BackTable ENT & Allergy

With no FDA-approved therapies for Sjögren’s disease, how can ENTs and allergists provide effective care and keep up with emerging treatments? On this episode of BackTable ENT & Allergy, Dr. Basil Kahwash interviews Dr. Kara Wada, a Columbus-based allergist, immunologist, and lifestyle medicine physician, about her personal and clinical experience with Sjögren’s disease. They discuss the major gaps in current treatment, the evolving role of otolaryngologists and allergists in multidisciplinary care, and the new therapies on the horizon.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction02:21 - Building A Direct Practice04:24 - Personal Sjogren's Diagnosis08:33 - ENT Presentations11:28 - Biopsy Challenges and Seronegative Disease15:48 - Pulmonary Complications17:55 - Clinical Trial Treatment19:47 - Immunology and Disease Mechanisms25:35 - Lab Workup and Risk Assessment29:32 - Overlooked Symptoms and Nutritional Considerations31:51 - Saliva Stimulants Tradeoffs34:42 - Deciding When to Escalate Systemic Therapy35:51 - Hydroxychloroquine Basics38:26 - Multidisciplinary Dream Team41:45 - Rituximab and IVIG44:35 - Investigating Phase Three Therapies47:23 - Path to Becoming a Sjogrens Expert53:33 - Key Takeaways And Resources

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More about this episode

Dr. Wada details her own diagnosis and the complex presentations of Sjögren’s across ENT subspecialties, including dry eyes, nasal and throat tissues, chronic sinus issues, laryngitis, reflux, salivary gland swelling, neuropathy, and dizziness. The conversation covers diagnostic workup, the importance of lip biopsy and expert pathology, the challenges of seronegative and pulmonary cases, and the limitations of current medications like hydroxychloroquine and rituximab. They also discuss ongoing clinical trials, dryness management, overlooked symptoms, and the emerging role of agents such as inalumab and dazedalimab in late-phase studies.

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Resources

Virtual Sjögren’s Summithttps://www.sjogrenssummit.com/

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What if your pharmacist could help optimize a patient’s asthma treatment before their next clinic visit? On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash welcomes clinical pharmacist Dr. Joelle Ayoub to discuss how ambulatory care pharmacists can partner with ENT and allergy clinics to optimize asthma management. Dr. Ayoub shares her experience working in a family medicine clinic, collaborating with providers through referrals, reviewing medications, and providing direct patient education on inhaler use and disease management.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction02:40 - The Role of the Clinic Pharmacist05:04 - Teaching Patients and Improving Inhaler Technique12:36 - Choosing Inhalers and Applying Guidelines18:51 - Comparing MDI, DPI, and SMI Devices28:15 - Tracking Asthma Control and Monitoring Adherence33:55 - Inhaler Education and Overcoming Barriers40:00 - Using Social Media for Patient and Provider Education44:16 - Pharmacist Collaboration and the Future of Team Care50:58 - Answering Biologics Patient Questions53:15 - SMART Therapy and Digital Inhaler Advances55:19 - Wrap Up

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More about this episode

They discuss common gaps in asthma care, with a focus on inhaler technique and medication adherence. Dr. Ayoub explains how device complexity, cost, and a patient’s ability to use their inhaler can all affect treatment. She also reviews the major inhaler types, common technique errors, and what to consider when choosing the right device for each patient. With this, Dr. Ayoub shares practical approaches to adherence monitoring, asthma guideline updates, and biologic monitoring. Throughout, Dr. Ayoub emphasizes the benefits of multidisciplinary collaboration and how pharmacists can help bridge gaps in care for patients with asthma.

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Resources

Joelle Ayoub, PharmD, BCACP, APh - https://www.westernu.edu/bios/?bio=jayoub

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Aspirin or biologics? How do you choose the right treatment for AERD? On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash interviews Dr. Andrew White, Director of the AERD Clinic at Scripps Clinic, to discuss the diagnosis and management of this often underrecognized condition. They cover practical strategies for identifying AERD, the importance of a detailed NSAID history, and how treatment decisions are shaped by patient goals and disease severity.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction02:08 - What Is AERD and Prevalence 06:32 - History Taking and Mechanism 11:10 - Typical Symptom Progression and Alcohol Intolerance 16:41 - When to Do Aspirin Challenge 19:00 - Challenge Protocol And Upper Airway Reactions24:53 - Aspirin Desensitization vs Challenge27:58 - Aspirin therapy after desensitization and Risk of GI Bleeds31:17 - Biologics Change AERD33:42 - Choosing Aspirin Desensitization vs Biologics 35:52 - Patient Counseling and Motivational Interviewing 41:26 - Convenience and Cost of Therapy 44:10 - ENT Allergy Collaboration47:22 - Rapid Fire Pearls51:13 - Future Research & Management Direction54:05 - Final Takeaways

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More about this episode

Dr. White explains that AERD affects about 8 to 10 percent of asthmatics, with even higher rates in those with severe asthma or nasal polyps. He reviews typical adult-onset progression, alcohol-related respiratory symptoms, and the underlying pathophysiology, including imbalances in arachidonic acid mediators and leukotriene surges after NSAID exposure.The conversation includes practical questions to ask when taking an NSAID history, such as reactions to common pain relievers or alcohol, and when to consider aspirin challenge. Dr. White also details long-term treatment strategies, including the role of biologics like dupilumab and aspirin therapy after desensitization, with considerations for dosing and gastrointestinal risk. He explains how factors like asthma severity, recurrent polyp disease, sense of smell, cost, and convenience all influence therapy choice. The episode concludes with a discussion of multidisciplinary collaboration, patient counseling, and Dr. White’s insights on future research directions in AERD management.

