Ask Us Anything About… Seasonal Allergies

Description – The video begins outside the Penn State Health Milton S. Hershey Medical Center and College of Medicine on a sunny day. You can see flowers, budding trees and two individuals standing next to each other looking at the camera. Standing from left to right is Dr. Faoud Ishmael, allergist and Scott Gilbert.

Scott Gilbert – From Penn State Health, this is ask us anything about seasonal allergies. I’m Scott Gilbert. Thanks for watching today. You see the trees, the grasses, the flowers behind us. A sure sign of spring. It’s also a sign of spring and seasonal allergies for a lot of people. So here to sort out what allergy sufferers can expect this season is Dr. Faoud Ishmael. He’s an allergist here at Penn State Health Milton S. Hershey Medical Center. Dr. Ishmael, thanks for being here today.

Dr. Faoud Ishmael – Thank you for having me.

Scott Gilbert – So let’s talk a little bit about this season and what we’re seeing in terms of allergens. You know it’s been a little bit of a whacky season weather wise. How does that play into it as well?

Dr. Faoud Ishmael – You know it’s correct. So here in Pennsylvania we typically expect our tree season which is what the spring time is probably start as early as the first week of March. Usually peaking within the, you know, first couple of weeks. So in that sense, we’ve had — we’ve actually had a pretty decent season so far. With some of the cold weather, some of the snow we’ve had, we haven’t had a sustained increase in the pollens like we expect. Now we’ll see what happens moving forward as the weather has been warming up a little bit especially as we get into April. Things may change. The tree pollens are going to come out a little bit more as the weather warms up. And so I think we’re going to end up seeing some symptoms within the next week or two.

Scott Gilbert – So that late March snow storm is going to have an impact, it’s just not clear exactly what type of impact yet.

Dr. Faoud Ishmael – Yeah absolutely. And you know, there are a couple of things to consider. One of those is many people out there are not allergic only to tree pollens. They may be allergic to grasses or weeds. And as we go through April and as we get into May, grass is going to come up. So people may not be complete out of the woods. For those who are tree allergic, one of the things that remains to be seen is whether, you know, we’ll get a rapid increase in tree pollens that kind of merges into the grass season. And maybe symptoms are going to start developing pretty quickly.

Scott Gilbert – So we’re just going to have to see which allergens emerge at what time then. Very interesting.

Dr. Faoud Ishmael – Yeah exactly.

Scott Gilbert – You’re watching ask us anything about seasonal allergies from Penn State Health, I’m Scott Gilbert along with Dr. Faoud Ishmael. We welcome your questions. Feel free to type them into the comment field below this Facebook post whether you’re watching the video live with us on Monday or if you’re watching it on playback. We can still track down some answers to those questions and get those to you. You know Dr. Ishmael, here in Central Pennsylvania it seems like we have a lot of allergens in this area. How does this area stack up compared with, say, other parts of the country?

Dr. Faoud Ishmael – Yeah so we definitely are in a hot spot when it comes to allergies. And when we think of outdoor allergies, you know there are a few things that we think about. So in general, we have four main seasons. We have the springtime which are primarily tree pollens. We have the summer which is primarily grass and a few weeds and then ragweed starts early fall kind of going into the first frost. And actually once leaves drop, they get a little wet we start to get the molds to come up. So we’re in the area that’s really prevalent in all of those things. So some people may have allergies starting, beginning of March and actually going all the way through the end of fall or going into winter. So yeah we’re certainly in an area with all of those things.

Scott Gilbert – I feel it as well. Every springtime. I’m among those who always know when it’s springtime based on the allergy symptoms. And talk a bit about avoiding those triggers. It seems like that’s a good important first step is to try to avoid them. Things like, you know, staying indoors when you can but that’s also tough because you want to get outside and enjoy the summer.

Dr. Faoud Ishmael – Yeah absolutely. So the really first step is avoiding allergens, reducing the exposure. That’s the — you know that’s kind of cornerstone in where do we start. Outdoor allergens. There are a few things that you can do. You know one of the common things, I think, is you know when the weather starts to warm up a little bit in the spring, people have a desire to open up the window. Get some fresh air. The problem is all those pollens come in and now you have a pretty high exposure especially when you’re sleeping. So that’s really the first thing. Avoid sleeping with your windows open. Some people will dry their clothes outside especially as the weather warms up. So that’s another thing to keep an eye on.

