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Your Checkup: What You Wish Your Doctor Explained
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: What You Wish Your Doctor Explained is your health ally in a world full of fast appointments and even faster Google searches. Each week, a family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: What You Wish Your Doctor Explained
Seasonal Allergies: Medications and Treatments That Actually Work
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Managing allergic rhinitis requires realistic expectations and a strategic approach to medication. Though no treatment will completely eliminate symptoms, the right combination of therapies can significantly reduce discomfort and improve quality of life during allergy season.
• Nasal corticosteroid sprays are first-line treatments that reduce inflammation in nasal passages
• Proper technique matters: point spray toward outside of nostril and sniff gently "like smelling a flower"
• Non-sedating antihistamines (Zyrtec, Claritin, Allegra) relieve itching, sneezing, and runny nose without drowsiness
• Nasal antihistamine sprays provide targeted relief and can start working within minutes
• Oral decongestants raise concerns about blood pressure and heart rate increases
• Avoid nasal decongestant sprays (like Afrin) beyond 2-3 days to prevent rebound congestion
• Combination therapies often work better than single medications
• Consider allergen immunotherapy when standard treatments don't provide adequate relief
Thank you for coming back to another episode of Your Checkup. Hopefully you were able to learn something for yourself, a loved one, or an allergic neighbor. Please check out our website, find us on Instagram, send us an email at yourcheckuppod@gmail.com and, most importantly, stay healthy my friends, until next time.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Dolesky, a family medicine resident in the Philadelphia area.
Speaker 2:And I'm Nicola Rufo. I'm a nurse.
Speaker 1:And we are so excited you were able to join us here again today. So you have been working really consistently for a really long time, like you picked your head up.
Speaker 2:One of us has to go to work.
Speaker 1:All right, don't blow me up like that. Coming week I am, and for the last two and a half years In 2025. The last two and a half years In 2025. The last two and a half years I have, you know, 24s nights, what have you? I know? Yeah, yeah, yeah, but you finally accomplished something, really great.
Speaker 2:I accomplished something really great. You acquired a day off. Oh, I mean, it's not really an accomplishment. I think it is. My boss practically told me to take off.
Speaker 1:Yeah.
Speaker 2:So I was like thanks, sis, twist my arm she's great and a day.
Speaker 1:So there happened to be days it actually so.
Speaker 2:It's the first weekend in April, and did I tell you this when I was setting my out of office? The from the previous one I last had was in January yeah, it's a little long.
Speaker 1:Yeah, that's a little long there's. So we had this Friday, but we had it together, and there's like sometimes where I'm doing like work remotely at home and like learning at home on a Friday or something recently, and it does not feel like a day off by any means, but you were home yesterday. We woke up. Thursday felt like Friday mm.
Speaker 2:Hmm.
Speaker 1:Very sincerely Friday all day felt like Saturday and then going to bed weirdly it felt like Sunday.
Speaker 2:Yeah, it did. I think it's because we made fat rigatoni and cookies for dinner and that's usually like a special Sunday thing.
Speaker 1:You know what? Maybe that is why and in this fat rigatoni we did shrimp that dish. I'm like a dog, my focus is only on what's in front of me. And now I'm not even sure the episode where we talked about your triumvirate of food has come out yet, but I just can't. It was the burger bowls, and now I just can't get off of fat rigatoni. And I know there's more in the fridge and I can have it and that's great, but like it, your food is just so amazing well, thank you.
Speaker 1:I just that's. I can't.
Speaker 2:I can't get over it, and we might get sandwiches tonight yeah, a hoagie with a salt and vinegar chip is honestly top tier yeah, and I kind of before.
Speaker 1:I definitely wasn't someone who was putting chips on a sandwich I can't believe you never did that before I mean believe it chips on a sandwich, like on a hoagie on the beach.
Speaker 2:Specifically, yeah plus or minus a corona.
Speaker 1:Or 12.
Speaker 2:Or 12. There's nothing better. Well, especially okay, perfect scenario. We get a hoagie at the beach from our favorite place salt and vinegar chips. We're on the beach, it's late in the day, we've been on the beach all day long. We're kind of tired from doing nothing all day. We get a sandwich, we have it, you put the salt and vinegar chip in the hoagie and then it's getting a little not dark, because I guess the sun sets at like nine o'clock in the summer, but it's like almost dinner time. It's a little cool. Then you have to put a sweatshirt on. They have a sweatshirt and your bathing suit. It's the end of the day, sun's going down, the lifeguards are coming in and you're eating your sandwich with your salt and vinegar chips on the beach and it's crunchy. There might be a little sand there somehow.
