast is made in partnership with the Allergy & Asthma Network

In this journal club episode, we break down the draft of the Chronic Urticaria Guidelines: 2026 AAAAI/ACAAI Joint Task Force (JTF) on Practice Parameters GRADE- and Institute of Medicine-based recommendations. We explain what counts as chronic hives, why the guideline leans on second-generation non-drowsy antihistamines, what to do when those are not enough, and what is new for both adults and kids. At the time of recording, the draft was open for comments; it closed for comments on June 30, 2026. What we cover in our episode about the new chronic hives guidelines What chronic hives are: A plain-language look at the two main types, spontaneous and inducible, plus angioedema (swelling) that can come with them. What a draft guideline is: Why the guideline is still being reviewed, and how comments can help shape it before it is final. What's new for kids: How children fit into the guideline, and why most do well without advanced treatments. The antihistamine shift: Why the guideline favors non-drowsy, second-generation antihistamines and moves away from older, sedating ones. When antihistamines are not enough: If higher-dose antihistamines do not work, the recommended advanced option is to start omalizumab (Xolair) plus two newer additions: dupilumab (Dupixent) and remibrutinib (Rhapsido). Download Infographic More hive resources  Read the draft guideline and comment details (ACAAI) Track your symptoms: Get the CU Download to access the UAS7 and the Urticaria Control Test (UCT) What are chronic hives? Chronic Urticaria Toolkit Living with Chronic Hives *********** 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 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.

Join Kortney and Dr. Payel Gupta as they unpack chronic spontaneous urticaria. Together, they define what hives actually are, explain how CSU is different from an allergic reaction and other types of hives, and walk through what is happening under your skin to cause all that itching. This episode was originally published June 6, 2024. We re-released it on June 25, 2026 with a new intro as the perfect foundation before our episode on the new chronic urticaria guidelines. Do you get hives and have no idea why? Then this episode is for you. What we cover in this episode about chronic hives: What hives really are. Urticaria is the medical word for hives, and the two signs are that it itches and it comes and goes. CSU versus other hives. How CSU differs from inducible hives (CINDU) and from an allergic reaction. Histamine and the itch. Why histamine drives the swelling and itch, and why scratching feels so good. What makes hives flare. CSU has no true trigger, but stress and other culprits can set off your mast cells. The Itch Podcast Hives Episodes Explore our full catalog of hives episodes Diagnosis and the basics Ep. 76 Diagnosing Chronic Spontaneous Urticaria Ep. 128 Is Chronic Spontaneous Urticaria an Autoimmune Disease? Ep. 90 Challenges in Diagnosis and Treatment of Chronic Urticaria in Skin of Color Treatment Ep. 78 Chronic Spontaneous Urticaria Treatments Ep. 131 What Is a BTK Inhibitor? Ep. 147 The REMIX Trial: Remibrutinib for Chronic Hives   Ep. 116 Why Fexofenadine Is Considered a Truly Non-Sedating Antihistamine Living with chronic hives Ep. 148 How Do You Know Your Chronic Hives Are Under Control?  Ep. 122 Mortality in adult patients with chronic spontaneous urticaria: A real-world cohort study  Ep. 80 Chronic Spontaneous Urticaria Myths and Misconceptions Ep. 79 Living with Chronic Spontaneous Urticaria: A patient story Ep. 91 A Patient's Experience with Chronic Urticaria and Skin of Color Ep. 107 Hives in the Latinx Community ______ This podcast is made in partnership with Allergy and Asthma Network.  We thank Novartis for originally sponsoring this episode. This podcast is for informational purposes only and does not substitute professional medical advice. Any mention of brands is also informational and not an endorsement. Always consult with your healthcare provider for any medical questions or concerns.  

Treatment options for eczema have come a long way, with many new non-steroidal choices. One type is the JAK inhibitor, which offers two things people have long wanted: a non-steroidal option and a more advanced option that, unlike a biologic, does not require injection. Kortney and Dr. Payel Gupta sit down with returning guest Dr. Nicole Chase, to break down what a JAK inhibitor actually is, how the pill and cream versions differ, how JAK inhibitors compare to biologics, and what to know about safety. They also cover what is new, including a topical JAK now approved for children as young as two. What we cover in this episode about JAK inhibitors for eczema What eczema really is.  How JAK inhibitors work.  Pills versus creams.  JAK inhibitors versus biologics.  Safety and side effects.  Made in partnership with The Allergy & Asthma Network. Thanks to Incyte 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.

