Deborah Howell (Host): So, we've all heard of seasonal allergies during the springtime, but how can people stay safe from an allergic reaction during the holiday season? Dr. Kerry Drain has worked as a board-certified allergist and immunologist since 2002. She's also board-certified in Internal Medicine and Pediatrics. Dr. Drain is here today to help keep all of us safe during the holidays. Welcome, Dr. Drain.

Dr. Kerry Drain: Well, thank you so much for having me. So, I have a little bit of a unique perspective, because I've had peanut allergies since I was a kid. And so, I have been the kid that's gone trick-or-treating and has had to have the awkward conversation about, "I just can't eat peanuts." I also was a mother of an anaphylactically allergic child to milk. And I've been doing this, once again, for over two decades. So as an allergist, I have a little bit of a perspective on and on all of this. So, I'm really excited to talk about this seasonal topic today.

Host: So, you are really the perfect person to talk to. Let's start with Halloween. For parents of kids with food allergies, handing over a bag of trick-or-treat candy can be really stressful. So what's the biggest mistake parents make with holiday sweets?

Dr. Kerry Drain: Oh, goodness sakes. I can't tell you, Halloween is really stressful. Stressful for parents, stressful for the kids. There's a couple things that we need to keep in mind. The first thing is on the trick-or-treating, it's really important to think safety first. So when you go out, we need to make sure that there are some rules. First rule, there is no eating along the trick-or-treat trail. You have to make sure that you know what your kid is eating. So one rule, make sure no eating while trick-or-treating.

Second rule, make sure you have your EpiPen. Make sure that it is with you, it is not just sitting in the car. Make sure that it's in the bag or it's on the patient or with the parent. Because if something happens, and God forbid, they accidentally get something that they're allergic to, you don't want to wonder where your car is or wonder where the EpiPen is in the car. You want to have everything that you need to treat right there.

The other thing that everybody needs to think about is everyone just assumes, "I am a great label reader. I know what is in this candy. I know this is safe for my child." And the crazy thing is that a lot of times the mini size or the fun size, they're actually made on a different line that can be shared with other candies that might have peanut in it or they might have almond in it. And so, just because the full-size candy is safe doesn't necessarily mean that the mini or the fun size candy is safe.

Host: I thought you were going to say because it's too small to read the label on the minis.

Dr. Kerry Drain: Well, and that is a problem. And that's a big problem. And so, usually, if you take a look, a lot of times the minis sometimes aren't even labeled. And so then, you have to look on the bag itself, the mini bag itself. And sometimes you can't do that as you're going from house to house to house.

We've troubleshooted this within my own practice in that sometimes at the end of trick-or-treating, we have kids do swaps, and so they can swap out their allergenic or their potentially allergenic foods. And then, the other deal that I've had some parents make is just even though you know it's the safe one and it's the mini one, why don't you exchange it for the full size that you know for sure isn't going to contain the allergen in it? And that has worked really well, because there's not a lot of kids who don't want to have a full-size candy.

Host: Sounds like a good trade to me. Anything else families can do to make trick-or-treating safer for the whole neighborhood before we move on to the next holiday?

Dr. Kerry Drain: So, I will tell you that I lived in a neighborhood and people would just assume that I would have candy for their kid that wouldn't have the allergen in it which was extremely stressful for the allergist involved. I finally ended up moving from that neighborhood, not for that reason. But whew, that was definitely a nice reprieve.

It's really lovely that people smarter than myself figured out the Teal Pumpkin Project. And so, it's a wonderful way of normalizing trick-or-treating for kids who have different allergens. And what it is is it's a teal pumpkin that can be hung on the outside of a household where they're giving out other things besides candy. They give out glow sticks or stickers or bubbles or a small toy. So, something that isn't allergenic at all and that can be more normalizing. And a lot of times it's such a wonderful idea if you have a neighborhood community or some sort of a place that you can go beforehand and say, "Hey, I have a child. Is there any way that we could implement this in our neighborhood?" Because once again, it takes away the stress of having to ask, "Can I take a look at that label?" Throw the bag of the fun size or I just can't take any peanuts. So, the Teal Pumpkin Project is just a wonderful way to get around that and just normalize the experience for all kids.

Host: I love it, but good luck keeping kids from taking more than one glow stick.

Dr. Kerry Drain: For sure, for sure. That is very true. I wish I would've thought of that when I was living in the neighborhood. That's for darn sure.

Host: All right, let's move into Thanksgiving now, my personal favorite. This holiday, of course, revolves almost entirely around food. And when it comes to traditional Thanksgiving recipes, what hidden allergens tend to catch people off guard?

Dr. Kerry Drain: Oh my goodness. When I was on call during Thanksgiving, I would always receive one or two calls because there was an accidental exposure to something in somebody's stuffing. It seems like stuffing seems to be the number one culprit. Either that somebody was going to put walnuts in the stuffing, or I even had somebody put chestnuts in the stuffing. And people just assume that it's going to be safe. But a lot of times, people who are creative cooks, they put things in. And I know growing up, I always got in trouble with Jell-O. I don't think they use Jell-O as much, but there was always something hidden in Jell-O that I would have problems with growing up.

Host: Interesting. Okay.

