Talk With A Doc

Unknown Speaker 0:00
Have any questions along the way, feel free to ask them it's no problem. They'll be doing some editing on this anyways.

Unknown Speaker 0:07
Alright, so let's get started. Thanks for joining us, Dr. shome. Can you tell us a little bit about yourself and your work with covenant and what brought you into this field?

Unknown Speaker 0:18
So my name is Dr. Gautam Schoen. I'm Allergy Asthma and Immunology specialist.

Unknown Speaker 0:26
I'm also a clinical professor at Texas Tech University Health Sciences Center

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where I teach residents in student and

Unknown Speaker 0:38
my basic background is in immunology, and allergy and immunology as the name itself turns you very closely connected to the immunology part of it. So there's one major incentive for me to follow that pathway. I was trained at the University of Michigan in allergy immunology. But before I went to the fellowship, I had training in internal medicine at Michigan State University. Currently, I'm the attending allergist and immunologist for covenant Medical Group, in addition to my responsibility as a faculty in the Health Sciences Center, where I'm a clinical professor.

Unknown Speaker 1:21
So this is a surprisingly big topic. And I really want to break our conversation into a few main pieces. So first, we're going to go through understanding seasonal allergies, and then prevention and then finally treatment. So let's get started by having a better understanding of this issue. Dr. Shum, can you tell us what are seasonal allergies? And why do they occur? what's triggering them? And are there certain allergens that are just more responsible for this? This they good question and a very relevant question. So let's talk about the seasonal allergy. And as the name suggests, we're talking about the season and the allergy.

Unknown Speaker 1:58
So

Unknown Speaker 2:00
in different geographic part of the United States, seasons a little bit different.

Unknown Speaker 2:07
Just for an example, I'll take the northeast part of the country, or seasons are much more defined. So starting from end of March, till the beginning of May is the tree season, I'm talking about tree pollen season.

Unknown Speaker 2:20
Then, beginning of June to end of July, you're talking about the grass season.

Unknown Speaker 2:29
From July till the end of September, get on with the weed season. And with the first frost in October, all the pollen counts are gone.

Unknown Speaker 2:39
So when you talk about the seasonal allergy, typically we talk about outdoor allergy, pollen allergy in particular, and it is defined only in certain parts of the country. So there is a significant overlap in many other parts of the country.

Unknown Speaker 2:56
Example would be the West Texas if you take it, you know even though we have three grass and weed pollen season,

Unknown Speaker 3:06
but you might see a seasonal allergy pattern even in the middle of December, when the temperature fluctuation is so high, sometimes we end up getting the seasonal allergy unfortunately in the non season you may call it in the middle of the winter. So this is how we talk about the seasonal allergy, mostly our pollen allergy, then of course there is already called non seasonal or perennial allergens. We talk about mostly indoor allergens, but there can be some outdoor allergens which are also perennial. But into allergies, we talk about animal in particular, pets, dog and cat, roaches in the inner cities, big cities, dust mite in particular, where the humidity moisture is high. So those are the, you know, perennial, mostly indoor type of allergens. But in reality, what we see is that indoor as well as outdoor allergens are usually, you know, together, you know not one person is only allergic outdoor stuff, or vice versa. So in other words, we see patients in in both groups at the same time.

Unknown Speaker 4:21
Go ahead. Oh, sorry. Go ahead. So your next question or why people get allergy? Correct.

Unknown Speaker 4:28
So this is a million dollar question. Unfortunately, allergy has many different reason behind it. If you ask me for one particular reason, or few particular reason in the better, most dominant factor in allergic diseases the genetic factor.

Unknown Speaker 4:44
Is it everything No.

Unknown Speaker 4:46
published studies suggest that 30 to 40% of patients with allergic diseases, genetic factors play a big role. But having the right allergy gene does not make you allergic to

Unknown Speaker 5:00
Legally speaking, so you have to have environmental interaction. So if you live in certain area of the country, or certain part of the geography, where you are exposed to different types of trigger what we call allergens in this case, so you need the gene, then you need the trigger to together produces the disease what we see. So it is not only just you may have allergy gene, but if you're not exposed to the allergens, you are not going to have allergic conditions. So you have to live in a place where the allergens, so the gene and environment interact together produces the disease.

Unknown Speaker 5:36
That makes sense. So, what's happening in our body when we're suffering from our allergens and when we're triggered with them? So that's a good question. So overwhelming majority of the patients will have defined characteristics of allergic disease process. So so far, I have talked about the environmental allergies, pollen, indoor, and outdoor allergens, etc. But most of the allergic diseases usually start when they're very young.

Unknown Speaker 6:04
In the children, for example, it may not be the environmental allergy, it may be the food allergy that starts in the beginning. So if you're genetically predisposed,

Unknown Speaker 6:13
you end up reacting to particular food.