Most adults with asthma never receive education about managing their condition, even though it is proven to help with better asthma control. The reason comes down to access. In this episode, we explore a digital platform called BREATHE, built from the ground up to change that. Dr. Payel Gupta and Kortney sit down with the two lead authors behind “Development and Usability of a Digital Asthma Self-management Education Platform: BRinging Exercise, Asthma Assessments, and TeacHing to Everyone (BREATHE)” published in JACI: In Practice, March 2026. De De Gardner and Sheryl Flynn, CEO, talk about how BREATHE was developed, what the app includes, and what the data showed after patients and providers put it to the test. What we cover in this episode about asthma self-management Asthma self-management education and why most adults never receive it. How BREATHE was built using a user-centered design process, shaped by what adults with asthma and healthcare providers said they actually needed. What the BREATHE platform includes: asthma lessons, validated control assessments, and an Asthma Action Plan, all in one app, in English and Spanish. What the usability study found: adults rated the app in the 81st percentile, providers rated the dashboard in the 76th percentile, and 80% considered making a behavior change after just two weeks. Where the program is now and where it is going, including how to access the free Allergy and Asthma Network Virtual Asthma Coaching Program today. Allergy and Asthma Network Virtual Asthma Coaching Program and the Spanish program. This podcast is made in partnership with the Allergy & Asthma Network.

We are continuing our series of interviewing thought leaders in the field of allergy and immunology. Dr. Gupta and Kortney sit down with Dr. Carla Davis, the president of the American Academy of Allergy, Asthma and Immunology. What we cover in this episode about Dr. Davis and the AAAAI What the AAAAI is and why it matters to patients. A 7,000-member organization working behind the scenes to support allergy and immunology care across the US and around the world. Dr. Davis's path to the presidency. From her early experiences advocating as a fellow to her major pivot from Baylor to Howard University, the journey that shaped her priorities. Initiative: AAAAI Advocate. A new platform connecting patients and physicians directly to their legislators, making it easy to share your story and push for better access to allergy care. Initiative: AAAAI AI Task Force. A dedicated group bringing AI tools into allergy care, including AAAAI Ignite, a Netflix-style platform that helps members find and curate personalized allergy content. Initiative: The Collaborative Translational Mechanistic Research Seed Award. A $100,000 grant pairing laboratory scientists with clinical allergists to move new discoveries directly into patient care. More resources American Academy of Allergy, Asthma and Immunology AAAAI Advocate platform Allergy & Asthma Network health equity resources   This podcast is made in partnership with the Allergy & Asthma Network.  

Kortney and Dr. Payel Gupta are joined by Tamara Hubbard, MA, LCPC, a licensed clinical professional counselor and food-allergy parent. Together, they dig into what food allergy anxiety actually looks like in teenagers, why some teens take more risks as they get older, and what parents can do to support their teens without making things worse. What we cover in this episode is about food allergy anxiety in teens: What makes teenagers a high-risk group for food allergy reactions. Independence is increasing at the exact same time parental oversight is decreasing, and that combination creates real safety concerns. What food allergy risk-taking actually looks like. It is not always what parents expect, and some of it is just teens figuring out how to belong. Food allergy social anxiety is its own distinct experience. The fear of looking different, being a burden, or standing out can drive behavior just as much as the fear of a reaction. Why parental anxiety matters more than most parents realize. The way parents talk about food allergies often directly affects how teens handle them. How to build confidence and ownership in your teen. What to do when a teen is either too anxious or not anxious enough. *********** Made in partnership with The Allergy & Asthma Network. Thanks to Genentech and Kaléo 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.

Food allergy anxiety in kids is real, and it does not always look like fear. It can show up as tantrums, clinginess, control-seeking behaviors, or a child who refuses to eat at a restaurant. Child life specialist and therapist Kelsey Mora joins Kortney and Dr. Payel Gupta to unpack what is really going on.  What we cover in our episode about managing anxiety in kids Food allergy anxiety does not always look like anxiety. Tantrums, clinginess, and control-seeking behaviors can all be signs that a child is struggling. Language matters from the start. How parents explain food allergies to young children can build confidence or quietly reinforce fear. Separation anxiety and food allergies are connected. Dependence on parents can make it harder for kids to navigate school, parties, and social situations on their own. Practicing independence at home builds real-world skills. Exposure to allergens in a safe home environment teaches confidence and communication skills kids need everywhere else. Passing parental anxiety onto kids. Co-regulation starts with the caregiver, when parents are anxious, kids have a harder time calming down. Helpful resources Food allergy anxiety information from Allergy & Asthma Network Kelsey's practice and services: childlifetherapist.com  Kelsey's workbooks and resources: themethodworkbooks.com  *********** Made in partnership with The Allergy & Asthma Network. Thanks to Genentech and Kaléo 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.