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Resources

Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthmahttps://pubmed.ncbi.nlm.nih.gov/16275362/

Polyphenolic Activation of Basophils Explains Alcohol Hypersensitivity in AERDhttps://pubmed.ncbi.nlm.nih.gov/41065188/

New insights into the mechanisms of aspirin-exacerbated respiratory diseasehttps://pubmed.ncbi.nlm.nih.gov/39641750/

The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunologyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC7980229/

Safety and outcomes of aspirin desensitization for aspirin-exacerbated respiratory disease: A single-center studyhttps://pubmed.ncbi.nlm.nih.gov/28550988/

Selection of aspirin dosages for aspirin desensitization treatment in patients with aspirin-exacerbated respiratory diseasehttps://pubmed.ncbi.nlm.nih.gov/17208597/

Factors influencing aspirin therapy after desensitization (ATAD) tolerance in aspirin-exacerbated respiratory disease (AERD) patientshttps://pubmed.ncbi.nlm.nih.gov/41022281/

Feed the Good Wolf: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindsethttps://pubmed.ncbi.nlm.nih.gov/42103433/

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Can viewing the airway as one connected system change the future of respiratory care and improve patient outcomes? On this episode of the BackTable ENT & Allergy Podcast, Dr. Cedric Jamie Rutland, pulmonary and critical care medicine physician, joins Dr. Basil Kahwash to discuss the unified airway hypothesis and its implications for clinical care. They explore how upper and lower airway inflammation are closely linked, and why multidisciplinary collaboration is essential for treating the whole patient.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction05:06 - Understanding the Unified Airway14:27 - Decoding Asthma Biomarkers20:34 - Endotyping in Clinical Practice26:36 - Addressing Asthma Symptom and “Outgrowing” Asthma32:13 - Strategies for Precision Biologics34:23 - Navigating Insurance and Treatment Indications35:36 - Treating the Whole Patient and Breaking Down Specialty Silos46:07 - Effective Patient Communication51:36 - Asthma Lightning Round57:33 - Biologics and Airway Remodeling1:00:00 - Closing Thoughts

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More about this episode

The conversation covers the biology of type II inflammation, the use of biomarkers and biologics for more personalized treatment, and practical strategies for overcoming insurance barriers and specialty silos. Dr. Rutland shares insights on patient communication, the limitations of current diagnostics, and the impact of chronic inflammation on systemic disease. The episode highlights the need for ENT, allergy, and pulmonology teams to work together and embrace a connected view of airway disease to achieve better patient outcomes.

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Resources

Dr. Jamie Rutland - https://www.lung.org/media/meet-our-experts/cedric-jamie-rutland-md

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

BackTable is moving beyond the traditional podcast experience and into a platform built specifically for clinicians. On this episode of the BackTable ENT & Allergy Podcast, hosts Drs. Gopi Shah and Ashley Agan welcome Dr. Aaron Fritts, interventional radiologist and BackTable CEO and Co-Founder, to discuss the history and future of BackTable, and what listeners can look forward to on the new BackTable App.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps00:00 - Introduction00:51 - Meet the CEO and Co-Founder02:32 - How Backtable Got Its Name04:32 - Why Move to the App07:31 - Community and Learning Features12:36 - Playlists and Transcripts15:42 - Beyond Backtable Content18:07 - Searchability and Other Platform Limits19:35 - Privacy and NPI Verification21:31 - Download the App and Give Feedback22:53 - October Timeline and Academy Party24:26 - Closing Thoughts

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More about this episode

Dr. Fritts shares how BackTable started as an app concept for medical devices in 2016, evolved into the IR podcast in 2017, and expanded to the ENT show in 2020. He explains how Gopi coined the name “BackTable” as an homage to the informal, behind-the-scenes conversations that fuel clinical learning. With eight shows now producing 30 to 40 episodes each month, BackTable will begin releasing most new podcast episodes exclusively on the BackTable app starting in October.

The conversation highlights the app’s robust features designed for busy clinicians, including physician-only NPI-verified guest Q&As, quick-study cases, searchable and organized playlists, episode transcripts, offline listening, upcoming CarPlay integration, and access to resources like the Curbsiders internal medicine podcast. The BackTable app is free to download and free to use, providing easy access to a growing library of high-yield medical education content.

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Resources

Download the BackTable App on Google Playhttps://play.google.com/store/apps/details?id=com.backtable.app&hl=en_GB

Download the BackTable App on the Apple App Store https://apps.apple.com/us/app/backtable/id6751363383

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BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app