Unknown Speaker 6:17
So that starts at very early age 70% of the Food Allergy issue starts by the time children's are one year of age 90 person by the time they're five years of age, only 10% of the food allergies start when they're adult. So suppose it starts with a food allergy, then it can progress to other energy, like Netherlands sinus allergy, worry call hay fever type of symptoms, then asthma, and of course, skin disease, you know, so what do we call you know, there's a beautiful term in our field, what we call atopic March, so people are individual who are destined to develop allergic diseases, they usually start with the allergic skin disease like eczema, food allergy progresses to the hay fever, then asthma, that sequence can change. You know, some people may start with eczema, some may start with nose and sinus symptoms, somebody can start with asthma, but one can progress to the next step, what we call atopic March.

Unknown Speaker 7:18
So pattern of disease is different. So if your issue is the food allergy, then it can affect in many different systems.

Unknown Speaker 7:26
But dominant system that is affected by food allergy reactions is the skin in the form of itching, rash. Sometimes you may have swelling of the skin tissue, what do you call ng edema is a fancy medical term of severe swelling.

Unknown Speaker 7:42
If it happens, the lips your lips rolling canceling, throat swelling that can be a deadly manifestation of severe food allergy.

Unknown Speaker 7:51
Then it can affect your airways when you have got asthma like symptoms like cough, who is in chest tightness, shortness of breath. So simple food allergy can have oily skin disease, as the Food Allergy become more severe, and life threatening those other serious symptoms can happen as I mentioned.

Unknown Speaker 8:09
So this is how food allergy presents. If you talk about her favorite type of symptoms, you're talking about mostly itching, sneezing, runny nose, and congestion and complication from those Netherlands sinus symptoms. As the disease progresses, many of them will develop asthma type symptoms, which can be cough, chest tightness, wheezing, shortness of breath, in the pediatric population in asthma symptoms in men are Bissau fears that I described it maybe the child may complain of chest tightness or chest pain.

Unknown Speaker 8:43
So, the presentation is variable depends on which organ system is involved, and what stage of their diseases in the atopic March

Unknown Speaker 8:57
it's definitely a lot more than just itchy, watery eyes and runny nose. Thanks for that, that background and information. Is there a genetic component to allergies? Are you more likely to experience them if your parents have seasonal allergies? Yes. So, I always try to tell the this is a very good question. So,

Unknown Speaker 9:15
even without any measure analyzes most of the studies will you will find that 30% of the genetic component, but I have simple thing yet if one parent is allergic to anything, like you have allergy conditions like hay fever or asthma or other allergic condition, ear with about 30% chance of having allergy condition, just wondering

Unknown Speaker 9:36
if your two parents are allergy In other words, they have both of them some allergic diseases, then you are increasing the reach to 70%. So your genetic load of allergic diseases is very high by then. Then you live in the environment where you have genetic interaction with the environmental factors, then you are more likely to get into trouble. Yes, strong genetic component

Unknown Speaker 10:00
even single parent 30% to parent 60 to 70%. Then of course, and I know that I'm throwing large numbers, but these are well studied and well documented. Wow, gosh, what are the common symptoms of seasonal allergies? And how do we differentiate between a common cold and seasonal allergies? Very common question. Very relevant question too. So seasonal allergies as the name itself tells you a lot. It happens during the season, particularly what the seasons are defined. So you're talking about the spring allergy season starting from the end of February or March till the beginning of May. You're talking about tree allergen or tree pollen causing allergy symptoms. Then of course, May June July, grass allergy grass pollen.

Unknown Speaker 10:47
August, September, October, you're talking about more weed season weed pollen. So if you're in the season, you're having symptoms, if you suspect something like that. So what are the symptoms of allergic diseases, when they affect the nose and sinuses, we have itching, sneezing, runny nose, congestion. postnasal rib like you cannot stop clearing your throat, it can affect your eye. So sometimes this is also interesting part. Many people believe that allergies only affect the nose and sinuses. But 50% of the patients with allergy in the nose and sinuses will have eye symptoms like eating and water nearby. I saw on a chart they will come and tell us. So those kinds of syndromes you will see in seasonal allergy symptoms in other interesting factories that not only their season happens or get washed during the season, but it is repeated every time of the year every time. The spring comes in that individual you know some of them rather than facing the fall or spring allergy season. They're more or less continuous and lasts for months, not days or weeks.

Unknown Speaker 11:56
The different how they differentiate between the common cold symptoms versus the allergy symptoms as I mentioned, season is one factor. recurrence of the syndrome is one factor duration of the symptoms. If you have a common core, you could acute onset of symptoms lasting only for a few weeks, not months or many years.

Unknown Speaker 12:16
Symptoms can be still runny nose in congestion, sneezing, itching, you mail to run the fever symptoms.

Unknown Speaker 12:22
Regular garden variety, hair fever or allergic symptoms usually do not have any fever, chills, muscle pain or joint pain. Because you're talking about some infection.

