Maggie McKay (Host): Welcome to St. Joseph's Health MedCast. I'm your host, Maggie McKay. From sneezing fits and itchy eyes to more complex sinus and breathing issues, allergies can seriously impact quality of life. Fortunately, we're joined today by an expert who helps patients breathe easier, literally. Dr. Haidy Marzouk is an Otolaryngologist with St. Joseph's Health where she specializes in diagnosing and treating a wide range of ear, nose, and throat issues, including those caused by allergies. Thank you so much for being here today, Dr. Marzouk.

Haidy Marzouk, MD: Thank you for having me.

Host: So a lot of people suffer from allergies. Can you explain what's actually happening in the body during an allergic reaction?

Haidy Marzouk, MD: Sure. Any type of allergy really means that the body is responding to something it should consider safe, as abnormal. So plants and trees all around us should be considered safe while we're inhaling the pollens. But the body is disagreeing and developing antibodies to those things. And when those antibodies get going, they release chemicals that cause changes leading to symptoms like sneezing, nasal blockage, itching, and the typical things we think about when we're suffering from allergies.

Host: What are some of the most common environmental and seasonal allergens you see affecting patients in Central New York?

Haidy Marzouk, MD: So the typical things we see in the environment in the northeast United States include trees, weeds, grasses, molds, dust, and of course pets like cats and dogs.

Host: You're not gonna believe me, Doctor, but I was never allergic to cats until after I was pregnant. I am not kidding you. I came home from the hospital and I was so allergic to our cat for the rest of his life. It's so crazy. How does that happen?

Haidy Marzouk, MD: That can happen with new exposures or changes in our immunology. We can get different sensitizations.

Host: Wow. Well, how can someone tell the difference between seasonal allergies and a chronic sinus or ENT issue?

Haidy Marzouk, MD: Actually, very often people can have both and it is very difficult to differentiate the two. Often when we have allergies, itching and sneezing with certain exposures tend to exacerbate the symptoms. Things that give you an indication that you might have something more along the lines of infection include a very abrupt change in your symptoms. Pain, fever, colored drainage, and a rapid increase in fatigue. Although a lot of people who suffer from allergies can experience things like chronic pressure, poor sleep, but infections typically don't last for more than two weeks until it becomes more of a chronic sinusitis and often allergies and chronic infection can coexist, which is where, you know, sometimes I have to play a little bit of detective to kind of drill down on what exactly is going on.

Host: And when should someone consider getting tested for allergies? And what does that process typically involve?

Haidy Marzouk, MD: So really when I tell people the testing comes in handy is if it's going to affect a change. If you're one of those people that every once in a while responds to an oral antihistamine and you don't plan on doing anything differently, it might not be for you, but there are three big areas that we target when we're treating allergies.

Environmental control, medication, and possible desensitization. So if you know what you're allergic to through testing, you can possibly do things in your environment to augment your exposure. If you're planning on getting desensitized, it's important to know what you're allergic to, to know what you're getting desensitized to.

And when it comes to medication, let's say you're only allergic to something that pollinates a certain time of year, it might be able to guide you as to when you want to really make sure you have your medication on hand and loaded up. So that's where the testing comes in handy.

There's two big workhorses in terms of how you can get tested. The first being skin testing, which in the past people used to correlate with many needles, and now we have more needle free techniques of skin testing that are a little bit less cumbersome and very quick where you can know your results within about 15 minutes. The other method is through blood work, where you can go for a blood test just like you would for other routine blood work and test for antibodies related to different allergens.

Host: Let's talk about treatment options. What are the most effective ones that are available today from over-the-counter meds to long-term strategies?

Haidy Marzouk, MD: Well, to be honest, all of them are effective, but different people who are have different levels of sensitization require different levels of treatment. So, for example, you know, not everyone who is sick needs injectable antibiotics, although they are effective, right? So I would say you want to get what's right in terms of controlling your particular symptoms with the least amount of side effects.

That being said, what I go to first, typically, once people get to my office, they very often already tried oral antihistamines. And so I tend to lean towards as first line therapy, nasal steroid sprays or nasal antihistamine sprays, for the typical adult.

In terms of the closest thing we have to cure for allergies, that would be desensitization, whether it be shots or through sublingual immunotherapy.

Host: Can you talk about sublingual medication that was just approved for ages five and up?

Haidy Marzouk, MD: Sure. So we've had approval for sublingual immunotherapy for grasses and weeds for some time now, but as of a couple of months ago, we've recently received FDA approval for sublingual immunotherapy tablets for dust down to age five, which is really a big deal given that dust allergy is all year round. It's not seasonal, and it can be a big trigger for children all over the United States, and it can particularly affect children with asthma. So I think that desensitizing children on the earlier side with a needle free technique might be very helpful to kids now that we have this medication.

Host: Definitely. What lifestyle changes or preventive steps can help reduce allergy flareups, especially during high pollen seasons?

Haidy Marzouk, MD: Typically the trees will pollinate in central New York starting towards the end of February and continue into about May. Then those start to die down and the grass allergens pick up towards the summertime and the fall allergens tend to be more of the weed family. Pollen counts typically are highest around seven to 10:00 AM. So potentially avoiding being outside during that time of day is quite helpful. Moreover, once you've been outside kind of changing your clothes and taking off your shoes and, making sure as little pollen sticks to you as possible. And nasal irrigation can be quite helpful in terms of avoiding keeping pollen in your nose.

In terms of indoor allergens, like dust, and mold, a lot of them can be humidity dependent. And so, keeping the humidity level low in the house, sometimes can be helpful with those.

Host: And a lot of people think they need to live with their allergies or that it's normal to breathe poorly. What are their reactions once they receive effective treatment?

Haidy Marzouk, MD: So when they receive treatment for approved nasal breathing, whether it be medical or surgical, a lot of people are shocked that oh this is how people can breathe regularly. And they really relay to me a lot of improvements from better sleep quality to improved athletic endurance, to improved energy levels.

We're learning more and more. There are books actually now out for the lay public about how important it is to breathe through your nose, how it can affect your dentition. Pediatric facial growth. So over the past couple of decades, we're learning more and more the benefits of nasal breathing. And so again, whether it be through allergy treatment or structural augmentation if needed, it's really important to people's quality of life.

And what we are talking about preventative medicine and healthy lifestyle. We're not just talking about fixing debilitating problems. We're talking about optimizing health, and I think that optimizing nasal breathing, as best you can really is part of quality of life improvement, along with other parts of people's health.

Host: Thank you for clearing up and explaining the facts around allergies. Again, that's Dr. Haidy Marzouk. For appointments at St. Joseph's Physicians' ENT Northeast Medical Center in Fayetteville, Call 315-744-1 5. That's 315-744-1505. And if you'd like to find out more, you can visit sjhsyr.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library, for topics of interest to you. I'm Maggie McKay. Thanks for listening to St. Joseph's Health's MedCast.