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Melanie Cole (Host): Welcome to Right Beside You, a Reid Health podcast. I'm Melanie Cole, and I invite you to listen as we discuss common allergies today. Joining me is Dr. Jason Casselman. He's an Allergist with Reid Health. Dr. Casselman, it's a pleasure to have you with us today. What are the most common allergies that you see?

Jason Casselman, DO (Guest): So, I guess it depends on what you're talking about when you say allergies. Allergies can affect different organ systems. In regards to the common things you'd think of with seasonal allergies, you would think of nasal and eye allergy symptoms. So, you know, when you think of pollen allergies, you'd think of stuffy nose and nasal congestion and sneezing and itching. Maybe some eye symptoms, itching and watering and things like that. We generally see that worsen with certain folks in certain seasons. So, patients will oftentimes complain of spring and fall allergy symptoms. But there can also be perennial allergens that we react to. For example, pets in the home, dust, mites, molds, and things like that, that can affect folks all year round.

Host: Well, thank you for that. And Dr. Casselman, just to clear things up when people hear the word allergies and you mentioned seasonal allergies and allergens we might find around the house or outside. What's the difference between these kinds of seasonal allergies, something like asthma, and then allergies to food?

Dr. Casselman: The difference can be very hard to identify in the sense that the symptoms can be very similar and different folks can react to different things. So, for example, pollen, you know, tree and grass pollen, ragweed, weed pollen, and things like that are generally seasonal. So, they only are present during certain times of the year. Whereas certain things in our environment can be perennial, meaning they're present all year round. So, depending on what exposures we have, we can react all year round versus seasonally. So, for example, if we have a cat or a dog in the house, reacting to the dander, then that can be a problem all year round. Dust mites for example are another common allergen that people can react to, which can cause nasal and eye symptoms as well. And those can also be all year round. So, there's depending on what you're reacting to and whether or not it's seasonal or perennial, patients can complain of symptoms at different times of the year versus all year round.

In regards to other conditions other than nasal and eye symptoms, you mentioned asthma. That's another common allergy condition. Not all asthma is allergy related. Asthma is a very complicated condition. However, asthma and allergies can oftentimes go hand in hand. So, patients will complain of things like shortness of breath and coughing and chest tightness and wheezing that can certainly be triggered by allergens in the environment in certain patients.

Host: So many of these symptoms Doctor are similar to things like a cold or they could be mild or they could be severe. How are we to know?

Dr. Casselman: So that's a great question. And oftentimes it's very difficult to identify that and elucidate whether or not we're dealing with an allergic reaction to something environmentally versus a viral or bacterial infection. So, a couple of things I would mention on that. Generally, with infection driven nasal symptoms and throat symptoms, for example, a fever will go along with it. Generally infections are present during certain periods of time. For example, viral infections are more prevalent in the fall and winter seasons, whereas allergic rhinitis or nasal symptoms in regards to reacting to environmental allergens can be present all year round or during different seasons as well. So, you know, it takes some getting used to in regards to identifying symptoms. But oftentimes the symptoms can overlap pretty significantly. You're correct on that.

Host: Doctor, as we talk about some of the complications of allergies, like allergic rhinoconjunctivitis, and parents don't even want to hear that word conjunctivitis. Tell us a little bit about some of these, including allergic skin conditions.

Dr. Casselman: Sure. Yeah. So, conjunctivitis is sort of a scary term and I think the most common thing you think of when you, hear the word conjunctivitis, is that pink eye and that a bacterial infection that kids can get pretty commonly and actually the term conjunctivitis just literally means inflammation of the eye.

So, it doesn't necessarily mean infection all the time, although that's what we think of. So, allergies can lead to conjunctivitis as well. So, for example, a patient that has a pollen or cat dander allergies, we can develop you know, eye itching, redness, tearing, irritation, all these things that sort of sound and look a lot like bacterial conjunctivitis in some patients. The way to differentiate that is again, you look for signs of infection, you know, fevers, chills, things like that, as well as usually with bacterial conjunctivitis it starts and affects one eye at a time.