Unknown Speaker 12:33
Infection, by definition has some other component you're stimulating the immune system in different way, which produces fever.

Unknown Speaker 12:41
Regular garden variety allergy symptoms, by and large, will not cause fever unless there's complication.

Unknown Speaker 12:48
And symptoms usually lasts less than three weeks. Common core symptoms. So if something is lasting more than in the three weeks of few weeks,

Unknown Speaker 12:59
you're taking antibody but symptoms are not getting better. Think carefully ask yourself, is it happening every year? Is it lasting more than few weeks? Few months? Or more than that? Is there a family history of allergy and asthma?

Unknown Speaker 13:13
Is outdoor factors like cutting grass mowing lawn, just weed raking leaves, etc makers seem to think about you

Unknown Speaker 13:24
know, seek attention.

Unknown Speaker 13:27
Ask very good questions to ask yourself. Yeah.

Unknown Speaker 13:31
So how can your reactions or can your reactions to allergens change over time? Absolutely. So, let me put this in a different context you know,

Unknown Speaker 13:42
allergic disease processes is like an orchestra. When you go to orchestra, you see first only one instrument start playing Correct.

Unknown Speaker 13:52
As the

Unknown Speaker 13:54
music progresses, many different instruments come into play. Similarly, in allergic diseases in the beginning or in our early stages of the disease process, only few chemical mediators play a role. So your symptoms may be mild or limited in nature. But as the disease progresses, symptoms recur moderate to severe, and you may develop new symptoms.

Unknown Speaker 14:18
So one of the common things that we talk about histamine and anti histamine. Histamine is a simple but very early player in the allergic disease processes when you have been eating and sneezing this type of picture. But once your inflammation sets in many other chemical factors play a role. So you have good more swelling, you know, more severe response. antihistamines are not going to do the trick to address your symptoms because your disease has progressed. Yes, allergic diseases progress. So this is the symptom progression I talked about. But how about the organ progression? Let's say in the beginning, when you have got allergy symptoms you're

Unknown Speaker 14:58
dealing with mostly now

Unknown Speaker 15:00
Excellent sinus symptoms, like ET sneezy, runny and stuffy nose. But as these rhinitis and sinusitis symptoms persist for long time, over the course of many years

Unknown Speaker 15:13
20 to 40% of them will end up developing asthma symptoms. You can consider it as a part of atopic March that I mentioned earlier. So you started in the nose and sinuses now we deal with the cough, wheezing and shortness of breath. In other words, asthma symptoms, which can be life threatening if you don't address it.

Unknown Speaker 15:34
How does the impact of allergies differ between children and adults? So, remember, as I mentioned to you, most of the allergic diseases usually develop and they're very young.

Unknown Speaker 15:48
And when they're very young, the arrows are still developing. So, simple problem in the adult, you know, maybe perceived as severe issue in the children, because their error is still small developing room for accommodation is low there. So they can return very seriously. Number one, so this is the environmental allergy affecting the respiratory system. How about food allergy in the children, most of them happen in the children Am I correct? So, if there is a case, you know, they can go into anaphylaxis and they cannot tell what is happening to them. Them? No, it is the caregivers responsibility, parent's responsibility. You know, when all of a sudden you never had a reaction to any food, and you put the peanut in their mouth and they have severe in a choking feeling turning blue, stop breathing.

Unknown Speaker 16:45
So those things can be very unique and potentially serious if you don't address in eighth grade them.

Unknown Speaker 16:52
So I'm coming back with a food allergy because these are more deadly issues. If you don't address it, it can be life threatening. Absolutely, yeah, they the food allergies is certainly a little scarier than it sounds like than the the environmental allergies. Are there some areas that or better climates to live in when it comes to seasonal allergies? Or is it just based on each person. And I asked that I know a person who was told by a doctor to move from Florida to the Pacific Northwest to help with their allergies. And that seemed really unusual to me because of how green the west side of the Pacific Northwest is and it just seems strange that you know, I know so many people in this area who suffer from seasonal allergies is that is that our seasonal allergies Regional Base sometimes. So, every region has different types of allergen picture, but no one in the United States, you will be able to get rid of all the environmental allergens. So, that is not the advice that I would get. So, what people feel this is interesting question that we face it on a regular basis too. Let's say you live in certain part of the country and you are sensitized to the local allergens, if you move to a new place that allergen picture is different. So, for the first few years, you may be fine because you have left in all allergens coming to a new allergens, environment, it takes at least two to three conjugative years of exposure to get sensitized to the local allergens, let's say I live in West Texas, then I moved to specific Northwest what will happen I will not have any issues with the pollen that we have in West Texas over there

Unknown Speaker 18:29
because I'm in a new environment. So I will be fine for first few years, but as I leave there for you know 234 years by the end of third fourth year, I had been exposed already three or four times. So I will get sensitized problem is not that you know

Unknown Speaker 18:46
you know you get better with allergens, no our genes are saying it doesn't matter when you move you are still going to carry your God gifted inherited genes

Unknown Speaker 19:00
to make it mildly, you know so, you may be okay for first few years, but you will be exposed to local origin then you will end up the same picture that you had while you were in Texas for example. So, in other words, moving place to place is not going to make a huge difference in the long run

Unknown Speaker 19:17
only short term approach

Unknown Speaker 19:20
that makes sense unless I go ahead unless you send somebody on the top of Mount Everest, you know there is no trees, grass roots and nothing someplace where nothing grows. Yeah.

