E5 Welcome Spring! Darn Those Allergies!

Welcome Spring ... Darn those allergies!!!
Dr Jen explains seasonal allergies and how to treat them.

Dr Jen's Recommendations for Seasonal Allergies:

1. Nasal Saline
2. HEPA Filter Fan
3. Diphenhydramine (Generic Benadryl)
4. Certirizine (Generic Zyrtec)
5. Levocetirizine (Generic Xyzal)
6. Fluticasone (Generic Flonase)
7. Qnasl

(The above list contains affiliate links to products that if purchased may generate a small commission. Dr Jen and Brent only recommend products they use or have extensive knowledge about their use.) 

Transcript

Speaker 1 0:04

[inaudible]

Speaker 2 0:04

Hi and welcome. It's Dr. Jen with Dr. Jin recommends today. I'm joined in the studio by Brent , and I'm going to talk all about seasonal allergies today,

Speaker 1 0:14

Seasonal allergies. So that's a problem here where we live. It seems like everybody has that runny nose, watery eyes junk in the throat.

Speaker 2 0:24

Yes. So allergies are a huge problem. We live in Kentucky on the Ohio river Valley here. So we are the allergy capital of the world, dunt dunt, dun. Um, so we are seeing a ton of patients right now that all kind of come in with similar similar symptoms. We've got lots of clear runny nose. We've got lots of nasal congestion, itchy eyes, scratchy throats , um , some skin that is itchy and that can be anywhere, especially if somebody is prone to have an allergic skin condition called eczema. So it makes things a little tricky , um, with, you know , the pandemic and COVID-19 coming. I'm actually seeing more allergies in the office than ever before. And that's because workplaces and school settings need to know, well, is this just the kid or teenager or adults, regular allergies, or is this COVID-19? So it has been very interesting just seeing more and more allergies in the office. And the tricky part is some people with COVID-19 may not spike a fever. And so they look exactly the same along with lots of other respiratory viruses that are going around right now.

Speaker 1 1:31

So allergies are different from infections because they're not caused by infectious agent they're caused by an allergen . So that's our immune system, seeing something that doesn't look right and it's going out there and throwing everything it has at it. And we feel like garbage because of that, correct.

Speaker 2 1:50

Basically you would be allergic to some type of pollen out there. So right now, tree pollen and grass pollen are on the rise. Tree is very high right now. Grass is on its way up. I think it is moderate in our area and it's super fun. I'm kind of nerdy, but I love putting this on my phone and YouTube can do this , um , through the weather channel. And I'm sure there's other weather apps out there that actually has a pollen tracker on it. And so that's fabulous. I check it most mornings, just so I know, you know, how bad are things going to be, but basically when our body sees these pollens and if we have a reaction to it, it kind of causes this whole cascade of events that ultimately end up releasing histamine. And so histamine is that terror, you know, it's this terrible little chemical that basically makes us react poorly to, you know, to those allergens. So that's what causes the itching, the runny nose, the sneezing, the poor eyes that keep watering and itch so bad. I've got some kids that come in, literally looking like they're trying to scratch their eyeballs out. So it's all to do about histamine.

Speaker 1 2:50

Histamine is kind of like a little chemical switch, right? It just turns on all these things that , uh , are, are not good , uh, in terms of how we, but they are good in terms of, if this were truly something that our body was attacking our body , uh , we would have the right response to get rid of it. Yeah ,

Speaker 2 3:07

That's true. That's true. So we really want to combat, and even maybe help prevent some of this reaction caused by things that, you know, we're going to be around seasonally, like trees and grass and heaven forbid if people are allergic to their pets, I always hate that having to minimize the contact with a pet, but yes, you're exactly right.

Speaker 1 3:26

So what if you don't know what you're allergic to? Is that important?

