A conversation with Dr. Zachary Rubin, top allergist and medical influencer, about the advice he gives patients and followers for conquering spring allergy symptoms.
Andy Meyers, CEO, HealthDay
So today we are pleased to be joined by Dr. Zachary Rubin. Dr. Rubin is a double board -certified physician in general pediatrics and allergy immunology and the head of the social media committee of the American College of Allergy, Asthma and Immunology. Thanks so much for joining us.
Zachary E. Rubin, MD, Double Board-Certified in Pediatrics and Allergy and Immunology
Thank you so much for having me.
Andy Meyers, CEO, HealthDay
So here we are, middle April. Everything's blooming. And of course, allergy season is kicking into high gear. We like to kind of be practical here at Health Day. So, we wanted to talk about what you can do when those symptoms start to kick in.
Zachary Rubin, MD, Allergist/Immunologist, Head of Social Media for ACAAI
So, there's a lot of different issues at play when it comes to seasonal allergies, especially as tree pollen counts are starting to climb in my area it just started down in the South. It's been that way for at least a month. If you're in Texas, it's been since December, January with Cedar fever. And so, it's not just about medications. It's about lifestyle changes to reduce exposure to what you are allergic to.
So, as an example, if you have a tree pollen allergy, you may need to minimize the amount of time that you spend outdoors if you know that the pollen counts, are going to be very high that day. And the pollen counts tend to be highest in the morning, especially if it's dry and windy.
And you want to keep your windows and doors closed as much as possible to avoid the outside air with those pollen grains coming into your home.
When you come home, you are going to collect pollen on yourself. So, you want to make sure that you are changing your clothes as soon as possible, keeping your shoes in one place in the house and bathing at nighttime, so you're washing away all those pollen grains and also rinsing your nose.
I've talked about this a lot, which is the idea that we brush our teeth every day. Why aren't we cleaning our nose every day? We have all these irritants, allergens, mucus in our nose. It's a dirty place.
It's meant to trap all those things to help you from getting sick, but where is that going to go if you don't clean it out? You're going to either let it sit there because you get congested, it goes to the back of your throat through post nasal drip, or you're going to sneeze or cough it out.
So, there's a lot of lifestyle changes you can work on before even considering medications. And then when we talk about medications, there are a few options over the counter, but they're not all the same. (:10)
So, antihistamines like Benadryl, they treat primarily itching, runny nose, sneezing.
It does not do a good job with nasal congestion or post-nasal drip or headaches because there's a lot more inflammation that's going on that's outside of the chemical histamine because when you take Benadryl it blocks that chemical.
Benadryl is also a drug that has a lot of side effects. It can make you very sleepy and if you are older, you're at risk of having what we call anticholinergic side effects. So that could be feeling dry, having urinary retention, constipation and taking it in high doses can cause cardiac problems.
So ,we try to move away from Benadryl and think about these newer second-generation antihistamines like Claritin, Zyrtec, Xyzal and Allegra that have much less side effects. They last longer in your body and they're either just as effective or more effective than something like Benadryl. So again, limited symptoms with those.
Then you've got nasal sprays that either contain steroids or antihistamines mainly. So, you have things like Flonase, Nasonex or Nasacort that is a steroid that helps shrink down that tissue, takes away that generalized inflammation, but you need to start that medication several days before you expect symptoms because it takes time to change that immune response through the medication.
Then there's also nasal antihistamines. the one that's available over the counter is called Astepro. It's a nasal antihistamine that can taste very bitter. So. you have to be careful how you take it.
But it's more fast acting than something like Flonase, because it's an antihistamine medication, not quite as effective, but I find using both of them in combination can be very beneficial for many of my patients.
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