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Kousha Navidar: You are listening to All Of It on WNYC, I'm Kousha Navidar. If you're like me, then you know that spring can bring the stuffiness and sniffles of allergy season. I'm always sneezing, but how do allergies actually work, and how can we best prepare our bodies to make sure that the pollen in the air doesn't rough us up more than it needs to?

Dr. Neeta Ogden is a New York-based allergy specialist, and Kenneth Mendez is the president of the Asthma and Allergy Foundation of America. They both joined us right before the beginning of allergy season to provide some helpful information.

We also took your calls and questions, so you'll hear callers in this interview, but hey, this is an encore presentation, so unfortunately, we can't take your calls live right now. I started by asking Dr. Ogden how allergies actually work.

Dr. Neeta Ogden: Unfortunately, they are the natural occurrence that happens as we interact with our environment. Like any allergy, what happens is that the human body sees pollen in this case as a foreign substance to which it develops an immune response. This is an IgE-mediated immune response, which is very typical of allergy. You'll read about or hear about IgE being that culprit antibody. Why exactly it happens with tree pollen, grass pollen, weed pollen, those seasonal pollens? Less clear, I don't have an exact answer why those, but they are the big, big problems here.

As Kenny was saying, and you as well are addressing that we're seeing those pollen counts continue to rise become more troublesome even for people who didn't necessarily have a history of allergy in their life because the levels are getting so untenable.

Kousha Navidar: Oh, interesting. It presents later on in life, you're saying?

Dr. Neeta Ogden: It can. That's what I'm saying, is that it can be a new phenomenon for people in life, for example, their 50s. Classically before climate change, before these numbers were so high, you'd see it more as a trajectory that had always been there in somebody's life since their youth, since their early 20s. So many of my patients I see come in for the first time later in life saying, "I never had allergies before, why am I experiencing symptoms now?"

Kousha Navidar: What are some of those symptoms that you see that are most common?

Dr. Neeta Ogden: The classic symptoms are itchy watery eyes, and I should say with tree season in particular, we see the eyes often very severely affected, even more than other seasons for some reason, and they can be very itchy, red. Again, in tree season, I'll see people saying things like, "I want to scratch my eyes out." Then you also can get an itchy watery nose, sneezing, scratchy throat, itchy ears. [unintelligible 00:03:04] you can see is the hallmark here. There is a wide variety of symptoms.

For some people, it will start involving the airway, and even asthma symptoms. Cough can be present, shortness of breath. Some of these people tend to have a history of their airway getting involved, whether it be with triggers such as allergies or even viruses. All of these symptoms can lead to sinus infections, bronchitis, prolonged cough. Increasingly, I've seen people actually also have their skin involved, very itchy skin, especially if they've been out, as you were mentioning, sunbathing on a hot high pollen day. There is definitely a variety of symptoms.

Kousha Navidar: Listeners, if you're just joining us, I'm Kousha Navidar on All Of It, and we're talking to two experts on allergies. Kenny, what are things people could do to make their office or home more pollen-proof?

Kenny: I think there are a couple of things. One is to use air filter indoors to make sure that you suck up some of the pollen that's in there. Keep your windows closed during the high pollen events. When you come inside from the outdoors, make sure that you leave your shoes, your coat, things that pollen gets onto at the door, and then wash your sheets on a regular basis because you want to make sure you get the pollen out of those. Actually, some people are allergic to dust mites as well, which could be in your sheet.

One of the things that Dr. Ogden was saying that I guess asked about all the time, I'm not a doctor, so she could confirm this here, but is total allergic load. I think it's the amount of allergens that are there. Some people have said, "I've never had allergies before," but because of climate change and because the allergy season has gotten longer and more intense, and I mean more intense because of carbon dioxide in the atmosphere, which supercharges the releases of pollen, then those allergens are so much more in the environment, and then some people who had a certain allergic load now have so much more of it and they're suddenly having allergies.

Kousha Navidar: Can you confirm that, Dr. Ogden? Does that make sense?

Dr. Neeta Ogden: Yes. Certainly, yes. That's sort of these double whammies that people experience in terms of multiple allergic insults. I really love that you're talking about pollen proofing the home because these are actually very simple steps that people can take just like Kenny mentioned. The big thing you're trying to do here is reduce your exposure. The less you're exposed to something, the fewer symptoms you might have is the logic.

Another thing to think about is at the end of the day, showering, washing your hair before you are in bed for eight hours, being silently exposed to the palm that carried around from being outside, and being thoughtful about your activities during this high season. Skipping those outdoor jogs. It's hard because we're so excited to experience the great weather. Maybe you want to head to the gym. Don't sleep with your long-haired pet in the bed who was out frolicking for a walk. These are places where you can take an extra step and reduce your exposure to pollen.

Kousha Navidar: I have on the phone right now somebody who is from Brooklyn. Sam from Brooklyn who might have a question that lines up with this. Sam, welcome to the show.

Sam: Hi. Thank you. I was just complaining about allergies today, so this is very timely for me. I have had what I think are allergies, but it's only ever affected one eye at a time. Oddly, it'll lapse on the left eye for maybe four, five days, and then it migrates over to the right eye. I've also been told allergies don't typically affect just one eye. I'm just curious if that's possible or if this may be something else.

Kousha Navidar: Sam, thank you so much. Dr. Ogden, what would you make of that?

Dr. Neeta Ogden: Yes. I don't think it's something-- Yes, commonly, we'll see bilateral involvement. I've certainly seen one eye be more affected and then it can end up being the other eye. There isn't always one steadfast rule, but the eyes being affected, that's enough. Especially if they're itchy and it's in the season, and you've had this before to suggest that there's a strong history here of allergy leading to the eye symptoms.

