Runny nose, sneezing watery eyes, itchy eyes or skin – these symptoms and more are caused by allergic rhinitis, an overreaction of your immune system to an allergen.
Most allergens are typically harmless substances such as pollen, pet dander, mold and more.
Diagnosing, treating and helping you manage rhinitis and other allergy, asthma, and sinus-related concerns is the specialty of Dr. Alan Goodman, Allergist/Immunologist with Summit Medical Group.
Selected Podcast
Allergic Rhinitis
Featured Speaker:
Dr. Goodman is Past President of the New Jersey Allergy and Immunology Society. He remains active on the New Jersey Allergy and Immunology Society Board of Directors. In addition, Dr. Goodman is a member of American Academy of Allergy, Asthma, and Immunology, New York Allergy Society, Medical Society of the State of New Jersey, and Essex County Medical Society.
Alan Goodman, MD
Alan J. Goodman, MD, JD, FAAAAI, specializes in allergies, asthma, rhinitis, bee sting allergy, and sinus disorders. Before joining Summit Medical Group, Dr. Goodman practiced privately with Allergy, Asthma, and Immunology, PA, in Livingston and Union, New Jersey. Dr. Goodman is Former Section Chief in the Division of Allergy at Union Hospital Medical Center in Union, New Jersey. He has been an allergy consultant for the Veterans Administration Medical Center Ambulatory Care Department in East Orange, New Jersey, Attending Allergist with Louis Lasky Medical Center in New York City, and an emergency department physician at Flushing Hospital Medical Center in Flushing, New York. While in Washington, DC, he was Director of House Officers and Employee Health at Sibley Memorial Hospital and an emergency department physician at Capitol Hill Hospital.Dr. Goodman is Past President of the New Jersey Allergy and Immunology Society. He remains active on the New Jersey Allergy and Immunology Society Board of Directors. In addition, Dr. Goodman is a member of American Academy of Allergy, Asthma, and Immunology, New York Allergy Society, Medical Society of the State of New Jersey, and Essex County Medical Society.
Transcription:
Allergic Rhinitis
Melanie Cole (Host): Runny nose, sneezing, watery eyes, itching eyes or skin can all be caused by allergic rhinitis. What is that and what can you even do about it? My guest is Dr. Allan Goodman,. He’s an allergist and immunologist with Summit Medical Group. Welcome to the show, Dr. Goodman. Tell us, what’s allergic rhinitis?
Dr. Allan Goodman (Guest): I think that with your introduction, you got it all down. It’s the classic symptoms of the runny nose, the itchy eyes, the sneezing. You have coughing. Coughing can come either from the chest itself or as the post-nasal drip goes down the back of the throat.
Melanie: So we’ve got some symptoms. People have these symptoms, how do they know it’s not a cold?
Dr. Goodman: If they have a fever, they don’t have allergic rhinitis as itself. Sometimes, allergic rhinitis may be associated with what’s known as a cold morbid condition—that is another condition that may be a factor in someone who has the underlying problem. If someone has allergic rhinitis, the nasal membranes may get blocked, and they may more likely to get a sinus infection. And that’s a complication of allergic rhinitis. Or, if they’re having wheezing or shortness of breath—again, another complication of allergic rhinitis known as seasonal asthma or allergic rhinitis-induced asthma. Typically, with allergic rhinitis you’re going to have a clear discharge. If it’s colored, very pus-looking, again, that’s probably not going to be allergic rhinitis.
Melanie: What would increase somebody’s risk for this, Dr. Goodman? Are there certain triggers out there? Are there certain risk factors that would predispose someone for this?
Dr. Goodman: You have to be exposed. People are not born with allergic rhinitis. This is something that you need to have exposure in order to develop it. The typical story is one who moves from a different part of a country or a different part of the world, and all of sudden they say, “What happened to me? I never had this before. I’m sneezing. I can’t breathe.” And then as they go back to from where they came, whether it’s a different country -- typically, in my practice, someone who’s come from Asia or South America, they’ve never been exposed to the tree pollens which are very prominent in the Northeast. As they go away from these things, they will never have another problem. Or, the other classical case is, “I got a pet about a month ago, and for three weeks, I’ve been absolutely miserable.” That is the problem with exposure. If you’re never exposed to anything, you’re not going to have a problem. Now, of course, there’s a predisposition from genetics. If you have allergic parents, it is more likely that you will have allergic rhinitis. But we have people in our practice who, no one in the family has any allergies, and all of a sudden, what is happening or the adult that is having these problems.
Melanie: So, pollen, pet dander, mold, there are all these substances that if you were never allergic before and you’ll come around these substances, you could have these reactions to them. Being in a different part of the country, anything like that. Now, how do you diagnose it? And then tell us about treatments.
