Joey Wahler (Host): They're triggered more this time of year, so we're discussing spring allergies. Our guest, Dr. Scott Burger. He's Chief Medical Officer for University of Maryland Urgent Care. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for being with us. I'm Joey Wahler. Hi there, Dr. Burger. Thanks for joining us.

Scott Burger, DO: Good morning. Thank you for having me.

Host: Great to have you aboard. So first, for those unaware, why is it that spring causes more of an allergic reaction in people?

Scott Burger, DO: Well, everything is starting to wake up, right? We've now left the winter doldrums. We're starting to see trees pollinate and you're seeing leaves and flowers starting to come about. And with that comes pollen, which is the main culprit, for springtime allergies as everything starts to wake up from its winter slumber.

Host: So, that pollen can be both a blessing and a curse, right?

Scott Burger, DO: Yeah. I mean, it's beautiful and it's great for everybody's mentality. Everybody starts to get outside more, exercise more, and do more things, but it is challenging for people who struggle with spring and summertime allergies.

Host: Right. So, what are the most common symptoms of spring allergies, and how can people distinguish them from other respiratory conditions?

Scott Burger, DO: Well, the most common symptoms that people will experience are itchy eyes, runny eyes, scratchy throat, runny nose, sneezing. Those are really the most common things that people experience. Other folks will experience more sore throats. You can experience some skin conditions, like eczema can flare up during this. People with asthma can have attacks of their asthma. So, different sort of respiratory type of conditions as well as some skin conditions can really flare up in response to those environmental allergens.

Host: Skin conditions, tell us about those.

Scott Burger, DO: Everybody has probably seen somebody who gets rashes on their skin and they often refer to it as eczema. That's usually patches of skin that are red, they're raised, they're rough, they're very itchy, and that can be something that flares in response to environmental allergens.

Host: Are there any lifestyle changes or home remedies, if you will, that can help alleviate spring allergy symptoms?

Scott Burger, DO: Most of it is avoidance, to be candid with you. So, avoiding activities when trees are kicking off the pollen first thing in the morning. I recommend the folks to keep their windows closed during the spring season if they really struggle with environmental allergies. If they do have that as well, they can consider doing a nasal rinse with some saline every day to just flush out any pollen that they've inhaled. Also if you go outside and you're spending a great deal of time outside, don't immediately come into your room and lay down in your bed. Anything that's on your clothing, in your hair, then will just settle onto your bed and bother you through the night. So, you're going to want to shower when you come in the house and change that clothing. So, those are really kind of the home remedies or things that people can do just to affect their environment and how they're interacting with it.

Host: At that last point, I was not aware of. So, change your clothes when you can, and I presume wash them as often as possible as well to get all that pollen off of there, right?

Scott Burger, DO: Yeah, that's right. Get everything off of there so that you're not engaging with that pollen that's still stuck on your clothing and in your hair for that matter.

Host: Gotcha. How about washing your hair on a more regular basis?

Scott Burger, DO: Yeah, I mean, mostly it's just the water element that's going to flush things off. But certainly, I think most people are shampooing their hair as part of their regular routine when they're showering.

Host: So, where can someone go to get help if they are suffering from severe or uncontrolled allergies?

Scott Burger, DO: Well, the first place that most folks can and should go is to their pharmacy and look in the allergy section for over-the-counter allergy medicine. In that aisle, you'll see things like over-the-counter antihistamines, things like Benadryl, Claritin, Zyrtec, and Allegra. You'll also now see things like nasal sprays, Flonase, Nasonex. These are nasal steroids. You can get decongestants, which can help with some of the immediate symptoms, but doesn't address the underlying problem of your body responding to that allergen. The antihistamines and the nasal steroids do those sorts of things. So, that would be the first place to go.

If you're not getting adequate relief from those, or you're not sure, what else you should or could do, or are your symptoms attributable to allergies, or are you sick, that's when you should go see your doctor, your child's pediatrician, or come to your local urgent care center. This is something we see a lot of through the spring, summer, and fall months. And we're able to provide additional guidance on how to use the medications, what's the best time of day to use them, which ones need to be used every day versus just when you feel like the day is going to be a rough day for you. And then, there are some prescription medications that we administer to patients and give people who just aren't getting adequate relief with the things that they can get in the pharmacy.

Host: So even if someone is using over-the-counter meds for allergy symptoms, you're saying if they need guidance, you can provide that because I know oftentimes, whether it's for allergies or a bunch of other things, you walk into the store, there are so many choices, your head's about to explode. You're like, "What do I buy here?" Pharmacists may be busy. You can help out with that.

Scott Burger, DO: Absolutely. Yeah, and that is something that we commonly see, is people are mixed up between, "Should I take Sudafed or should I take Claritin? How do I use the nasal sprays?" That's one of the ones where there's a lot of confusion around that because that's one that you have to use every single day, the nasal steroids. And they take about a week to 10 days to really fully kick in. So ,it's not uncommon that somebody comes into our office and says, "You know, I bought this stuff. I used it for a day or two. It didn't change how I was experiencing my symptoms. So, I didn't think it was working." And the reality is that they just needed to take it for longer.