Speaker 2 3:30

Um , yes, it, it actually, it is important. And so, so the good thing is you can treat your symptoms and help minimize your symptoms, even if you don't know exactly what you're allergic to. Um, however, if you do tend to be miserable all the time or you have very severe reactions, you know, it's, it's a wonderful thing to see our friends, that the allergist to be able to get tested and , uh , know exactly what you're allergic to. I can give you an example. So myself, I'm only bad for two weeks in the spring and about a week during the fall. So I can probably anticipate that fall reaction is probably ragweed. There is some type of tree that blooms and I do not know which one it is cause I've never been allergy tested, but really I'm only miserable for two weeks. You know, I had a child come into the office and this was an elementary school aged kiddo. And they were just completely miserable. They had moved houses. Uh , the child was, I mean, a snotty just mess . And she was miserable. She was in and out of the doctor's office all the time, missing a ton of school. And we actually did an allergy panel on her. And after she saw the allergist, they learned that the number one tree she was allergic to, there was an entire row leading up to their very long driveway. And so there was about 40 of those trees right outside her literal front door. And so that was that clue that the parents were like, Oh, I think we need to maybe, you know, get a different tree. And that was a lot of trees to cut down, but she got markedly better because that was one of the higher things. So it does, it does behoove you to get allergy tested if you have significant problems. And this is more than just a week, a week in the spring that you're miserable. So we can get allergy tested by either a skin prick test that the allergists do or there's blood panels that are available too . So check with your doctor.

Speaker 1 5:20

So short of cutting down 40 trees and in your front yard, what are some other ways that you can remove allergens from your life so that you have less of a reaction?

Speaker 2 5:30

Well, we can always, you know, remove ourselves from anything that's green. That would be unfortunate. So just a concrete jungle. So no, I do not. I don't, that's just kidding. I don't recommend that at all. However, if you do know your allergens, you can try to minimize that exposure. So let me give you an example. So, you know, let's say heaven forbid you happen to be allergic to one of your pets that you have at the home. So I, as a pediatrician, I would never tell somebody to get rid of their pet. Pets are our family members. I actually know a lot of allergist and they've, they've loosened up on that as well, and that we would never recommend that, but you do want to minimize the exposure to them . Meaning maybe if it's the child that's allergic, you know, they don't sleep in the child's room and that you've removed carpets and rugs and things that would hold that pet dander more and have hardwood or tile or some other type of flooring that is easily, easily wipeable or cleanable so that the pet danders not living in it. Um, some other really good tips are if you do have seasonal allergies . So when you walk outside or go for a walk or a hike, you're completely miserable. When you get home, you do want to shower, like literally remove that pollen from your skin. Um, another really great thing. And I know ear nose and throat doctors and allergist loved this, but saline nasal saline is like our best friend. I know a lot of people just don't like doing it. Um, however, if you would just add nasal saline to your regimen, especially after you're exposed to those allergens, you're literally washing away the allergens from your nasal passages, so that can help a ton. And if you kind of get used to just doing that daily, you're sort of preventing , um , or just constantly washing away , um, those, those things, plus you're helping decrease your congestion , um, and the, the snot itself.

Speaker 1 7:17

So does it matter , uh , if you use one of the aerosol sprayers or the Mr , or if you just, you know , put some saltwater in your hand and snip it , does it make any difference ? Yeah ,

Speaker 2 7:29

Well , um, you know, all of, all of those are, okay, now the making your own, you definitely do want to use some type of sterile water. So like a bottled water or something. You've got , gotta be careful with tap water. Um , you know, of course all of our tap water is tested by our own city. Everybody's tap water is different also. So just in case there were any contaminants, bacteria, molds, things like that. You want to be careful with tap water, but all of those applications actually have their place. Some people prefer, you know , more of the bottles that you, you know, you just pump. I personally love the aerosol cans. I actually recommend that a lot to parents of babies and children, because it's a little bit easier. Um , they can be sitting in the upright position when you use them. And I like that it gives a little bit more force , um , on those same lines that are , if we wanted to get the most aggressive there's even neti pots. And a lot of the neti pot companies actually make the bottles that, you know, you squeeze, I think I've even seen a, an electric one that's battery operated. And so that one kind of pulses and really gets it up there. So that's a good , that's a great way to kind of clean out the sinuses and the nose. So ,

Speaker 1 8:40

So you're washing away pollen whenever possible. You're trying to avoid it when you can, you know, there's some people that are just sick all year round with allergies. So is that different from seasonal?

