Ashlee Williams, MD: If you're one of the millions who suffer from seasonal allergies, you know how frustrating and uncomfortable they can be. But what's really happening in your body when those symptoms hit? And more importantly, what can you do to keep them under control? Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm joined by Dr. Troy Baker, a Board Certified Allergist with Kaiser Permanente. Together, we'll break down the science behind seasonal allergies, discuss the most effective ways to manage symptoms, and explore the latest advancements in treatment. Dr. Baker, thanks so much for joining us today.

Troy Baker, DO: Thank you, Dr. Williams for having me. I'm glad to be here.

Host: Okay, Dr. Baker, seasonal allergies impact millions of people, but what exactly triggers them?

Troy Baker, DO: You're right. Allergies are a big deal and they affect about 25% of all adults. So as you can imagine, that's a lot of tissues. So, we ask the question, why do I get allergies? Allergies are an immune response to a trigger. So basically in the case of pollen, the immune system sees the pollen as an enemy, and it starts to develop antibodies against the pollen.

And when that pollen comes in through your nose or through your mouth or at your eyes, it has those antibodies connect with an allergy cell and that allergy cell will then release a bunch of histamine. The release of histamine from the allergy cell is what makes you feel so bad. That histamine is going to cause you to get congested, sneeze, itchy and watery your eyes, and it'll just make your nose start to run.

We don't know why exactly people get allergies, but we do know that your family genetics and the type of environment you grow up in, will play a role on whether you get allergies or not. So individuals who grow up from birth with a pet in their home, will be generally better off than someone who doesn't see pets from birth.

People who grow up on farming communities are generally better off than people who grow, grow up in a city. So there are a lot of environmental and genetic triggers that we're still trying to discover of what causes people to get allergies.

Host: Right. I do notice that our family starts going through a lot more tissue during allergy season. Can you talk about what symptoms people have when they start having allergies?

Troy Baker, DO: Some people want to know, am I sick or am I just getting allergies? The common allergy symptoms that people will experience is runny nose, itchy, watery eyes, sneezing, congestion. It can cause them to cough, it can cause asthma symptoms to flare up. Those are common allergy symptoms that can happen during the right allergy season. I often get the question, well, am I sick? Do I have a virus or do I have allergies? The patients are correct to think that there's a lot of overlap between the symptoms of allergies and the symptoms of being sick. But there are some key differentiators that I ask my patients to look out for.

So anytime you get a fever, you have muscle aches; that's generally pointing towards a virus causing the problem, not an allergy. Sure that there is runny nose, congestion, and cough that overlap between allergies and sicknesses, but fevers and body aches generally do not happen with allergies. Often, sometimes even the color of your mucus can start to point towards infection.

Allergies usually have clear drainage, but infection usually points towards, um, greenish mucus, that type of thing is more in line with an, with a infection instead of an allergy.

Host: I agree. It is a little tricky because a lot of the symptoms do overlap. So what advice do you give your patients to prepare for allergy season and minimize their exposure once it starts?

Troy Baker, DO: Yeah, that's a great question. I usually will talk to them about starting earlier. Usually allergy season is going to start around Valentine's Day each year. So right when it starts to get warm and that spring is starting to try to come out, some of the trees will start to wake up and pollinate.

So if you keep in your mind, generally the pollen season is from Valentine's Day through October 1st, and then set your medication plan about two weeks ahead of that, you're generally going to be well protected. So I will tell my patients to monitor pollen counts using their favorite kind of pollen apps, start medications early, usually around February 1st, and continue that through when they know their peak pollen season is over. Now, if you have pollen allergy, it's important to recognize that pollen is very sticky. So when you go outdoors and you're walking around, that pollen starts to stick to all your clothes.

It sticks to your hair, and then when you come back inside your house and, and you're sitting down and you're on your furniture or laying down on your bed, you're going to start to transfer the pollen from your body onto your furniture and your bed. So coming home, it's sometimes really good to change your clothes, take a shower to wash all the pollen off your body.

Also, when you have to be outdoors working, wearing glasses, like protective like sunglasses or even wearing a mask, if you're doing yard work and you're susceptible to pollen allergy. Those kind of things will help create a barrier from the pollen getting into your nose, your mouth, and your eyes. The last thing I would say just briefly is using saline as well, just to kind of rinse out the pollen out of your nose, that's also helpful.

Ashlee Williams, MD: Wow. Allergy season starts pretty early. I mean, Valentine's Day, I think usually people think about like March when it starts getting warmer, but Valentine's Day is a pretty early time to start preparing. You touched on medications. Can you talk a little bit about what medications and treatments you recommend for allergy symptoms?

Troy Baker, DO: Sure. The goal always is to be on the least amount of medication as possible, but often I will see the more severe people as an allergist. And so typically my patients will be on as many as five medications at a time. So certainly, if you feel like you're managing it well with just one medication, that's where I would stay.

