Search for tag: "allergies"

Interviewer: You've tried the sprays and the pills for your seasonal allergies, but they just don't seem to work. So what are the next steps to finding allergy relief?

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's really good with allergies too. So in our previous conversation with Dr. Oakley, we talked about managing those symptoms with prescription and over-the-counter sprays and other medications. If you haven't listened to that podcast, be sure to check that out first. But Dr. Oakley, if those sprays and pills aren't working, what are the next steps that you would take with a patient?

Dr. Oakley: The main next step that we generally talk about with patients is allergy testing, and that is identifying what the patient is specifically allergic to or the things, you know, they're specifically allergic to. And the goal behind doing that allergy testing and the reason we don't necessarily do that upfront is because the main goal is kind of a step towards the immunotherapy option. And this is a treatment for allergies that can be very effective for a lot of patients who, you know, are still struggling after medical therapy. And the idea behind it is basically desensitizing your immune system to the allergies, so it's less reactive to that allergen or those allergens.

Interviewer: And it seems like most people I talked to that have allergies, they'll be like, "Oh, I need to go get my allergies tested." In their mind, it's the first thing that you do. Do you find that to be common?

Dr. Oakley: I do. Yeah. I get that question actually a lot, "Should I be allergy tested?" And it's certainly satisfies our curiosity in many cases of, you know, what we're allergic to, but it doesn't necessarily change the treatment if we haven't done those medical management steps yet, because if, you know, whether you're allergic to this specific pollen or that specific, you know, weed, or this tree, or that grass, you're still going to be using those as, you know, your earlier steps. You're still going to be using, you know, those nasal steroids sprays first or the oral antihistamines first and the antihistamine sprays first, because that has, you know, a broader effect, you know, on all of those.

So that's what we generally don't do that upfront, because it doesn't necessarily change our first couple steps and, you know, the treatment. But it does affect, you know, our later steps. If we're thinking of immunotherapy, we need to know what we're specifically treating for that to work. And so that's kind of where it comes in and the point behind the testing, you know, at that stage generally.

Interviewer: Yeah, so your patients that you take at that point to the testing stage, I'd imagine they're just not finding any sort of relief from the first steps, or their allergies are just so terrible. I mean, what kind of patient then makes it to the testing stage usually? You're able to . . . I would imagine the medical things that you do first, the sprays and the pills take care of a lot of what patients experience.

Dr. Oakley: Yeah. I would say the patients that generally get to that next stage are those that are getting either really severe or really bothersome seasonal allergies that are refractory to the medical therapy. And they just don't want to, you know, suffer every summer, all summer or every spring, all spring. Those are good candidates for immunotherapy. They're getting breakthrough symptoms despite those, you know, medical treatments.

Other patients will have year-long allergies because they may be allergic to, you know, dust mite, and it's all around them. It's in their house. And, you know, there are things they can do, like, you know, try cleaning their house really well. However, we've not seen that those things will fix the problem in a noticeable way. They'll still get their symptoms. And so, you know, those patients are suffering all year, and, you know, there are immunotherapies that can help with those perennial allergies.

An additional option, for example, would be a patient who has a cat that they're allergic to, but they're very, you know, emotionally connected to their cat. It would be distressing for them to get rid of their cat, or it's a partner's cat and, you know, they can't necessarily avoid it. It's not so easy to always get rid of a pet. So that'd be another case where immunotherapy may, you know, play a good role for that patient.

Interviewer: When you get to that point, you do some of the testing, and then after you get the results, how do you proceed to the immunotherapy and how does that work?

Dr. Oakley: So generally, we're identifying the allergies that are causing, you know, the sensitivities that the patients have based on how they respond to, for example, skin prick testing, which would be the most commonly used allergy testing upfront. It can be done, you know, in the office. Patients are tested for multiple allergies at once usually on their arm. You're using a grid system to see what skin responses are the most significant to determine what they're, you know, most allergic to. And those are the allergies that you target, you know, their worst reactions with the immunotherapy. And the idea behind the immunotherapy is giving them very small but ramping up doses of that thing that they're allergic to, to just gradually desensitize the immune system to it.

Interviewer: I remember getting those as a kid. I've had more success with the first line of defense in later life, with some of the new medications that came out, I don't know, probably 20 years ago now, but I say new. So like my experience was the immunotherapy didn't really help me. Do a lot of people experience success with it?

Dr. Oakley: It's generally considered to be 80% to 90% effective. But, you know, it's not 100% effective, as you said. So some people don't get that response. It's generally very effective, but it is a commitment. It's very much a time commitment. You know, it's a three to five-year treatment where patients are coming in anywhere from a weekly to a . . . or I should say anywhere from a twice weekly to a monthly basis for injections, you know, to get that benefit.

Interviewer: Yeah. I remember it was twice a week I'd go in and get those allergy shots. So if immunotherapy doesn't work then, then it sounds like the last option is surgery, and I didn't even know there were surgical methods for allergies. Talk about that.

Dr. Oakley: Well, I should clarify because surgery is more of an assistive option.

Interviewer: Oh, okay.

Dr. Oakley: So not so much a treatment. It doesn't specifically cure or treat allergies. It helps with the symptoms, but in and of itself would not be sufficient. It goes along with these other treatments. So surgery can address some of the more bothersome nasal obstruction symptoms. For example, well, let's just say specifically from anatomical factors, like a deviated septum or enlarged turbinates, which are, you know, shelves of tissue in the nose that warm and humidify the air but can get quite enlarged with allergies. So treating some of those anatomic, you know, factors can improve symptoms of nasal congestion, but you need to treat the trigger as well, the ongoing allergy trigger. So that's that medical management or immunotherapy as well. So the surgery helps, but it's not a treatment in and of itself.

Interviewer: If somebody is listening to this and you just would want them to take away one thing after we're done with our conversation, what would that be?

Dr. Oakley: The main thing I would say is don't suffer in silence. This is a really common problem with many options for treating it. We know from, you know, research study after research study that there is a significant improvement in quality of life when these allergies are managed appropriately in patients rather than just struggling with really bothersome and really distressing, you know, symptoms on a day-to-day or seasonal or yearly basis. You know, try some of these easier steps. Don't hesitate to come in and get some, you know, formal consultation and talk about other options that can really, really benefit you.

Interviewer: There is no cure for allergies. Really the best you can do is manage the symptoms, and the first step to doing that is to avoid the things that give you allergy symptoms, but that can be hard. A lot of times you can't do that. So then the next step are sprays, pills, and eye drops.

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's also an allergy expert, and she's going to take us through the process of trying to figure out how to manage those symptoms and then maybe help us understand when you might need to get professional help. So Dr. Oakley, let's first start with allergy sprays.

Dr. Oakley: There are a couple main nasal sprays that work really well and have great evidence behind them for the treatment of allergies. Our first-line treatment based on the literature and just how well it works in patients is nasal steroid sprays, and fortunately they're all over the counter. Some of those sprays would be, if I were to name some, Fluticasone nasal spray, Mometasone, Budesonide. Those are probably some of the three most common. There're a couple others in that, you know, similar family and those work really well.

You can use them up to twice a day, more than that is not going to help anymore, but once or twice a day use. They're very reliant on regular consistent use, and they have a bit of a slower ramping up effect, so you really want to use them for at least, you know, a few weeks on a daily basis just very regularly to get their full effect rather than, you know, here and there when your symptoms bother you.

Interviewer: If the over-the-counter stuff doesn't work, are their prescription ones that are very different from that, or is most of them over the counter nowadays?

Dr. Oakley: There's an antihistamine spray that is a prescription that can actually work great for a lot of patients too, either as their primary treatment or as a, you know, secondary, an additional treatment if the corticosteroids sprays alone don't work enough for them. That antihistamine spray is called Azelastine, and it works particularly well for those let's call them the wet allergy symptoms, which is, you know, more of those like sneezing, runny nose, itchy, watery eyes, that kind of tickle sensation that we can get with allergies. They work okay for the nasal congestion symptoms, but the steroid sprays work better for that.