Dr. Goodman: Well, the first diagnosis in any sort of medical condition is listening to the patient, listening to what’s going on. With allergies, we want to look for patterns, we want to look for clues. The typical thing for the seasonal allergies is that, “Why is it every March, April, May, it just happens? I just feel miserable. My eyes start tearing up, I start sneezing.” That will have classical symptoms; and then we can do allergy testing, either a skin test or a blood test to confirm that this is going on. Again, another question that comes up is like, “Every time I go into the house with the cat, I start sneezing.” So these are the clues that there is allergy that’s going on.
Melanie: Then what do you do to treat it?
Dr. Goodman: Okay, that’s an interesting question. This is, after the second millennium, previously, anybody who needs any sort of allergy treatment would have to go to the doctor’s office and get the medications. Now, many of the medications—typically, the antihistamines—are available over-the-counter. And there are no very few prescription antihistamines available presently. As the doctor, as the allergist, I’m seeing the more complicated cases because I’m seeing the ones who have failed the over-the-counter medications. Also, it’s very important that when someone sees the doctor, they learn how to properly use the medications. The big thing I see is, yes, these people have the proper medications, but they don’t know how to use it properly—when is the timing of the medication, how to administer it, which medications are available for what problems. That’s where I or other allergists can help modify the disease and make these patients feel much more comfortable.
Melanie: Dr. Goodman, I know exactly what you’re talking about because I know people that have inhalers and they don’t seem to work for them, and then when I watched them do it, they are not even using it correctly. I hear what you’re saying about maybe not using your meds correctly or not taking them, maybe not adhering. What about allergy shots? We hear about these all the time. Are these applicable in allergic rhinitis?
Dr. Goodman: That’s the bread and butter. That’s the patient for whom the allergy shots are well-designed. Going back to the earlier statement, we want to see cause and effect. And the more cause and effect relation, correlation that there is, the more likely that the allergy shots are going to be effective. Allergy shots are injections of the things to which you’re allergic. For example, if you’re allergic to the tree pollens and you’re exposed to the tree pollens, 95 percent of those people will do a lot, lot better with allergy shots. Now, the other question to ask: is it necessary? And the patient has to be very motivated to have allergy shots because allergy shots are very time-consuming. We sort of break in the categories. Although the shots will be likely to work, it has to be determined, is it worth it for the patient? If someone has only one week of severe symptoms, it might not be worth it for the patient. However, if they are miserable—and which is a fair number of our patients who have problems from March until the first frost—then these patients are more likely to be adherent with the allergy treatment regimen, with the allergy shots. Because these are people who have significant morbidity, significant illness that goes on for many months, and these people want to feel better.
Melanie: Now, what about home treatments, things that people can do to manage their own symptoms? Are there certain things you can do—keeping your house clean, air filters, avoiding those triggers, avoiding those allergens—is there any way to do that?
Dr. Goodman: Okay, with the whole environment -- again, if you’ve never been exposed to something, you’re never going to have an allergy. So what could we do to limit the allergens? On a nice, cool, spring day, keep the windows closed. “What? It’s wonderful out.” Well, all the bad stuff that’s coming from the outside are coming in.
In the history taking of the patient, we have to determine: are you better indoors or better outdoors? And for the outdoor things, you want to keep the outdoors outside and the indoor problems indoors. If someone has outdoor allergens such as trees, grasses, ragweed, keeping those windows closed and using the air conditioning as a filter—not just to cool the place but to use as filter—prevents the allergens from entering the house. Likewise, if you have things in the house that are problematic, we have to figure out how to get rid of them. If you’re allergic to dust mites, cats, other animals, you want to get rid of these collectors of the dust or these allergens—removing the carpeting, just minimizing amount of stuffed animals, keeping the animal out of the bedroom. People always ask about air filters for inside the house, and they’re really, overall, not very effective. Where they may be effective is for patients who have animal allergies because the cat, the dog, allergen is a lighter allergen, so they’re more likely to be trapped by the air filters. The dust mites are a heavier allergen, so having an air filter is less likely to be of any benefit. It may make your house a little less dusty, but don’t count on it for making you less allergenic.
Melanie: We only have a couple of minutes, Dr. Goodman, left, but tell me about controlling dust and dust mites. You’ve talked about that. Do you feel that some of these bedding and sheets and things that people can buy at various stores, do these really work, these anti-allergenic sheets and blankets and those kinds of things? Do those work?