Whereas you know, allergic conjunctivitis from environmental allergies usually affect both eyes and you'll look for seasonal patterns as well as other symptoms that sort of go along with environmental allergies. Generally, patients will complain also of nasal allergy symptoms and sneezing and itching and things like that as well.

Host: Now, this is just an interesting question to me, and I'd really like to get into treatments and even home and environmental remedies things we can do, but do we know what causes them? Can you speak about the immune system just a little bit, and as we try and keep everything cleaner and safer, and now we're all using sanitizer all the time; by doing that, are we not really strengthening our immune systems like we used to? Is that a theory, Dr. Casselman?

Dr. Casselman: Yeah, that's an interesting thing to bring up because that's, it's actually a quite complicated question and you're absolutely correct. The reason we believe that allergies exist is we call it the hygiene hypothesis in the sense that we've become so hygienic and try to eliminate exposure to these allergens in the environment where our immune system really needs that in order to build that immunity.

So, what ends up happening is that there's a sort of over excessive response to these exposures with time and certain individuals. And we believe about up to 30% of the population have some sort of allergic condition. So, it's becoming more and more prevalent and the more we try to eliminate the exposure and become more hygienic and clean and use the air filters and things like that, the higher the prevalence is going to be. So yeah, that's an interesting topic. And really what we believe now, from an allergy standpoint is that early exposure to these allergens is actually a good thing. You know, there's been data that has looked at you know, kids that live on farms versus folks that you know, live in more hygienic environments. And those kids that have lived on farms actually have a lower prevalence of developing allergic conditions than other folks. So, it's an interesting phenomenon but we're seeing more and more folks come in and complaining of allergic conditions nowadays.

Host: Well, it certainly is interesting and probably could be its own, you know, immunodeficiency theory, topic of its own podcast. So, it is so interesting to me as well. Now, speaking about things you might do for somebody, when someone comes to you and you've determined, it's seasonal allergies, or you know, they're allergic to something. Tell us about the first line of defense treatment options, whether you're using decongestants, antihistamine, what do we do, doctor?

Dr. Casselman: Yeah, so, there's a lot of different options. And just before we get ahead of ourselves on treatment, generally, what we will do is we will have the patient and just simply have a discussion and go through their clinical symptoms and their history and see what we think they're reacting to in general.

And then the process usually starts with some form of testing. So, we will generally start with what's called a skin test to these allergens and we have standard panels in my office and in other allergy offices that we use that is basically based on you know, regional allergens that are generally common in the region.

So, for example, my Aero allergen panel is a Midwest panel because that's where we live. So, we will either do skin testing or we can do another type of test which is a laboratory test to evaluate that particular patient's allergic what we call sensitization or environmental allergies. And once we find that, we'll have a discussion and we'll give the patient options on treatment. The first thing we always talk about is environmental control measures, which basically means how can we attempt to eliminate exposure to the things we're allergic to? And as you know, that can be difficult.

We can't simply live in a bubble, but there are certain things that we can do environmentally to try to prevent exposure. And I can go through those in more detail. The other thing that we discuss is, you know, medication. So, there are various medications, depending on what we're treating, nasal and eye symptoms.

We generally separate those medicines into two main categories. We think about our topicals, meaning our nasal sprays and our eye drops versus oral and systemic drugs, meaning usually tablets. The third option for treatment would be allergy immunotherapy we call it, which is basically what you think of with allergy shots, which we can get into with more detail.

So, medication wise, there's a lot of different options. Oftentimes patients will come to me having already attempted some over the counter medications. Over the counter drugs include oral anti-histamines things like Zyrtec, Allegra, Claritin, Benadryl, things like that. You mentioned oral decongestants, like Sudafed things with a D in the last letter of the names Zyrtec D, Alegra D for example, is a decongestant.

There are some nasal sprays that are also over the counter. There are nasal steroid sprays like Flonase and Nasocourt and things like that as well. Eye drops are over the counter as well. Once we've exhausted those options and the patient generally needs extra help with their symptoms, they will always usually present to me and complain of refractory symptoms to the standard over the counter treatment. And we will give them other options from a prescription standpoint as well.

