Scott Webb (Host): Seasonal allergies are the worst, and though staying indoors would help many of us to avoid them, that's just not practical when the weather is nice. I'm joined today by Dr. Dennis Rademaker. He's a Board Certified Physician specializing in allergy, immunology, and pediatrics, practicing at Franciscan Health, and he's here to discuss seasonal allergies and how Franciscan Health can help.  

Scott Webb (Host): This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's great to have you here. We're going to talk about seasonal allergies and, uh, I'm in the, the throes of it as I'm sure many people are as we're recording this. So let's just start there. Maybe you can share some of the background on what seasonal allergies are. Like when is allergy season? For me, it's right now, but how about for everybody else? 

Dennis Rademaker, DO: So seasonal allergies, typically occur at specific times of the year, which is the season. It's usually repetitive, so year in and year out, we have pollen about the same time. And it typically causes an intense increase in allergy symptoms. So usually starts at about three years of age and up.

And, usually requires several years of exposure on a yearly basis before patients really start to have a lot of symptoms. Affects about 10 to 30 percent of the population. In our area, it's usually tree pollen, grass pollen, weed, and ragweed. So it kind of depends on when those pollens are elevated.

Host: Yeah, I see what you mean. And I know what my symptoms are, but how about for other folks, what are the common, you know, seasonal allergy symptoms?

Dennis Rademaker, DO: Symptoms are much like just regular allergy symptoms, but much more intense. So, classic symptoms are sneezing, runny nose, nasal obstruction, nasal itching is really prevalent. Some patients get itching of their palate. Their inner ear feels itchy. They do a clicking noise to try to relieve their itching of their soft palate. A lot of this leads to post nasal drip, cough. Patients complain of irritability and fatigue. It disrupts their sleep patterns. They suffer from work and school impairment. So it's more than just a nasal disease, really. It's kind of a global disease. Eyes, itchy, teary, burning, swelling around the eyes, they develop allergic shiners, which are bluish tint to their eye sockets. Young children typically don't blow their nose, so parents come in complaining that they're constantly snorting or sniffing or coughing and constantly clearing their throat.

 Then there's the allergic salute, which is when patients push their hand up their nose to try to get relief and relieve the itching and the, drainage. And then, there's a new condition recently discovered called oral allergy syndrome where patients get itching of their mouth and tongue when they eat certain foods, especially during the allergy season.

So the body kind of confuses, pollen allergy with the foods that have those same allergens in them. So bananas, fruits, avocados, apples are pretty common.

Host: Yeah, interesting, as you say, a whole range of symptoms, more sort of global symptoms. So wondering, how does Franciscan Health diagnose allergies? What type of testing is needed? That sort of thing.

Dennis Rademaker, DO: Sometimes the diagnosis is kind of obvious. A patient comes in year in and year out in the same time of year and only has it during that time of year and not other times. You know, that's pretty much seasonal allergies. Sometimes it gets a little bit confusing because you get crossover of the pollens between seasons.

So in those patients where it's more prolonged or multiple seasons, we usually do skin testing when possible. And that involves pressing allergen into the skin and then waiting 15-20 minutes and reading the reactions. Skin testing is the most accurate and sensitive test that we have. In some cases where we can't really skin test the patient, either because of their skin type or they can't get off their allergy medicines, we can do blood testing, which is RAST, R-A-S-T testing, and that measures the body's IgE against specific allergens.

Host: All right, so a battery of things that you can do, as you say. If the, the same patient comes in the same time of year, you know, year after year after year, it's pretty obvious, but may not be as obvious with some other folks, other symptoms. So let's talk about the treatment options, whether it be over the counter products, things like antihistamines, decongestants, and so forth.

Dennis Rademaker, DO: Well, first thing I tell patients is to try to do avoidance, but they don't like to hear that because that means being indoors during our nicest time of the year. So, in that case, we do have some great products available and most of them now are over the counter and generic. They work very well.

Antihistamines, we have the new second generation antihistamines. So, more 24-hour acting, low drowsiness, very few side effects, and they work more mainly for sneezy, itchy, runny symptoms, examples of those are Claritin, Zyrtec, Allegra, and others. There's nasal steroid sprays, which work typically better for congestion and swelling and post-nasal drip.

So medicines like Flonase, Nasonex, Rhinocort. There's recently been released an nasal antihistamine spray, which is as Astepro or, or Patanase. And those reduce the runny nose, sneezing, uh, kind of dries the patient up a little bit. We have decongestant products which, control congestion and post nasal drip.