Speaker 2 8:52

Those are different. Those are called perennial allergies and perennial things tend to be as the name implies it's things you were around daily. And so those tend to be more dust mites, molds, pet dander. If you have those pets , um, cockroaches is included in that one and that's totally gross. It does not mean anybody is not keeping their house clean enough and that it's actual cockroaches. No, this is totally gross. So pardon me, it's cockroach poop wa wall and it becomes dust and it is just commonly in all of our dusts. I deserve that one, but it's a fun fact and kids think it's really, really kind of fun when I say, Oh, you're allergic to cockroach Pooh .

Speaker 1 9:32

Yeah. I wanted to use that button for a long time. So thank you for bringing up the cockroach,

Speaker 2 9:37

Sorry, but those are more of those perennial type allergies. And so really, you know, how you end up wanting to treat your allergies kind of depends on, is this more of a perennial thing? Is this a one-week , you know, problem that , that like I have or something in between that. So luckily there are lots of different treatments out there.

Speaker 1 9:58

So I've heard when it comes to doing your laundry, if you have perennial issues with dust mites or something like that, that , uh, you have to follow a couple of rules. When you do laundry,

Speaker 2 10:11

We do want to wash clothes in hot water and you do want to dry them actually cause the act of drawing sort of dislodges all of those allergens. So yeah, definitely good. Uh, there's also some other things we can do , um, to our homes to help kind of allergy proof them as much as possible. And some of that includes HEPA filters that can, can be not only in our heating and air filters, but you can also put HEPA filters in your vacuum cleaner so that, you know, a lot of times with regular filters, well , this is totally gross when you think about it, but you're vacuuming and the air that's being exhausted may actually have a lot of allergen still in it. So you're just sort of moving them around. And that also is a very good recommendation as well. If you have a child, especially that is very, very allergic on those days that you do clean , uh , you actually want them to like vacate the premises. And I've had a few allergic kiddos that are so severe that if you do dust and vacuum, you are stirring it up in the air. So it might be a good time for the next couple hours after that for the kid to go play somewhere or let's go on a little outing somewhere to let that dust settle back down so that they don't walk in and are breathing that all in. So, yeah.

Speaker 1 11:26

Okay. So you mentioned HEPA filters and you can put those in your air conditioning HVAC systems and your vacuum cleaners. I think there's also some that are available for district room air. There are different , uh, fans at a pool circulate the air that through a help HEPA filter,

Speaker 2 11:44

That is true. And those are so readily available on the market now, especially due to COVID and trying to have safer spaces and such. And so those would be , uh, often approved for viruses, such as COVID-19 and other things as well as allergen . So those are very readily available and I highly recommend those especially to put in the child or adult, if you have allergies put in your bedroom, actually.

Speaker 1 12:09

Okay. So step number one is remove yourself from allergens. Step two would be to get the allergens cleaned out, whether that's through literal, washing or filtering, but what happens if you know, they've got ya and you've got the symptoms, how are you going to treat them ?

Speaker 2 12:28

Yeah, so we'll , luckily we have a ton of different treatments. And so if, if, if you go outside and you just get attacked that day and you know, the allergy you come in and you're a sneezy snotty mess, and you need something fast acting, you know, the old school anti-histamine such as Benadryl , um, are, are still some of the best and that it's gonna , it's going to work quickly, you know? Yes, they have their side effects of being , um, sedating. So you do need to watch that, you know, don't take a big dose of Benadryl and then pop off to work. If I did that, I'd probably be found in an exam room taking a nap maybe, but , um, especially when you get home, you're getting ready for bed. If you do need a dose of Benadryl it's it's okay. Um, so we do use that some in children, you definitely go by the, the box recommendations and if the child is younger than that, definitely contact your physician on the dosing for your child or toddler.

