Melanie Cole, MS (Host): Let's talk about allergies. What causes them, how to manage them, identifying those triggers and when it's time to seek professional help. Whether you're struggling with seasonal allergies or allergies to food, we are here to offer tips to help you breathe easier and stay healthy year round. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and joining me today as always is Dr. Anirudh Rai, fan favorite. He is a primary care physician at Henry Mayo Newhall Primary Care.

Dr. Rai, always a pleasure to have you with us. So I'd like you to start by kind of identifying, we hear the word allergy, but that's really a pretty broad umbrella, right? So tell us a little bit about what we're talking about when we think of seasonal, environmental and allergies to food because they're all different.

Anirudh Rai, MD: Absolutely. That allergy itself is a very vast topic, and to give a better idea of allergy, I think it's good to delve a little bit into the boring parts of it, which is how it happens. So usually with allergies, we found out, at least from our research for now, there are at least five different types of what they call allergies.

Best way to describe it is actually hypersensitivity. That's usually the term that we use in medicine to describe any kind of reaction like this. And there's been known to have at least four different types of hypersensitivity, the ones you're referring to with food, with seasonal allergies, can be classified as what we call hypersensitivity type one, and usually with that involves certain types of cells.

These cells are called mast cells, which in their cell bodies have a lot of what they call antigens or, and things like histamine, things that are responsible for the reaction you get. For example, with an allergy, if something rubs against your skin; your skin has cells that react to certain what they call antigens, meaning certain parts of whatever that particulate is, whether it's pollen, whether it's dander, whether it's dust; your skin sees that, it grabs onto it, and it kind of questions what it does with it. For type one hypersensitivity in which you get these seasonal allergies, where you get runny nose, where you get congestion, a similar reaction happens. You breathe through your nose, you breathe through your mouth. So anytime allergens or dust get in there, your body has a chance to see it. And when it sees it, when it comes to hypersensitivity type one, it reacts to it in a certain way. It connects to these cells, mast cells and basophils, which are types of cells that react to these kind of allergies and lead to these kind of reaction, which are gonna be, you have sneezing, you have coughing, you have stuffy nose, all the classical signs of what they call seasonal allergies, and these are very common.

And the idea is your body gets attuned and introduced to these antigens, which are by nature inert, meaning they cause no damage, but your body sees it and reacts to it. So eventually down the ri down the line, everyone's gonna have some form of what they call hypersensitivity one or allergies. The most common one we talked about is going to be milk allergy.

So lactose intolerance and the theory behind that is pretty interesting actually. So when you're young and you're a baby, you're, you need the lactose as a enzyme to break down the milk so you could digest it. But as you get older, your body actually learns to say, you know what? I don't think I need the milk anymore.

And eventually down the line, most people do get some form of lactose intolerance, which in a sense is a type of hypersensitivity where your body sees it, says, Hey, this is not good for me. And you get the reactions like diarrhea. So when it comes to the term allergies, it's quite broad. And food allergies also run in that, sort of same category where your body sees a certain component of the food. Reacts to it and then has this reaction. For our nose, it's going to be this congestion. And when you eat foods, it's going to be diarrhea, bloating, gas, and these are what we call type one hypersensitivity for the most part. And also it could be linked to, particularly in the food, well, something called irritable bowel.

So allergies are a pretty vast topic and we're just touching upon one part of it to be honest.

Host: So I have a question, Dr. Rai, that is bigger than either of us podcasters here, but I really want to know what you think about this. Are you seeing more allergies than we used to? And are we sort of over sanitizing? Because there's a lot of theories about gut microbiome, allergies, certain autoimmune diseases that are cropping up a little bit more.

And we kind of sometimes put those two together. And I mean, do you personally, and this is your opinion, I'm asking here, because you are an expert. Do you think that we are seeing more of them and do you have any theories on that we're keeping our kids cleaner and safer, but yet are we losing a little bit of immune function doing that?