Scott Gilbert – Because the pollen’s flying through the air —

Dr. Faoud Ishmael – Absolutely. The pollens will deposit on the clothing and you know, when you bring it, now you have another source of exposure. You know there are a few other things that may help. Pollens tend to be highest in the morning. So if you’re going to go out for a run or walk or spend some time outside, doing it towards the end of the day might actually be a little bit better than the beginning of the day. And when you come in from the outside, you have to be aware the pollens are going to deposit on your skin, your hair, your clothing. So it’s a good sign to throw your clothes in the hamper. Maybe have a shower to get those off. Outside of that, you know, there’s not a whole lot you can do. You know it’s probably better to go outside and get some exercise than to completely avoid it. You know a few important things too that may be helpful. When you’re indoors especially as the weather gets warmer, run your air conditioning might help. The AC filter is sufficient to filter out most of the pollens were exposed to. And if you have central AC change the filter on a regular basis is also something else that can be really key.

Scott Gilbert – Good advice. You’re watching ask us anything about seasonal allergies from Penn State Health. I’m Scott Gilbert along with Dr. Faoud Ishmael. And we welcome to share this interview. If you find this information useful, feel free to share it right now. Live while we’re doing this interview or even again if you’re watching after the fact. And of course, feel free to ask your questions as well and we’ll track down some answers for you from Dr. Ishmael. Boy there’s —

Dr. Faoud Ishmael – a lot for some of the more severe symptoms. Things like lots of mucous produced, postnasal drip, congestion. So that’s really when we think about going to the next step which would be intranasal steroids. Now you know, even those these are steroid medications, they’re actually a safe kind of a steroid. These are, you know, what you think about if you have a swollen joint you get a cortisol shot. Those are [inaudible]. The nose spray forms are even safer because it’s topical. It’s really going to the nose only. So those are anti-inflammatory medications. And those really will treat the vast majority of allergy symptoms. Both nasal and it turns out, eye symptoms as well. One of the key things to remember with the intranasal steroids is they don’t act right away. You need to use them every day probably for a good week, maybe two weeks for them to really build up. So as you think about your springtime allergies, you may actually want to start that a week or two before when your symptoms normally would occur. And usually we’ll tell people continue them daily throughout the allergy season or at least their allergy season. Now, you know, there are a few medications that we, in general, tell people to avoid. And those are decongestants. They can be either oral decongestants, topical decongestants, either a nose spray or eye drop form.

Scott Gilbert – And why is that? Because I was on a decongestant for a while and it seemed to handle the symptoms but that’s not optimal. Right?

Dr. Faoud Ishmael – Yeah exactly. So the way that decongestants work is they constrict blood vessels which reduces swelling in the nose and actually the same thing in the eyes. The problem is your nose gets used to that medication. And after using it maybe for about three days in a row, it turns out that your nose will be so used to it that if you stop it, you may get a rebound of symptoms. The other big thing that we worry about this effect on the blood vessels can occur throughout your —

Scott Gilbert – option, is that kind of a resort when the other medications you talked about don’t work?

Dr. Faoud Ishmael – Yeah absolutely. So we think about shots in a few different settings. One would be someone’s tried all of those options. They’ve tried the oral histamines. They’ve tried the nose spray and they still contain and have symptoms. That would be a setting where we probably want to see someone like that in our office. A few things we’d be thinking about would be allergy testing. You know what are you allergic to? A lot of times there may be combination of indoor things and outdoor things that are causing allergies. People have allergies in different seasons where maybe nine months out of the year you’re going to be miserable. That would be another indication for someone to think about shots. There are some down sides with shots. The main issue is that — — probably for at least three years to get benefit. Now the upside of shots is that effect may be permanent and that’s the hope is that people have long lasting benefit after completing a course of shots. So you know, kind of in summary, it’s a good way to potentially reduce the need for medications. Treat symptoms when other things aren’t working and maybe a long-term therapy to hopefully take allergies away or at least reduce the symptoms quite a bit hopefully forever.

Scott Gilbert – We welcome your questions for Dr. Faoud Ishmael on this edition of ask us anything about seasonal allergies from Penn State Health. Some really interesting information so far here. You know I would like to ask you a bit about children versus adults. It seems like — I mean I know for one, I knew very early on in life that I was going to have seasonal allergies and they’ve stuck with me ever since. Is that typical?