Unknown Speaker 19:32
Do you recommend that people get tested to see what see what allergens affect them? Okay, so unless and I do not recommend allergy testing unless they have symptoms. So if you have got issues

Unknown Speaker 19:48
with allergies, like as I mentioned, seasonal perennial, lasting issues, you have a trigger that you know is coming every spring every fall.

Unknown Speaker 19:58
Then you suspect something is there.

Unknown Speaker 20:00
is a nagging problem, it doesn't go away, you go to the primary care doctor, they give you an antibiotic many times, you don't get any better.

Unknown Speaker 20:08
So how long is the long, you know, if you have good months of symptoms, there's more than enough. You need to know what is happening, why you need evaluation. So they can go to their primary care doctor. But ultimately, if your symptoms are chronic in nature, lasting more than five months in a year,

Unknown Speaker 20:25
you have other factors that I mentioned, seasonal factors and triggers, you need to find out what you are sensitive to or allergic to. Since that is one of the major trigger for nose and sinus issue.

Unknown Speaker 20:36
Find out how severe the problem is how extensive the problem is, then comes the treatment part of it. You know, if it's a mild disease, you know, it doesn't affect your quality of life. You don't lose any sleep, don't miss any work or school. You can, you know, maintain them under well controlled occasion on medication with your primary care doctors advice. I don't think you need to do any special testing. The dangers of unnecessary testing is that a significant false positive reactions? So if you're doing fine, let's say food allergies, the most common culprit here, we see all the time.

Unknown Speaker 21:12
I have no trouble with any food doctor. But my you know, one of my kids is allergic to filthy, but I have no problem whatsoever. Can you test me for 50 different food.

Unknown Speaker 21:25
That is a big challenge significant drainage for money, economy in general. So because 50% of the tests will be positive, I test them for 100 foods, for example, half of them will be positive. But this kid is eating everything without any problem. He never had any problem.

Unknown Speaker 21:44
But parents are concerned they come for testing. And if I do the testing what to do with the positive test.

Unknown Speaker 21:51
So you are digging a hole for yourself, you don't want to do this test. And this is a big challenge to try. But if you have a strong history of reaction to food, we are all for testing food. But without any good history.

Unknown Speaker 22:03
It is not advisable to test for food allergy, for sure. Even environmental allergy one has to be very cognizant of the fact what I'm going to offer by casting

Unknown Speaker 22:16
doing blood tests for unnecessary reason. That is not what I personally prescribe, you know, except in selective cases. And penile testing is one of the hardest thing you know, they will order a bunch of pennant.

Unknown Speaker 22:30
You come with a food allergy one foot in let's say you're allergic to Apple, and dependencies that your can different foods independent, you end up testing all of them.

Unknown Speaker 22:41
But this kid never had a problem with any food except apple.

Unknown Speaker 22:45
Now I find half of them is positive what I tell them.

Unknown Speaker 22:49
So you you put yourself into a big, you know,

Unknown Speaker 22:53
ethical dilemma, you know,

Unknown Speaker 22:55
what do you do that? Their concern? Of course, the only concern is our job to do the testing judiciously and recommended according to the guidance, no panel testing, no testing without any history of clinical reactions. For the food for the environmental allergy, you go with the symptoms first.

Unknown Speaker 23:14
Yeah, that's really helpful background. So, before we jump into treatment, let's talk about prevention. So, what are options when it comes to avoiding seasonal allergies? What are usually like the first suggestions you give to someone experiencing those those types of seasonal allergies? And are there lifestyle changes they can make to limit exposure okay. So, let me answer it in a few different steps here. So, prevention after establishment of the disease means you have history of reactions in the past like you are having etc runny stuffy nose sinus condition feeling miserable during the spring season.

Unknown Speaker 23:54
And now, you come to the doctor what can I do to prevent it happening next time Correct. Is that the question?

Unknown Speaker 24:01
So, if that is the question, let me just explain to you. So you have got two important part here. One, your genetic factors are there already we know that we will develop the disease.

Unknown Speaker 24:13
Second thing you live in an environment where there are factors that can affect and interact with the gene and then you have the disease. So once you have all this you're fully in disease state now. So how can you avoid trees grass and weed pollen?