Interviewer: What is it that makes it so different from person to person that perhaps maybe a steroidal spray would work for one person but not another, they'd have to use, you know, an antihistamine spray? Is it just the difference in us as humans?

Dr. Oakley: We don't always know exactly why some patients respond better to some sprays, you know, versus others. It may just be a severity of their symptoms. You know, they may get 75% better with the steroid sprays, but it may just not quite be enough. Whereas somebody else where their symptoms are maybe moderate rather than severe, they may do great, and that's all they need.

Some patients may be a little more bothered by like the runny nose and the sneeze, whereas, you know, in those cases antihistamine sprays would work better for them. So sometimes we just get different presentation of our allergies, different symptoms and different severities. But you're right that the other factor is we're all just a little bit different and we respond just a little bit different to certain treatments.

Interviewer: It can be a little frustrating as an allergy sufferer sometimes because I think sometimes as patients we think, "Well, I'm going to go in and the doctor's going to give me the cure," right? But with allergies it sounds like, you know, sometimes you have to do some experimenting on what's going to work best for that individual person.

Dr. Oakley: Exactly. There's definitely some trial and error there to try to get it just right for that patient. The third thing in terms of nasal treatments I didn't mention, that I'd be remiss if I didn't mention, is very straightforward, and it's just some saline in the nose, saline irrigations specifically. Those can work really well as an adjunct treatment. It's not going to in and of itself fix your allergies, but it can help with some of the symptoms along with some of these other treatments by mechanically washing, you know, those allergens, those irritants, those pollens out of the nose so they're not just sitting, you know, on the lining of the nose inflaming it. So it can help, you know, in some of those ways as well.

Interviewer: So do you normally go nasal spray first and then oral medication? Is that how that usually goes?

Dr. Oakley: I would say, in general, yes. I like to give people topical treatments over oral treatments if possible, just because your side effects tend to be lower. The other thought in that however, that I'll talk to patients about, is that certain oral treatments, like oral antihistamines specifically, those tend to work similarly to a nasal steroid spray, have similar effectiveness, but sometimes patients will have symptoms that are not just in the nose. They'll have, you know, maybe some dermatitis that they get with their allergies that bother them or, you know, symptoms like that that are elsewhere, and sometimes the systemic therapy, an oral therapy in that case can be a little bit more helpful than a localized therapy.

Interviewer: So oral medications, let's talk about over the counter first. What are kind of the choices there?

Dr. Oakley: I would say the main one, the front runner are those oral antihistamines. So the newer versions that tend to work better for patients with fewer side effects are those medications like Loratadine and Cetirizine and Fexofenadine. Those are the main kind of newer generation oral antihistamines. The older generation antihistamines would be, you know, what we know as Benadryl, which can work too but has, tends to have higher side effects and be more sedating for patients. So we generally recommend those newer generation, non-sedating medications. And they have great evidence behind them, they work well, and those are over the counter.

Interviewer: And then itchy eyes is another symptom that a lot of people have with allergies. I used to suffer terribly, and then I was prescribed some eye drops, which now I think I can just get over the counter because I've bought them. I think they're the same thing, which makes all the difference in the world. Can you talk about some of the eye drops you might want to look for if itchy eyes are part of your allergy symptoms?

Dr. Oakley: Yeah, eye drops can actually help a lot, and it is generally an antihistamine eye drop. There are a couple different ones. One that's popping into my mind is Olopatadine. That can actually help patients significantly because a constant itchy eye will drive you crazy.

Interviewer: And just like all the other things, the nasal sprays, the oral medications, I had to try a couple of different antihistamine eye drops before I found the one that really kind of worked for me. So you know what, I started out thinking, well, let's see if we can give people, you know, some things they can try on their own, but then you start talking about how, you know, this combination isn't proven to work as well as that combination, and it can get really complicated really fast. So I'm starting to think maybe if like the first nasal spray doesn't work, maybe go see a doctor to try to figure out what combinations of stuff because that does get complicated pretty fast, doesn't it?

Dr. Oakley: It does get complicated pretty fast. It is certainly reasonable to try a couple over-the-counter meds on your own. I personally, you know, if I were in the patient's shoes, I would start a nasal spray and give that a few weeks personally. If that didn't work, you know, I'd maybe try an oral antihistamine for a couple weeks and see how I do. But after that, I don't see a lot of sense in just suffering. I think it's worth going in and talking to your doctor about some alternative options that may help quite a bit rather than just being miserable.

Interviewer: You think you or maybe your kids have pinkeye. How will you know for sure and what should you do about it? We'll talk about that next on The Scope.

Announcer: This is From the Front Lines with emergency room Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. Pinkeye. Let's talk about how you would diagnose a case of pinkeye and then what you would do about it because I hear it could be kind of difficult to diagnose like a school nurse, for example, might not be able to tell the difference from allergies or not. Is that the case?

Dr. Madsen: That is the case. And that's always what I'm thinking in my mind. So the most common thing we have is someone comes in and they say, "My eye hurts" or "My eyes hurt". I look at their eyes, they're red. So a couple of questions I ask and I say, "First of all, did this start in both eyes or did it start in one eye and spread to the other?"

If it starts in one eye, that's more likely what we would call pinkeye. And pinkeye is a bacterial infection often. Sometimes it's a viral infection but it's really tough to tease out which are bacterial and which are viral. Of course the ones we worry more about are the bacterial infections because we're going to treat those with antibiotic drops, but you figure it's not going to necessarily start in both eyes at the same time. It kind of start somewhere. It's going to start in one eye and then maybe you're rubbing that eye and then it spreads over to the other eye. So typically with pinkeye, that's the case.

Interviewer: Okay, so one eye hurts before the other generally.

Dr. Madsen: Exactly.

Interviewer: Red like bloodshot red, what's that red look like?

Dr. Madsen: So the red . . . Yes, that's tough to distinguish from allergies.

Interviewer: There's nothing really unique about it, huh?

Dr. Madsen: Not particularly. It can look a lot like allergies where just if you've ever had like allergies, just seasonal allergies, your eyes are bloodshot, they hurt, they itch, pinkeye looks very similar. With pinkeye though, we often see more discharge or more drainage from the eye. This kind of stuff that's not so much, just your eyes watering, which you have with allergies, but stuff that's kind of a little more whitish in color that looks more like you would imagine an infection looks.

So someone who says they wake up and my eyes are like matted shut. Again, allergies, we can sometimes see that but it's usually more with pinkeye. They have to pry their eye open or their kids' eye or they use like a washcloth and hold it on there to kind of loosen that up and pry it open. That's pretty typically with pinkeye and that helps me out to make that diagnosis.

Interviewer: All right. So then what does treatment look like? You said if it's a bacterial cause, then you would use antibiotic drops. It's hard to tell though, so you just . . .

Dr. Madsen: It is.

Interviewer: You just use antibiotic drops across the board or . . .?

Dr. Madsen: Typically yes, and you don't want to over-treat with antibiotics, but in practical terms, if I were to try and get a culture of the eye, send that to the lab, it takes couple days to get the result. It's not really that useful. So even though it might be viral, it's often bacterial so we treat with antibiotic drops. It means using drops several times a day or often for a week just make sure this clears up. Most people are going to have improvement in their symptoms after two or three days.

Interviewer: What if it's viral though and you're using the drops, they're not doing anything, will it just get better on it's own or . . .?

Dr. Madsen: It will.

Interviewer: Really?

Dr. Madsen: It will. Yes, with the viral it will just get better on its own and the antibiotic drops probably aren't going to do a whole lot for it but, again, it's hard to say because maybe after two or three days, you're feeling better and it could be that the virus got better on its own or maybe the drops treated the bacteria. But it's not the sort of thing, again, where a culture would be that helpful because it's going to take two or three days to get the results back. If it's bacterial, it could get significantly worse and really progressing, cause some issues wherein you can get infections around the eye or extending behind the eye as well.

Interviewer: And untreated, could it cause long term problems if you didn't go into anything about it or would it eventually just clear up regardless?

Dr. Madsen: It could clear up but the concern with the bacterial infections would be something that progresses, again, to where it spreads around the eye.

Interviewer: Infects the rest of, yes, other parts of your eye.

