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Maggie McKay (Host): Spring is such a pretty time of year. The flowers are blooming, the grass is green, but with that, the sneezing and wheezing, coughing and itchy eyes can also resurface. Yes, it's that time of year again for seasonal allergies. So, today we'll find out how to identify, treat, and possibly prevent the symptoms. Welcome to Flourish, a podcast brought to you by PRISMA Health. Thanks for joining us. I'm Maggie McKay. Joining us today are Dr. David Amrol, an Allergy and Immunology Physician with PRISMA Health PRISMA Allergy Asthma and Immunology in Columbia, South Carolina and Grayson Ford., A Physician Assistant also with PRISMA Health PRISMA Allergy Asthma and Immunology in Columbia, South Carolina. Thank you both for being here today. We appreciate your time.

David Amrol, MD (Guest): Thank you for having us.

Grayson Ford, PA (Guest): Yeah. Thank you.

Host: Let's start with you, Dr. Amrol. Can you develop seasonal allergies as you age? And can they go away?

Dr. Amrol: You can. So most people who develop seasonal allergies or allergic rhinitis, they're going to be atopic people, meaning they have a genetic predisposition to be allergic. And so most of the time it's going to start after the age of one or two, but then before you're really thirties or forties. So, most people between the age of three and your twenties you'll develop allergic rhinitis.

But certainly some people we do see with no previous history can develop it in their forties or fifties or even later. But most of the time it'll be a little bit earlier.

Host: And Grayson, how can you tell if your child, for example, has seasonal allergies?

Grayson: There are definitely some classic symptoms that you see with the seasonal allergies, itchy eyes for one, runny nose, congestion, sneezing, postnasal drip, those things, especially if they go on for a long period of time can kind of indicate that seasonal allergies may be the problem.

Host: Dr. Amrol, what's the best way to manage seasonal allergies in children and adults?

Dr. Amrol: So the best medicines we have now are nasal sprays. And several of these you can get over the counter. And most people who they have a very classic history of allergic rhinitis, or we confirm it with testing, will start with a nasal steroid spray. An example over the counter would be Flonase or nasal fluticasone.

And for children who are two and up, we oftentimes do one spray per nostril. And then in older children and adults, we can do two sprays per nostril. And then also you can do oral anti-histamines like cetirizine or Zyrtec. And for children, we usually do, over two five milligrams. And then for adults, 10 milligrams, you can also do Loratadine or Claritin, fexofenadine or Allegra.

And these are all the non-sedating antihistamines. You want to avoid the more sedating antihistamines like Benadryl, if you can.

Host: Okay. And, What about saline? Does that work Doctor?

Dr. Amrol: Yeah, I do like saline rinses. So the best evidence we have that saline rinses work well or with chronic sinusitis. So for all my patients who have chronic sinusitis, especially with polyps, I recommend doing saline rinses either with a Neti pot or something called a Neilmed sinus rinse.

We don't have as much evidence for allergic rhinitis, but certainly I do use it frequently and we think it's relatively harmless and it can be pretty beneficial for some people by washing away the allergens and irritants, moisturizing the nose, and also washing away some of the mucus.

But we do recommend using either preboiled or distilled water, because rarely there can be things such as amoeba or other organisms in tap water that could cause a severe infection.

Host: And Grayson, Dr. Amrol mentioned Neti pots. What are they? And are they effective?

Grayson: Neti pots can be very effective. So basically, it's a rinse with kind of a salt water type solution that you put in your nasal passages. And it can help clear out, like he said, some of the mucus in your nose, and some of the irritants and allergens as well, that can cause some allergic rhinitis symptoms.

Host: Dr. Amrol do filtration systems work, how much dust and dander is too much?

Dr. Amrol: It's a complicated question because some of our allergens like dust mites tend to be more settled into the carpet and the pillows and the bedding and is not airborne very long. So usually an airborne filtration system doesn't do a whole lot for dust mites, except when you're vacuuming or cleaning, there will be some airborne levels for about 30 to 60 minutes. Now they can help for pollen. So I do recommend keeping the windows closed and using the air conditioning during the pollen season, during the spring and the fall, and an indoor HEPA filter or a high efficiency particulate filter can help. It's controversial, whether they do help for animals, it seems they may help some people, but by far the best treatment for allergic rhinitis to a pet is pet avoidance, but not always feasible or practical since pets are frequently members of the family. And they're hard to put outside or re home. So I would say they're, they're, they're moderately effective, but I don't tell patients to spend a whole lot of money on these air filters. And I usually do not recommend cleaning the air ducks or these other costly things, which have probably marginal benefit.

Host: So Grayson, when should you consider allergy testing?

Grayson: I think you should consider allergy testing whenever you're having those classic symptoms, runny nose, congestion, itchy eyes that are interfering with your life. The allergy testing can be especially beneficial because it helps you identify, what exactly you're allergic to. So, things like dust mites can kind of be prevented with lifestyle changes, feather pillows, you can switch those, cats and dogs, so it can help you kind of pinpoint what exactly you're allergic to.