Host: What about at home? What can we do? Do you recommend nasal lavage or, you know, air filters? You mentioned that earlier pillow cases, there's so many things around us all the time. What can we do at home that might help to decrease some of these symptoms?

Dr. Casselman: Sure. So environmental control measures are important and they can certainly help in minimizing symptoms and exposure. So, from a pollen standpoint, from a seasonal allergen standpoint, it does become difficult. Pollens travel hundreds of miles in the environment. So, if you're outdoors, you're pretty much always going to be exposed.

The best thing to do in pollen season is to if you are indoors, keep the windows closed, it seems like common sense, but people like fresh air. And that's just generally not the best idea for those pollen allergic patients. If you've been outside all day, for example, maybe on the weekend and things like that where we know you've been around the pollen and it's always good to kind of rinse off. Take a shower or bath prior to lying in bed. So, you're not lying in bed in pollen. In regards to those other things that we test for some of the perennial things. You mentioned, dust mite covers. So, dust mites live really in two places, dust mites live in house dust and in our bedding. So, in the regards to the house dust, it's important to keep things clean in the house, meaning floors cleaned. Vacuumed. The carpet, furnace filters changed on time. Usually I ask patients to get their duct system cleaned out every once in a while, maybe yearly. In regards to the bedding, dust mites live inside the bed. So, with time, they will accumulate as the mattress and pillows age. So, it's important to update the mattress if it's old, usually recommend about every five years or so.

Dust mite covers do work well at providing a nice barrier. So, they simply zip up and go on the mattress. And the regular sheets would go over top of those. You know, feathers can be an issue. Feathers are basically in down pillows and down comforters. So, if you have a patient that's feather allergic, you always recommend that they stick with the synthetic pillows and sort of regular blankets as well.

People are also allergic to mold. So, mold can be a both an indoor and outdoor allergen and usually outdoor mold is a problem in the fall when the leaves come down seasonally, but there can certainly be indoor molds as well in areas of water damage in the home and damp musty areas as well. Some of the things we can work on in regards to that, you mentioned air purifiers and air filters. Always a good idea to have those, especially in the bedroom. If you think about it, usually we spend most of the time if we're home in the bedroom, sleeping seven, eight hours a day. So, it's important to keep that area as allergen free as we can make it.

Host: This is such an informative episode, Dr. Casselman. So, as we wrap up, when is it time to see an allergist? A lot of people suffer with these and they don't bother to go see anybody because they don't think there's really anything that they can do. So, when is it, you would like people to come and see you and please give us a piece of great advice about allergies and seasonal allergies and what we can do. Wrap this all up for us.

Dr. Casselman: Sure. So, what I would say is that the symptoms that patients experience can range from being very, very mild to anywhere from being very, very severe. So, I suppose it depends on how severe the symptoms are. I think patients it's reasonable to start with some over-the-counter medications, such as oral anti-histamines, maybe nasal sprays. But what I would say with that is that oftentimes the more severe patients I see are not going to respond well and they will still have pretty significant symptoms, despite those over the counter medications. So, at that point, if you're still struggling, it's never a bad idea to see an allergist, to have testing done and to go through the treatment options.

A piece of advice I would give patients. Well, I would say that it's never a bad idea to get in with an allergist and at least have a discussion. Allergy testing seems like a scary thing. It's really not. Most of the testing that we do now is needle free. It's very easy. It takes usually about 15 to 20 minutes at a time, and it will give us a lot of information. And there's a lot of options that we have from an allergy standpoint that patients maybe are not aware of as far as treatment goes.

Host: It's great information. Thank you so much, Dr. Casselman. I hope you'll join us again and update us and give us more great information. And you can call (765) 966-6360 to schedule your appointment today. Or for more information, you can always visit Reidhealth.org to get connected with one of our providers. That concludes this episode of Right Beside You, a Reid Health podcast. Please remember to subscribe, rate and review this podcast and all the other Reid Health podcasts. I'm Melanie Cole.