Speaker 1:But for some reason it's really good. I guess which sandwich from our favorite place are you putting it?
Speaker 2:Well, I mean really on any of them, but I love that turkey one with the pepper shooters on top.
Speaker 1:I could see it going on the one we got last time. Okay, sure, yeah, I feel like we haven't done that a whole lot, though, with the chips.
Speaker 2:I have. I don't know what you've been doing.
Speaker 1:That's fair. I mean, you're not going to put it on a buffalo chicken version. Knows, maybe that would happen. Maybe that would be something to try.
Speaker 2:Uh, I this picture that you painted needs to come now, yeah, we can try on like memorial day weekend and we'll report back because, it'll still be like kind of a little chilly, because it'll be, may you know yeah, oh gosh, that's.
Speaker 1:I can't wait for that.
Speaker 1:In other news, I'm uh, falling apart, um, I mean, it was like last week at this point where I was like outside doing a run and then just walking and I was listening to the like the feature special where lebron was on the pat mcafee show and I just like randomly hyper, extend my knee while walking up a curb very nonchalantly, some guy like double took and saw like what I did and I was like that's weird. So then I kept walking like nothing happened. But I was like a little nervous because I have that whole like work in medicine, anxiety about health oh I know poor baby.
Speaker 1:and then, like three days later, my calf hurts, which I'm so much more grateful that this is probably just a calf strain and nothing like interior on the knee there. But then I'm going back to the gym and I'm doing legs again and I decide like it's time to be athletic and then boom, all of a sudden low back pain and like this is probably my karma, for, like I don't know, I thought I was very sympathetic for my most recent back pain patient, but maybe I didn't listen as well, or like it could have done a little better in the on the margins, I don't know. But now I'm living it and this is my karma.
Speaker 2:so now I have like low back pain well, you really don't like stretch or work on any kind of like mobility, ever no, which doesn't help you no, I don't.
Speaker 1:I do feel like sometimes this is probably catching up to me. Um, I'm like at this point in my life I'm someone who's like squeezing workouts in and I don't know, like, if I peel myself out at 550 and then I'm able to like make it into the room by like six, maybe I should stretch more. I'm making excuses. This is ridiculous. I should just stretch more, yeah.
Speaker 2:It'll help.
Speaker 1:It probably will help. That foam roller experience was something.
Speaker 2:I can't believe. You have never done that and, like you, were an athlete growing up.
Speaker 1:I certainly was. No, never really foam rolled. I mean, that's why I had so many soft tissue injuries. Who knows, perhaps Probably Mayhaps, mayhaps. I'm saying mayhaps more. All right, what do you think?
Speaker 2:What do you think? Should we dive in Sure?
Speaker 1:Okay. So the next section we're going to talk about here is managing allergic rhinitis, but using medications and some other treatments as well. So if you will join us on this next part of our journey here. So the most common first line treatment is a nasal corticosteroid spray.
Speaker 2:Listen, I need to say one thing Go ahead Before we start talking about all these magic medicines. Yeah, none of them are going to fully make you feel better. No cocktail of anything is going to completely change your life. It'll just take the edge off a little bit.
Speaker 1:okay, which is better than nothing so you're like almost implying just like managing symptoms instead of like cure maybe yeah, you're not going to all better.
Speaker 2:It's gonna be like a tooth. If you're a pollen allergy girly like myself, it's gonna be like a two sucky months out of the year you can take your medicine. You'll feel like a little bit. You'll be like a mildly less miserable well, I guess, do you?
Speaker 1:do you consider that maybe, like you have, you may have a more moderate to severe flavor of this? Oh yeah, so then maybe, maybe there is some benefit that could be had for people with like mild ish to moderate well, yeah, maybe I'm just saying like to like set expectations.
