Michael Anderson (Host): everyone, and welcome to this episode of The FortCast. I am your host, Dr. Michael Anderson, ear, nose and throat, physician and president and CEO of Fort HealthCare. And with me today is a very special guest. We have with us, Dr. William C. Hofmann, ear, nose and throat physician, and somebody who's been a dear friend of mine for many, many years.

William Hofmann, MD: Echo that brother. Good to see you.

Host: Dr. Hofmann, welcome. We're going to be talking today about seasonal allergies. A very common topic, but oftentimes people aren't aware of the advanced treatments that Dr. Hofmann can offer here at Fort HealthCare. But before we dive into that topic, Dr. Hofmann, how long have you been with Fort HealthCare?

William Hofmann, MD: Well, I was trying to figure that out, but since I was always lousy at math, I'll just say I came up here in 2009. And I've been happy ever since. So, I think that means I'm getting close to 20 years, but not quite there.

Host: I think that sounds pretty accurate, and it's good to hear that you're happy. I know our patients and community are very happy. They've been flocking to you now for, like you said, almost 20 years. And you see plenty of people here in our Fort Atkinson and also in our Watertown areas. So, thank you for that.

William Hofmann, MD: No, it's been a great ride. I'm enjoying it.

Host: Good, good. Well, hey, you ready to talk about some seasonal allergies?

William Hofmann, MD: Let's do it because it's here, man. It is definitely here.

Host: It is here. It is here. We get a little break over the winter months. But Dr. Hofmann, can you kind of just summarize for our audience what exactly are seasonal allergies? What does that mean? If somebody says, I am a seasonal allergy sufferer?

William Hofmann, MD: It's always a good question. What it means is essentially there are certain times of the year when you're going to notice symptoms like sneezing, nasal congestion, nasal drainage, itching in the eyes, and those symptoms may drive you a little bit nuts for a few weeks, maybe a couple of months, and then they seem to go away. And they come back about the same time next year. So when you have that kind of a situation, treating your allergies makes sense because it will make you much more comfortable.

Host: Now, Dr. Hofmann, can somebody have allergy symptoms that you just highlighted in multiple seasons of the year? We traditionally think of spring, summer, fall, and winter. But is it possible for somebody to have symptoms in more than one season?

William Hofmann, MD: Absolutely. I just saw a patient that fits that bill perfectly.

Host: Yeah. We often see that in our community where it starts with one season, but then extends into other seasons. So when somebody has those sort of symptoms, Dr. Hofmann, they may seek treatment through their primary care physician or provider. And what kind of medical treatments exist, pharmaceutical treatments?

William Hofmann, MD: There are several different ways to treat it. Most people, I think, are quite familiar with antihistamines. They've been around for a very long time. And currently, we have several that are what are called non-sedating antihistamines that work quite well. And only need to be taken once a day. People will also use things like nasal steroid sprays, which are extraordinarily effective. In fact, they are probably the most effective ways to treat the nasal symptoms of allergy.

People can also use things like intranasal antihistamines, such as Astepro. And there's been some recent literature that shows that using Astepro in conjunction with a nasal steroid spray is highly effective at treating most of the symptoms that people will experience.

Host: I think we can both agree that we've been around long enough where we have seen a lot of these allergy medications go from prescription to over-the-counter. So, those classic antihistamines that you were talking about, like our friends, Allegra and Zyrtec and Claritin, And then, the over-the-counter nasal steroid sprays, Flonase, Nasonex, and Nasacort, Those are now all available at patients' disposal.

William Hofmann, MD: Exactly. And easy to get ahold of and very easy to use.

Host: You're right. Just follow the directions. So when you see somebody in your office, Dr. Hofmann, is it somebody who has tried those medicines typically and they're just not getting better? Is it somebody referred to by their primary care provider? Can you take us through that journey a little bit as to what drives the patient to come and see you as an allergy specialist, ear, nose, and throat allergy specialist?

William Hofmann, MD: Well, I think the main reason people will come in is they just don't feel good, quite frankly. , They've been taking their medication. And it's either no longer working or it's working a little bit, but not like it used to. So, they have symptoms much more frequently and I think people just get tired of it.

A lot of people will tend to use one medication. And one of the things that, well, both of us know is that sometimes two and maybe even three medications are needed to help get them under better control. So, one of the first things I generally do when I see a patient is I try to find out what they've tried and what's worked for them, what hasn't, and then I will often mix in other medications to see if we can't give them some more relief.

Host: Now, one thing I want to touch on. When somebody has not gotten to where they want to be medically with their seasonal allergy symptoms, at what point do you consider allergy testing that patient?

William Hofmann, MD: Excellent question, Dr. Anderson. Really, you can do testing just about any time if people really want it. For folks that are not getting better on a couple of medications, I think, allergy testing is extraordinarily helpful. In addition, if people have an underlying diagnosis of asthma or other respiratory issues, allergy testing is, some would say, almost essential. Just because allergy can affect those other lung issues as well.

So in my book, I start to think about testing when people just aren't getting better. If they're coming into my office and they're not getting better on their stuff, I'm going to recommend it more times than not.

Host: And I think that's really well said. And oftentimes I bet when people seek you out, they definitely have chronic symptoms. It's not like it just started last year. They've been suffering with this for quite some time. And most of the time, they're going to want some answers. "What am I allergic to, or how allergic am I to X, Y, or Z?" So if we talk a little bit about the allergy testing itself, Dr. Hofmann, what do you test for when a patient goes through allergy testing?

William Hofmann, MD: Well, we have a mix of common allergens that are in our area. We test for various trees. Some of the field weeds that people are familiar with, like ragweed and such. Mold is a big contributor; grasses, huge contributor given where we live. We also test for pets, dust mites. And a couple of things which aren't so pleasant like cockroaches and mice. We also have the ability to test for things that people might want. For example, if someone keeps horses or rabbits, we have the ability to test for allergy to those as well.