Unknown Speaker 24:32
Simple word it is impractical and almost impossible to avoid trees, grass and weeds. Okay, you can enforce You cannot force anybody in this country or infect any country. Okay, lock the doors and windows. Stay in the basement never get out is not practical. No it's not. So, but you can minimize your exposure to reduce the symptoms you may not be successful 100% But you can minimize to a degree but

Unknown Speaker 25:00
Having said that, I must tell you it's impractical. So what how can minimize where the dirt is blowing, somebody's cutting grass or mowing the lawn, don't go outside and take a deep breath and enjoy the free weather, mellow, fresh cut grass. You know, this is the thing people do here in every part of the United States that can actually so don't expose them to the environment where there is significant chance that you will get into trouble. nose and sinus issues are still problem. But as my attack can be severe from those exposure, so avoid the outdoor environment when the pollen count is very high, usually early morning and late afternoon, and somebody's doing something in the lawn or in the yard. Number one, keep the doors and windows close when the dirt is blowing, wind is blowing very high, keep their room air conditioned as far as possible. That reduces the pollen count indoor pollen count to a degree. But those are very minor.

Unknown Speaker 25:59
Many times insignificant in limiting the amount of pollen exposure that you will be. So this is one thing you can do. There's nothing wrong with it.

Unknown Speaker 26:09
You can do it. But if you ask me adduction Is there any study that suggests that you will be feeling better you will not needing any medication? Nope.

Unknown Speaker 26:19
So next step in the prevention is that you know the season is coming, you might starting and histamine nasal shara, they are all over the counter medications. So you can prevent the symptoms happening. So you know that you know 16th of

Unknown Speaker 26:35
August or you know that's when the weed pollen comes in start antihistamine nasal spray before the real season comes in. Pollen can get picked up.

Unknown Speaker 26:46
You can do the avoidance you could do a little bit of medication, they don't need prescription now. Those antihistamines are over the counter natural steroids over the counter, you can use it.

Unknown Speaker 26:57
So this is how you can do a few of the preventive things. You know,

Unknown Speaker 27:01
people always ask other options, but those are not practical.

Unknown Speaker 27:06
So speaking of practical things that we can do, you know, we're starting to get to that season where people are going to be having their air conditioning running oftentimes in their homes. Is that something that really does help reduce the pollen in the in those allergens in your home? Yeah, but as I told you, they do reduce, but there are no good studies that document those things.

Unknown Speaker 27:27
I mean, we have all advised if you can run their condition and do it you know, it does reduce the pollen count to a degree but it is not something that I'll lie when I have a significant symptoms

Unknown Speaker 27:39
is that because of the HEPA filters within those are what is that? That's okay, so yeah, HEPA filter is you know, this is one other thing that you know, HEPA filter has a different role in reducing the allergen is one of them. But have a HEPA filter doesn't harm you. So if you have got a few extra money to spend, please do it. But don't ask me to give you an article that tells you that using HEPA filter reduces pollen and reduces the symptoms, I don't have that article to share with you. So as a bad place, I cannot just throw something at you $500 $600 machine, you know, they sent this in one time I found the HEPA filter in my home, somebody sent it to me some of the HEPA filter company, but I have not written one prescription for HEPA filter ever. And I've done it for a long time.

Unknown Speaker 28:25
Yeah, yes. If you have money, it is not harmful that much I can tell you, but is it helpful? I don't know. Got it. So let's talk about allergy prevention medications or histamine blockers. Did those work well for prevention and what are they doing to the body when you take them? Okay, so as I mentioned to you, in the beginning stages of the allergic disease process, particularly hay fever type of symptoms, like itching, sneezing, runny nose, etc. Histamine is a big player

Unknown Speaker 28:54
and antihistamines of the first line of medication that we use that block those chemical mediators called histamine. And if you don't have a histamine, you don't have or you will have significantly reduced itchy nose and eating is the cause for sneezing. So you stop the sneezing

Unknown Speaker 29:14
and you also stop runny nose from there.

Unknown Speaker 29:17
But this time it has got a little or no effect on the stuffy nose. If somebody said My nose is blocked or stuffed up, and we keep on gobbling those antihistamine appeal, don't expect magic out of them.

Unknown Speaker 29:30
That's where many times these antihistamines are combined with what they call pseudo Ferdinand decongestion, Allegra D Claritin. D. Those medicines are combined because antihistamines alone are not good enough to control your stuffiness. But I don't prescribe those D medication a lot, particularly in the elderly population or senior citizen or anybody above the age of 50. I'm very very careful, because one those decongestion has lot of side effect

Unknown Speaker 30:00
He's gonna raise your heart rate blood pressure, you know, affect your eye pressure. So why do we invite more trouble if you can do without it?