Dr. Faoud Ishmael – Yeah, so it’s typical. So children especially with the outdoor allergens, we tend to see it starting maybe around the age of 4, 5, 6, or so. In general, we need — you know children need probably few years of seeing pollens to start becoming allergic. The problem with allergies is once you have them they typically don’t go away. So they typically start in childhood and persist throughout adulthood. And so they are pretty [inaudible] in that sense.

Scott Gilbert – So when it comes allergy season for asthma sufferers, are there some additional issues there that those people need to worry about?

Dr. Faoud Ishmael – Yeah absolutely. So we tend to think of allergies as things involving the upper airway, the nose, the eyes. Asthma’s a disease of the lower airways but actually can be triggered with the same things. So allergies are a major trigger for asthma. So people who have asthma and allergies, they’ll have symptoms like wheezing, coughing, shortness of breath, chest tightness, and essentially the same thing’s happening as someone with nasal allergies. You’re getting swelling in the airways. You’re getting mucous production. It’s a little bit more dangerous though. We think of an allergy as really is more being an issue with quality of life. People are miserable. Asthma really can be something a little bit more severe. You’re worried that people may end up in the emergency room if their asthma’s not controlled. So it’s one of those things that we like to keep a close eye on. If we have asthmatic patients who are allergic, we like to counsel them a little bit that some of these triggers might also worsen the asthma. Some of them may need to be on a daily inhaler at least during the allergy season and so if someone notices those types of symptoms, it’s a good idea to contact their physician.

Scott Gilbert – You’re watching ask us anything about seasonal allergies from Penn State Health. I’m Scott Gilbert alongside Dr. Faoud Ishmael who’s giving us some great information. We welcome your questions as well. So you suffer seasonal allergies every spring, what are some of the issues you deal with? Here’s a chance for you to get some advice straight from a physician. You know it seems it never fails. Anytime the symptoms —

Dr. Faoud Ishmael – persistent usually throughout the course of that season. Most viruses tend to last a few days and then they start to get better but in the end, it can be a little difficult to sort out. So luckily a lot of the allergy medicines really work very well for colds as well. Things like antihistamines can help sneezing regardless of the cause. If symptoms keep persisting, that’s a sign that it’s more likely to be allergy driven.

Scott Gilbert – Okay. And we’re talking a lot about outdoor allergens. That’s our focus today but there’s a whole different set of allergens that affect people indoors, all year round. Can you talk just briefly about those and how those compare to outdoor allergies?

Dr. Faoud Ishmael – Yeah absolutely. And in fact, many people have both indoor and outdoor allergies. So people may have symptoms year round and then get worsening during the seasons. So to me indoor allergens are dust mites. That’s a big one in this area. Dust mites live in fabric actually. So they’re in your bedding, your pillows. They may be in carpets. So people may have symptoms even during the winter if they’re allergic to dust mites. Animals are another major source of allergens. Things like cat and dog. Typically furry animals are the ones we think about. You know in this part of Pennsylvania we don’t think about this a whole lot but there may be things like cockroaches that maybe issues. Those tend to be more in inner city type environments. Rodents also may be sources of allergens. And you know here, we say most often our lab workers where we use some of these as models to study disease. So quite often people have — may have both.

Scott Gilbert – So when it comes to allergy testing, who should consider that? You know given all these allergens that are out there. I mean at what point do you suggest that for patients as a way to sort out what are and aren’t triggers for that individual?

Dr. Faoud Ishmael – Yeah. So first of all, really anyone just wanting to know what they might be allergic to. Even if they have symptoms just one particular time of year. That might be helpful because we can potentially make better recommendations about how to avoid things. Certainly people who have tried the medications and it’s not helping, we’d want to think about testing. And then someone who has symptoms, you know, as we talked about multiple seasons of the year maybe year round that might be considering something like allergy shots. That would be a key step is to determining what they’re allergic to.

Scott Gilbert – Good advice. Dr. Faoud Ishmael, thanks for your time today.

Dr. Faoud Ishmael – Thank you.

Scott Gilbert – And thank you very much for watching. Again we welcome you or your questions and your comments even after the fact. If you add your questions to the comment field below this Facebook post, we’ll make sure to get those to Dr. Ishmael and get an answer posted for you. And please feel free to share this post if you found this information helpful. And thank you again for watching ask us anything about seasonal allergies from Penn State Health.