Anirudh Rai, MD: A great question and yes, that is, there's a theory behind it. For me personally, again, this is an opinion. I am seeing more allergies, I'll be honest with you. And, that is part of the course of, of life in general. When your body sees a certain antigen or a certain pollen or dust or dander, your body will eventually get some form of reaction to it.

Whether it's something where it's big enough where you go to a doctor or start taking allergy pills. That may be part of the course. But that interesting point you bought out is this sort of hygiene theory of allergies. I have read a couple papers where they mentioned that with kids if you have introduction, they're pretty dirty in general, but the idea is to promote that so that their body gets introduced to these allergens and forms, what they call sensitization, meaning your body sees it, but doesn't react the same way as you do with allergies.

And so there's some theories about saying, you know, we're maybe too clean as a society, and that's why we're having these reactions when we're older. But it's hard to say. I mean, I, am kind of in the,

Melanie Cole, MS (Host): let's talk about allergies. What causes them, how to manage them,

identifying those triggers and when it's time to seek professional help.

Whether you're struggling with seasonal allergies or allergies to food, we are here to offer tips to help you breathe easier and stay healthy year round. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and joining me today as always is Dr. Anirudh Rai, fan favorite. He is a primary care physician at Henry Mayo Newhall Primary Care.

Dr. Rai, always a pleasure to have you with us. So I'd like you to start by kind of identifying, we hear the word allergy, but that's really a pretty broad umbrella, right? So tell us a little bit about what we're talking about when we think of seasonal. Environmental and allergies to food because they're all different.

Anirudh Rai, MD: Absolutely. That allergy itself is a very vast topic, and to give a better idea of allergy, I think it's good to delve a little bit into the, the boring parts of it, which is how it happens. So usually with allergies, we found out, at least from our research for now, there are at least five different types of what they call allergies.

Best way to describe it is actually hypersensitivity. That's usually the term that we use in medicine to describe any kind of reaction like this. And there's been known to have at least four different types of hypersensitivity, the ones you're referring to with food, with seasonal allergies.

can be classified as what we call hypersensitivity type one, and usually with that involves certain types of cells.

These cells are called mast cells, which

in their cell bodies have a lot of what they call antigens or, and things like histamine, things that are responsible for the reaction you get. For example, with an allergy, if something rubs a,

against your skin. Your skin has cells that react to certain what they call antigens, meaning certain parts of whatever that,

uh, particulate is, whether it's pollen, whether it's dander whether it's dust your skin sees that it grabs onto it, and,

and it

kind of questions what it does with it for type one hypersensitivity in which you get these seasonal allergies, where you get runny nose, where you get congestion.

A similar reaction happens. You breathe through your nose, you breathe through your mouth. So anytime allergens or dust get in there, your body has a chance to see it. And when it sees it, when it comes to hypersensitivity type one, it reacts to it in a certain way. It. Connects to these cells, mast cells and basophils, which are types of cells that react to these kind of allergies and lead to these kind of reaction, which are gonna be, you have sneezing, you have coughing, uh, you have stuffy nose, all the classical signs of what they call seasonal allergies, and these are very common.

And the idea is your body gets attuned and introduced to these antigens, which are by nature inert meaning they cause no damage, but your body sees it and reacts to it. So eventually down the ri down the line, everyone's gonna have some form of what they call hypersensitivity one or allergies. The most common one we talked about is, uh, going to be milk allergy.

So lactose intolerance and the theory behind that is pretty interesting actually. So when you're young and you're a baby, you're, you need the lactose as a. Enzyme to break down the milk so you could digest it. But as you get older, your body actually learns to say, you know what? I don't think I need the milk anymore.

And eventually down the line, most people do get some form of lactose intolerance, which in a sense is a type of hypersensitivity where your body sees it, says, Hey, this is not good for me. And you get the reactions like diarrhea. So when it comes to the term allergies, it's quite broad. And food allergies also run in that, in that sort of same category where your body sees a certain component of the food.

Reacts to it and then has this reaction. For our nose, it's going to be this congestion. And when you eat foods, it's going to be diarrhea, bloating, gas, and, and these are what we call type one hypersensitivity for the most part. And also it could be linked to, particularly in the food, well, something called irritable bowel.