Dr. Madsen: Exactly. And so that's why even though in my mind I say, "Okay, this could be a viral infection," I'm also saying, "I want to treat this as likely a bacterial infection because the possibilities with the bacterial infection could be pretty significant." And I don't necessarily want to tell this person, "Wait two or three days and then come back when you have a significant infection around your eye that might require even something like IV antibiotics or hospital admission," if it got to that point and got that serious.

Interviewer: And don't need to go to an emergency room for this sort of thing. Urgent Care or a primary care provider probably would be able to take care of it.

Dr. Madsen: Absolutely.

Interviewer: And you could . . . even if you have to wait a day?

Dr. Madsen: Yes. Even if you had to wait a day, you're probably okay. I think the challenge for most parents is if their kid gets pinkeye, they're not going to let the kid come to school because it is highly contagious. You've got to make sure you're washing your hands, your kid's washing their hands. Kids get this at school, they pass it to other kids. So a parent's probably not going to want to wait a day to get in to see their primary care doctor. They'll go to an Urgent Care. If you have to come to the ER, you come to the ER. Either way, I'm guessing most parents want to get that treated and get their kid back to school and get them out of the house as soon as they can.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 2, 2018
originally published: August 19, 2016

Interviewer: A new study is suggesting that watching funny cat videos can help expand your life expectancy. But there are a lot of funny videos, lots of cats, and lots of funny videos of cats. Which ones are the most beneficial to watch if you want to live a long and healthy life? This is coming up next on The Scope.

Announcer: Covering all aspects of women's health. This is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Interviewer: It's been said that laughing has great effects in life. Not only does it reduce blood pressure but it helps with stress and anxiety. Unless you're allergic to happiness, laughing just makes you happier. It's just that simple. But a new study out today is suggesting that laughter from watching a funny cat video not only brightens your day but it can actually help you live a healthier, longer life. Dr. Kirtly Jones is a woman's health expert and she knows all too well that emotional health is a key component of overall good health. But Dr. Jones, the study is telling me that even if I'm not a cat person, watching a funny video of a cat can help with my health. What's going on here? Let's talk about this.

Dr. Jones: Well, actually, there's been a great deal of research about funny cat videos and overall health. And it's important to know that various studies have shown that not only does it help your immune health, and we can talk about that, your cardiovascular health, and most importantly your emotional health. There are some caveats, though, some important things to know.

First of all, some of the early studies had men and women in the same group and those studies weren't as strong. You really have to separate men out because men watching videos, they really only laugh at videos of other men expressing gas or doing something incredibly stupid. So we really need to focus just on women.

Interviewer: Just on us?

Dr. Jones: Just the women. Now, secondly, you have to really identify women who identify with cats because so they did study comparing cat videos with dog videos and lo and behold, there was a subset of people who responded well to dog videos and not cat videos. So they separate them out by a questionnaire. The questionnaire had two questions: one, I think cats are incredibly adorable; and two, I think cats are useless bird killers. And if they separated out the women who responded that they thought that cats were useless bird killers, then the adorable cat lovers were perfect for studying. So indeed, in those women who watched cat videos then there were benefits in a wonderful number of domains. Let's talk about those a little bit.

Interviewer: Okay, yes. Let's break this down to health benefits. So if I want good cardio health but I hate cardio activities like running, cycling, the elliptical stairs, I hate it all, what's my alternative?

Dr. Jones: There's some very good evidence that watching cat videos and laughing is exercise because laughing is exercise. So looking at longer videos, 90-minute videos, you can increase your heart rate and you can increase your respiration and that's really wonderful and you return to baseline very quickly. So 90 minutes might give you an extra 10 calories. Now, a two-minute video doesn't have much cardiovascular benefit, but most people watch their cat video at least 10 times.

So the 10 times , times 2 calories, and then if you get up and have to go pee, which you will, if you keep laughing if you're a woman, so you're going to have to go pee a little bit and come back, you can get to 10 calories by watching it 10 times.

Interviewer: Okay. So now my cardio is good, but if my immune system is kind of just out of whack and I get sick every week, besides drowning my body in orange juice and eating an apple a day, what else can I do to maybe only get sick every other week?

Dr. Jones: There's some very, very good evidence on cat videos and immune function. So they have to laugh and that's important because some cat videos don't make people laugh. If you laugh, then that increases your salivary IgA. Also, laughing makes your killer T-cells, cells that help fight viruses and tumors, be more active. And that's been shown in men who watch videos . . . I can't really discuss about the kind of videos they're watching and laughing at, but for the women and cat videos, their T-cell function worked better. So also, watching cat videos calms people, particularly kitty videos. So if you're watching kiddy, K-I-D-DY and kitty, K-I-T-T-Y, putting them together makes people's cortisols drop and they feel much calmer.

Interviewer: And that in return helps my immune system.

Dr. Jones: Absolutely.

Interviewer: Okay. So because we're talking about women, beauty comes to mind, is there a cat video I can watch to maybe enhance my natural beauty? I mean, if I can deal without my current beauty products, I want to do it without them.

Dr. Jones: Oh great, right. Well, first of all, it's important to understand the smile. Now, you may not have your skin tone be that much more beautiful, but if you have a natural smile and practice your natural smile, you will be much more attractive to others. So practicing that smile, but it has to be a real smile so what they call the Duchenne smile, which involves your facial muscles and your eye muscles, not what they used to call the Pan Am smile or the . . .

Interviewer: Like the Hunger Games smile.

Dr. Jones: The Hunger Games, right. Right. Or the Botox smile. So in fact, it's not so much that your beauty itself and your skin tone, but when you smile, you look more beautiful and practicing your smiles. You practice your smiles in front of the mirror when you're looking at yourself, but the real smile, the Duchenne, named after a very famous neurologist, that reaches your eyes which you only get watching cat videos. So practice those cat videos and your smile will be much more natural.

Interviewer: Remembering all this is going to just stress me out. I'm just going to get stress anxiety because I have to remember every single cat videos that you're telling me about.

Dr. Jones: Think about that "aw". What makes you go "aw"? and there's a cat video for stress relieve as well and this is any video with a cat and a toddler. So if you just Google or go to YouTube and put in "cats and toddlers," you will have definitely an option for stressing out.

Interviewer: It's cuteness overload.

Dr. Jones: Absolutely. Absolutely.

Interviewer: Okay. All right, all right. I don't suppose there's anything that's going to give me abs, is there? Or that just seems way too much now?

Dr. Jones: No, no. Nothing but ab workouts are going to make your abs. But if you want to get rid of that bloating feeling, that unwanted water in your system, you can try watching videso of cat ambushes.

Interviewer: Cat ambushes.

Dr. Jones: Now you may be passing gas when that happens. So if you're startled, but if you have a certain way that you respond to cats ambushing other cats or human beings or birds, anything really of an ambush, you may actually . . . it may help with the bloating.

Interviewer: Earlier, you mentioned that watching kitty videos helps regulate my immune system. What about allergies? Is there anything I can watch to calm them down, keep them at bay?

Dr. Jones: Sometimes, your allergies are an overwork of your immune system. So allergies are complicated and it gets their own category of cat video. I always prescribe the cat cucumber video for people who say that they have allergies, their eyes get red and puffy, they feel kind of puffy in the springtime, that's the perfect video for allergy symptoms.

Interviewer: What if I'm allergic to cats themselves?

Dr. Jones: Well, that's no problem because cat videos had been proven to be hypoallergenic, safe for all ages and persons.

Interviewer: Okay. What about pain? If I'm dying of pain, can a cat video help me?

Dr. Jones: No, Chloe. If you're in pain, you need to see a doctor.

Interviewer: Okay. That's fine. I'm just checking because there seems to be a cat video for everything. Okay, no cat videos for pain relief.

Dr. Jones: Well, that's not exactly true in people with chronic pain. So acute pain, no. So if you ruptured your appendix, I strongly recommend . . .

Interviewer: I got to go see a doctor.

Dr. Jones: That you see the doctor. However, chronic pain, back pain, laughing at videos and the "aw" of cats and babies decreases the sensation of chronic pain, back pain, fibromyalgia, that kind of thing. It just calms . . .