Host: And I'd really like to highlight that being primarily in a rural farming community, we are able to tailor allergy testing to some of those furry friends that we may have on a farm, like you mentioned, like horses. I think that's so important for our audience to understand.

William Hofmann, MD: I would agree with that because if you're exposed to it and you're allergic to it, you will have symptoms. And it can explain why people feel badly year round. It's not that it's seasonal, it's that their horse has given them a problem.

Host: Right. So, Dr. Hofmann, do you do specific food testing when you have somebody allergy tested?

William Hofmann, MD: Also a very good question, and I get that a lot actually. We do not do food testing largely, because it's not terribly effective. Interestingly, there's often some cross reaction with environmental allergens. So if someone is allergic to a certain allergen, for example, and they have an apple for instance, they can get tingling in the mouth and so on. So oftentimes, if people are tested and they go through therapy or they treat their allergies aggressively, their food symptoms tend to get better.

Host: Well, let's dive into a little bit of that therapy that you just mentioned. So when somebody gets allergy tested, it sounds like it's a wealth of information? What do you typically do with that information? Are there other options for patients once they've been allergy tested?

William Hofmann, MD: Absolutely. The main reason that allergy testing is effective is because it tells the patient what they're allergic to so they can avoid it if possible. The best way to treat allergies is to avoid what you're allergic to. Now, sometimes you can do that and sometimes you can't. But to give you an example for folks that have a dust mite allergy, for example, use of dust mite covers on mattresses and pillows in conjunction with frequent washing of bed linen is a great way to control the allergy exposure. And people will feel better.

In addition, if I know what you're allergic to and, more importantly, how allergic you are, we can start thinking about doing things like immunotherapy, whether we do sublingual drops or allergy shots, which are more definitive, and actually offer a chance not to control the problem, but to actually get rid of it.

Host: if you could just put it in the most simplest of terms, I know immunotherapy is a very, very realistic option for a lot of patients who suffer from seasonal allergies. What exactly, just in simple terms, is immunotherapy?

William Hofmann, MD: Immunotherapy is basically training your body to ignore what you're allergic to. And we do that either with drops that are given daily under the tongue or with the more commonly recognized allergy shots, which are given weekly.

Host: So, do you have a specific conversation with patients about—let's say they're interested in immunotherapy. What are the different pros and cons, if you will, on doing the traditional allergy shots or considering sublingual immunotherapy? What are the differences between the two?

William Hofmann, MD: The biggest difference is frequency of treatment. With the sublingual therapy or the allergy drops, it's a low-dose treatment that is given daily. And it's safe to be given at home, because it is a very low exposure. So, people build up a resistance to the allergen that they were treating over time. It's great for kids because I don't know a kid that really likes needles. I'm an adult and I don't like needles. So, it does give people a way to treat their problem much more comfortably and without discomfort.

It has an additional advantage in that you don't have to mistreat them. If the family wants to go on vacation, they take the drops with them. And they don't miss a beat. Now, allergy shots are still considered the gold standard, I think, because they tend to work in over 90% of people. The way these are given is in office. People will come in, they get their shot, and then they got to stick around for about 20 minutes. That's due to the fact that any allergy shot can lead to problems with breathing. And we have to monitor folks for that for the first 20 minutes or so. After that, they're free to go and come back next week.

Host: So, it sounds like on an individual level, Dr. Hofmann, you go through quite a bit of the pros and cons whenever somebody is considering immunotherapy. And part of that discussion is what is the typical timeline for immunotherapy? In other words, how long does somebody have to do this until they will notice a noticeable difference or the effects will become permanent?

William Hofmann, MD: Again, a very good question. And the base response is it depends on how allergic you are. Obviously, the more allergic a patient is, it takes longer to desensitize that patient. I usually tell folks we're looking at a couple of years, at the very least. But the results tend to be excellent after they complete their therapy.

Just to give you an example, my son is a terribly allergic person. We tested him when we actually started our program here, you might remember, and I think he topped out at—I honestly think it was 28 out of 30 allergens. And he was just ridiculously responsive to all of them. We started him on allergy drops, and he's now 23 and feels fantastic with no allergy symptoms whatsoever. It took us about five years to get him there because he was so allergic. But he's the exception, not the rule. I think most people are going to feel better within about anywhere from six months to a year.

One of the things that they'll often experience is their medicines that they didn't think were working, now were working. They seem to be feeling better on them. And that's a real sign that the treatment's having a good effect for them.

Host: I would say immunotherapy overall is extremely effective at treating seasonal allergies. Would you agree?

William Hofmann, MD: I would agree with that a hundred percent. Some people would say 90 plus percent, especially for the allergy shots, because that's been better studied, I think.

Host: Gotcha, gotcha. Well, Dr. Hofmann, I can't thank you enough for being on this episode of the FortCast Podcast. Thank you very much. I learned a lot about seasonal allergies talking with you, and I'm sure our listeners did as well. So, thank you, my friend.

William Hofmann, MD: Always a pleasure, Dr. Anderson. Anytime and with any other subjects that you want to bring up, I'm always happy to talk. I love what I do, and I'm just happy to be able to help folks. It's a fun thing to be able to do every day.

Host: Well, we appreciate it. Your patients. Appreciate it. So, thank you.

William Hofmann, MD: Anytime my friend, you need me. I'm here.

Host: I hope our listeners appreciated it also. So, thank you for tuning in to this episode of the FortCast. Please share us on our social media channels, and also please check out our full library at Fort HealthCare where you can view past episodes of the podcast as well. Thank you and have a great day.