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Dr. David Hill (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. And today, I'm talking with Stephanie Zuber, PA-C, with the Otolaryngology, Head and Neck Surgery, Allergy, Ear, Nose and Throat Division at Carle Richland Memorial Hospital. Stephanie, welcome.

Stephanie Zuber: Hi. Good to be with you today.

Host: Thank you. So today we're going to talk about something that is near and dear to my nose and throat, allergies, and probably a lot of people. We have seen data that allergies are actually getting progressively worse. So, almost everybody is affected in some way, if not them, someone they know and love. So, how do we know? When do we get worried that somebody might have allergic rhinitis?

Stephanie Zuber: Absolutely. And we're certainly in the perfect area for that here in the midwest. But good ways to differentiate between allergic rhinitis symptoms and possibly, say, your everyday viral cold would certainly be nasal congestion, runny nose, sneezing, itchy or watery eyes, you may even have a little bit of ear pressure and fullness, certainly postnasal drip that can lead to cough and some hoarseness, excessive throat clearing of course are very common as well. Those can be with a viral illness. But what we're not going to see too much with allergies is a fever, general body aches, increased fatigue. You may be a little bit more tired, but certainly not those good body fatigue illnesses and symptoms like that. So, they can be just as intrusive and cause a lot of problems for a lot of people, but those are some good factors that may help you differentiate between cold versus allergies.

Host: Can we talk about itching for a minute? How prominent is itching, nose, eyes, throat, when you're thinking about allergic rhinitis?

Stephanie Zuber: Absolutely. That's a very common symptom as well. We'll also often see these things we call allergic shiners, which you can tell when people are messing with their eyes a lot and they may not even notice it. There's also this little crease that we may see in the patient's nose, indicating that they may be rubbing their nose quite a bit. All those are classic things with itching. Patients actually usually get itching in the ears sometimes as well.

Host: So, let's say I'm concerned that I might have allergic rhinitis, I'm going to go to the drugstore and there is a shelf and it is a large shelf and it's got a lot of stuff on that. What should I be reaching for? Do some things work better than others? Are there things I should just avoid altogether?

Stephanie Zuber: Absolutely. That can be a very daunting task for people to figure out what's best to take. And I often have patients come in and say, you know, "I haven't tried anything. I was just concerned it would interfere with my other medications" or I" wasn't sure what was going to work best."

So first and foremost, sticking with a basic antihistamine, such as Claritin or Zyrtec or Xyzal, the generic versions of those are perfectly fine as well , it can be really helpful. That should provide you about 24-hour relief with just taking that one pill. If you have a lot of nasal symptoms as well, something like Nasacort or Flonase, the nasal steroid sprays are going to be the most beneficial for that. There's actually a newer nasal spray available over-the-counter now, which is previously primarily only been prescription, which is Astelin or azelastine, Astepro and that is actually an antihistamine nasal spray, which can be very effective in treating a lot of those very common and stubborn symptoms. Certainly, there are decongestants as well. Those you do have to be a little bit more careful with in regards to medications and cardiac conditions and things like that. But if you're really stuffy, decongestant can be helpful. If you're really runny, that's where you want the drying agent, which would be the steroid or the antihistamine.

Host: I want to think a little bit more about decongestants because we just got this news that a common decongestant, phenylephrine, doesn't really work. What should people be using instead?

Stephanie Zuber: So, I hesitate to recommend decongestants because they can cause a little bit of difficulty, like I said, interference with other medications and just side effects, but for absolutely very temporary relief, so no more than three days. Patients can get significant benefit from using Afrin, but again, that's no more than three days, because your nose can get dependent on that. But it can be very helpful to help you get a good night's sleep if you just can't breathe through your nose, until you can get some other medications on board that may take a little bit longer to work.

Host: And what about non-medication treatments? I've seen these bottles of saline water that you squirt up your nose. Can that be helpful for people?