So allergies are a pretty vast topic and we're just touching upon one part of it to be honest.

Host: So I have a question, Dr. Rai, that is bigger than either of us podcasters here, but I really want to know what you think about this.

Are you seeing more allergies than we used to? And are we sort of over sanitizing? Because there's a lot of theories about. Gut microbiome allergies, certain autoimmune diseases that are cropping up a little bit more.

And we kind of sometimes put those two together. And I mean, do you personally, and this is your opinion, I'm asking here, because you are an expert.

Do you think that we are seeing more of them and do you have any theories on that? We're keeping our kids cleaner and safer, but yet are we losing a little bit of immune function doing that?

Anirudh Rai, MD: A great question and yes, that is, there's a theory behind it. For me personally, again, this is an opinion. I am seeing more allergies, I'll be honest with you. And, and that is part of the, the course of, of life in general. When your body sees a certain antigen or a certain pollen or dust or dander, your body will eventually get some form of reaction to it.

Whether it's something where it's big enough where you go to a doctor or start taking allergy pills. Um, that may be part of the course. But that interesting point you bought out is this sort of, uh, hygiene theory of allergies. Um, I, I have read a couple papers where they mentioned that. With kids if you have introduction, they're pretty dirty in general, but the idea is to promote that so that their body gets introduced to these allergens and forms, what they call sensitization, meaning your body sees it, but doesn't react the same way as you do with allergies.

And so there's some theories about saying, you know, we're maybe too clean as a society, and that's why we're having these reactions when we're older.

But it's hard to say. I mean, I, I am kind of in the, in the, uh, the ballpark. I think most people are that, yes, I think it is, the hygiene theory is part of the course where if you're living in a society that's way too clean, you're gonna get more of these allergies that come up later in the future.

And part of the reason for that is a lot of pediatricians that have done a couple of studies on, on peanut allergies, there's the most common ones that people sometimes can get. And there have been some studies that said that, say that if you, introduce small bad bits of peanut butter to a child, eventually they'll be okay with getting peanuts in the future. So it's a good way to kind of introduce your body to it. But I am seeing more of these seasonal allergies, a lot of, what they call GI allergies or intolerances as well with foods. So it's something I'm seeing a rise of, whether it's due to this hygiene theory hypothesis, it hard to say, but I do think that is playing a role in it personally. I'll be honest.

Host: Well, I mean, I agree with you and we're going to touch on the food allergies and some of those, where you try just a little bit. But before we do, when you talk about allergies, we have children's allergies, we have adults allergies, and we don't typically think of adults as coming up with new allergies like seafood.

And I've known a few people personally that have like all of a sudden they eat shrimp and they're in their like forties and they break out in some kind of hives or tomatoes or any of these kind of things. It's like, whoa, what just happened there? So what's the difference when we think of our childhood allergies and which some of which can be severe?

You mentioned. Peanut and wheat is another one. But then there are those environmental that we talked about. Tell us a little bit when you see whether it's children or adults, the types of allergies, the most common that you see.

Anirudh Rai, MD: That's a good question. So allergies by itself, when it comes to those particular type of allergies, which I would categorize as type one, allergies or hypersensitivity, they're in a, pretty much in a spectrum where you can have simple, a simple reactions such as, you know, mild rash or even a cough and a stuffy nose to all the way to the other spectrum, which is what we call anaphylaxis, meaning your body just goes into shock about when they're introduced with certain things.

And seafood is a common or one of the more ones we're aware of that can cause some of these allergies to be propagated. And the whole idea is with childhood allergies, your body is, the immune system is new, so it is still developing. So it is to a point where, I would say everything that your body as a kid or as a baby, everything in the environment tends to have some reaction one, one way or another, but it's a matter of how your body takes into it, for example.

Peanut allergies, a child might not get when they get a little bit older, when their immune system has gotten a bit more matured. So childhood allergies do differ in that sense, where your immune system is a bit more naive, but when you get older, your immune system becomes a bit more matured. So it tends to have a more thorough reaction.

