Transcription:

Scott Webb: Though some allergies are more severe than others, living with them at all can affect our quality of life. And my guest today wants us to know that there is help available either from our primary doctors or, if severe enough, allergists. And joining me today is Dr. Devin Wheeler. He's a family physician with Genesis.

This is Sounds of Good Health with Genesis, brought to you by Genesis healthcare system. I'm Scott Webb. Dr. Wheeler, thanks so much for your time today. We're going to talk about allergies and I know a lot of folks have them, be they seasonal or otherwise. So it's great to have your expertise. And as we get going here, what are some of the types of allergies that you see in your practice?

Dr. Devin Wheeler: Allergies are caused by a specific allergen, right? And then, your body reacts to it. And there's a number of different ways to classify allergies. I like to think of them in three main types. So the first would be environmental. So you mentioned seasonal allergies, so allergies to pollen or grass, pet dander, dust mites; in my mind, even including like insect bites, I mean, things of that nature. And then also food allergies. So there's a number of different food allergies, but allergies to tree nuts, shellfish, milk, eggs, et cetera. And then, allergies to medications or other medical instruments or products, so to drugs such as antibiotics or medical products like latex or different metals and whatnot.

Scott Webb: It seems like a lot of these can be prevented or avoided. Am I hearing that right?

Dr. Devin Wheeler: Correct. Yeah.

Scott Webb: So maybe that's something you deal with where folks come in and say, "I have this reaction to this," or "I had a reaction to that." What do you generally say? Well, then don't do that.

Dr. Devin Wheeler: I mean, avoidance is key, right? So if you can avoid that as much as you can, then your body is not going to come in contact with it and you're not going to have the normal allergic reaction, immune response that you would have when you do come in contact with it. So from a prevention standpoint, I mean, that's step number one.

Scott Webb: Yeah. And then maybe we can go through how do you help folks really to identify, you know, the triggers, what's actually bringing on these allergic reactions or allergy attacks and so on. How do you sort of roll up your sleeves and get to the root causes?

Dr. Devin Wheeler: The biggest thing would be trying to identify the specific timing. When does this reaction occur, right? So is it always when you are next to your cats or like it's always happening in the springtime or in the fall when there's ragweed? So, I mean, ultimately, the timing and the severity of the reaction when it does occur to try to identify the particular allergen that's causing the issue.

Scott Webb: I'm sure a lot of folks sort of deal with this, this kind of risk-reward maybe is the way to put it where they know the things that are the triggers, but they love those things, be they food, cats, being outdoors, whatever it might be. And then, they have to decide for themselves if they're willing to accept the risks, if you will, or the results, which might be these allergic reactions, right?

Dr. Devin Wheeler: Correct. I mean, at least trying to mitigate the risk, to try to lessen the reaction. For instance, use the example of like seasonal allergies. So, from a prevention standpoint, I mean, if you can stay inside at peak pollen counts, which you can find that online for your area, or making sure you do regular cleaning of your house, regular maintenance of your air filter, of your furnace, changing the filter regularly, considering like a HEPA filter, taking showers after being outside.

So, for most allergies or most allergens, there's ways to try to at least lessen the severity, at least from the avoidance, before you get to a medication standpoint.

Scott Webb: Yeah. And let's talk about that because, obviously, as we're kind of talking through here, there's things that we can do to avoid things or mitigate the risks and so on. But there are medications and there are very good reasons why we would come to someone like yourself to get some relief here. So let's talk about that. What are some of the best methods or medications short-term, long-term? How can you help folks?

Dr. Devin Wheeler: So, I guess in terms of treatment, there's kind of an algorithm, a stepwise approach to try to help somebody that's having like an allergic reaction or having allergies on a consistent basis. So, if avoidance, lifestyle behavioral changes aren't enough, next step are medications. The most common first steps would be like intranasal corticosteroids and/or oral antihistamines. And these can be used independently or often together. So the corticosteroids, so that's something like Flonase or Nasonex, those are nasal sprays, and they're steroids, so they help decrease inflammation and ultimately decrease the sinus congestion and the sinus pressure that's caused by allergens. And then the other one, the oral antihistamines, that would be Zyrtec or Claratin or Allegra, and they decrease the effects of histamine. So when you come in contact with an allergen, it sets off a chain reaction, including the release of histamines that causes their allergic reaction and contributes to the allergic symptoms. So if you can lessen the effect of histamine, ultimately, that plays a big role.

So like I said, oral antihistamines and the intranasal corticosteroids, beyond that, there's intranasal, so like a nasal spray that's an antihistamine or like oral steroids, if it gets severe enough. But ultimately, if patient has continued symptoms, despite the avoidance, despite the medications, then ultimately we can refer to an allergist. And they can decide if allergy shots or like the immunotherapy, doing allergy testing would be beneficial.

Scott Webb: Yeah. Wondering do allergies change over time or are there childhood allergies that people can grow out of? Or if you didn't have allergies when you were a kid, can you develop those along the way? And if so, maybe you can help us understand how does that happen? How do we become sort of allergic to something that we weren't already allergic to?

Dr. Devin Wheeler: Short answer is yes. So certainly, allergies can change over time. I mean, it's possible that you're tolerance to a specific allergen can either increase or decrease. So like you mentioned, a child with a particular allergy may have less of a reaction as they get older and as they build up a tolerance to it. And the opposite can be true to where, like an adult that's never had an issue with like seasonal change, for instance, may start to develop an allergy to it.