Interviewer: It just calms me down.

Dr. Jones: It calms you down, decreases, and especially as you watch it over and over, you'll feel more calm. As you search the Internet more broadly for even more cat videos, you'll find you won't be thinking about your pain at all.

Interviewer: Okay. Now, this just sounds ridiculous now at this point. Are we . . . Is this study even real or what's going on? Because I feel like you're just playing with me here. Can cat videos actually help me live a longer life?

Dr. Jones: Sorry. Sorry, Chloe.

Interviewer: What's going on? You're laughing? You're laughing and I know why. I know why you're laughing. It's because we just played a prank on everybody. April Fools. Watching cat videos does not help you live a long and healthy life. But, Dr. Jones, tell everybody what does.

Dr. Jones: Laughing is good for you. Those things I said about laughing have been studied in looking at funny videos versus videos, watching, telling you how to repair your vacuum cleaner so people who watch funny videos versus that instructional videos actually do have an improvement in their immune function, a decrease in chronic pain and improvement in their cardiovascular response. And smiling the real smile, not the Botox smile, actually improves not only your sense of wellbeing but those around you. So on this April Fool's Day, I hope everybody gets a smile.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Gellner: Like all food allergies, milk allergy can be difficult to manage in a child. How can you help your child when milk is a common ingredient in so many foods? I'm Dr. Cindy Gellner with some tips for this tricky food allergy on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on the Scope.

Dr. Gellner: A milk allergy is not the same as lactose intolerance. Lactose intolerance only affects the digestive tract and it cause symptoms such as bloating, gas, and diarrhea. A milk allergy is a reaction by your child's immune system to the protein in milk. Our immune systems normally respond to bacteria or viruses that attack the body, but sometimes the body's immune system mistakenly believes that a harmless substance such as the proteins found in milk are harmful.

In order to protect the body, the immune system goes on attack with antibodies against that food. And the next time you eat that food, your immune system releases huge amounts of histamine to protect the body against the evil food proteins. That is what causes the symptoms that make us so miserable.

Casein is the main protein found in milk. It is found in the solid part of milk called curd when the milk goes sour. Whey, which is the liquid that remains once the curd is removed, contains the rest of the proteins. Your child can be allergic to the proteins in the curd, the whey, or both.

In very young children, cow's milk is the leading cause for allergic reactions. Milk is one of the eight foods that are responsible for food allergies in children. The other foods include eggs, soy, peanuts, tree nuts, wheat, fish, and shellfish. The good news is that most kids outgrow milk allergy by two or three years of age.

If you think your child is allergic to milk, dairy products, or any other food, it is important to get a diagnosis from your pediatrician or an allergist. Usually the history of the reaction is all we need to determine the allergy. But there are blood tests to confirm for some of these foods.

Milk allergies are typically discovered very early in formula and breast-fed babies. If a mother drinks cow's milk, the milk protein also comes out in her breast milk. The symptoms seen in milk allergy depend on whether or not the child has a slow or rapid reaction to milk.

The slower reaction is more common and the symptoms develop over time. Symptoms that occur slowly over several hours or sometimes days include diarrhea, often with streaks of blood, wheezing, rashes like eczema flares, and failure to grow very well. Symptoms that occur rapidly within seconds to hours may include severe wheezing, vomiting and hives.

If a mom is nursing, the pediatrician will most likely recommend avoiding milk products to the mom and taking calcium and vitamin D supplements instead. If your baby is formula fed, sometimes pediatricians will recommend a soy-based formula. These formulas contain soybean proteins, vitamins and minerals. The switch to soy formula helps for about half of the baby's allergic to milk. For those babies who still have reactions to milk proteins, pediatricians recommend hypoallergenic formulas. There are two types.

Hydrolyzed formulas contains proteins that have been broken down so they are easily digested and less likely to cause a reaction. These include Nutramigen, Alimentum and Pregestimil. Elemental formulas have proteins in their simplest form and are used when hydrolyzed formulas continue to cause symptoms. These include Neocate and EleCare.

The only treatment for a child with a milk allergy is to completely avoid milk and foods that contain milk products. Many processed food and restaurant foods contains milk or processed milk products. And you will need to change the way you shop and prepare foods.

The first step is to learn how to read labels and become familiar with ingredients that contains milk or dairy products. Always ask about ingredients if you are not sure. Foods and ingredients that contain milk include milk from other animals such as a goat, as well as yogurt, cheese, cottage cheese, cream, anything with casein or whey, butter and sadly chocolate. And also be careful of any ingredients that begin with "lac" such as lactose, lactate, lactalbumin, and lactic acid, and also fat replacers such as Simplese.

Reading labels to avoid allergens has become a lot easier. Foods that contain common allergens must be listed in plain language on the ingredient list. There are still some things to watch out for when reading food labels. Watch out for the words "may contain". Milk may not be an ingredient but the food may be made in a factory which also produces foods made with milk. If you see the words "may contain," there may be very little of the allergen or there may be a large amount.

A common question from parents is how to avoid cross contamination. Avoid battered or fried foods. The oil is often used for many different items, some of which may contain milk. Separate cooking utensils, cutting boards, and dishes used to prepare dairy products from those used to prepare food for your child.

Your child can still have a healthy diet as well as continue to enjoy some kid favorites. The main nutrients found in milk are protein, calcium, vitamin D and riboflavin. It is important to either take supplements or eat foods that are high in these elements. There's a lot of protein in milk, poultry, pork, fish, beans, nuts, and seeds. Ask your pediatrician about calcium and vitamin D supplements. Good sources of riboflavin are meat and eggs, whole grain or enriched cereals, and dark green leafy vegetables. Many foods such as bread and orange juice are now supplemented with calcium and vitamin D.

There are several brands of soy and rice milks that are enriched with calcium. They can be used for drinking and to pour on cereal. If milk is part of a recipe just to provide liquid, you can substitute water. Soy and rice milk, as well as fruit juice works well when substitutes baking. Oils, milk-free margarines, and soy butter can take the place of butter.

You can also visit foodallergy.org where there are many other helpful tips. Prepare your child's lunch at home. Talk with teachers about your child's needs. Ask the teachers to keep an eye out and explain the situation to other children if needed. Have the teacher call you if there is a special event or party planned so that you could bring a few modified treats that your child enjoys and can share with other kids. Make a card that lists foods and ingredients that should be avoided and give one to the teacher.

Living with food allergies is possible. I'm proof of that. By making others aware of your child's food allergy, you will keep your child safe. If your child is old enough, even as young as three or four, make sure they are aware of their food allergy. This will empower them to be in charge of their own health.

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Dr. Miller: Allergies, colds or something else? How do you tell and how do you treat them? That's next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi. I'm here with Dr. Jeremiah Alt. He is an ENT surgeon. That's an ear, nose and throat surgeon. He's a member of the Department of Surgery here at the University of Utah. Jeremiah, how does one tell the difference between an allergic symptoms of nasal discharge versus a common cold or sinusitis? Is there a way to sort of know if you have one or the other?

Dr. Alt: Yeah. That's very difficult. Even very difficult for the physician to figure that out in many cases and requires a thorough history with the patient to figure some of these things out. In general, allergic rhinitis if it's seasonal will occur during the season, where if you have hay fever, you'll get itchy eyes and a runny nose.

Dr. Miller: I always think of hay fever as being itchy.

Dr. Alt: Right.

Dr. Miller: Right? So people are scratching the corners of their eyes and they're blowing and sneezing.

Dr. Alt: Right.

Dr. Miller: The back of the throat is kind of scratchy. Sometimes when I think of the common cold or sinusitis that doesn't feel very itchy. That's [inaudible 00:01:15].

Dr. Alt: Right. So the common cold will have some of the similar symptoms, as there's definitely overlap where you can have increased congestion and nasal blockage. You'd probably be more likely, though, to have some facial pain and pressure. We commonly talk about the loss of smell occurring with sinusitis. But this can also occur with allergies as the inner lining inside your nose is swollen and angry, and inflamed and it can block off some of the ability to smell.