Dr. Goodman: They work to a point. Again, we have to figure out what are we trying to trap? The dust mites, trapping those dust mites and the dust mites species inside the mattress so they don’t get breathed, inhaled is going to be effective. Those covers are not going to be effective if you have the cat sleeping on your bed because that is something that is going to be exterior. You want to wash your bedding frequently. It doesn’t matter if it’s the animals, the dust mites, because washing it puts the allergens down the drain and not into your system, into your respiratory system.
Melanie: Dr. Goodman, in just the last minute, would you please wrap it up for us about allergic rhinitis? The most important information you want the listeners to know and why they should come see you at Summit Medical Group.
Dr. Goodman: Okay. In summary, we have to limit the exposure of the allergens so they can be most effective—the treatment. No exposure, no treatment. And then, to figure out what is the best medication for your problem? Whether it’s an antihistamine, whether it’s a nasal spray, whether it’s an eye drop, whether or not someone needs an inhaler for breathing, or, in the best case scenario, what’s our long term treatment? Are allergy shots a way of preventing this problem, keeping the problem from developing year after year as a way of this diseases-modifying agent?
Melanie: Thank you so much. You’re listening to SMG radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Allergic Rhinitis
Melanie Cole (Host): Runny nose, sneezing, watery eyes, itching eyes or skin can all be caused by allergic rhinitis. What is that and what can you even do about it? My guest is Dr. Allan Goodman,. He’s an allergist and immunologist with Summit Medical Group. Welcome to the show, Dr. Goodman. Tell us, what’s allergic rhinitis?
Dr. Allan Goodman (Guest): I think that with your introduction, you got it all down. It’s the classic symptoms of the runny nose, the itchy eyes, the sneezing. You have coughing. Coughing can come either from the chest itself or as the post-nasal drip goes down the back of the throat.
Melanie: So we’ve got some symptoms. People have these symptoms, how do they know it’s not a cold?
Dr. Goodman: If they have a fever, they don’t have allergic rhinitis as itself. Sometimes, allergic rhinitis may be associated with what’s known as a cold morbid condition—that is another condition that may be a factor in someone who has the underlying problem. If someone has allergic rhinitis, the nasal membranes may get blocked, and they may more likely to get a sinus infection. And that’s a complication of allergic rhinitis. Or, if they’re having wheezing or shortness of breath—again, another complication of allergic rhinitis known as seasonal asthma or allergic rhinitis-induced asthma. Typically, with allergic rhinitis you’re going to have a clear discharge. If it’s colored, very pus-looking, again, that’s probably not going to be allergic rhinitis.
Melanie: What would increase somebody’s risk for this, Dr. Goodman? Are there certain triggers out there? Are there certain risk factors that would predispose someone for this?
Dr. Goodman: You have to be exposed. People are not born with allergic rhinitis. This is something that you need to have exposure in order to develop it. The typical story is one who moves from a different part of a country or a different part of the world, and all of sudden they say, “What happened to me? I never had this before. I’m sneezing. I can’t breathe.” And then as they go back to from where they came, whether it’s a different country -- typically, in my practice, someone who’s come from Asia or South America, they’ve never been exposed to the tree pollens which are very prominent in the Northeast. As they go away from these things, they will never have another problem. Or, the other classical case is, “I got a pet about a month ago, and for three weeks, I’ve been absolutely miserable.” That is the problem with exposure. If you’re never exposed to anything, you’re not going to have a problem. Now, of course, there’s a predisposition from genetics. If you have allergic parents, it is more likely that you will have allergic rhinitis. But we have people in our practice who, no one in the family has any allergies, and all of a sudden, what is happening or the adult that is having these problems.
Melanie: So, pollen, pet dander, mold, there are all these substances that if you were never allergic before and you’ll come around these substances, you could have these reactions to them. Being in a different part of the country, anything like that. Now, how do you diagnose it? And then tell us about treatments.
Dr. Goodman: Well, the first diagnosis in any sort of medical condition is listening to the patient, listening to what’s going on. With allergies, we want to look for patterns, we want to look for clues. The typical thing for the seasonal allergies is that, “Why is it every March, April, May, it just happens? I just feel miserable. My eyes start tearing up, I start sneezing.” That will have classical symptoms; and then we can do allergy testing, either a skin test or a blood test to confirm that this is going on. Again, another question that comes up is like, “Every time I go into the house with the cat, I start sneezing.” So these are the clues that there is allergy that’s going on.
Melanie: Then what do you do to treat it?