But the idea is pretty much the same, where you have a certain antigen, a component that normally your body doesn't even know it's there. It reacts to a certain component in your immune system. And you actually have this reaction. So immune reactions work similarly as a child versus as an adult. The whole introduction to that is how your immune system is when it comes to its maturity.

And as a child, it's very immature, so the reactions may not be as severe, and sometimes if it is, it tends to be very severe. So it can be in both spectrums there. But as you get older, pe I have a lot of patients who say, Hey, I was never allergic to X, Y, and Z. I mean, they're like. Food is one of them, the shrimp, and all of a sudden I'm getting these allergies to it.

I'm like, it is pretty common. Allergies tend to be introduced more later in the future, and that's the whole idea of this exposure to this antigen and this constant exposure will eventually get your body to have this reaction. You may not have that once you know one your body sees it, it grabs a hold of it and says, okay, it's nothing.

You might have a little bit of a reaction. The best way to describe it is when you have this interaction, your body takes into it via T-cell. So your cells see them grab it, goes to your immune system and says, Hey, is this something to worry about? The immune system says, I'm not sure, but it produces antibodies.

You get more of these IgEs, which are another form of immunoglobulins, which propagate a lot of these allergies and you have a lot of mast cells, because of what your body sees. You may not have enough to form a reaction yet, but these reactions get more and more where to a point where eventually you start getting these, these rashes, these sort of weels they call them. So this reaction is pretty normal from childhood to adult. It's just the maturity of the immune system that kind of propagates it. And the worst case scenario would be anaphylaxis where your throat closes up. And that's just the extreme form of this type one hypersensitivity.

Thankfully we have medications for that, but allergies in itself is, I would say something that everyone in life will eventually get some exposure to. I'll be honest with you.

Host: That was an excellent explanation, Dr. Rai. So when we think of triggers, because that's so important to understand the triggers when we're talking about managing allergies, whether it's for our little kiddos or for ourselves as adults, identifying those triggers. So tell us a little bit about symptoms, things that we need to watch out for those early symptoms, those red flags, and then realizing, oh, I'm dusting the house and this stuff is starting to get to me. Well, that's just dust, right? That doesn't mean it's an allergy, but you step outside, the cottonwood's everywhere and you go, oh. Identifying those triggers is what can help to manage those symptoms, right?

Anirudh Rai, MD: Absolutely. Absolutely. And some of the more common symptoms of season allergies include things like a stuffy nose, maybe itchy eyes, watery eyes, and that's just a natural way that your body's seen that so. Anytime you're in the environment, like the pollen, the dust, dander, that gets introduced into your nose, into your throat, and even into your eyes because they are open and they have the same sort of function where you, they see something, they react a certain way.

Some of the symptoms, the most common ones that you see for the face, there's going to be stuffy nose, a runny nose. Sometimes you have clear mucus coming out. And that would be another cause of it. Itchy eyes, heavy eyelids. Sometimes, swelling in those regions that can be a bit more difficult to look at times.

A lot of those symptoms we do see with these seasonal allergies. The other ones to kind of watch out for are things of the skin. Sometimes you get these, what they call weels or, the medical term would be urticaria, which is essentially itchy skin for some reason. And that can be due to to allergies as well.

And, the environment is a great way for that to be propagated to into anyone, honestly. But the main thing to watch out for, honestly, is if it gets to a point where it happens very frequently, it causes your quality of life to decrease. You can't sleep, I'll take it to your doctor.

Thankfully, there are great medications out there, over-the-counter medications for allergies is a good place to start. They're safe enough to use and it's a good way to kind of see how your body has seen them. Thankfully, there are medications that we can prescribe as doctors to see if we could get a better response. But I would say the best thing to do for any patient is understand when these occur, and a bit be a bit more cautious if you eat certain foods, see if you're having a certain reaction. Honestly, a process of elimination is the best way to see if that trigger is there or not. It's hard to do that in the environment, but ideally, I would say just practicing a bit of caution in that scenario.