One of the big differences though, is we commonly think of discharge. So if the discharge is yellow or green, this is more signs that this is more severe than just an allergic reaction.

Dr. Miller: More inflammation, more at that issue of infection in the sinus.

Dr. Alt: Correct.

Dr. Miller: So one goes to the store to self-remedy what they would consider to be a fairly short course of this problem. If they have rhinitis, that is the itchy symptoms, what should they be using to treat that problem with? I think most of the medications now are purchased or can be purchased over the counter.

Dr. Alt: Correct. The oral antihistamines are a great option, and they've been used for many years. The second generation are non-sedating, like the Benadryls were that can make people very tired. Although, the second generations can make some people tired.

Dr. Miller: I've taken Benadryl and it works as an antihistamine. But man, does it knock me out. I think it does the same with some people and some people, they don't seem to have that fatigue that I get or that a number of people will get.

Dr. Alt: Correct.

Dr. Miller: Now, I've heard with Claritin, which is an example that comes generic as loratadine, that it's not sedating. But do you think it works as well as something like Benadryl or diphenhydramine?

Dr. Alt: Well, partly it's also what we're targeting. The itchiness, I think, works great. Another great antihistamine is Zyrtec. So if the patient has the itchiness with the runny, drippy nose, what we call clear rhinorrhea, or clear, drippy nose, the Zyrtec is actually quite more drying than let's say the Claritin. So we would push the patient more towards the Zyrtec, which is a more drying medication.

Dr. Miller: This is also listed as a non-sedating antihistamine.

Dr. Alt: Correct. One thing to consider is even if the second generations make you drowsy or feel a little fatigued, you can also take them at night which is an option.

Dr. Miller: So sleep a little better and maybe get a little bit better coverage for the allergic symptoms.

Dr. Alt: Yeah. A third option that's more recent is a topical spray antihistamine. This is not taken by the mouth and you can spray it in the nose. This type of antihistamine, I've never seen it cause drowsiness or fatigue in patients, and you can use it on contact. So if you know you're going outside you can quick spray it in your nose to reduce the antihistamine response that you have for your allergies.

Dr. Miller: So Jeremiah, does that require a prescription or is that available over the counter?

Dr. Alt: That one is still a prescription medication. So you really need to get that from you allergist or your ENT, or your primary care doctor.

Dr. Miller: Now, there's another class of medication used to treat allergic rhinitis as well, and that would be the nasal steroids.

Dr. Alt: Yeah. So the nasal steroids actually have great evidence to be used both for allergic rhinitis and for many of the diseases that we talked about in some of the other podcasts, including chronic rhinosinusitis or reoccurring acute rhinosinusitis, where there's just an overall inflammation inside the sinonasal cavity. This just calms the inside of the nose down. It's a topical steroid. It's sprayed within the nose, usually dosed once or twice a day. What I like to think of it, it addresses the root of the problem.

Dr. Miller: The inflammation.

Dr. Alt: The inflammation, correct. So it really reduces the overall amount of goblet cells in the nose, the inflammatory, or those mediators in the nose and the immune system that are really creating the immune system to start with to create this inflammation.

Dr. Miller: Now, do you think that a patient with allergic rhinitis could also take the antihistamine orally, antihistamine nasal spray, and a topical steroid nasal spray, or should they use them separately? What's your thought on that?

Dr. Alt: It really depends on the patient's response and the overall diagnosis that you've come up with your doctor and your treatment plan. However, commonly we like to use both and we feel like patients get a good response by both blocking with an antihistamine and using a topical nasal steroid like Flonase or Nasonex.

Dr. Miller: Both of which they could get over the counter.

Dr. Alt: Correct.

Dr. Miller: It's possible that they could start their own treatment and then if things weren't going well they could end up seeing their physician.

Dr. Alt: There is a new medication, Dymista, that has actually combined the two together. So you can get it in a single spray, which patients are noting that they've really enjoyed using just one medication instead of two separate.

Dr. Miller: Now, let's say they have the common cold or sinusitis. Do the same medications work?

Dr. Alt: Yes. In general, though, we don't typically use antihistamines for chronic sinusitis unless they have a comorbidity or that's one other disease process that they also have on top of the chronic sinusitis that we want to help control symptomology. So if they have allergies and we want to help control some of that drippy nose, postnasal drip symptoms, we can add on an antihistamine. But, yeah, the steroids are great, as we talked about. It's really disease of inflammation, so that topical nasal steroid is ideal for helping.

Dr. Miller: Would you recommend using an oral, what we call, sympathomimetic, like pseudoephedrine or Sudafed for someone who has the common cold or sinusitis?

Dr. Alt: Those are really two different diseases and two different applications for that. For an acute onset cold or viral rhinosinusitis or bacterial, this can help make the patient feel better. I don't think it really helps get you over the illness quicker. But it can help improve your overall well-being. Now, in sinusitis it can also improve your overall feel of increasing your ability to breathe through your nose.

But this doesn't get at the root of the cause of the disease itself, and we commonly don't like to think of using these long-term in a disease like chronic rhinosinusitis, which is a chronic condition. You'd have to use this over potentially months and years, which we're concerned about the possibility of hypertension.

Dr. Miller: Now, you could also use the same medication as the nasal spray for a few days, I understand.

Dr. Alt: Afrin or over-the-counter oxymetazoline is a great sympathomimetic, which really reduces the overall swelling inside the nose. We commonly like to really counsel the patient that these are great short-term. So these are two to three-day treatment options, and then they really need to consider trying to come off of them.

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updated: February 19, 2019
originally published: December 1, 2015

Dr. Gellner: Latex allergy is more common than you might think. I have it, and it's one of the main reasons latex is not found in medical offices anymore. How do you known if your child is allergic to latex or not, and what should you do about it? I'm Dr. Cindy Gellner on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Latex is a substance made from a milky fluid that comes from the rubber tree. With a latex allergy, the body treats certain proteins in latex as if they were harmful and triggers an allergic immune response. This may happen when products made from latex touch your child's skin, mouth, or even if they are just inhaled. Children who have chronic diseases, such as spina bifida, or have a lot of surgeries, may be exposed to latex from the medical procedures. They may become sensitive to it.

Children who have allergies to certain foods may also develop a latex allergy. Both the foods and the latex have some of the same proteins. These include fruits such as bananas and kiwis, vegetables including avocadoes and tomatoes, tree nuts, peanuts, and shellfish. If you think your child is allergic to latex, it is important to get a diagnosis from your health care provider or allergist.

Symptoms of a latex allergy can develop over several hours, or they may be immediate and severe. The most common reactions are skin reactions, such as hives and eczema flares. If latex is around the mouth or inhaled, your child may have wheezing, trouble breathing, itching and swelling around the mouth, and a rapid heartbeat.

It is possible to have an allergic reaction called anaphylactic shock. This is a serious reaction that is sudden, severe, and can involve the whole body. It can cause swelling of the mouth and throat, dangerously low blood pressure, and trouble breathing. This type of reaction is an emergency. It is treated with antihistamines and injectable epinephrine. Usually, parents or caregivers of children who have severe allergic reactions carry their own epinephrine in case of an emergency. If epinephrine is used, or your child has a reaction, and epinephrine is not available, call 911 immediately.

Many things contain latex, including baby bottle nipples and pacifiers, rubber bands, balloons, Band Aids, IV tubing and catheters, many kinds of medical gloves, and dental dams used in dental procedures. In general, any item that can be stretched may contain latex. There are many things that can be used instead of things that contain latex. These are made from vinyl, plastic, or silicone.

If your child has been diagnosed with a latex allergy, teach your child to known and avoid latex products. Make sure your child wears a medic alert bracelet or necklace. Know what to do in case of an emergency. Ask your child's health care provider about a prescription for injectable epinephrine in case of emergency.

Finally, be sure to tell all dentists, health care providers, teachers, daycare providers, babysitters, friends, and family members that your child has a latex allergy. Anyone your child's going to be spending time with needs to know about this. Something as simple as going to a birthday party with latex balloons can trigger a serious reaction. Be sure you are always prepared for your child.