But if you need to go up, I'm going to go over some principles to consider. If you could only be on one medication, we generally believe that intranasal steroid sprays will be the most helpful to a patient. So the ones you might be familiar with that are over-the-counter are Nasacort, Flonase, Rhinocort.

Those are three that will often be really helpful and I would start those one spray in the morning, one spray at night. Now if you're going to be on two medications, usually an antihistamine nasal spray would be the second one I would have my patients on, and they can be safely used together with the nasal steroid spray. The one you might be familiar with, over-the-counter is called Astepro, and it's very effective.

So you could use the Flonase or the Nasocort together with the Astrepro twice a day. From there, I recommend my patients be on a long acting non-sedating antihistamine pill, which the ones that are we know best are Zyrtec, Claritin, and Allegra. So any of those would be fine. And taking that once a day will also help.

The final medication I kind of talk about with patients are eye drops. Often we don't use eye drops and we let our eyes suffer and just itch uncontrollably. It's especially bad in children. Using an eye drop such as a Pataday and Pataday just came out with 0.7% over-the-counter, which is the strongest one that, Pataday makes is really good.

It's one drop, once a day. It can be used in kids and adults. So those are kind of the, the main medication categories I talk to patients about.

Host: Yeah, I'm a big fan of the nasal sprays. I recommend them to my patients all the time and to help them remember taking them, I'll say, put it by your toothbrush, because it can be used twice a day or once a day. You can do the two sprays once a day or once spray twice a day. And brushing your teeth is something you usually always do.

So I tell them, put it by your toothbrush. Once you brush your teeth, do the nasal spray. It'll help you remember taking it because consistency really is the key.

Troy Baker, DO: That's fantastic. Yeah.

Host: Yeah, so there's different types of seasonal allergies, right? How do seasonal allergies differ between summer, fall, and spring?

Troy Baker, DO: Great. So the first thing that wakes up out hibernation are the trees. And so trees are always going to pollinate first and they're going to come out again, usually around Valentine's Day, the elm tree, the maple tree, cedar tree will wake up and start first, and then we're about to get into the oak and birch and beach tree season right around tax day.

So trees come first and they're going to peak, March and April are really big tree months. Following that, the grass is the next to emerge. So grass is typically going to come out at the end of April and May is the big grass month for people. My patients will definitely feel that if they have grass allergy when they're out.

People are cutting the grass and that grass pollen's flying through the air. May is particularly hard. Now there's always overlap going on, but generally grass is going to slow down around July and then the weeds start to come out. So weeds are going to come out the end of July and go through August, September.

Ragweed is the biggest one that probably affects most people in North America. And come October 1st, all the pollen will be out of the air. The other point that I make to patients is if you have a mold allergy, mold can be year round and so can things like dust mites, pet allergy, those are kind of things that can be affecting you year round as well.

Host: You've given lots of great tips of things we can do over-the-counter to treat our allergy symptoms. When should someone come and see an allergist?

Troy Baker, DO: I think if people just are curious to know whether they have allergies or not, they can ask their primary care doctor to order an allergy panel and if they feel like I don't want to take all these medications, I would like to go on something more effective, more long lasting; allergy shots are a great thing to consider.

So allergy shots, just to go over them briefly, is probably the most effective form of allergy treatment because it's actually going to change their patient's immune system, but it also requires a lot of effort. Patients, if they decide to do allergy shots, will be on a weekly injection for about six months.

Then after that six months of weekly shots, then they'll only need to come one time a month for about three to five years. After five years of completed allergy shots; you should expect to have a very long duration of benefit, where you don't need as much medication, and you feel pretty good during your pollen season, and that can often last several decades. About 20% of people who do allergy shots will eventually go back on them again, but 80% do not.

So allergy shots are a very attractive option if you don't like to take a lot of medications or you just are kind of just fed up with suffering and you like to be outdoors and would like something better. Allergy shots would be a wonderful thing that an allergist could offer to our patients.

So, when to see an allergist. One if you are interested in allergy shots. Two, if you've tried all the tricks and you just still aren't quite feeling good enough, well enough to do the things you like to do; seeing an allergist is always a good idea.

Host: Great. Dr. Baker, thank you for sharing such valuable insights. We've learned a lot about seasonal allergies and how to manage them. Here are the top takeaways. One, seasonal allergies occur when the immune system overacts to airborne allergens like pollen. Two, common symptoms include sneezing, congestion, itchy eyes, and post nasal drip. Monitoring pollen counts and limiting exposure can help. Three, treatment options range from over the counter antihistamines and nasal sprays to immunotherapy for more severe cases. No matter what you choose, consistency is key. Four, allergy triggers vary by season with pollen from trees in the spring, grasses in the summer, and weeds in the fall, and five, if medications don't provide relief or you experience breathing issues, an allergist can help pinpoint your triggers and may recommend allergy shots, which take time, but can be highly effective.

For more information, from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to subscribe and share it with others who may find it helpful. Thank you, and from all of us at Kaiser Permanente, be well.