Ep. 131: What Is a BTK Inhibitor?
LISTEN TO EPISODE 131: Apple Podcast • Spotify • Amazon Music
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For decades, allergists have focused on blocking what happens outside the mast cell with 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.
A BTK inhibitor works on Bruton’s tyrosine kinase, a molecular “light switch” within the mast cell that controls activation and degranulation. Turning this switch off may prevent hives, swelling, and other mast-cell–driven symptoms at their source.
Dr. Matthew Giannetti joins Dr. Payel Gupta and Kortney 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 we cover in our episode 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 simplified: 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 and mast-cell–related diseases.
About our BTK expert, Dr. Matthew Giannetti
Dr. Matthew Giannetti is an allergist and immunologist at Brigham and Women’s Hospital in Boston, where he serves as Associate Director of the Mastocytosis Center. He’s also an Assistant Professor of Medicine at Harvard Medical School. Dr. Giannetti specializes in mast cell disorders, including chronic spontaneous urticaria, mast cell activation syndrome, and systemic mastocytosis.
More resources about chronic spontaneous urticaria:
More episodes about urticaria
Ep. 122: Mortality in adult patients with chronic spontaneous urticaria - A real-world cohort study
Ep. 80: Chronic Spontaneous Urticaria Myths & Misconceptions
Ep. 75: Understanding Chronic Spontaneous Urticaria: Hives Demystified
Ep. 90: Challenges in Diagnosis and Treatment of Chronic Urticaria in Skin of Color
Timestamps
Our episode discusses autoimmune csu and autoallergic csu.
01:11 What is CSU
02:32 Mast cells and the immune system
04:11 What a trigger means in CSU
07:28 Why food allergy testing isn’t helpful
09:58 Autoimmune causes of CSU
12:13 Two types of autoimmune CSU
15:35 Type I (autoallergic) CSU
17:53 Type IIb autoimmune CSU
21:17 Four possible causes of CSU
24:15 Key takeaways about autoimmune CSU