Unknown Speaker 30:09
What about like nasal steroid sprays? Do those work the same as antihistamines or can you use both? Okay, yes, that's a good question. So as I mentioned to you, the antihistamine doesn't affect the stuffy nose part of it and as a condition. So nasal steroid is the first line drug for full blown allergic rhinitis. It not only addresses eating sneezing and runny nose, but also addresses the stuffy nose of congestion. So if you have one medication that you want to address, all the symptoms use nasal steroid, which are also over the counter, like, you know, Flonase nasal spray or Fluticasone nasal spray moment, as soon as it spread that is Naza car and there's a nasal next. So there are a lot of different medications over the counter that you can use to address all these symptoms.

Unknown Speaker 30:57
My daughter used to have terrible allergies and it felt like she would build like a tolerance to one type of medication. So it Do people actually do that. Do they build a tolerance to antihistamines and or do you recommend switching to another brand? If it seems like what you're currently using doesn't work well. So remember, I told you in the outset of my talk is orchestra in the beginning you history and played a role. You fell magic with antihistamine everything was perfect. But as the time goes by, your disease is progressing. You can do it the same but they're not going to help. Then you're doing this steroid. They're helpful but you outgrow those, those medication. Yes, you can combine a natural anti steroid with antihistamine together Yes, you can.

Unknown Speaker 31:42
Do that's really helpful. That's really helpful to think of each medication is a different different instrument in the orchestra. And sometimes you just have to play a different instrument. Exactly, exactly. So sometimes this question is very common, you know, can I change the brand, but all antihistamine you're eating, maybe individual perception, changing the brand is not going to change in outcome, but individuals have, you know, experience different experience. So you've tried the clarity for a long time, of course is one of the weaker and histamine and now you're not feeling good. Try Allegra, Allegra and Zyrtec. You know there's a market name for fexofenadine and citrus in those a little bit stronger. So you might feel a little better after that. But as the time goes by, they become less and less effective.

Unknown Speaker 32:28
And what about allergy shots and versus tablets? So okay, so let's talk I specialize you know, but even what they call immunotherapy in the wolf, the fancy name is immunotherapy. We've called them for allergy short for a long time. So let's talk about allergy shot, you know, whether you give it by injections, or by sublingual tablet.

Unknown Speaker 32:50
So let's start with the injections immunotherapy. Why? Because we practiced injection immunotherapy for more than 100 years in this country. In fact, United States the pioneer in allergy injections, using allergy injections for allergic diseases. So we have a very good and strong track record for this. So let's start with what is allergy injections.

Unknown Speaker 33:16
In allergy injection, basically, you give the same stuff that one is allergic to in a gradually increasing doses, so that when you are naturally exposed to those allergens, your body's not going to react. You can consider it as a sort of de sensitization, same stuff natural thing. You're giving it

Unknown Speaker 33:37
in a way that the body can tolerate and build up to the point

Unknown Speaker 33:41
that when you are naturally exposed to those allergen, you're not going to react. So allergy injection is considered the best long term solution for allergic diseases like hay fever, allergic asthma, allergic eczema or atopic dermatitis. So, we have a strong track record highly if it is downright remember, allergy injection, the little expertise, one has to understand that not only the immune system, but understand the good history, connect them with the environmental factors seasonality, do the right testing. So it needs a little bit of

Unknown Speaker 34:16
nuance there. So one has to understand what you're doing. If you do it, right. Success rate is very high, close to 80%. No long term side effect, how many times you can prescribe something for long time and said no long term side effect. Almost everybody gets itching and redness at the side of injections. However, one in a million roughly can have serious life threatening reactions. So allergy injections should be done only by the specialist

Unknown Speaker 34:44
or at least recommended by them. And they have to take that small risk one in a million however small it is but if it happens to you, it is not one in a million, but it does happen. It has happened in the past and we have good track record in this car.

Unknown Speaker 35:00
To Be careful in screening and observing them after shot,

Unknown Speaker 35:04
but success rate is very high as many. So what do you mean by success rate, so this is also important. So allergy injections benefits are many, it reduces the symptoms, like ET sneezy, runny nose that you mentioned, itching and water nearby by 80% or more.

Unknown Speaker 35:21
It reduces the use of you don't need an antihistamine or hardly any medication. So 80% reduction in symptoms, about 80% reduction in the medication use. But now, we are also finding that if you do the allergy injection, right time, you also prevent the development of asthma. Let's say your child comes to me with nose and sinus and chronic allergy issue.

Unknown Speaker 35:45
Then I start allergy shots before she or he developed Allergy Asthma.

Unknown Speaker 35:51
Then what I'm doing actually not only addressing your symptom in the nose and sinuses, but I'm also cutting down her chance of developing or his chance of developing allergic asthma by 50%. That's a huge deal. But it has to be done by the right person should know what they're doing. So this is the challenge now for the younger allergies in this country. That makes a huge difference. Wow. Especially when you're when you're dealing with children. So wow, who's usually a good candidate for immunotherapy or allergy shots. Okay, so this is also very good question. So we don't do allergy shots, usually when they're

Unknown Speaker 36:33
until they're six years of age or now. So moderate to severe allergy condition like allergic rhinitis or hay fever, we call it

Unknown Speaker 36:41
people will not respond with a medication they've tried over the counter medicine, like antihistamine, nasal steroid, not responding.

