Caitlin Whyte (Host): This is Woodlawn Health Doc talk. I'm Caitlin Whyte. With me today is Dr. Christopher Ricketts, a primary and obstetric provider at Woodlawn Health. We will be discussing seasonal allergies, diving into symptoms, causes, and solutions to help you manage this common condition. Well, start us off here today, Doctor, just what are seasonal allergies?

Dr. Christopher Ricketts: So Caitlyn, I think that's a great question to start with, because having a good working definition is important to having a conversation about whatever topic we're discussing. I think one of the common misconceptions with seasonal allergies is that any runny nose in the spring or fall could be an indication of an allergic process, and that just isn't the case. There are a number of things that can cause runny noses and sinus congestion and itchy, watery eyes and scratchy throats besides allergies.

Host: Well, on that note, what are some of the most common symptoms of allergies?

Dr. Christopher Ricketts: Because most allergies involve the upper airway, the majority of symptoms are going to be limited to that part of the body. So for example, people tend to have a runny nose, itchy, watery eyes, scratchy throat, and puffy eyes, but they can also complain of lower respiratory symptoms such as coughing, feeling short of breath, and wheezing. This usually is because of the airway inflammation that accompanies the allergic response. So in addition, sometimes people will even have skin manifestations of allergies such as hives or eczema or dry skin. I will say rarely when people get an allergic response to an environmental allergen like pollen, they can also get gastrointestinal symptoms such as abdominal cramping, nausea, and diarrhea. But these are relatively uncommon for the majority of allergy sufferers.

Host: Well, what causes these seasonal allergies?

Dr. Christopher Ricketts: So, I think if we just look at the terminology of seasonal allergies, number one, there has to be a seasonal aspect to the symptoms. You know what this in practice means is that someone has a particular time of year where they're relatively free of allergy type symptoms, and then times a year when they're particularly bothered by the allergy symptoms.

Looking also at the term seasonal allergies, the second word is also important. There needs to be something that is an allergen, which is to say something that triggers the allergic response. And so, these two together are really, in summary, how we define what a seasonal allergy really is.

Host: And how are these seasonal allergies diagnosed then?

Dr. Christopher Ricketts: That's a good question, because that can be tricky. So many times, the diagnosis can be made based on symptoms alone. When there's a lack of clarity or perhaps a lack of response to medicines, which typically help allergic type symptoms, further testing can be obtained. And so, what I tell people is testing can take the form of blood work and/or doing what's called skin prick testing. Blood work can often be done through your primary care doctor's office, but more advanced and specific testing, such as skin prick testing, is typically done by an allergist.

Host: And how can we tell if it's really allergies or a cold?

Dr. Christopher Ricketts: That's the age old question. There can certainly be a lot of overlap in symptoms. And sometimes it's difficult to tell the difference. Although people can have unilateral symptoms, meaning just on one side of their sinuses with allergies, most commonly the symptoms are going to involve both sides of the sinus cavities. Whereas upper respiratory infections can either be unilateral, on one side, or bilateral, on both sides.

Similarly, a cold or allergies can cause phlegm or that snot mucus to be produced that can look quite thick. Typically though, allergic rhinitis or the seasonal allergy type drainage is thin and watery. And then, if the patient develops a bacterial infection on top of an upper respiratory congestion, then the drainage or phlegm that sometimes gets produced can turn darker or thicker. Also, unlike allergies, any infection can cause fever. So, sometimes people will say, "Well, it must be a bacteria because I had a fever," or "It must be a virus because I did not have a fever." And unfortunately, fevers can happen with both bacterial or viral infections, but fever will not occur with just seasonal allergies.

Host: Well, what treatments can help our allergies out?

Dr. Christopher Ricketts: Sure. So, one of the best things that helps with either allergies or honestly even just a basic upper respiratory infection is sinus rinsing. And so, this is where distilled water, not tap water, is used to flush into the nose through the sinus cavity. And what this does is it flushes out the mucus and the phlegm that's up in the sinus cavities. And this can be really beneficial to decrease that pressure feeling and that risk of progression to a secondary bacterial infection. What I mean by the second part is that sometimes when people get a lot of sinus congestion, it can trap bacteria. So, whatever may have started as a virus or allergies can over time become a secondary bacterial infection.