Host: I'd like to touch on something you just mentioned, the over-the-counter. Because there's so many, you could stand in front of that allergy aisle, and now they put a lot of those in back of the pharmacist. So the pseuephedrine and all those kinds of things you have to ask for. I know even my kids are like, oh, I'm going to go take a Claritin because my allergies are bad.

I'm like, I don't know, is that allergies or is it just sort of a, stuffy nose or is it just that it's really humid outside and there's things floating around, they take them. People really do take a lot of these. Are they okay then when we think of Claritin, Zyrtec, there's so many, dr. Rai, what do we make of all of these over-the-counter allergy medications?

Anirudh Rai, MD: That's a good question. To kinda step back a little bit, the most common actually cause of allergy, like you mentioned, are actually are cat dander and dog dander. There's going to be the most common ones. And more often than not, I get complaints about patients saying, Hey, I've never been allergic to my pets before, and all of a sudden I am.

And that is a normal response. So usually pets tend to be pretty key component of getting these allergic components. As well as the environment. But when it comes to medications, those over-the-counter medications, Zyrtec, Claritin, Allegra, they're generally very safe for anyone to use.

Generally for a pediatric sort of scenario, I would say talk to your doctor just because they have to be dosed very specifically, but generally they're pretty safe enough to try. I always tell my patients, you know, whatever you get a hold of, they tend to be okay to try. And if it is something that you have a question about, definitely talk to your doctor to see if there's maybe something a bit stronger or if you're having certain reaction to these allergy medications.

They're generally pretty safe enough to use. I haven't had anyone with a bad reaction to it. But you did mention this overlap. Yeah. Usually with these symptoms, it's hard to say whether you're having, a little bit of a viral illness or is it allergies? And you're right, it, it is difficult because there's a lot of overlap with that.

We always try as physicians to kind of use physical exams and maybe even a history to kind of say, okay, is it allergies or is it an infection? I always try to tend to be a bit more cautious, just depending on the season. You know, if there's certain symptoms, like fever and I'm like, okay, it's likely an infection, but that doesn't mean you don't have allergies.

So it's always important to, to be cautious, be aware of what environment you're living in. Like for here in Santa Clarita it's, very easy to have that overlap. Tons of pollen, wind, it is very easy to get allergies on top of an infection. So as, a provider, as a physician, it's important to be aware of that.

But as a patient, it's always important to, to honestly go to your doctor and be like, Hey, is this an infection or is this allergies? It's good to be more aware of that in general, I think.

Host: Really important information when we talk about managing your allergies at home and when it's really time to see that professional. And before we wrap up, I want to touch on that exposure therapy that you mentioned briefly. And this is really. I mean, I don't know that it's new per se, but it's been kind of gone like this a little bit.

But for wheat, for peanut, for egg, for seafood, you know, they're doing this a little bit. Tell us a little bit about what this is and how parents, if their doctor recommends, let's try this. How not to be like sort of terrified, oh, you're going to do that, really. But it's also terrifying for parents of kids who have these really severe food allergies to send them to school or camp or anything, terrified that they're going to end up in anaphylaxis, like you say.

So just touch on that a little bit before we wrap up and then I get to ask you your best advice.

Anirudh Rai, MD: That is a great question. Anaphylaxis, typically, you're right, is is the worst case scenario and oddly enough, I'll be honest with you, it's very hard to even prepare for that. Usually patients do well and this anaphylaxis comes pretty much out of the blue.

Sometimes we could talk about it in the history of saying, Hey, as a child, did you have any reaction to certain things? Is there a family history of anaphylaxis? It is something, I'll be honest with you, that, that we're still learning more about. As for exposure therapy, yeah. I've heard some of these, studies that say, yeah, exposure therapy could help desensitize a lot of your immune system.

It's hard to say. I'll be honest. The ones they tested on are basically the penicillin is the most common one they tested on. Especially with these drug allergies, drug allergies is a little bit more different. Drug allergies are more, I would say, type, two or three. So they're different type of allergies, but exposure therapy nonetheless has been studied on that, saying, if you give a little bit of this antigen, introduce that the system, your body will eventually recognize it enough to not have that reaction.