Unknown Speaker 36:50
They affect their quality of life, they cannot sleep.

Unknown Speaker 36:53
They miss school.

Unknown Speaker 36:55
adult men miss work.

Unknown Speaker 36:58
So those are the things not respond to the medication affecting their quality of life, and diseases progressing. Even if you're doing antihistamines and nasal steroid, they're still you know, every time season change, they come with a bronchitis or asthma type of picture. So what it tells you that disease process from the nose and sinuses now going down to the chest.

Unknown Speaker 37:20
That's good enough indications for starting allergen immunotherapy or allergy shot or immunotherapy.

Unknown Speaker 37:27
Thank you. So let's talk about somebody who's just realizing that what they're suffering from is not a cold that they may actually be having a seasonal allergy. So, for for the adult or the child that may just all of a sudden be realizing that they have an allergy issue, what are some of the home or over the counter treatments that they should start with? So this is also good question you know, what do you do? It is not easy even go to the primary care let alone specialist. So first thing they can do, we're very safe and histamines the market.

Unknown Speaker 38:03
So if you cannot afford the allergens, as I mentioned is hard. Then start with some antihistamines, see how they go. In the beginning many of them will get significant relief. You don't need to rush to any doctor just for the regular allergy symptoms. You can use the antihistamine like Zyrtec Allegra in age appropriate doses.

Unknown Speaker 38:25
Plus nasal steroid, they're also use over the counter, you know, I don't like to use it as a steroid in the children as much. If you don't do it, right, it can cause nosebleed and some other complication from us. So one has to know how to use the nose spray correctly. So those two medicines are highly effective in the early stage of the allergic diseases, particularly high fever. So that's when you but if they have asthma symptoms like cough, wheezing and shortness of breath, that is the time you cannot just do home remedy. You have to go to your primary care provider, make sure that you are not losing doesn't need any acute individualized, systemic steroid or no oral steroid injections, steroid or other medication for asthma. Anytime your chest symptoms like cough, wheezing, chest tightness, shortness of breath, that is the time to go to the doctor.

Unknown Speaker 39:09
Excellent. Are there supplements or holistic remedies that you've seen people have good luck with? Okay, so this is also an interesting question. And I'm not an expert on the holistic. So my views are very personal. And I don't want you to generalize it, you know, because there are no studies on those holistic medicine. So if something is not published, that is not my forte, I don't comment on that. So

Unknown Speaker 39:32
following family tradition, if that has helped, you know, and sometimes we may not put science behind it, but it doesn't negate the family value. You know, we have a food allergy for example, you know, now we are saying, going back to the family history, you know, you know, you will realize it many years ago in the United States will tell the parents don't get peanut until they're three years of age.

Unknown Speaker 39:53
But that has changed in the last 10 years. Now we're saying that expose them to your family value

Unknown Speaker 40:00
If your mom gave you a pinata six months of age, do that. No, people don't follow our guideline, we suggest you introduce them to the table for by the time they're six months of age, you know, but do not delay after 12 months, you know?

Unknown Speaker 40:16
Do not do that. Do it between six months and 12 months, and follow your family's tradition. So yes. So as far as holistic medicine is concerned, my advice is follow the family tradition. I don't have any science to back it up. Got it. I you know, I have family members that have had great success with acupuncture and also with local honey. So I know that you know, some people do have success with those things. But yeah, I appreciate your your scientific approach to that, too. So when someone is suffering from seasonal allergies, and the basic prevention and treatments aren't working, should they go to their primary care doctor first or look to an allergist? what should be their first steps. So my point is that if you if you fit the criteria of chronic condition, like nose and sinus symptoms more than five months in a year, going on for a couple of years, you have gone to the primary care doctor, only thing he or she is offering you is antihistamines and nasal steroid. And you're exposing yourself to the higher systemic steroid multiple times.

Unknown Speaker 41:20
Those are the good reasons you should go to a specialist

Unknown Speaker 41:27
what primary care is going to do for you, that's my answer to you. If you aren't going to get the same treatment multiple times, it is not going to change the outcome, no changes in long term outcome, you might go. Of course, if you're having acute asthma symptoms, you should always go to the doctor that is given.

Unknown Speaker 41:45
But if your nose and sinus symptoms are persisting, and they're recurrent,

Unknown Speaker 41:50
and you are already doing NASM unnecessarily

Unknown Speaker 41:54
and you every time you go to the doctor what he or she will do, He will give us some more systemic steroids.