Speaker 1 13:21

Yeah. And you know, anti-histamines are maintenance medications. They're not typically rescue medications. You want to get those on board before you start reacting if possible, but if you just get hit by some allergens and they've got a hold of you, you can go ahead and start them. Just know that it may take a bit of time before they really kick in, and you don't necessarily stop taking those the day that you no longer have symptoms. Right?

Speaker 2 13:49

And so when I can catch kiddos that , um, or teenagers that we know that every spring that they have pretty bad symptoms, then I love to go on in about two to three weeks before we think trees are going to start blooming, go on and get them on their allergy regimen so that they are fully equipped to battle those. And so I love the long acting 24 hour anti-histamines, those are, there are wonderful. There, there are different types of long acting and histamines . And so, you know, you find the type that works the best for you. Um, those are often quite , uh , genetic in how they work. You know, I, I see family members that do better with one type versus another. So it's all a chemical and just, just, it depends on how our bodies metabolize that particular chemical and how we react to it. But there's wonderful options out there. They have less side effects than your quick acting and our short acting ones. Um, and those would be less sedation. You know, you still can get some dry mouth with them, but it's just once a day, which is lovely. And you can kind of be on them for longterm if you need to, if you have more perennial allergies.

Speaker 1 14:54

Yeah. You know , uh , Zyrtec works really well for me. Uh , I like to take the , uh, uh , generic version of that. It seems to do the best and it doesn't make me drowsy. I do sometimes use the 12 hour instead of the 24 hour, just because I don't necessarily need to be on it for a long term . But , uh, I like the control of having every 12 hour dosing rather than every 24, but either way that one works great for me. I know some other folks like to use a leg GRA , uh , and some other folks use Claritin

Speaker 2 15:29

And the new, the new kid on the block is XYZ all . And I've actually had very good results with that one as well. So yeah, it's kind of all in just how your body responds to it. So if you have been on a long standing anti-histamine and you feel like it's not controlling your symptoms, you know, I'd definitely encourage patients. Well , you know what, let's try, try a different one and just see how your body responds to that one .

Speaker 1 15:51

And all of those products come in combination with decongestant as well. So if you need more than just an anti-histamine, you can get the combination decongestant, an anti-histamine typically those are behind the counter. You can get them at the pharmacy at the pharmacy counter, but if they have a Sudafed , uh , then they're going to have to require a signature. And , uh , there's a national database where any purchases are held. You can only buy so much for particular period of time, but they weren't great. I mean, they work really well,

Speaker 2 16:24

Especially if you have not only the runny nose, but the very congested symptoms as well. Um , I do put a caveat in there as well. If you, if you do have problems with high blood pressure or very sensitive to Sudafed, then you will want to watch that product. So, but I do love that and sometimes need that one. So I switch it up. So that's great. The next thing that often gets recommended is an inhaled corticosteroid. So a nasal spray , um,

Speaker 1 16:54

That those

Speaker 2 16:55

Are awesome. And so, you know, they control a lot of symptoms. The problem that I face in my practice is that I'm dealing with children and teenagers and nobody likes using a nasal spray. And that's very unfortunate because when you actually pair, if you did a side-by-side or I call it in the office, always say, if we had a cage match between the anti-histamine and the inhaled corticosteroid, which one on , on its own actually controls the allergy symptoms. The best the inhaled corticosteroid actually is the superior product. And so, you know, it's still a hard sell for some teens and kids, but I do love the product. You can pair the two together as well for sort of the ultimate , um , results. But I love using, I love using those when, when I can get a kid to buy into that. Because once again, just like what Brent said earlier, that one is definitely one that you need to be on to help control those symptoms. You can't just expect to take it in the morning and it'd be working by later that afternoon. So most , um, most of the time I actually tell my patients, you need to be on it for even 10 to 12 days before you start seeing some, some good effects from it. So

