Our latest podcast episode tackles that oh so sneaky, sneezy foe, seasonal allergies. Virtually unheard of until the 20th century, allergies have steadily increased as civilization has become more industrialized, and, by extension, more removed from the outdoors. The lack of exposure to bacteria and pollen from an early age actually makes it more difficult for the immune system to properly identify common pollen from a true threat. While this may sound impossible to regulate,
have no fear. There are indeed many ways to mitigate allergic response, and
even prevent allergies altogether.
Below is a transcript of the episode, modified for your reading pleasure. For more information on the people and ideas in the episode, see the links at the bottom of this post.
Full Episode Transcript
Hi, I'm Agatha Luczo, mother of four.
Dr. Greene: (00:08)
And I'm Alan Greene, pediatrician.
Welcome to Bambini Furtuna's podcast Mom Driven, Doctor Aligned. I am so excited to bring this podcast to everyone today because this is such a big conversation in our household. We're talking about seasonal allergies. We've got great stuff for you. Dr. Greene has taught me so much about seasonal allergies and I'm just so excited to bring all this information to you because it's such a big conversation in our household. A few of our kids have seasonal allergies and also food allergies, but let's start the conversation today with an explanation of allergies.
Dr. Greene: (00:46)
That's a fabulous place to start. We have this incredible immune system that is all the time on guard paying attention to different things in the environment that might be harmful to us and it learns and it's standing ready to attack and destroy any particle that gets in that might be dangerous. Allergies happen when the body identifies something that's actually not so bad as dangerous and then mounts an immune response that's out of proportion to what you're exposed to and basically chemical warfare releasing histamine and leukotrienes and prostaglandins that create all the symptoms of allergy that we know.
I think the big question and a lot of parents' minds is how can you tell the difference between an allergy and a cold? Because that's what I struggle with the most. In the morning when I see my kids with a stuffy nose, I'm always wondering, can I send them to school today? Is this an allergy or is it a cold?
Dr. Greene: (01:46)
Well, telling the difference between a cold and an allergy can be really, really tricky because they're, in some ways, the same thing. What happens is, in the nose, your immune system identifies something that doesn't belong. It might be a virus. In the case of a cold, it might be pollen, in the case of seasonal allergies, and it has the same repertoire of stuff to try to get rid of it. It creates sneezing, the blow it out, it creates nasal discharge, it creates congestion all trying to get rid of it. So they can look really similar. The difference is that in the case of a seasonal allergy, it's a slightly different part of the immune system. And so it releases histamine is a dominant part of that, that causes itching. So if there is itching of the nose or what we call the allergic salute, where you rub the nose, or itching of the eyes and a clear nasal discharge, that's more likely to be an allergy, especially in a family, or in kids that have allergies.
Dr. Greene: (02:47)
Whereas the virus triggers white blood cells to come that it may start with a clear runny nose and start with sneezing. But pretty soon it starts to get cloudy from the white blood cells or creamy or even green because all these white blood cells and the remains of white blood cells that end up getting in the nasal discharge. So it might be a little bit of a fever too, because the body's trying to get rid of the virus that way.
Right. And then also a pediatrician can tell the difference by looking in the child's nose or in the throat. Right?
Dr. Greene: (03:16)
The exam looks can often look quite different and the duration is different too. A cold typically lasts about a week in kids -- maybe five days, maybe 10, maybe even 14, but it doesn't go on and on the way that allergies can.
Right. And then also another way, if you're ever confused, I think if your child has an allergy or a cold is looking online and seeing what the environment is doing, the count of the grass and the weeds and the trees are the pollen counts.
Dr. Greene: (03:42)
Yeah. If there's an exposure that makes it a lot easier to tell either an exposure to something they're allergic to or an exposure to somebody else who's got a cold. That can tell you a lot.
And also an allergy can cause a cold.
Dr. Greene: (03:56)
Right. So the other thing is the kids who do have nasal allergies are more likely to get colds because the system may be clogged up in the nose. I'm more likely to get sinus infections because the sinus openings are closed and more likely to get ear infections too. So they're really tightly linked and it can be back to back or even at the same time.
Right. And also because kids are touching their nose constantly and bringing other bacterias into their body as well. So what are seasonal allergies?
Dr. Greene: (04:24)
So for that we should talk a little bit about the birds and the bees or at least actual birds and actual bees.