Unknown Speaker 42:01
And I always tell my patient, you know do feel better for a while. Steroid injections are not allergy injections, they're not extra made out of the pollens

Unknown Speaker 42:12
or other things. Steroid is a potentially serious medication with multiple different side effects that can affect your blood pressure, diabetes, bone health, increased risk of infection, obesity, you name it, and there is no end how much I can talk about side effect of this terror. So yes, if you have issues like that I mentioned ask if I'm a doctor, you have been to him many times already. So make an effort.

Unknown Speaker 42:40
Go to a board certified allergy and immunology specialist.

Unknown Speaker 42:45
What are the top three things you want our listeners to take away from this discussion? First of all, I will say that allergy unfortunately is a chronic disease is a genetic component, an environmental component. So unfortunately, you cannot change your gene. These are non modifiable risk factor. Whatever the environment, you can change from place to place, but you will be exposed to the local allergies because you have the right allergy gene, don't expect that moving place to place is going to make you feel better. Even if it does, it is going to be very short lasting. If your symptoms are mild doesn't affect your quality of light. As I mentioned, try some ageism unnecessarily. If you have to go to the doctor a few times a year to get a steroid shot or antibody, not a good sign. Seek an allergy specialist advice.

Unknown Speaker 43:30
And before we go, is there anything we haven't discussed that you want to make sure our listeners know about allergies and treatments. So one thing I would say that in addition to everything that we talked about the cause of the disease, the prevention of the things, trip mind treatment of the disease, if you do the allergy short for our immunotherapy, remember, it is going to lasting benefit. Prevention of asthma is something that we want to mention. And allergy injection has no long term side effects. People worry about am I going to get injections and is it Yes, it is painful. So next question they want us where can they get a tablet sublingual immunotherapy that is also FDA approved. But only problem is that in the United States, people are multi allergy sensitive, or what we call in medical camp Paul is sensitized. So there are trees grass, weed, pollen, dog and cat dander mold, but grass tablet or the other tablets that we have sub for sublingual immunotherapy only for selective allergens like grass, dust mite cat, but we have got 20 different allergies that play a major role. So you will be spending more money but you will not be able to you know grass allergy tablet is not going to protect you from the wieder legends or three allergens. So you have to do so much things. Yeah. And they're not better than injection immunotherapy.

Unknown Speaker 44:52
Does it make sense? It is more expensive. You know, you don't have much availability

Unknown Speaker 45:00
Different allergenic tablet.

Unknown Speaker 45:02
And of course, you know expense is one of them.

Unknown Speaker 45:07
Perfect. Well, thank you so much for this conversation today it's been really helpful to to learn our what our options are for treatment and prevention of these allergies. Thank you for having me.

Unknown Speaker 45:19
All right, Christi.

Unknown Speaker 45:22
Okay.

Unknown Speaker 45:25
Hello, everyone and welcome to talk with the doc The show where we bring common questions to medical experts for insight and information. I'm Jennifer Semenza. And joining me is Dr. gutem shome, an expert in the field of allergies and Immunology at covenant Medical Group, a full clinical professor at Texas Tech University and Health Sciences Center, both in Lubbock, Texas and a diplomat of the N. C.

Unknown Speaker 45:48
triad again.

Unknown Speaker 45:50
Hello, everyone and welcome to talk with the doc The show where we bring common questions to medical experts for insight and information. I'm Jennifer Semenza. And joining me is Dr. gutem shome. An expert in the field of allergies and Immunology at covenant Medical Group, a full clinical professor at Texas Tech University and Health Sciences Center, both in Lubbock, Texas, and a diplomate of the American Board of Allergy and Immunology. We're in peak season of allergies. And so we're here to discuss how allergies might be affecting you effective treatments and strategies to get you through this allergy season. And to enjoy both the indoors and the outdoors. So let's get started. Hi, Dr. Shom.

Unknown Speaker 46:29
All right, jumping to the outro.

Unknown Speaker 46:35
Thank you for joining us today on Talk with a doc we look forward to continuing the important conversation on health and wellness with more experts from Providence in future episodes. Episodes. That's a good word.

Unknown Speaker 46:48
Thank you for joining us today on

Unknown Speaker 46:53
Third time's a charm.

Unknown Speaker 46:56
Thank you for joining us today on Talk with a doc. We look forward to continuing the important conversation on health and wellness with more experts from Providence in future episodes. Make sure to listen to all of our shows on lit live radio under future of health radio or your favorite podcast platform and follow us on social media. We can be found on x and Facebook at Providence and Instagram under Providence Health System. To learn more about our mission programs and services go to providence.org and remember the information provided during this program is for educational purposes only. You should always consult your health care provider if you have questions regarding a medical condition or treatment. And thanks for listening and remember at Providence we see the life in you.

Unknown Speaker 47:36
I want to do just that last sentence.

Unknown Speaker 47:40
Thanks for listening and remember at Providence we see the life in you

Transcribed by https://otter.ai