Speaker 1 18:04

Those nasal steroids are all over the counter. Now are , most of them are over the counter. Uh , they're, they're not , uh , the least expensive things that you can find in a pharmacy, but they're not as bad as they used to be when they were all prescription. Now, some drug bland, some third-party beneficiaries will still pay for the generic fluticasone nose spray as a prescription, but those are becoming fewer and fewer as we go. So if your insurance doesn't cover what you're looking for, look in the allergy section of your OTC row there in the pharmacy,

Speaker 2 18:40

The , a product that I really like to that's , um, it's an inhaled, a nasal steroid, but it is an aerosolized one. And so it's called Q nasal. And it's almost like if anybody has asthma out there, your albuterol inhalers, this is like an albuterol inhaler for your nose. Almost you stick that up there. It's got some force. And I think that's why I like it is , um , I have had to use one in the past and I loved it because I actually felt like it got to where it was supposed to go. A lot of insurances will not cover that one just cause they want you to try one of the generics first. But for those that may be , feel like, Oh, the, the, you know, the, the normal sprays just kind of drip out, or I don't, I feel like I'm sucking it, you know, breathing in too hard and then I'm just swallowing it. This is at least makes another option. And I really liked the way it kind of gets up there. So

Speaker 1 19:25

Yeah, now that product is a , uh , steroid as well. It's not albuterol in terms of, it's not a beta blocker.

Speaker 2 19:33

I just made, it looks like one. I'm sorry. And it, it , it , uh, it, it acts like one as far as when you're pressing it. So sorry about that. No, not to confuse anybody. No, it is not albuterol for your nose. Um, they also make some , um, nasal sprays that are actually anti-histamine nasal sprays. Um, I've used those some, most of the time, those come from the allergist that are recommending those and they definitely have their place and can be nice additions to , to other, you know, other treatments. So yeah, love those too .

Speaker 1 20:04

So here's the thing that I see at the pharmacy all the time. My allergies are acting up and my doctor won't write prescription for an antibiotic for me, and I really need one. So can you explain to folks why you don't need an antibiotic for allergies, right?

Speaker 2 20:20

And this, this is, you know , so difficult. Um, you know, people get that, you can get miserable with allergies. You know, you get the sinus pressure, you get a sinus headache. Um, you know, you get all these symptoms, but unfortunately, you know, an antibiotic is exactly what it's saying, anti bacterial. So when you have a bacterial infection, an antibiotic is going to help when you have allergies or a virus, an antibiotic is not going to do anything. Now, when people do have significant allergy symptoms and they're snotty and congested for days and days, and weeks upon time, that can turn into a bacterial infection. You know, usually, you know, our textbooks used to tell us that 14 days of symptoms and all this, you know, if you have sinus pressure, if you are having fever, if those, if that typical allergy kind of snot, that's usually thin and clear, then becomes thick and tan and you're feverish and puffy and, you know, feeling very poor, then yes, that could be a bacterial infection that then needs an antibiotic. But I know it's something we talk about a lot in the office that, you know, two days of clear snot does not need an antibiotic. So definitely something to talk to your healthcare provider about though, if it's been going on for a long time. So if you are one that does have significant allergy symptoms and you're, you know, you're on your way to see the allergist to get allergy tested. You know, another treatment for allergies is actually allergy injections or immunotherapy injections they're called. So basically that is giving you an injection of exactly what you're very allergic to in order to help build up some tolerance to that. And so , um, you know, we have kids that get allergy injections. I have, I know several adults that get them and you know, it's not a quick process. It definitely can take sometimes upwards of years. I've , I've known people to have to be on allergy injections for two to three years. Um, so it's, it's definitely a commitment, but it can make a huge difference.

Speaker 1 22:22

Dr. Jen, thank you for those recommendations regarding allergies and what you can do to treat those. Thanks for listening to Dr. Jan recommends. We want to hear from you, please send us an email at info at Dr. Jen recommends.com. Let us know what you think you liked the show. Do you not like the show? What would you want to hear about? And for goodness sakes, please hit that subscribe button. We'll see you next time on Dr. Jen recommends [inaudible] .