Speaker 1:Yeah, that like you're not gonna like pop a zyrtec and like boom, be fine all better yeah, and go rolling some pollen, okay, no, that's, I was awesome, so we're going to go through each class of medications and try to be a little more detailed. So there are nasal corticosteroid sprays or nasal steroids. Essentially, how they work is that the steroid helps reduce the inflammation in the nasal passages that are causing all of the symptoms and that's the main cause of the allergic rhinitis, and so the idea is to get at the core of the issue and try to help manage it. The effectiveness is generally that these are considered the first line treatment and in a few studies, are considered more effective than the oral antihistamines for relieving most symptoms of allergic rhinitis, and so they can relieve a runny nose, congestion, itching and sneezing. There are some examples of over-the-counter medications by the brand called Flonase, sensimist, flonase Allergy Relief, rhinocort Allergy, and there are some prescription options available as well.
Speaker 1:One of the most recent things I've been counseling people on more sincerely is how to use the nasal medicines better.
Speaker 1:So the idea is to properly use this with good form, and what you're going to do is you're going to hold your head straight with your chin slightly tucked.
Speaker 1:You are going to take off the cap and make sure, maybe send a primer or two of the squeeze, you're going to put the medication in your nose the applicator and you're going to point the applicator away from the middle, so towards the outside of your nostril, and you're going to squeeze and deliver the medicine.
Speaker 1:And you're going to squeeze and deliver the medicine and you're going to sniff gently like you're sniffing a flower. If you snort it, you're going to taste the medicine and it's going to shoot all the way back into your throat, maybe into your lungs, and you're going to taste it. And that's when you know you've done too much. But if you inhale and waft like you're smelling a flower, you're going to deliver the medication right into where it needs to go up in your sinuses, towards the top of your nasal passages. Sometimes people will hold one nostril closed while spraying the other and it's a decent suggestion to spit out any extra medication that goes into your throat because it's not going to do anything in there. Sometimes people have some luck using a saline nasal spray before they apply their aflonase or their fluticasone, if you will, to clean it before they use the medication. Nikki, when do people usually feel like they can expect relief?
Speaker 2:It varies. Some people say that they have relief with the first day, but it can take days to weeks to actually experience any relief. So good luck.
Speaker 1:Yeah, it is important to regularly use this medication. It's described that they're best used when you do them daily, and especially when you have recurring or persistent symptoms, and once your symptoms have gotten better, you might be able to reduce the dose and so like with. The first thing that people usually say when they are talking about using a medicine is, unfortunately, like I don't care what this medicine does for me, but what is the side effect? So the side effects are a slightly unpleasant smell or taste. Sometimes there is drying of the nasal lining. There can be irritation, crusting and bleeding of the nasal septum, especially in the winter, and that can be minimized by reducing the dose and perhaps using a moisturizing nasal gel or spray ahead of time or switching to a water-based spray. Is there in terms of long-term use? Is it okay? Is it something to think about? What are we thinking about? Long-term use?
Speaker 2:Long-term use of these medications are generally safe to use and really not associated with any side effects For children. However, if your child is taking it for more than two months out of the year, it may slightly slow your growth rate. So something to think about.
Speaker 1:Talk to your doctor about and specifically, these are very different than steroids taken orally.
Speaker 1:And they have far fewer side effects than those medications may imply. And for pregnancy, certain sprays like chromalin, which we're going to mention later, fluticasone, budesonide and memetazone are generally considered safe. But please don't take our word for it. Ask your own doctor who's taking care of you. So that was the nasal steroid spray. There's another class of medication that can be very helpful, and they're called antihistamines. You mentioned earlier in the episode that histamine release can be at the core of the reason that people are experiencing these symptoms. So antihistamines work by relieving itching, sneezing and the runny nose by blocking the effects of histamine, the chemical that's released during the allergic reaction. But notably, they do not relieve the nasal congestion, and so there are oral antihistamines that are taken by mouth. Of course, there are non-sedating ones, which tend to be causing less drowsiness, and examples of this include loratadine or claritin, desloratadine or clarinex, cetirizine, zyrtec, levosetirizine, called Zyzol, fexofenidine or Allegra, and most of these, like loratadine, cetirizine, fexofenadine, are available over the counter. There are ones that are more sedating, and they should be used more with caution. This is like Benadryl or diphenhydramine or chlorpheniramine or, brand name, chlor-trimetron. Generally, newer, non-sedating medications are preferred because they don't make you fall asleep. The side effects are more so associated with the older brand and for use in pregnancy, most of the time, cetirizine, loratadine are helpful and safe and then use in children. They do come in some liquid forms, and so many non-sedating antihistamines are also available for that reason.