Dr. Greene: (04:29)
Many plants in springtime will dress themselves up with these beautiful flowers. They're there to attract birds and bees and other pollinators. Butterflies to come and move pollen from one to another. And that's how the plants reproduce. Pollen is basically their sexual reproduction material. But there are other plants that aren't as flashy and they have a different strategy and that's grasses and a lot of weeds and trees that aren't flowering. And what they do is they make lighter pollen. They pump out millions and millions of grain sometimes even in just one day. And that pollen gets carried by the wind and it's the yellow stuff you see on cars. That pollen gets into the nose and if somebody's body thinks of it as a threat, they start to make antibodies to it. And then whenever that pollen is released and you're exposed to it, you mount an allergic response.
So seasonal allergies are essentially allergies to pollens. What are the solutions to seasonal allergies? There's over the counter, there's natural remedies. What do you recommend for parents and where do we begin with how to help our children?
Dr. Greene: (05:40)
So since it's a problem of mistaken identity, the very best thing to do if allergies are a big problem and there are issues and medications year after year, it's to teach the body to no longer recognize the pollen as a threat. And that's done through something called immunotherapy. And that can be done with allergy shots and what you do is you take a very tiny amount of the pollen or other allergens that they might be allergic to. And gradually by getting tiny, tiny amounts over, a lot of time the body begins to think, wait, okay, these are not a threat and that's fantastic. I had allergy shots as a kid and my allergies to weeds and grasses reversed. It's fabulous.
Yeah. One of our children is going through allergy shots as you know.
Dr. Greene: (06:28)
So that's how you reverse the allergies.
Dr. Greene: (06:32)
And there's a sublingual form, too for this. It's called SLIT or SubLingual Immune Therapy where a little bit goes under the tongue and that has the advantage of being something you can do at home. And has the advantage of being portable. Something you can do when you travel. And it has the advantage of being really gentle.
Right. And how long do the allergies shots take?
Dr. Greene: (06:51)
That can be years too. Sometimes it depends on how many allergens and how allergic the person is, but I tend to think about three years. Is the time for that. Maybe shorter or longer and about five years for the drops.
Right. One thing I like to do is wipe down my children's eyes. I love using the Itchy Eye solution and also washing their hands down immediately. And those are some of the few things I do immediately and see if it helps calm down their allergies and then what are the next steps parents should take.
Dr. Greene: (07:24)
There are a bunch of things people can do in the meantime, thankfully, and it helps a little bit to picture what's actually going on with an allergic reaction to pollen. Our nose is lined with the cells called mass cells that are immune cells ready to destroy particles that are not helpful to us. And if you're allergic, you have made antibodies to that specific pollen that sit on the surface of the mast cell and they're just watching for the pollen to come around. And when it gets there, it attaches to the antibody and that activates the mast cell that starts pumping out chemicals to get rid of the pollen. And histamine is the big one. It gets released and it causes the itching and swelling. But there's a bunch of other chemicals that go out and it causes increased nasal discharge, increased mucus, it causes swelling of the blood vessels, dilation of the blood vessels, which causes congestion because the blood vessels are so big in your nose and the blood vessels become leaky as a result of it.
Dr. Greene: (08:22)
So that's all that's going on. So the very first thing, while you're waiting for this allergy to be reversed and not be a problem is to try to avoid the pollen connecting to the antibody. And there are a few ways to do that. The little minuscule grains of pollen are like these little Velcro balls that stick and clothes, and stick in hair. So if kids are playing outside where that pollen happens to be, it's great when they come in for the day, that's a good time for bath time or showertime.
Wash them off.
Dr. Greene: (08:53)
To wash them off, even to wear a little light layer of something outside. They can change their clothes too for inside cause it's at night when the issue's going to be. So when they come in for the day, it's a really good time to take off the hat, take off the clothes, do the washing and you can do specific washing, too. It turns out like you were talking about nasal irrigation and eye irrigation, eye washing are two of the best things you can do just to get pollen grains out of there. And you might do that in the nose with a nasal saline spray. You might do it with nasal saline drops, their neti pots. There's lots of ways you can do that. But rinsing that mucosal layer is really helpful. And same with eyes. It can be saline eye drops. It's a super gentle natural thing to do and surprisingly effective
Air purifiers as well.
Dr. Greene: (09:40)
So yeah, air purifier in the house are a great idea. HEPA filter can get 99.97% of the pollen out of the air in the home.