So, ultimately, there's different types of reactions that you can have with allergies. The most common would be if you come in contact with it, you release the histamine, you release the different chemicals that causes the runny nose, the itchy eyes, all the way down the line.

Scott Webb: Yeah. It does seem like sort of once you've been exposed to something maybe that you weren't allergic to before, or you just having sort of an adverse or an unusual reaction to, it seems like then the next time your body goes, "Oh, right. I didn't like this last time. And so I'm really going to emphasize the point this time. Let's not do this. Let's not eat that. Let's not get bitten by that bug again."

Dr. Devin Wheeler: But it can go off the rails essentially, right? Because part of a normal reaction, you want your body to be able to do that. So if you come in contact with like a foreign invader, like a virus or bacteria, then you mean you want your immune system to respond to it? I mean, the problem with allergies though, is that it reacts to that allergen and causes that allergic reaction. And oftentimes, it can be to your own detriment, obviously, right? Well, I guess with all allergies, to your detriment, but for something like a nut allergy for instance, obviously it has huge reaction to the substance that normally would be innocuous, right? It would not cause you any harm, but your body's causing this reaction.

Scott Webb: As you say, we want our body to give us that reaction, because we need to know. And unfortunately, I think for a lot of folks, especially maybe even children, they can have these emergency sort of reactions, right? These emergency sort of allergic reactions. The consequences can be dire, right? So what's your best advice then? If you're not sure if you're allergic to something, if you haven't eaten something before, like how can we sort of prepare for the reactions?

Dr. Devin Wheeler: Certainly, use caution. In terms of allergies, there's different severity. So the normal seasonal allergies or the allergies that you're talking about with the cat, I mean, the majority of the time, mild symptoms, but allergies go all the way from mild to severe to where you have narrowing of your airways, your blood pressure drops, up to like an anaphylactic reaction, right? So that's an emergency and needs immediate care in an emergency department if that happens.

So for instance, a lot of people have allergies to bee stings, right? They're obviously difficult the first time you come in contact with it. But once you know that you have that reaction, then something like an EpiPen, there's different measures that you can take to prevent it, but also to be ready as much as you can if you do come in contact with whatever the offending agent is, so that way we don't have such a severe reaction.

Scott Webb: I wanted to ask you, as we get close to wrapping up here, about OTC medications. you know, I I've gone down the aisle. My wife has said, "Get me some Zyrtec" or something like that. And I've stood there in the aisle, you know, at the drug store, at the grocery store. And my head starts to spin. There's just so much stuff there. There's just so many options, and 12-hour, 24-hour, drowsy, non-drowsy all this stuff. What are your thoughts about OTC medications? Are they safe? Should we speak with a provider before we sort of self-medicate, if you will?

Dr. Devin Wheeler: The majority of the medications that we had talked about, the intranasal steroids, oral antihistamines, for most patients, they're relatively safe and they can be taken long-term if needed. Obviously, no medication is without risk, right? These medications are not an exception. And so for instance, some of the older antihistamines and they can be more sedating, can cause drowsiness. The newer ones, less drowsy, but certainly you want to be careful. You take those and then go operate or go drive a car, that can be a problem. And then sometimes people use like decongestants when they get more sinus pressure, sinus congestion. But some of those, you don't wanna take if you have high blood pressure. They can raise your blood pressure.

So for the most part they're safe for most patients. But again, I mean, if there's any question or concern in regards to treatment of allergies or taking over-the-counter medications, obviously, we would encourage patients to talk to their PCP for sure.

Scott Webb: Yeah, it just seems like a good practice, especially if you know you have high blood pressure or low blood pressure or anything that could be affected by these medications.

Dr. Devin Wheeler: Yeah.

Scott Webb: As you say, they're safe for most people. But when in doubt, always speak with your PCP. This has been educational and fun today, good conversation. As we wrap up, when it comes to living and dealing with allergies, what's your best advice?

Dr. Devin Wheeler: So for one, identifying what's causing the problem, right? So sometimes you have these symptoms and it's almost like being a detective trying to figure out what allergen or offending agent is causing the problem. So, that's step one. And like we've talked about, trying to mitigate that risk, right? So avoid the allergen, if possible. And then, ultimately, if not then, there's different over-the-counter treatments. There's different treatments that we can discuss in office. And ultimately, I mean, allergy shots, right? Seeing an allergist. For some people that have pretty significant allergies and haven't found relief elsewhere, obviously that can be life-changing. Based on national data, more than two in 10 patients, so 20% of patients in the US will have the diagnosis of allergies to the point to where it's affecting their quality of life, daily performance, productivity. So, a lot of people deal with allergy symptoms and oftentimes you meet patients to where they just been dealing with it for years. There's obviously ways to help with allergies without using medications. But certainly, that's always a discussion we can have, talking to your primary doctor, so that way we can improve quality of life and productivity.

Scott Webb: That's perfect. It does seem like most of the folks that I know that suffer from allergies, they just seem miserable. And a lot of trial and error with OTCs and, as you say, it affects their quality of life, and it doesn't have to be that way. So we want folks to reach out to folks like yourself, to, you know, primary care providers, to be referred to allergists if they need to get that far and just know, as you've said here today, that there's a lot that can be done. They don't have to be miserable. They just need to reach out, right?

Dr. Devin Wheeler: Absolutely. Absolutely.

Scott Webb: Well, that's awesome. Well, doctor, thanks so much for your time today and you stay well.

Dr. Devin Wheeler: Yeah. You as well. I appreciate it.

Scott Webb: And for more information, visit genesishcs.org. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.