Stephanie Zuber: Absolutely. Simple saline spray can be a very effective way to help irrigate the allergens out of the nose. I'm a huge proponent of the NeilMed Sinus Rinses, it doesn't have to be that brand of course, but just any type of sinus rinse. They sound scary, they look kind of scary. It doesn't sound like a pleasant experience, but they can be very helpful in flushing out allergens after, say, spending time outside, but as well as it helps clear out that mucus from running down the back of your throat, which can lead to all those other symptoms and just kind of clear your head a lot more. So, they sound weird, they look weird, but they are very effective. And I would suggest people to try them and not be too scared of them.

Host: And let's say I move away from the pharmaceutical aisle and instead I walk down to the dietary supplements. Do I need local bee pollen, local honey, something else? Do we have any supplements that we know work?

Stephanie Zuber: I'm not aware of any actual supplements that are FDA approved for treatment of allergies. Certainly, you'll hear patients with a lot of home remedies and I am kind of the preference of, "If it works for you, I think that's great. But if it doesn't, certainly you know where to find us if you need some more help with that."

Host: All right. So then, let's go to your clinic. Say I've tried the stuff at the store, I'm still not feeling better. How are you going to figure out what I'm allergic to? And what can you offer that I can't get at my local drugstore?

Stephanie Zuber: First and foremost, we always do a consult visit, which we discuss what you have tried and haven't tried in the past, and your signs and symptoms, and make sure everything is consistent with allergies. And then, we talk about allergy testing, which is done in the clinic. It is a different day procedure, but we do skin testing with both prick devices and intradermal devices. So, some people get a little nervous about needles, but it's just a tiny injection underneath the skin. That whole process takes about an hour and a half to two hours. And we test for about 56 different things. So, that includes the grasses, trees, weeds, molds, cats, dogs, cockroaches, dust mites, all the little furry critters that people may have as pets as well, also some cattle and things like that since we have a lot of farms around here. It is a little bit time-consuming, but we test the skin and see how your skin reacts. And that's how we know if you're allergic to certain things.

Host: All right. That's helpful. And once you find that out, what can we do about it? I mean, Obviously, we could give away the dog or the cat or the horse, but what if I can't? What if I really like my dog, cat, horse?

Stephanie Zuber: Yeah, absolutely. Obviously, avoidance is key with a lot of things, but we can't avoid going outside. I personally don't really recommend people to get rid of their pets because they're part of the family and I just know that's not super realistic for patients. But if you do have allergies that we find on testing, you're a candidate for what we call immunotherapy and that's allergy shots where we help desensitize you to specifically what you tested positive for that we know you are allergic to. And it can really help relieve some of those symptoms that you experience in nature when we desensitize you to it.

Host: Wonderful. Now, I've heard about some new forms of desensitization. Is there anything on the horizon if I don't like shots?

Stephanie Zuber: There are some locations that will do sublingual immunotherapy. Currently, Carle does not offer that, but I'm hoping sometime in the future. That can be a very effective avenue for people to take. It can be very beneficial for those that can't come to the clinic weekly if they live a little bit further away, we do work in a more rural area. So, that would be awesome if we could at some point offer that. I'd look forward to that. But for now, unfortunately, injections are the way to go.

Host: All right. And for our listeners who are concerned about allergies, do you have any last takeaways or messages for them?

Stephanie Zuber: I would say just don't be afraid to try the over-the-counter options that are available. Always ask the pharmacist as well. They can be very helpful. And if you're suffering through your day to day life, don't put that off. I find a lot of people don't realize how symptomatic they are because, with allergies, we do kind of just deal with it. And you don't realize how far from your normal you have gotten. So, don't hesitate. It can be a little bit time-consuming, but it can be very worth it. I speak from experience. I am on allergy immunotherapy and I have gotten great success with it. So, I have that little snippet as well to share with patients. But yeah, just be your own advocate. And if you're not happy with how your things are going, don't hesitate to come see us and see if we can't help you out.

Host: Great message, wonderful words. Thank you, Stephanie Zuber, for talking with us today.

Stephanie Zuber: Awesome. Thanks for having me.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.