Oh wow. And also can making sure that sheets are frequently changed or the pillow cases?
Dr. Greene: (09:54)
Yup. Yup. And that's especially good if you have dust mite allergies too. But it's good even for pollen allergies cause it can build up there over time. So then besides that, the avoiding the pollen itself or washing it off the body, using the saline to irrigate the area, which is really powerful. There are some common medicines that are sort of the mainstay of allergy treatment and those are antihistamines, which as you might guess, work against histamine, and I should say a word about those. Antihistamines work best to stop the histamine being released from the mass cell. So that means they're far more effective just before you get exposed to the pollen than they are after, they help some after with the cleaning up a bit, but they're much more powerful before. So when your kid's allergy season is high, if you've checked, like you suggested and found out that that pollen is high, that's the time to start doing it every day to try to prevent the histamine from being released and doing it daily and not skipping to prevent.
Oh, and why do some people get allergies and others not?
Dr. Greene: (11:00)
Oh, that's such a good question. And related to that, why have allergies increased so much over the last century or more?
Yes. Why? I mean, it's tremendous. I feel like everyone is developing allergies. I don't have allergies and sometimes I'm sneezing.
Dr. Greene: (11:14)
Yeah. So we know a couple things about that. One of them is that the tendency to develop allergies is genetic. Some people are far more likely to get it than others. And it's genetic and it's a dominant gene.
And isn't the number something like if both parents even have a slight allergy, you have a 70% chance of your children developing an allergy?
Dr. Greene: (11:37)
Yeah, that's very close to that. If one parent has allergies and one copy of an allergy gene, then about 25% of the kids will have it. And if both parents do 70 - 75%, something like that, will end up with allergies. A lot. And if either parent has two allergy genes, got it from both of their parents, that 100% of their kids will inherit a tendency.
Wow. That's really high.
Dr. Greene: (11:59)
But that hasn't changed that much over the last hundred years. That's been pretty stable. If there are allergies in your family, there's a good chance that you could get allergies, and your kids could get allergies.
Why has it changed? Increased?
Dr. Greene: (12:15)
So there are a few things that happened. So before about 1900 there were essentially unheard of seasonal allergies and it was right or MBA, maybe 2030 years before that. It started creeping up in the medical literature. It was first described maybe 30 years before that, but around 1900 shortly after they started to become pretty common.
Dr. Greene: (12:34)
And it was originally called the rich person's disease because it was only the wealthy who got seasonal allergies. And it was a big deal in New York. Everybody would leave during ragweed season and go out of the city to get away from the ragweed that was there. That was their treatment -- to travel away from the things that they were allergic to. So what happened? There were several things. One is before that time, almost everybody was exposed to a lot of animals early in their life. Most Americans lived on farms or their ancestors lived on farms. There were animals roaming, even in the streets of New York. And people were exposed to animals early. The second big thing that changed was people spent a lot more time indoors, a lot less time outdoors. And they had gradually over the 20th century got better insulation and kept their windows closed up until the 40s and 50s windows were open a lot of the time in the summer months.
Dr. Greene: (13:32)
And so early on you're going to get exposed to all this pollen in your home and your body recognizes it's normal. The first year or so the body's trying to figure out what is it that's normal, what's a threat? But starting in the middle of the 20th century, people weren't exposed to animals. They weren't exposed to a lot of pollen because they were inside. And when they were inside the windows were closed more and more and the insulation was better and the houses were sealed. And all of a sudden when they finally did get exposed to pollen, it was something new and unusual and genetically active. And so the body thought this is the threat.
So what do you think about having pets in the house? Does that help?
Dr. Greene: (14:08)
Having pets in the house is a great idea, especially if they're introduced before the kids start to walk, when their immune system is trying to learn the most.
Dr. Greene: (14:17)
A dog or a cat can be one of the best probiotics that there is in terms of helping to cultivate the beneficial bacteria, which is probably the common denominator on all the things that have changed. We've decreased the diversity of the bacteria that help our immune system not get out of control. So pets are great. There was just a brand new study, another in a long line of studies that came out August, 2019 showing that kids who are raised on a farm or even visit a farm or even are exposed to just a farm are less likely to develop allergies later on.
Dr. Greene: (14:51)
So take a lot more visits to the zoo and to the farm.
Dr. Greene: (14:53)
Visit the zoo, visit farms early on is great. Playing outdoors is great. It used to be the typical American child would have two to four hours of outdoor play seven days a week. And now kids are pretty much playing outdoors just when they have sports and it's not every day and it may not be so long. So getting outdoors early is great.