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Dr. Gellner: Even if cats and dogs make you sneeze, will you save your kids from aggravating allergies by getting them a pet? It's a theory we'll discuss today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Early pet exposure reducing the risk of allergies in children. It's part of something called the hygiene hypothesis, and it's been tossed around for a few years now. Evidence is mounting that it may be true. Studies found that exposure to pets in early years of a child's life might significantly lower the risk according to some pediatric allergy specialists.

The allergy researchers followed a group of about 500 children almost equally split between boys and girls from birth to age seven. Children were checked regularly with blood tests to measure antibodies that cause allergies, skin reaction tests that show if someone is sensitive to an allergy, and a breathing test to measure their lung function commonly used to detect if their child has an asthma flare or not.

The researchers also collected information on exposure to cigarette smoke, home and daycare environments and measured allergen levels in the household such as dust and other air samples. They also asked about pets in the home.

So the allergists found that children who lived with two or more animals were significantly less likely to have a positive skin test, which signifies a reaction to the allergen rather than those who had no exposure to pets. Children with pets were also less likely to have allergen antibodies in their blood. Boys especially seem to benefit from pet exposure. Not only did they have lower antibody levels, they had better lung tests and less evidence of asthma if there were two or more cats or dogs in the house.

The study adds to the growing literature about the hygiene hypothesis that the cleaner we live, which is common in our western world lifestyle, the more likely we'll get asthma and allergies. It confirms that observation that children with a history of pet exposure in the first years of life may have less asthma. Boys do tend to get more asthma and allergies, though.

The study falls short of proving that pets can prevent allergies and asthma. You shouldn't automatically just go out and get two dogs and two cats. It's a correlation that may be true but it hasn't been proven yet. It could be that the study shows that only children who have a risk of allergy or asthma tend not to have cats or dogs in the house.

By working on this same hygiene hypothesis, pets may not even be a necessary factor in increasing a child's immunity. Siblings might also play the same role as pets. Infections in early life, especially with viruses, may help drive the immune system away from being sensitive and causing allergies. Kids can get the same kind of exposure from older siblings in the first month of a child's life. Usually the older siblings will bring home lovely viruses from school, or the child themselves will be exposed to viruses at daycare.

Just like we say don't go out and get two dogs or two cats just to keep your kids from getting allergies, we don't necessarily mean you have to put them in daycare in order to expose them to these viruses. More studies need to be done following children in their early lives before any conclusions can be made about the hygiene hypothesis.

So does this mean you should go out and get a pet? Well, not so fast. If there's someone in the house who has an allergy to a dog or cat, you really don't want to put that family member through misery. Also, genetics play a large role as well. Children have a one in three chance of developing allergies if just one of their parents has allergies. If both of their parents have allergies, their risk is nearly 70%. The risks increase by similar amounts for asthma. Pets are a lot of responsibility, too. Be sure to think about all family members, pets included, if considering a dog or cat.

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Dr. Miller: Hives, what are they? How do we get them? And what do we do about them? This is Dr. Tom Miller on Scope radio. We're going to talk about that next.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Miller: Hi, I'm here with Dr. Mark Eliason. And he is a professor of dermatology here at the University of Utah. And Mark is going to tell us a little bit about hives. What are hives? What's a hive? I think of a beehive but I don't know if that's what a hive is.

Dr. Eliason: This is the right state for that. No, well a hive is simply... the easiest way to think about it is like a bug bite. Imagine a mosquito bite. Something that's raised, it itches, and it bothers you. Most all hives will itch. And there are a lot of things that will cause them as well. But generally speaking, they're raised areas on the skin that are red and usually they will draw your attention to them.

Dr. Miller: I mean, do they happen rarely? Do some people get them and others don't? I mean, who get's a hive?

Dr. Eliason: So, we know that anyone who spends any time outside, especially in the morning or in the evening during mosquito season certainly knows what hives are. You can get a lot from the environment. But beyond just the hives that come from insects that bother you, a number of people develop hives spontaneously. And that can be because they have an allergy to something that they've taken, or something that they've eaten. Or they can also get hives sometimes without anything that they've done wrong, so to speak. Their body sometimes just makes their own hive.

Hives are interesting things to think about because it's an old reflex that our bodies have built into it that draws our attention to a part of us. And if you think about it, when something hurts, we pull away from something. Hurting is a way for our bodies to say, "Stop what you're doing." Itching and hives are a way to tell us that we need to pay attention to a part of our body.

Dr. Miller: Like a mosquito bite. You're near mosquitoes, move away from them.

Dr. Eliason: Right, or something is in us that's itching. Pull that thing out of us. And so it's sort of an opposite built in reflex that sometimes gets turned on inappropriately if something triggers it when it shouldn't.

Dr. Miller: Now, I think our audience might actually be interested in the spontaneous hives, because I've had patients who come in and they describe hives as being something that just pops up in an area that they didn't have any insect bite. So tell me about that a little bit. Because I think if people have hives that are due to, say mosquitoes, they kind of know what's caused that. But sometimes they just don't know.

Dr. Eliason: Sure, and hives can be scary. Because sometimes you get one or two little spots that will show up on your skin and that's not too much of a problem. But people will come in sometimes, they can be covered in hives. And not only are they just uncomfortable because they're itching like crazy, but it's frightening. Some people will feel parts of their body swelling. Like their lips can swell. They can feel like, sometimes they get nervous. Their breathing can be affected too. Hives can become something very worrisome.

Dr. Miller: But more rarely, correct?

Dr. Eliason: That's correct. I should be careful to tell you that most of the times hives that happen on the outside of the body, don't actually cause problems with breathing. But it is one of the things that people watch out for. The number one rash that people go into the emergency room for are hives.

Dr. Miller: So let's talk about that for a second. So let's say a person has never had hives before and they develop one or two episodes, do they need to see a physician? Or should they just maybe not worry about it so much?

Dr. Eliason: That's a great question. And a lot of it depends on what the hives are doing to them. People that are developing a handful of hives, some that are bothersome but they're not affecting at all the way that they're working or their ability to do the things they do during the day, usually don't necessarily need to see a physician until they've tried some of the over the counter products that are available to treat hives easily.

Dr. Miller: And what would those be?

Dr. Eliason: Of course assuming that people don't have any reasons why they couldn't take them, simple things like Benadryl or some of the non-sedating antihistamines with names like Zyrtec or Allegra. Or of course the generic equivalents of those are very safe things for people to start to just try to treat their hives and see if you can get them to go away easily.

Dr. Miller: Is one better than the other? The non-sedating versus the sedating? Because some people will take Benadryl and fall asleep at work, which is bad. Or if they're operating expensive dangerous machinery. That could be a problem.

Dr. Eliason: Right. That's a great point because any medicine that you give someone, if you give them enough of it, you can get side effects with it. So during the day I usually advise patients to consider using things like Zyrtec or Allegra because those are non-sedating. And most people do great with them.

Dr. Miller: Now how often do you find a reason for someone to have spontaneous urticaria? Aside from an insect bite.

Dr. Eliason: Yeah, this is a hard question. And with the spontaneous or acute urticaria, that's the kind that just shows up. It's only around for a couple of weeks. We don't always find the causes. In children it's usually related to an infection. And so it doesn't mean you have an infection that's creating your hive. You could have an infection like a common cold. You could have strep throat.

Dr. Miller: A virus.

Dr. Eliason: Exactly.

Dr. Miller: Or a bacterial pharyngitis.

Dr. Eliason: Precisely.

Dr. Miller: Sore throat.

Dr. Eliason: Those infections can, they don't cause hives, but your body's response to the infection accidentally creates hives on you. It's almost like your body makes a little bit of a mistake while it's cleaning out the infection and incidentally creates hives in the process.

Dr. Miller: Well when should that patient find their way to your office?

Dr. Eliason: We like to see patients when it bothers them. And so for some people that means that they get hives and they have a chance to try some of the over-the-counter antihistamines. And they don't work. In which case we certainly want to help them because there's a lot of other things that we have access to, prescription-wise, that can be stronger.

Dr. Miller: Do you have a definition of, sort of, mild, moderate, or severe hives in terms of how often they occur or how extensive they might be? Maybe that would help our audience know when they should seek medical advice.

