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Spring Allergies 101

Jennifer Toh, MD, practicing allergist and immunologist at ENT and Allergy Associates, and member of the executive committee of the New York Allergy & Asthma Society, answers questions about diagnosing and coping with spring allergies.

Title: Spring Allergies 101

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Amina Srna: It's the Brian Lehrer Show. I'm producer Amina Srna, filling in for Brian today. It's that time of year again. Spring has sprung, the cherry blossoms are in bloom, but unfortunately, pollen is, too. That's right, it's allergy season, sadly, preventing so many from truly enjoying the warmer weather. How do these seasonal allergies work, and more importantly, how can we truly take back spring from our immune systems?

With us to walk us through everything on seasonal allergies is Dr. Jennifer Toh, a practicing allergist and immunologist at ENT and Allergy Associates, and a member of the executive committee of the New York Allergy and Asthma Society. Welcome to the show, Dr. Toh.

Dr. Jennifer Toh: Thank you for having me. I'm happy to be here today.

Amina Srna: Listeners, do you have a question for Dr. Toh? How are you trying to fight your seasonal allergies? Do you have any tips or tricks to share with your fellow listeners? We want to hear--

Dr. Jennifer Toh: Yes.

Amina Srna: Oh, we want to hear from you. Call or text us now at 212-433-WNYC, that's 212-433-9692. Dr. Toh, to get us started, what kind of allergens are actually in the air at this point?

Dr. Jennifer Toh: Right now, in New York City and probably northeast and most of America, tree pollen is out in the air right now. That is the notorious pollen for springtime.

Amina Srna: Is it mainly pollen or also mold spores?

Dr. Jennifer Toh: Mold spores can come out right now, but it's typically low. We may see it more in the fall when things get a little more damp, but I think the major allergen that we're tackling right now is various tree pollen.

Amina Srna: For those who react to these allergens, what is actually happening inside the immune system as we breathe these in?

Dr. Jennifer Toh: To put it simply, for those who are allergic to tree pollen, our bodies are reacting to it by having symptoms like sneezing, runny nose, nasal congestion. It can affect our eyes, with itchy, watery eyes. Sometimes people can feel itchy. For patients who have asthma, their asthma can also act up. For those with eczema, their eczema can also flare.

Amina Srna: Listeners, how are you fighting your seasonal allergies? Do you want to give us any tips or tricks? We can also just hear you call in and complain. Give us a call now at 212-433-WNYC, that's 212-433-9692. Dr. Toh, there are so many types of pollen, from grass to ragweed, but how do you know what kind of pollen you're actually allergic to, or if you're reacting to something else, or even if you have a virus?

Dr. Jennifer Toh: That's a really great question. Well, first of all, seeing a board-certified allergist immunologist would be probably a great first step to find out what you're allergic to as we can do allergy testing to determine what you might be reacting to.

Basic things that can probably distinguish your symptoms from a viral infection versus allergies, typically, we'll see fevers, chills, body aches or sore throat, that might suggest more of a viral infection, whereas sneezing, itchy throat, itchiness or watery eyes or itchy, watery eyes may suggest allergies. Also, the timing of this could also be helpful, too. After three or seven days, and the symptoms resolve, it may just be a viral infection, whereas, if it lasts longer, it could suggest allergies.

Amina Srna: Dr. Toh, we're getting a couple of texts, and we're not giving medical advice here, but I will read them. "I thought what I had was allergies. Now I don't know. I had a raw throat all night, my nose is stuffed, I have no energy, nothing with my eyes, no itchiness." What does that sound like to you?

Dr. Jennifer Toh: It could be a viral infection, it could be allergies. I think the first great step would be to see your provider and start from there.

Amina Srna: Here's a tip, and I hope I get this pronunciation right. "I've been living on azelastine nose spray, which gives me instant relief but sends me to sleep." Are you familiar with this product?

Dr. Jennifer Toh: Yes. Azelastine is the medication that's also known as Astepro over the counter. It is an antihistamine nasal spray. Rarely, but it does help happen, we can see some sedation in patients that do take this medication, even in a nasal spray form. What I would suggest is actually, obviously, discussing with your provider if this is possible to switch to something like a nasal steroid, which is actually commonly the first line of treatment for allergy medications. I would obviously discuss with your provider if you can make such a switch.

Amina Srna: Let's go to a call. Mark in Nyack. Hi. You're on WNYC.

Mark: Hi. Thanks so much for taking my call. For years, I tried immunotherapy, all kinds of things, to manage my hay fever symptoms. Funny enough, I quit drinking three years ago and saw a dramatic improvement in my symptoms. I was wondering if there's any correlation between alcohol intake and histamines.

Amina Srna: Thanks for your call, Mark. Dr. Toh?

Dr. Jennifer Toh: Yes. Just for the callers, immunotherapy is a long-term treatment option for allergies. They're also widely known as allergy shots. I'm glad that you shared that information with us. In terms of the relationship between alcohol ingestion and allergies, alcoholic beverages do have ingredients that can cause allergic-type symptoms in some patients. They can have histamines in the drink or sulfites that can cause various symptoms. Maybe some of the factors that were playing in your specific allergies may have involved alcohol.