Dr. Greene: (15:15)
Other things that we know that have influenced it include diet, eating fruits, eating vegetables. There's some more than others. Things with beta carotene. Citrus fruits tend to be the best. Any Mediterranean diet is good, but the more servings of fruits or vegetables the less likely to develop allergies. And now we have a lot more packaged foods than we used to have.
Dr. Greene: (15:35)
Exercise makes a big difference. Sleep makes a big difference, but sometimes it's just the perfect storm. You happen to be exposed to a pollen at a moment where your body is on the lookout and you develop an allergy to it. So besides just visiting a farm or having a pet dog, there is a rich microbial world and some places that have been less disrupted than others like old forests and at the seashore and visiting places like that with young kids is fantastic, too.
So get outdoors, travel more, expose yourself to more bacteria. Do parents need to be paranoid about washing the kids' hands? Or is it good for them to be exposed to bacterias and let them stick their hands in their mouth? Does that help them prevent these allergies?
Dr. Greene: (16:20)
There was an interesting study a few years ago looking at what happens when a pacifier falls on the floor, and it's been looked at for awhile since and some people don't wash it. Some people do rinse it off in water. Some moms put it in their mouth to kind of clean off the gunk that's on there. And they looked at what the habit was and then what happened in terms of developing allergies. And it turns out the ones who develop the fewest allergies were the ones where the mom stuck it in her mouth and cleaned it off that way. So getting exposed to mom's bacteria is a really good thing. Cleaning it off a little bit so it's not other stuff that's on there is probably a good thing too. And it's a little bit the same with hands. I think that washing hands before eating is a good thing.
Washing them all the time is not necessary?
Dr. Greene: (17:04)
We want kids to get exposed early on to the common things around so their body recognizes it and says, "Hey, this isn't a big deal." And building up their immune system.
Dr. Greene: (17:14)
You know, one thing before we go further, I mentioned there's a couple of mainstays of over the counter treatment. One of them is anti-histamines, the other one are steroid nasal sprays and those are probably the single most effective. Again, they're most effective if you start them before the pollen exposure, but at least starting at the same time, it'll help with the next pollen you're exposed to and they're more effective if they're consistent.
And you usually lasts for 10 days, correct. The pollen in the air. So if you keep the kids on the medicine for about 10 days,
Dr. Greene: (17:44)
it depends. Some pollens and some areas are out a lot longer than that. Some are shorter than that. That's where looking up the pollen counts is really valuable and actually doing it by the numbers if you can.
Great. So from our conversation, it seems like there's three takeaways. One, knowledge is power, two take control of exposures, and three would be support and calm the immune system.
Dr. Greene: (18:07)
Yeah, I agree with all three of those. When it comes to knowledge being power and allergies, it's really powerful. And that means if allergies are a big problem for your family it's worth knowing exactly what your kid's allergic to. Get tested and then you'll know what they are, and it's very much worth tracking what the pollen levels are. And you can find that on most websites and app where you can get the weather. They'll also give you a pollen count. And if you know your child's allergic to Birch and you know when Birch's pollen is out and when it ends, you know when to really focus on the shower when they come in and when to focus on maybe using over the counter or natural remedies to prevent the histamine release. So knowledge is power.
Dr. Greene: (18:42)
The second thing you said about taking control of exposures there are different ways to do that. One is with allergy shots or SLIT to use tiny tiny exposures to teach the body not to be allergic. The other is to control the exposures to pollen actually in their nose or eyes with HEPA filters and all the things we talked about before.
And then also if your children don't have allergies, just expose them to everything.
Dr. Greene: (19:06)
Yeah. Especially in the first couple of years is a really good thing to be exposed and that's a very good point. And then the last one about controlling and calming the immune system. We know that a diet with lots of fruits and vegetables helps. We know actually eating fish helps. When kids eat fish at least a couple of times a month, their immune system's a little bit calmer. Outdoor play helps unless their pollen is out right now, but the vitamin D and other things from the sun is useful. Exercise is useful, sleep is useful, and there are some plants that we know that calm, excess histamine release. Citrus onions can do that too,
Which would make them great ingredients in a natural product.
Dr. Greene: (19:44)
Great. Thank you all for joining us on the Bambini Furtuna podcast "Mom Driven, Doctor Aligned".