Secondly, from the standpoint of over-the-counter medicines. There are a lot of good antihistamine options, but people really should be careful about their other health conditions they may have, such as dizziness, constipation, and trouble urinating, which really can be exacerbated by antihistamines. And by antihistamines, I mean medicines that people are commonly familiar with, such as Claritin, Zyrtec, Benadryl, Allegra, and so forth. Also, some people are very sensitive to antihistamines, especially from the sleepiness or sedation standpoint. And so, they really should exercise caution and certainly involve their healthcare provider if they choose to take any over-the-counter medicines. So, those are kind of the antihistamine part.

In addition, there are a type of medicine called nasal steroids. And this is a really useful tool, because they help decrease the inflammation and swelling in the sinus cavity. And so, nasal steroids would be something commonly known as Flonase would be one example of a nasal steroid. The challenging part is what I find a lot of people do with these is that they either use them wrongly in terms of they don't administer them properly, spray them in properly, or they really don't give them enough time before deciding if a nasal steroid has been beneficial or not. As a rule, nasal steroids such as Flonase do take about five to seven days to begin working. So, it does take patience to see the benefit.

Separate from all these, most of the other treatments out there are going to be prescription medicines. I will comment that I really advise against using the nasal spray Afrin. There is a lot of risk with this medicine, and it really is something to be avoided by almost all patients.

Host: So, it sounds like there are a number of treatments available, but can see seasonal allergies be prevented at all?

Dr. Christopher Ricketts: Sure. So, I think if we go back to our definition of seasonal allergies, really our first order of business is to try to identify the trigger, and if the trigger can be identified, then avoidance would be the first step in prevention. If we can minimize exposure to the offending items such as pollen or hay fever, that's really the first step in minimizing the risk of developing those bothersome allergy symptoms that most all of us have suffered from.

Long before the COVID pandemic, I had many patients using masks when they would be in a dusty, dirty environment such as mowing the grass or working in the fields to minimize the exposure of their sinus cavity to the allergen. I find this as a very effective means of prevention, which is to say, to have a barrier between you and the allergen. After this, the next step would be to do the sinus rinsing, which we've already talked about. So if you don't happen to have a mask or if you find yourself in an environment you weren't planning on being in, such as being around a bunch of hay fever, then as soon as you can get home and rinse your sinuses out, and that'll wash off that hay fever or pollen from the sinus cavity, which is the mucus membrane in our nose. And that really also can help decrease the allergic response.

 Lastly, if none of this seems to be helpful or you've tried other means, with your primary care doctor, sometimes if you see an allergist, there are actually specific preventative measures or preventative serums that can be developed and injected by the allergist to help decrease or prevent the allergic response. This really does not apply to very many patients though, so I don't want to set up any false hope about just going for an allergy desensitization shot, and that will fix all the problems. It can be helpful for a lot of people, but it's not a cure.

Host: Of course, of course. Now, Doctor, are seasonal allergies genetic at all?

Dr. Christopher Ricketts: Yeah, that's a good question because I get that a lot. And there definitely is a genetic component with particular seasonal allergies. There are a lot of people that I hear will just off the cuff say, "Oh, it's my allergy to pollen. My mom had this, my grandpa had this," et cetera. So, there sure seems to be a genetic component.

Host: And on the other side, can allergies also develop later on in life?

Dr. Christopher Ricketts: Yeah, the immune system is actually a very dynamic part of our makeup, as is most of our body. As all the listeners will recognize, what your body does to you when you're in your 60s is not what it did when you were in your 40s, and it's not. What it feels like when you're in your 20s. And so, certainly, there are people that will develop allergies later in life as their immune system adapts and matures. But also, the immune system sometimes gets damaged by significant infections.

For example, COVID, COVID is a great example. People might they'll remember in the early days of COVID, one of the hallmark symptoms was loss of taste and smell. And there are a number of people who, after they have a virus-- and COVID is just one example-- but after they have a severe viral infection, do find that they are much more sensitive to things in the environment than they were before the infection.

Host: Wow. All right. Well, Doctor, wrap it up for us today. When should I seek out a doctor's help when it comes to seasonal allergies?

Dr. Christopher Ricketts: So, I would say if somebody has been struggling for more than say, 10 to 14 days, or if there is a worsening degree of symptoms, or if somebody develops a fever, then certainly I think that it's wise for them to reach out to their primary care doctor or provider and see if they do need seen or not.

Host: Thank you, Doctor. That was Dr. Christopher Ricketts. For more information, visit woodlawnhealth.org. If you enjoyed this podcast, please share it on your social channels and explore our entire podcast library for more topics of interest to you. This is Woodlawn Health Doc talk. And I'm Caitlin Whyte. Thank you for listening.