Host: And that's again a great point you made toward the end there, doc, about the sprays, because I tried them once or twice a while ago, and I was confused. Like, how much of this am I supposed to be spraying up there? Sounds simple, but when you use it for the first time, it's really not necessarily, right?

Scott Burger, DO: Yeah. And it's just very common that people don't recognize and realize because you know what? The reality is when you take a Benadryl, Joey, you feel better within a few hours, right? With Benadryl, you certainly might feel very tired. So, why wouldn't another allergy medicine like a nasal spray work the same way? But because the way the medicine works in your body is very different, the effect of that medicine takes longer. It's really more of a suppressive medicine, whereas, you know, if I'm going to go out and cut the grass, I'm going to take a Claritin right before I do that, because I know it's going to help me right away. But if I know I'm going to go on a camping trip, and I'm going to be struggling for the whole month of May, I'm going to start the nasal spray at the end of April and take that until the beginning of June.

Host: Gotcha. How about allergy shots, immunotherapy? How effective are they in managing these spring allergies and who might benefit there?

Scott Burger, DO: They're very good medications. They're for people who are not responding adequately toover-the-counter and prescription pills and/or sprays, drops that we can use. These are, essentially, very small doses of the allergen that triggers that immunologic response in our body. And over time, you get a maintenance dose of that to try to decrease your body's response to that allergen. It takes years for somebody to develop an appropriate response to it. So, about 60% of people will have long-term relief of their symptoms from the use of allergy shots, but it's a commitment. And that's really something that needs to be managed by an allergist immunologist after testing to validate exactly what are the triggers for the allergies.

Host: Absolutely. Couple of other things here. Are there any other specific precautions or tips you recommend for people with spring allergies that can help them better manage their condition during peak allergy season? And I guess one thing I'm thinking of is trying to find that balance between enjoying being outdoors, but not overdoing it. Trying to find that sweet spot in between, it's tough sometimes, right?

Scott Burger, DO: Yeah. And I always say that an ounce of prevention is worth so much. So, most folks after a number of seasons, they know when their allergies are coming on. And so, starting your regimen of medications that's worked for you in previous seasons right before that season is kicking into full gear is really the best way to go and then, to be consistent about your use of the medications through that season. Certainly, as you referenced, trying to limit some of your time outside, if your allergies are pollen and things of that nature; to try to kind of minimize some of your exposure in your house doing things like changing your air filters on your central air conditioning system, if potentially having a HEPA filter to try to filter some of those things out are important things to do. Other things that I referenced earlier like doing the saline rinse daily can really help and go a long way to decrease a person's response to those environmental allergens.

Host: How common would you say it is from your experience for some people to develop an allergy later in life? Let's say middle age. And I'm also wondering, doc, how common is it for someone that's had allergies for all or most of their life to eventually outgrow it as they get older? How often do either of those things occur?

Scott Burger, DO: So, seeing a lot more of the former; not much, I will say, of the latter. We're seeing more and more people who didn't have allergies before being captured into this web of environmental allergies. It's partially a function of global warming. As our climate is changing, particularly in this part of the country in Maryland, our winters are not as cold, our spring starts sooner, so we're starting to see higher and higher pollen counts. And really, it's just a function of how high does that pollen count get and is it high enough to trigger a response in folks.

Interestingly, some of the people with the lowest rate of allergies are folks like farmers, people who spend their lives outside from a young age, because they've been constantly exposed to these things throughout their entire life, so they just don't get it the same way the rest of us do, who work at a job inside, drive in our cars, we are in our air conditioning, we spend time outside enjoying ourselves, but we're not out there with that high level of constant exposure.

Host: Finally, doc, in summary here, how important would you say it is for those with spring allergies to work closely with a healthcare provider like you and yours to develop that personalized allergy management plan that you've already discussed? And what key elements to kind of summarize things here should be included in that?

Scott Burger, DO: Yeah. I think it's important for somebody to make sure that they're talking with their primary care doctor or coming to an urgent care center to make sure that they understand the treatments that are available to them to improve the quality of their life. I mean, so many people are struggling with sinus headaches, chronic sore throats, coughs, all these different sorts of things that could be so easily managed just with the right guidance and input from from a health care provider. So, trying to do it alone, if you're not getting the relief from the simple things that you can do over-the-counter, really I would implore everybody to take the time to come in be seen to get that guidance and advice because you'll reap the benefits of it for years and years to come.

Host: Well, folks, we trust you're now more familiar with spring allergies. Dr. Scott Burger, valuable information indeed. Thanks so much again.

Scott Burger, DO: Thank you for having me.

Host: And you can find more shows just like this one at umms.org/podcast as well as on their YouTube channel. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.