Speaker 1:But antihistamines are not limited to oral medications. There are nasal antihistamines which some people find very helpful. They work by relieving symptoms of post-nasal drip, congestion and sneezing right at the source, and they can start working within minutes. Examples of this are azelastine or astilin or astapro and olopatidine, which is like a brand name patinase that technique that we talked about before you should use for this. You keep your head tilted forward and you do all of those things we mentioned before. The side effect really is just a bad taste in the mouth. So all of those can be very helpful, and sometimes what they do is they combine them together. They take a corticosteroid and an antihistamine spray, and so it combines the benefits of both the steroid and the antihistamine, and there's some evidence out there that both together may work better than either drug alone, which isn't rocket science, but I think you have to actually do the research to be able to do that. The brand name of this medication is called Dimista, where it combines fluticasone and azelastine. A combination of multiple over-the-counter agents is probably going to give you the same benefit. Once again. The side effects of this might be bad taste, nosebleed and possibly a headache, and it's approved for use for people in age 12 and over.
Speaker 1:So another class of medications are decongestants. How they work is they help to relieve the nasal congestion by narrowing blood vessels in the nasal passages, and this is, while they're very effective, they're often combined with over-the-counter allergy medicines and they include common medications like pseudofedrin or phenylephrine. And a gigantic word of caution is that, frankly, we discourage people from using oral decongestants because there is a potential side effect of increased blood pressure and increased heart rate. They really aren't appropriate for people with high blood pressure and certain cardiovascular conditions, and that's what we have to say about that. They are not really safe for people who are pregnant, and especially in the first trimester. Nasal decongestion sprays, like medicines like oxymetolazone or Afrin, are also out there, or other brands of phenylephrine, and really these are not recommended for allergic rhinitis because, well, frankly, they can't be used for more than two or three days in a row at a time, because they can cause something, or rebound congestion or rhinitis medicamentosa, which is difficult to treat and is consistent persistent rhinitis when the medicine isn't present, and that is very challenging, and so it's best to avoid that altogether by avoiding these medicines, if you can.
Speaker 1:One of the last ones we're going to talk about is acromalin nasal spray. What this does is it prevents the symptoms of allergic rhinitis by interfering with the ability of allergy cells to release the inflammatory chemicals. Really, these aren't as effective as other treatments, but sometimes they can be used before symptoms begin. If you know you're heading to an area, it's just another option in the toolbox. It happens to be really safe for people who are pregnant and also possible for children as well. It really has to be used several times per day to be effective. Can you tell us a little bit more about nasal irrigation and saline sprays?
Speaker 2:I mean, it's exactly what it sounds like. You're just rinsing the nose with a saltwater solution and the idea is that it washes away the allergens from the nasal lining to remove the allergen.
Speaker 1:Those were all of the most common treatment options and there are a lot of options available are all of the most common treatment options and there are a lot of options available. But something to note is that if and we're not going to speak a whole lot on this because neither of us do this every day and it's more specialty realm is that allergen immunotherapy whether that be an allergy shot or an oral medication, could be an option. But in my experience that is pretty much limited to an allergy specialist, which, if your symptoms are really bad and aren't managed by anything we've previously talked about, perhaps you need to think about it. And that's pretty much where we'll limit our conversation to today, so we don't speak too far outside of the scope of what we're more familiar with. So, in conclusion for this week's episode of your checkup, we just really want to reiterate that allergic rhinitis is very common, but hopefully with today's tools, you can recognize that it might be a little bit manageable. Right, like there's no magic bullet. Perhaps that's going to make you feel all the way better, but maybe we've come across some things that might help. We should identify triggers and reduce the exposure to those. We talked about different medication options and made you all aware that there are allergy specialists out there and maybe immunotherapies that could be helpful if none of the stuff that you listened to earlier has been helping you, and, moreover, we want to thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or an allergic neighbor. Please check out our website, find us on instagram, send us an email, your checkup pod at gmailcom and, most importantly, stay healthy, my friends, until next time. I'm ed daleski. I'm nicole rufo. Thank you and goodbye, bye.
Speaker 1:This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.