Dr. Eliason: A lot of this isn't necessarily with the frequency but more of the severity. Hopefully I can make that make sense. When hives are developing and they aren't preventing people from doing what they normally do during the day, and they also are not causing any changes where parts of their body are swelling, then usually people can try over-the-counter products without having a worry that they need to rush in to see a physician for it.

If people are developing hives where they are getting swelling in their skin, so like I mentioned, lips can swell, ears can swell, or they can just have big welts. Their wrist gets too large. And it looks kind of doughy sometimes. Those are reasons to get into be seen by a physician sooner. Of course if people are having any difficulty breathing, it's a trip to the emergency room very quickly.

Sometimes when hives present, and they cause changes in breathing, people don't necessarily feel like they can't breathe. But they just start coughing sometimes. And those are things to watch for. Of course, you don't ever delay in that case. If you ever feel, if people ever feel like they can't breathe normally, it's straight to the ER.

Dr. Miller: Thank you very much. This is very helpful Mark.

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updated: August 21, 2018
originally published: February 23, 2015

Dr. Kirtly Parker Jones: "Don't put that in your mouth." How often have we said that our babies on the floor, who picked up the dog's bone and starts to chew on it? We try to keep our infants safe from diseases by keeping them away from anything dirty, by keeping their environment ultra clean. But maybe a little dirt in our infant's beginnings helps them in the future life. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at the University Healthcare, and this is the down and dirty about babies and allergies today on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Kirtly Parker Jones: How does our body learn what the immune system should fight off and what it should accept? The immune starts developing in the womb, but the real work begins at delivery. The bacteria that are very important and populating the newborn's gut comes from the mother's vaginal flora and her skin, and the bacteria the baby experiences is in early life.
Having a lot of different bacteria is a good thing. Babies born by a Caesarean section without labor have more asthma, more autoimmune diseases, and eczema. But what about after birth? We evolved our immune system by living in the dirt, not with hand sanitizer. It's a good thing not to be allergic to your environment, so what is the evidence that we should let our babies suck on their pacifier when it falls in the dirt or chew on the dog's bone? Today, we're going to talk about babies and allergies.
It's long been known that many of the autoimmune diseases that we see in the U.S.; asthma, eczema, autoimmune colitis like Crohn's Disease are very rare in third world countries or, to be politically correct, developing countries. A mounting body of research suggests that exposing infants to germs may offer them greater protection from illnesses such as allergies and asthma later on in life. There's something called the Hygiene Hypothesis which holds that when exposure to parasites, bacteria, and viruses is limited early in life, children face a greater chance of having allergies, asthma, and other diseases later in adulthood. In fact, kids with older siblings who grow up on a farm or who attended daycare early in life seem to show lower rates of allergies.
Just as a baby's brain needs stimulation, input, and interaction to develop normally, the new research is read to your kid from birth, not just put them in front of the TV, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself.
It's been observed that infants from farm families, especially those with older siblings, have much less asthma and allergies to pets or other animals. I think old siblings thing is that the older sibling puts their dirty hands on the infant, and this is not such a bad thing, as it turns out. It is innate behavior of infants to pick up everything and put it in their mouths, including their hands, their feet, and anything they can reach. Well, maybe there's a reason for that. They aren't hungry, and adults don't do that. Even children over 3 don't do that anymore. So maybe they are priming their gut with bacteria to help them later in life. That's just a guess.
Recently, it's been shown that bacteria in the newborn's gut are important in regulating the developing immune system. And finally, a new study from John Hopkins looked at asthma in inner city children. Infants were followed from birth to 3 years. Now, we know inner city children have high rates of asthma and triggers include cockroach droppings, mouse, and cat dander. So they tested these children and their homes for these exposures as well as doing a quote "bacterial analysis" of their home. Infants who were exposed to cockroach droppings, mouse, and cat dander and a wide variety of bacteria had a 17% incidence of wheezing by age 3 compared to 51% of wheezing in kids who weren't exposed to these factors as infants. Wheezing in early childhood can be a sign of future asthma in children. The important and curious fact is the exposure has to happen in the first year of life to be protected.
We know that our fear of germs and our babies comes from the knowledge that around the world, the number one killer of newborns is infectious diarrhea from unclean water, so we don't want to expose our kids to bacteria and unclean water and from people who are sick. These germs are sick people germs, not from the environment. We should take care about exposing our infants to people with diarrhea and upper respiratory tract infection, but I'm talking about crawling in the dirt.
So what should we do as moms and grandmas? If the child is otherwise healthy and doesn't already have a compromised immune system from disease, its okay to let the dog lick the baby's face, and the binky doesn't have to be sterilized if it drops in the dirt. Let the infant sit or lay on the ground or the floor. A little dirt won't hurt her none. So that's the down and dirty about babies and their developing immune systems. Stay tuned because this is an area of research that's growing very quickly, and thanks for joining us on The Scope.

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Scot: You're at a restaurant, eating. Somebody next to you has a massive allergic reaction to something they ate. What can you do to help them? We'll examine that next on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Scot: Seems like we're more and more aware of food allergies, and some food allergies can be very, very serious, so much so that it closes off your ability to breathe and other symptoms as well. What if you are at dinner and somebody has a food reaction? What should you do? We're with Dr. Troy Madsen, Emergency Room Physician at the University of Utah Hospital. What should you do? What could I, as a bystander, do for that person?

Dr. Troy Madsen: Well, you know, when I think of food allergies or any allergy, I think of them in two different ways. Number one, there are the allergies where people get a rash, and that's one thing. Yeah, you want to treat it.
But number two, there are the allergies that you mention where it's actually affecting a person's ability to breathe, and that's much more concerning. If a person's complaining of their tongue swelling, their throat tightening, their lips tingling, you know, those sorts of things, then I'm more concerned about the airway. So that's much more emergent. In that kind of situation, the number thing is to call 911. You want to get them there. These patients need immediate treatment to treat their allergy.
One thing you can do if you have it available, and I don't know if you would, people have had allergic reactions before and they might have this or someone in the restaurant might have this. But if a person's having a severe allergy, and they are saying, "I am having a lot of trouble breathing," there's something called an EpiPen. This is something where you inject yourself with epinephrine. Sometimes you may have heard it referred to as adrenaline. We're not talking about Pulp Fiction here.

Scot: How'd you know what I was thinking?

Dr. Troy Madsen: I knew exactly what you were thinking.

Scot: Sorry. 911 is about as good as I'll be able to get because I can't do that.

Dr. Troy Madsen: Yeah, you're not giving it in the heart either.

Scot: That was hilarious. That's not how you're going to do it.

Dr. Madsen: Okay. But we are talking about an EpiPen or, again, called adrenaline where you're giving that in the thigh. And if a person previously has had severe allergic reactions, they probably have this available. So if you're in a restaurant and this happens to someone, number one, again, get 911. Call 911. But if this person is not breathing or is having a lot of trouble breathing, maybe someone with them knows, "Oh, they always carry this EpiPen," you give that.

Scot: Yeah.

Dr. Madsen: You inject that into the thigh. You just hit the thigh with it, and it'll inject it.

Scot: Okay. Is there anything else that I should know? Because my thought process here is, 'If people have one of these severe allergies, likely they know about it and they'll know what to do. And they'll probably be able to take care of what needs to be taken care of. But as a bystander, to ask for an EpiPen, call 911, is that pretty much it?

Dr. Madsen: Well, you know, the other things that we typically do in the ER, if it's more of a mild allergic reaction, we'll give Benadryl. If you were to have some Benadryl, you could give it, but, personally, I wouldn't rush to give it. The reason being is that the EMTs are probably going to be there within five to ten minutes. Benadryl is going to take 30 minutes or more to really have an effect anyway. So I don't know if there's a lot of benefit, especially in someone that has potential airway issues of trying to get them to swallow down some water and take some Benadryl as well.
I think the biggest thing is to get the EMTs there to get them there help they need. If an EpiPen is available, if this person is with someone who knows they have these reactions and hash an EpiPen with them, you absolutely want to administer that because that is going to have the biggest impact, and it's going to have an impact within minutes.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. The University of Utah Health Sciences Radio.