Amina Srna: Let's go to another call. Olivia in Manhattan. Hi, Olivia. You're on WNYC.

Olivia: Hi. I have a question. I was wondering about, what is the purpose of the histamine reaction? What is my body trying to do? Is it trying to get it out? Is it trying to protect against something? Is there any evolutionary purpose to this?

Amina Srna: Great question. Dr. Toh?

Dr. Jennifer Toh: That's a great question. What's happening in your body is that our cells are releasing mediators, and one of those mediators is histamine. That's usually in response to something that you're allergic to. If we wanted to look at evolution, those same cells are also known to treat or to combat parasites. Histamine is an active molecule that can attack parasites, so maybe there is some evolution involved in having these cells in our body. Maybe we don't have any use for them anymore, but I'm sure science can tell us more.

Amina Srna: Let's go to Mary in Greenport, who says her sister in law may have a potential home remedy. Hi, Mary. You're on WNYC.

Mary: Hi. Yes, my sister had very, very bad hay fever. Her eyes would swell up, they'd water. She would have a really hard time. She began taking two tablespoons of apple cider vinegar mixed with honey every night. I don't know if it was one or two, actually, but anyway, she took every night. It took a long time, but after years, now it's gone. She doesn't have it anymore.

Amina Srna: Thanks for your call, Mary. Dr. Toh, we're getting a couple of callers in. Another caller suggests acupuncture. I wonder if you wanted to weigh in on anything that you think works, actually, as a home remedy.

Dr. Jennifer Toh: Let's start with the first caller about the apple cider vinegar and honey. That is actually something that a lot of patients have mentioned that honey has been helpful, or people have read that honey may be helpful. When you think about it, the honeybees are gathering pollen from flowers. The pollen that a lot of us are allergic to are actually from the trees, not necessarily from the flowers. In theory, it may make sense for those who may have allergies to pollen from flowers, but it may not be helpful for those who are allergic to the most common allergens, such as tree pollen.

Amina Srna: There's another thing that Mary said there in her call. She's saying that this was a home remedy that was used over the course of a period of time, over a course of years. Do seasonal allergies get better or worse with age? Is there a trend there?

Dr. Jennifer Toh: That's a great question. As we get older, our allergies can also evolve. They can certainly get worse with time, especially with the more seasons that you're exposed to. At the same time, our immune system changes as we become older. I currently have patients even in their 60s and 70s that are actually undergoing allergy immunotherapy or allergy shots right now.

Amina Srna: That's so interesting. Jeannette in Greenpoint. Hi. You're on WNYC.

Jeannette: Hi. Thank you for taking my call. I was just wondering if there's a difference between Claritin and Zyrtec, and if you have a specific allergy to something, should you take Zyrtec versus Claritin? I just been going back and forth because I'm just clueless.

Amina Srna: Probably a question a lot of people have. Dr. Toh?

Dr. Jennifer Toh: I think I mentioned before, first-line treatment for seasonal allergies, assuming you don't have any significant medical problems, is actually a nasal spray or a nasal steroid. Something like Flonase, Nasonex, Nasacort are usually the first-line treatment for allergies. For those who revert to oral medications, you had mentioned a few oral antihistamines. Claritin, Zyrtec, Xyzal, and Allegra are all available over the counter. They all have some unique features. I would say my favorite is actually Allegra. It's the least sedating out of all the antihistamines.

For those who don't like large pills, because Allegra is one of the largest of the oral antihistamine pills, Claritin, Zyrtec, or Xyzal are significantly smaller. Some pharmacologists say that Claritin may be the weakest of all the oral antihistamines, but for those who are particularly sensitive to medications, it might be a good first step. Then I just want to touch upon the sedating antihistamines like Benadryl, which I do not recommend as they are sedating, short-acting, and when used long-term, it can lead to undesirable side effects when used chronically.

Amina Srna: We have so many callers calling in, but I think we're just going to be out of time. One quick question for you, Doctor Tooh. Some people have been noticing that allergy season has been lasting longer than usual as of late, with some even correlating this to climate change. Do you have a take on that?

Dr. Jennifer Toh: Yes, I do think with climate change, spring allergy symptoms can start earlier and last longer. Research has shown that warmer temperatures and increased carbon dioxide levels due to global warming has been contributing to increased pollen production, leading to a longer and more intense allergy season. Classically, spring allergies would start between March and May, now we're seeing it as early as early March into February, and now even lasting through June.

Amina Srna: All right. That's what we'll leave it for today. Our guest has been Dr. Jennifer Toh, an allergist and immunologist at ENT and Allergy Associates, and a member of the executive committee of the New York Allergy and Asthma Society. Dr. Toh, thank you so much for joining us today and answering all these many good questions from our listeners.

Dr. Jennifer Toh: Thank you very much for having me.

Amina Srna: The Brian Lehrer Show producers are Lisa Allison, Mary Croke, me, Amina Srna, Carl Boisrond, and Esperanza Rosenbaum. Our intern is Henry Saringer. Megan Ryan is the head of Live Radio. Juliana Fonda and Milton Ruiz are at the audio controls. I'm Amina Srna, and this is The Brian Lehrer Show on WNYC. Stay tuned for All Of It.

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