And if you want to start allergen immunotherapy, or allergy shots, then that also helps us determine what exactly is put in the mix. And that can help the allergy symptoms later on down the road.

Host: Okay, Dr. Amrol do over the counter allergy medicines really work?

Dr. Amrol: Definitely. A lot of our best medicines are over the counter now. As I said earlier, nasal steroids are probably the most efficacious medicine for allergic rhinitis and it's usually our first line treatment. And the ones that are over the counter are the fluticasone or Flonase, Rhinocort or budesonide and then Nasacort, or triamcinolone.

Those are all very effective and they're just as effective as any of the prescription nasal steroids. And the oral anti-histamines, they're not as effective as nasal sprays, but they're very good too. And so the ones like Zyrtec, Claritin, Allegra are all the same ones you get with the prescription. Some options such as nasal anti-histamines, which are only available with the prescription, but those are usually add on after you've tried the nasal steroids and the oral antihistamines.

Host: And, Grayson, how can we tell if it's seasonal allergies, a cold or even COVID-19 cause sometimes we have these symptoms and we're thinking, oh, it could be any of those how do you know?.

Grayson: Yeah, it definitely could be very hard to tell between all of those. Really duration is what we look at because runny nose, sneezing, congestion, all those things, especially with a cold and seasonal allergies can kind of overlap. So if it's something that's coming back month after month, year after year, then you would look more in the seasonal allergy realm.

Whereas a cold or COVID-19 would be typically shorter acting and COVID of course could have, things like loss of smell, muscle aches, more severe symptoms that you wouldn't necessarily see in a cold.

Dr. Amrol: Also if patients have other comorbid things like eczema or asthma or a food allergy, they're much more likely to have allergic rhinitis. And if there's a strong family history that can help us too, so like if a child comes in with eczema, peanut allergy and nasal symptoms, odds are he's going to be allergic. Whereas if you have seven year old who comes in with no previous allergy history and he has constant runny nose, that's probably going to be more of a non-allergic rhinitis.

Host: And Dr. Amrol, what can we do about allergy eyes otherwise known as allergic conjunctivitis?

Grayson: Yeah. So there was some very good over the counter medicines for this too. The ones I like to use are what's called ketotifen. And there's a brand name called Alaway or Zaditor. There's also something called olopatadine or Patanol is the brand name. And those are both excellent eyedrops and they used to be prescription and now they're the same things we prescribed frequently.

So those can be used twice a day to control the itching, the watering, the redness. Also really like using rewetting drops like a Natural Tear, Sustain, Blink, Refresh, and those can be used throughout the day to help moisturize the eyes and also to rinse away some of the irritants and allergens.

Host: We talked earlier about getting allergies later in life. Is this possible? I had just have to ask you when I came home from the hospital, after having my son, I was allergic to our cat forever. Is that weird?

Dr. Amrol: A little bit. You know you wouldn't think you have a cat your whole life and all of a sudden get allergic, you know? But we do see something called Thanksgiving effect where the thought is that sometimes we have children who grew up with pets and they have no problems. And then they go away to college and after several months of avoidance, they come back and have some symptoms.

So there could actually be benefit to being born into a house with pets and have that constant exposure. And then if we lose that exposure, it's possible to get allergic rhinitis later. And it is possible to get allergic rhinitis at any age, but most of the time it's going to happenor at least something's going to start within the first three decades, but not always.

Host: , Dr. Amrol can you tell us about allergy shots or immunology treatment?

Dr. Amrol: So allergy shots are allergen immunotherapy have been around for a hundred years and, what we do is we first see what patients are allergic to either with skin testing or some other, you can also do blood testing if needed, but skin testing is generally a little less expensive and quicker. And then if you're allergic to dust mites or ragweed pollen, or grass pollen or tree pollen, and if medications and avoidance are not effective, we can do a course of allergen immunotherapy. It's a big commitment where you're getting injections usually weekly or even twice weekly for the first several months. And once you get to your maintenance dose, we continue that dose for three to five years. But after that, there should be a good long-term improvement in your allergy symptoms, which is actually sustained even after you stop.

So that's the only current treatment which modifies your allergy, where it's actually, reducing the symptoms over time. Whereas the medicines help, but as soon as you stop, the symptoms return almost immediately.

Host: Wow. That's good to know. Three to five years, you're right. That is a commitment, this has been such useful information to help people who suffer from allergies to find out more, please visit Prismahealth.org/flourish. That's Dr. Amrol and Grayson Ford of PRISMA Health. If you found this podcast helpful, please share it on your social channels. And thank you for listening to Flourish, a podcast brought to you by PRISMA Health. I Maggie McKay. Be well.