Announcer: It's time to get an update on the latest in allergy treatments. We're going to examine that next on The Scope. Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: When I was young, it was the scratch test and shots. That's about the only options I had for my allergies, and they didn't work. But I guess things have changed for allergy sufferers since then, quite a bit. We're with Dr. Kevin Wilson, ear, nose, and throat specialist at the University of Utah Hospital. Tell me about some of the newer treatments for allergies. Maybe we should start with I come in with allergies. What are you going to do?

Dr. Wilson: The first thing I'll do is ask what your symptoms are because, really, the treatments are often directed at specific symptoms, and different treatments work those different symptoms. As I talk to a patient about their options, I divide treatments into three categories. The first is avoidance, or we also call it environmental control. So if you know what you're allergic to, then you can take steps to decrease exposure to those allergens and therefore reduce your symptoms. The second category is pharmacal therapy or medications. There's a wide variety of medications from nasal sprays to eye drops to pills, and they all work differently and target different symptoms. I really like to understand what the symptoms are so I can target that medication to those symptoms. The third option is something called immunotherapy, which is what you were mentioning before: allergy shots. We also offer allergy drops, which are drops under the tongue. The idea here is that we give the patient the things that they're allergic to, and over time, their body becomes desensitized to those allergens so that they stop making the allergic response or at least significantly reduce it.

Interviewer: Is there a logic to this hierarchy?

Dr. Wilson: There is. It depends on the severity of the symptoms and how much the patient is willing to invest in this treatment. Some things are relatively simple. Taking a pill can be a relatively simple thing. There are some side effects to different medications. Avoidance can sometimes be a simple thing such as by maybe taking the cat out of the bedroom and not letting it sleep next to you on the pillow or trying to keep dust down in the home. But sometimes it can be more difficult if you're allergic to grass pollen. Then, really, your option is don't go outside for two months of the year. Most patients aren't going to go for that.

Interviewer: Sure. Yeah. Understood. Have treatments gotten better over the years?

Dr. Wilson: Well, certainly, the medications have improved. In the old days, and people who are treated 20 years ago may remember how horribly tired they became with antihistamine pills. There's a new class of antihistamines that have come out since then that are not sedating or are very minimally sedating so that you can take a pill and still function throughout the day and not be sleepy and falling asleep at the computer at work.

Interviewer: Are they more effective at treating the symptoms? When I was a child, as I said, I got the shots, and I never really felt a lot of relief from those.

Dr. Wilson: Yeah. It really just depends on, again, what the symptoms are, what you're allergic to. Most people do respond to the shots or the drops. The studies show about 80 to 90 percent of people do respond to them.

Interviewer: Wow. That's pretty good.

Dr. Wilson: So you were unfortunately in that small minority, it sounds like, if you didn't respond.

Interviewer: Lucky me.

Dr. Wilson: Yeah. So most people do respond. The downside to the immunotherapy is that it is a long-term treatment. So it's typically a three to five year treatment. Obviously, that's going to require a significant commitment on that part of the patient. If their symptoms are on the mild side, they may not be willing to do that. But it's certainly a good option for those for whom the medications don't work or who continue to have a lot of symptoms with medications.

Interviewer: Tell me a story about somebody who came in suffering from allergies and how your treatment changed their life.

Dr. Wilson: Maybe I should give my own experience. I am currently on immunotherapy shots.

Interviewer: So you're on that third stage?

Dr. Wilson: Yeah. Yeah. I've been treating my own allergies my whole life with different pills and sprays, and they work OK. But they have their downsides.

Interviewer: What are some of those downsides for you?

Dr. Wilson: Well, the pills always made me sleepy. So I could function, but I was always falling asleep, even with the newer generation of antihistamines. I just wanted something more definitive. I wanted to be able to go outside and not have to worry about it. I like to ride my bike to work. I didn't want to get to work with itchy eyes every day. So I put myself on the shots basically, and life is a lot better.

Interviewer: Really?

Dr. Wilson: I'm a lot happier. Yeah. And I've got a whole group of patients that are doing very well and they're real happy with the treatment they're on.

Interviewer: Do you know if insurance covers these types of treatments?

Dr. Wilson: In general, it does.

Interviewer: In general it does. So what would you want an allergy sufferer to know at the end of the day?

Dr. Wilson: If your symptoms are bothersome, there is help. There's help out there.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

Interviewer: Can you prepare for spring allergy season in the winter? We'll examine that next, on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: So, about this time in the winter everybody's dreaming about spring, except for maybe allergy sufferers and I think even they perhaps are dreaming about spring, maybe a spring without allergies. Is there actually something you can do in the winter to prepare for that? Dr. Kevin Wilson is an ear, nose, and throat specialist at the University of Utah hospital. What can I do now to prepare for allergies in the spring? Is there anything?

Dr. Wilson: Well, it depends on what you're allergic to.

Interviewer: Okay.

Dr. Wilson: So, if you're allergic to a year-round allergen like dust or your cat or dog or mold you've probably been suffering all winter long and it hasn't made a difference for you.

Interviewer: So mold's year-round, interesting. Okay.

Dr. Wilson: There are some seasonal parts of it because it tends to grow in moist, warm environments so it can grow in the thatch under your lawn.

Interviewer: Gotcha.

Dr. Wilson: So, when you first start mowing it's been that moist kind of melting snow and you'll get some mold in there and that'll start kicking up. You may notice some of that.

Interviewer: Alright.

Dr. Wilson: If you're, you know... spring's going to be bad for you if you're allergic to trees. That's the first thing that's going to be blossoming in kind of March-April time frame. Next will be the grasses in June-July area and then the weeds will be more in the fall so that can give you kind of an idea about when your symptoms are as to what you're allergic to. So, if your symptoms occur just as the snow is melting then you can assume it's a tree.

Interviewer: Darn trees!

Dr. Wilson: Yep and there's not really a lot you can do about it to prepare. Again, it's about avoidance, it's about treating the symptoms if you can, and then hoping that the time will come when those trees stop pollinating.

Interviewer: So, in the tree season if I'm on some sort of medication so I need to start ramping that up or can I start taking as soon as tree season hits? Do I need, like a two week period or whatever before?

Dr. Wilson: That's a great question. So, one of the main medications that we use is nasal steroid spray and that's a spray you get from your doctor. It's not available over the counter and it takes about a week or two for it to work so if you're going to be using a spray like that, then yeah you would want to use it a couple of weeks before you expect those symptoms to begin. The antihistamines like the pills and things, they work pretty rapidly so you can just start using those as needed when you start to get symptoms.

Interviewer: So really only if I'm using a spray is there anything I can really do to prepare other than just be aware it's coming?

Dr. Wilson: Just be aware.

Interviewer: Alright. Not a lot of preparation you take it as it comes. What about putting in... do filters in my house, heating and cooling systems make a difference?

Dr. Wilson: Yeah, you know, you can spend a lot of money on filters and purifiers and other things. The studies aren't that great, unfortunately.

Interviewer: Oh, okay.

Dr. Wilson: If you're going to invest in a filter, it's probably better to do an in-room filter rather than a whole house filter because they're more efficient and with a full house filter you'll really wear out your blower on your furnace.

Interviewer: Because you'd have to keep that on all the time...

Dr. Wilson: You've got to change that filter all the time because unfortunately pollens and allergens are very, very tine so you've got to get a very high efficiency filter for it to really be effective and of course that's going to plug up those holes pretty quick.

Interviewer: Sure.

Dr. Wilson: So I don't recommend in general the full house filter. I feel like treating the symptoms and focusing on the patient rather than on the environment, maybe getting the patient out of the environment rather than trying to change the environment is a lot more effective.

Interviewer: Final thoughts on preparing for allergies?

Dr. Wilson: Good luck with the season; everyone thinks that this year is the worst year. The reason is we have a very short memory.

Interviewer: Every year is bad!

Dr. Wilson: That's right! Every year is bad, there are worse seasons than others but you know your systems will likely roll around every year.

Announcer: We're your daily dose of science, conversation, medicine, this is The Scope, the University of Utah Health Sciences Radio.