Dr. Kerry Drain: So, with the stuffing, it can be wheat, it can be gluten. You can also have eggs and dairy in certain casseroles, or a butter brushed over the top of a roasted turkey. All of those things could be triggering based on what you're allergic to. But once again, the big most important thing is making sure that you communicate with the people that you're going to be eating with. Because even something as simple as a cross-contamination in a busy kitchen with multiple people cooking can cause a problem. So, making sure that you let them know beforehand what your needs are. And I always like just to give people the out, saying, "You know what? I am more than happy to bring food for myself and my family,because I know it's a stressful time anyway, but these are my concerns," and just try and make it work for everybody involved.

Host: Got it. So, what tips do you have for families both for preparing Thanksgiving dinner or maybe on the receiving end if they need to ask for a list of ingredients?

Dr. Kerry Drain: Frame it with appreciation. So, you want to say, "Everything looks fabulous. It looks incredible. But because of my allergy or because of my son's allergy, could you just please let me know what's in this dish so we can all enjoy this dinner safely?"

Host: That's really great. Are you ready to move on to the most wonderful time of the year?

Dr. Kerry Drain: I think I'm ready.

Host: Time to put up that tree. And people may have heard of Christmas tree syndrome when you experience sneezing and maybe watery eyes or wheezing after bringing home a real Christmas tree. Does this usually indicate a pine allergy?

Dr. Kerry Drain: We are in the inland northwest, and we are surrounded by pine trees. And let me tell you, it is so rare to find someone who's actually allergic to pine trees. The pollen itself is huge, and it's really hard to get into the respiratory lining. So usually, it actually isn't the pine tree. Now, once again, you can have tree sap or terpenes that can cause a mild skin rash when you touch it.

But the itchy eyes, the runny nose that people are experiencing usually, believe it or not, is mold on trees. So, trees, they grow outside. And in that environment, there are molds. And they kind of go quiet as it gets colder in this part of the world. But then, when you take a tree and you bring it into your house, it's warm. You are watering the tree. And so, those molds can be aerosolized, causing the symptoms. And once again, I would say two to three times a year, I get a referral because people just know that they're allergic to their Christmas tree, and they know that they're allergic to pine tree. And majority of the time when we test them, it has nothing to do with the pine, but it has everything to do with those molds.

Host: So, is there a way to remove the mold, or what's your suggestion?

Dr. Kerry Drain: There is no way to 100% remove the mold, but you can take the majority of that allergen off. And so, it sounds crazy, but if you can hose down your real Christmas tree outside with warm water just to kind of wash away that dirt and mold, and then let it dry in your garage or on the porch before you bring it inside. That is really important. And believe it or not, my husband used to work at a Christmas tree lot, and he had said that they actually have mechanical tree shakers that can also help. So if you bought your tree, if they have one of those mechanical tree shakers, they could shake it off, but you would still want to make sure that you rinse off that tree at home.

Host: Wow. The inventions I've never heard of.

Dr. Kerry Drain: Me neither.

Host: did not know I would wake up learning that today, but thank you for it. Now, if people do decide to switch to an artificial tree, does that mean they're safe from an allergic reaction?

Dr. Kerry Drain: From everything I just told you, you would think yes. But actually, artificial trees have their own issues. The first thing is that most times we put them back in the box, so the box isn't sealed, and it's usually stored in a basement or an attic or in the garage. And so, you can get a lot of dust on those artificial trees.

So, it's important when you take them out, to make sure that you wipe down the branches, maybe with a damp microfiber cloth, or it sounds odd, but vacuuming them before you decorate them. And then, after the season—which is always a sad time for me—but after the season, when you store the tree, you want to try and store it in a sealed plastic storage bag rather than a porous cardboard box.

And then, for both artificial or for a natural tree, since we're not going to be able to get rid of all of those potential allergens and irritants, making sure that we have, like, a HEPA purifier, air purifier that's in the room where the tree is set up just to kind of help capture any of that lingering allergen and the spores or the dust particles.

Host: You have me rethinking how I store my ornaments now and other decorations.

Dr. Kerry Drain: True. Very True. Ornaments are kind of hard to clean because they're so dainty. So, making sure that they're sealed is a wonderful idea.

Host: All right. To wrap things up, what are some key takeaways for our listeners this holiday season?

Dr. Kerry Drain: Number one, remember that many Halloween candies may not be as safe as you think they are. Make sure that you have rules for the road. No eating while we're walking, and make sure that you have your EpiPen with you. Communicate early with holiday hosts about ingredients and cross-contamination contacts. And then, remember, wash your live tree or wipe down artificial trees before bringing them indoors.

Host: Beautiful. And anything else in general you'd just like to add?

Dr. Kerry Drain: I think that everybody just needs to make sure that they have a wonderful holiday season. And if you need to do a little bit of work, especially communicating even to your community about maybe implementing a teal pumpkin program or communicating with that grumpy aunt about her chestnuts in her stuffing, I think all of that will just make it so it's less stress and so everyone can just really enjoy the holidays.

Host: That's very logical. And we thank you, Dr. Drain, so much for being on the podcast today. We really enjoyed having you.

Dr. Kerry Drain: Well, thank you so much for having me. I really enjoyed being here with you.

Host: And you can learn more about this subject, providers and services at Pullman Regional Hospital online at pullmanregional.org/allergy. I'm your host, Deborah Howell. And this has been the Health Podcast from Pullman Regional. Thanks for listening, and have yourself a great day.