Unfortunately, those are controlled substances, so the patient has to sign for those. And can only get a certain amount. And, uh, the other problem is it can affect blood pressure and, and also, uh, affect your sleep. Eye drops, there's many of those on the market now, highly effective. Really good for allergy symptoms, can be used daily or multiple times a day.

Prescription products, Singular Montelukast is available by prescription mainly for congestion and mainly as an add on medication to the antihistamines and then in those patients that fail everything, we can use oral steroids. You have to use those cautiously because they have a lot other side effects. Raise your blood sugar and then possible long term side effects. So those are kind of a last resort.

Host: Yeah, Doctor, I've heard of CAR T-Cell immunotherapy, but I want to ask you about immunotherapy as it relates to seasonal allergies.

Dennis Rademaker, DO: The two approved types of immunotherapy that we have and what the process there is that we are trying to desensitize the patient to reverse their allergies. So instead of treating symptoms like medications do, we're trying to reverse them, basically. So, first one is subcutaneous immunotherapy or allergy shots.

That's giving the patient, uh, allergens that they are known to be allergic to, but you do it in a, small dose and a very gradual increase until the body tolerates it. Usually those are weekly and eventually monthly. Typically about a five year program. We don't usually use it for just single allergen immunotherapy like if you're just allergic to one thing, but typically if patient's allergic to several things, then allergy shots probably will give them relief.

Sublingual immunotherapy, this is a new treatment, it's called SLIT, and basically the patients place an allergen pill under their tongue, and do that on a daily basis at home, typically starts about three months before the season starts. We have it for grass and ragweed pollen so far, And so in February, the patient comes into the office and does a tablet under their tongue for grass pollen, and then uses that therapy until June. For ragweed, same thing, usually starts in June and goes till October. Usually, takes three seasons to desensitize.

Host: Yeah, it's really interesting stuff. And I don't know if this is true or not, but I've heard that allergies seem to be worse at night. So wondering, is that true for some folks or most folks? Is there anything that we can do to ease those nighttime symptoms?

Dennis Rademaker, DO: Yeah. So it's interesting that even after the allergen is gone, cause you're exposed to the pollen during the day, the inflammatory reaction continues. So, that is most noticeable in the patient, of course, at night. And then our body produces chemicals that kind of help control allergy. So, adrenaline is one thing that's higher during the day than at night.

And, uh, corticosteroids like cortisol, also lowest at night.That's called the diurnal rhythm. And so the chemicals that kind of help our body control allergies aren't there.

Host: That's generally my experience. like, it's like you're saying, you know, if you get folks who just stay inside, but of course nobody wants to do that when it's nice out, right? So we go out and we subject ourselves, you know, so to speak. And then at night, it seems to be worse and it can be hard to get to bed, stay asleep, that sort of thing, right?

Dennis Rademaker, DO: Right, right. Definitely affects sleep patterns, but taking your medicines on a more consistent basis sometimes will help, and early and often, really, with the medicines, will kind of smooth things out throughout the day. Again, a lot of the antihistamines are 24-hour acting, so that's something that can be beneficial even when the patient's sleeping.

Host: Yeah, early and often, yeah. I find that I often forget to do something, to use the things that I have until I've already been exposed and then, you know, I complain to myself, you know, why it's not working. It's like, Oh, right, because I didn't take it before I went out. I sort of took it, you know, while I was out or after I got back. And at that point, it may be a bit too late, certainly to save my sleep that night. Uh, this is good stuff, doctor. Really educational. Great to hear about immunotherapy and the other treatment options. Just wondering what else you want folks to know about allergies and what they can do or what you can do to help them.

Dennis Rademaker, DO: Yeah, so, early treatment essential, so don't wait till the season's really going and your allergies are really bad before you start your medicines. Kind of layer the medicines, so antihistamines can be used with a steroid nasal spray plus an antihistamine spray and eye drops and all these things can be kind of used together.

It doesn't hurt to keep the house closed up and run the air conditioning, during the season. And then if you've been outdoors for any extent, come in and shower, change your clothes, kind of wash the pollen off. But definitely seek help if symptoms don't get better right away.

Host: Yeah, that's perfect. One of the things I usually do is after a long day of being outside is, as you say, shower, like change your clothes, shower, kind of wash the pollen off, right?

Dennis Rademaker, DO: Yep, yep,

Host: Yeah, that's perfect. That's something that's definitely within our control, hopefully for all of us. So, Doctor, thanks so much for your time today. I really appreciate it.

Dennis Rademaker, DO: Yeah. Thank you, Scott.

Host: And to learn more, visit franciscanhealth.org and search allergies.

 And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.