Dr. Goodman: Okay, that’s an interesting question. This is, after the second millennium, previously, anybody who needs any sort of allergy treatment would have to go to the doctor’s office and get the medications. Now, many of the medications—typically, the antihistamines—are available over-the-counter. And there are no very few prescription antihistamines available presently. As the doctor, as the allergist, I’m seeing the more complicated cases because I’m seeing the ones who have failed the over-the-counter medications. Also, it’s very important that when someone sees the doctor, they learn how to properly use the medications. The big thing I see is, yes, these people have the proper medications, but they don’t know how to use it properly—when is the timing of the medication, how to administer it, which medications are available for what problems. That’s where I or other allergists can help modify the disease and make these patients feel much more comfortable.
Melanie: Dr. Goodman, I know exactly what you’re talking about because I know people that have inhalers and they don’t seem to work for them, and then when I watched them do it, they are not even using it correctly. I hear what you’re saying about maybe not using your meds correctly or not taking them, maybe not adhering. What about allergy shots? We hear about these all the time. Are these applicable in allergic rhinitis?
Dr. Goodman: That’s the bread and butter. That’s the patient for whom the allergy shots are well-designed. Going back to the earlier statement, we want to see cause and effect. And the more cause and effect relation, correlation that there is, the more likely that the allergy shots are going to be effective. Allergy shots are injections of the things to which you’re allergic. For example, if you’re allergic to the tree pollens and you’re exposed to the tree pollens, 95 percent of those people will do a lot, lot better with allergy shots. Now, the other question to ask: is it necessary? And the patient has to be very motivated to have allergy shots because allergy shots are very time-consuming. We sort of break in the categories. Although the shots will be likely to work, it has to be determined, is it worth it for the patient? If someone has only one week of severe symptoms, it might not be worth it for the patient. However, if they are miserable—and which is a fair number of our patients who have problems from March until the first frost—then these patients are more likely to be adherent with the allergy treatment regimen, with the allergy shots. Because these are people who have significant morbidity, significant illness that goes on for many months, and these people want to feel better.
Melanie: Now, what about home treatments, things that people can do to manage their own symptoms? Are there certain things you can do—keeping your house clean, air filters, avoiding those triggers, avoiding those allergens—is there any way to do that?
Dr. Goodman: Okay, with the whole environment -- again, if you’ve never been exposed to something, you’re never going to have an allergy. So what could we do to limit the allergens? On a nice, cool, spring day, keep the windows closed. “What? It’s wonderful out.” Well, all the bad stuff that’s coming from the outside are coming in.
In the history taking of the patient, we have to determine: are you better indoors or better outdoors? And for the outdoor things, you want to keep the outdoors outside and the indoor problems indoors. If someone has outdoor allergens such as trees, grasses, ragweed, keeping those windows closed and using the air conditioning as a filter—not just to cool the place but to use as filter—prevents the allergens from entering the house. Likewise, if you have things in the house that are problematic, we have to figure out how to get rid of them. If you’re allergic to dust mites, cats, other animals, you want to get rid of these collectors of the dust or these allergens—removing the carpeting, just minimizing amount of stuffed animals, keeping the animal out of the bedroom. People always ask about air filters for inside the house, and they’re really, overall, not very effective. Where they may be effective is for patients who have animal allergies because the cat, the dog, allergen is a lighter allergen, so they’re more likely to be trapped by the air filters. The dust mites are a heavier allergen, so having an air filter is less likely to be of any benefit. It may make your house a little less dusty, but don’t count on it for making you less allergenic.
Melanie: We only have a couple of minutes, Dr. Goodman, left, but tell me about controlling dust and dust mites. You’ve talked about that. Do you feel that some of these bedding and sheets and things that people can buy at various stores, do these really work, these anti-allergenic sheets and blankets and those kinds of things? Do those work?
Dr. Goodman: They work to a point. Again, we have to figure out what are we trying to trap? The dust mites, trapping those dust mites and the dust mites species inside the mattress so they don’t get breathed, inhaled is going to be effective. Those covers are not going to be effective if you have the cat sleeping on your bed because that is something that is going to be exterior. You want to wash your bedding frequently. It doesn’t matter if it’s the animals, the dust mites, because washing it puts the allergens down the drain and not into your system, into your respiratory system.
Melanie: Dr. Goodman, in just the last minute, would you please wrap it up for us about allergic rhinitis? The most important information you want the listeners to know and why they should come see you at Summit Medical Group.
Dr. Goodman: Okay. In summary, we have to limit the exposure of the allergens so they can be most effective—the treatment. No exposure, no treatment. And then, to figure out what is the best medication for your problem? Whether it’s an antihistamine, whether it’s a nasal spray, whether it’s an eye drop, whether or not someone needs an inhaler for breathing, or, in the best case scenario, what’s our long term treatment? Are allergy shots a way of preventing this problem, keeping the problem from developing year after year as a way of this diseases-modifying agent?
Melanie: Thank you so much. You’re listening to SMG radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.