It is hard to say, but food allergies, sensitization, especially with peanuts, yes. That's been studied, I say, as a child given a little bit, has been shown to, to decrease peanut allergies in the future. But it's hard to say whether that constitutes for us parents to introduce a bunch of stuff to kids and then get them all hyped up on different things. It's hard to say, but, the best thing to do, honestly, is to see what they could tolerate. If they could take the side effects of certain food groups, like for instance, the diarrhea and the bloating with like milk and gluten, I would say just take it with maybe a little bit of grain of salt saying, go little by little and if they can't tolerate, don't force it on them.

Honestly, it is a pretty much something that we base it on the patient's reaction to. Anaphylaxis, it's a bit more severe. Usually we would want to be a bit more aware of that. And there's other telltale signs that give us clues that it is something that relate to anaphylaxis. Things like your throat closing, reaction to certain things being a bit more severe, itchiness, tongue swelling.

These are all signs that point us toward, hey, this is a bit of a severe reaction, and when that happens, we as physicians will prescribe epinephrine, which is extremely effective, works really well, saves a ton of lives, and thankfully there's good treatment for it. And so anaphylaxis is a bit more complex, I would say, as parents, just be cautious about how your child behaves and what they complain about when eating certain foods. Sensitization is okay to try, but it would be based on if the child or if the adult can tolerate those symptoms. But nonetheless, take it at your own pace. There are allergy pills to help decrease a lot of these symptoms. For instance, with milk, there's lactase, you get over the counter, to help dissolve some of the lactose so your body could still eat or drink milk. So it is something that we have found ways around, but it's going to be based on what the patient can handle and it's based on what your physician also kind of agrees on with for the therapy.

Host: Yeah, EpiPen's, what a medical innovation that was. Like you say, it's just saved so many lives and you've given us a lot of information here today. So you know, I always like to ask you to wrap it up and summarize for us your best advice for either preventing flareups or really identifying those triggers, whether it's seasonal, environmental, pets and dander like you said, or something else, or even food.

So just give us your best advice as the great physician that you are about identifying those allergies and kind of keeping them in check a little bit.

Anirudh Rai, MD: Absolutely. So in summary, I mean like taxes, allergies are imminent, so it is something that everyone's going to eventually have to, to pay up in a sense. The best thing to do is to be aware of it. Be aware of certain reactions, be of certain foods that cause it. Be aware of certain environments. For instance, smokey, or if it's a seasonal thing, definitely just be cautious about it.

When that happens, talk to your doctor or start taking allergy pills once a day. See if you get a better reaction to it. For the severe cases of anaphylaxis, just be cautious about the side effects of swollen tongue, swollen lips. You feel like your throat is closing, that your doctor know right away.

EpiPen has saved many lives, and it's something that we could prescribe as doctors to save anyone who has those reactions. Allergies are a natural in everyone's life, so it is something to be cautious about with pets. Eventually everyone will get some form of allergies to it. There's eventually no way around it.

Everyone loves their pets, loves their cats and animals, but ideally, allergies is a small price to pay, but it is some price everyone will eventually pay. Nonetheless, allergies is treatable. It is something that we as physicians see all the time, and the overlap between that and infections can be a bit tricky.

But go to your doctor if you have any questions about your allergies, about your infections, about any exposures, and they can kind of guide you through. Honestly, just simple elimination therapy can be all you need. Stop taking certain things, avoid certain things, and see how your body reacts. Your doctor is there to help you to kind of guide you through it, and if there's any sort of problems, definitely go to your primary care.

They could easily help you along the way.

Host: Great advice. It really is great advice, and you're just such a great guest as always. Thank you so much Dr. Rai for joining us today and always sharing your incredible expertise with us. And please visit our website@henrymayo.com/medicalservices/primarycare for more information or to get connected with one of our providers like Dr. Rai. You can also visit the free health information library@library.henrymayo.com because there's a lot of really great information there. You've been listening to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.