Kousha Navidar: Sam, thank you so much for that call. Kenny, I want to bring the conversation to you and your work with the Asthma and Allergy Foundation. We had talked about asthma earlier in this segment. How does asthma play a role in allergic reactions? Is there a connection there?

Kenneth Mendez: Yes, definitely. Thanks for asking that. Over 10 people die each day from asthma, and you have to understand what your triggers are for asthma, and allergies can be a trigger for that as Dr. Ogden said. One of the things that we always say as a patient advocacy group, we want to make sure that we provide patient support. We've got an online community and we tell people to go see specialists like Dr. Ogden so they understand what their triggers are, and if they have asthma that they can have it well controlled because asthma can be life-threatening if you don't have it well controlled.

It's really important, especially during the pollen season, to make sure you understand what your triggers are, and that if you have allergic asthma, that it's well controlled and you're seeing someone like Dr. Ogden who can help you with that.

Kousha Navidar: We have a text from a listener who says, "Neti pots," Neti pots. I've used Neti pots before. "Neti pots are annoying, but NeilMed works really well. Premeasured salt to add to water must use with distilled water." I open this up to both of you. Have you used a Neti pot before? Is that good advice?

Dr. Neeta Ogden: I love this question because it really talks about steps that people can take at home to help mitigate their symptoms. Using a Neti pot or saline brands is a very easy way to wash pollen out of the nose, especially before bedtime, or if you're already congested. Keeping mucus membranes moist is so key to getting through that allergy-related congestion. This is something that comes up often with Neti pots. Some people love them. They tend to have a higher volume. Maybe if it's technique dependent, people don't necessarily always love them because, first of all, it can lead to a lot of clearing, improvement of sinus infections symptoms especially.

Some people might feel slightly more congested if they're possibly not doing it right. However, what your listener was talking about, NeilMed. I think it's a great product that makes it very just easy to do where you have a premeasured amount that comes in a packet, use it with distilled water, fill it up, shake it, and spray inside the nose and it leads to a lot of clearing of those secretions. Using methods like this, I think are all very helpful.

Kousha Navidar: Sorry, go ahead.

Kenneth Mendez: I've never used it myself, but as a caregiver, I'm miserable. It's my family that has allergies, but my kids have used it and that's helped. The other thing, again, when we see, say go see a specialist, if you're really miserable, you can get allergy shots and treatment. That's something that someone like Dr. Ogden can help you with which desensitizes you and makes the allergy season less intense for some.

Kousha Navidar: I love that you just brought up the different types of medicine. We have a caller on line one right now that has a question that's pertinent to that. It's Aaron from East Meadow, New York. Hi, Aaron.

Aaron: Hi. Thank you for taking my call. I'm a longtime allergy sufferer. Funny enough, I'm allergic to my dog and I've had seasonal allergies my whole life. I've gone through the circuit of all the different kinds of over-the-counter allergy medications you could find. I don't know if I'm allowed to say brand names on the air, but all of them, I've tried them all. I'm just curious if you could tell me the differences between them. Do they have different active ingredients? Are they for different people or different symptoms? Thank you

Kousha Navidar: Dr. Ogden, why don't you take that?

Dr. Neeta Ogden: Yes. There's so many allergy medications available now over-the-counter and this is why I really suggest that people see an allergy specialist sooner than later because they're going to help you navigate the very complicated pharmacy aisle that is devoted to allergy and allow you to navigate it efficiently with the exactly the type of question that he just asked. Because different allergy symptoms definitely require different medications and many of these medications have more than one ingredient.

It really depends on your symptoms and your past medical history, for example, about what may help. Certainly, in terms of treating allergy season symptoms, a place that most providers will start is with an over-the-counter antihistamine and something like a nasal steroid spray and there are a lot of different brands devoted to that. I think that is definitely the starting place for a lot of providers. I feel a lot of people reach for Benadryl which is fine but there are definitely other options that can be more again, efficient, lasting longer, and more efficacious because there is a greater symptom relief over a longer period of time.

Kousha Navidar: I want to thank Aaron for that call. Kenny, you wanted to--

Kenneth: Yes, just to build on that. For years, one type of over-the-counter allergy medication was my go-to medication and then one year it just did not work anymore. I was really miserable, so I actually switched medications. I switched over-the-counter medications and that one seemed to work a lot better for me. I think it does vary over time in terms of what medications work or do not work for you.

Kousha Navidar: We've got about a minute and a half left. I want to wrap this up with getting some final ideas and words of advice. Kenny, how is your organization raising awareness this spring season?

Kenneth Mendez: We will be releasing our allergy capitals report. We look at the hundred largest cities in the US and the ones that are most challenging to live in with allergies. We use three things to raise awareness about that. One is access to specialists like Dr. Ogden, pollen counts, and then over-the-counter medication usage. Those three scores will make you higher on the list depending upon where you rank because those are the three things that we think really express how bad you are experiencing allergies.

If you don't have access to a specialist, if you're using a lot of over-the-counter medication, and if the pollen counts are high, you're going to be miserable. See a specialist like Dr. Ogden, visit our website @aafa.org. There's a lot of good information there that can help you navigate this and know what to ask the doctor when you go see them.

Kousha Navidar: That was my conversation with Kenneth Mendez, the CEO of the Asthma and Allergy Foundation of America, and Dr. Neeta Ogden, an allergist immunologist and we were talking about how to best manage our allergies this season.

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