PODCAST: Can Seasonal Allergies Be Prevented?March 7, 2023
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If you're among the estimated 25 million Americans suffering from seasonal allergies, spring may not be your favorite time of year. It marks the start of watery red eyes, runny nose, sneezing and coughing, all signs of airways inflamed because the immune system is overreacting to the presence of pollen, mold or some other allergen. What can an outdoor lover do? Are allergy seasons getting longer and longer or does it just seem that way? And why is Houston such a hotspot? In today's episode, we discuss one of the most common but overlooked diseases, allergic rhinitis.
Hosts: Zach Moore, Todd Ackerman (interviewer)
Expert: Dr. Mas Takashima, Otolaryngologist
Notable topics covered:
- What the 2023 season has in store for allergy sufferers
- How allergies are an unintended consequence of our ancestors' defense against parasites
- What allergy sufferers should do on high pollen days
- How to distinguish between allergies and sinus infections
- The most common triggers for Spring, Summer and Fall
- How global warming is affecting allergy seasons
- The ages at which allergies hit hardest and start to decline
- Potential solutions: Allergy shots? Masks?
- Which matters most when it comes to allergies — genetics or environment?
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ZACH: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I've worked in multimedia and television for over 15 years — and I'm also a longtime podcaster.
TODD: I'm Todd Ackerman. I’m a writer/editor who previously covered Science and Medicine for the Houston Chronicle.
ZACH: And, Todd, when I say allergy season, what comes to mind for you?
TODD: Well, fortunately, I don't suffer from allergies, but just seeing people around me, I think of watery eyes, runny nose, sneezing, just that people seem pretty miserable.
ZACH: And we're releasing this episode in the spring, which is only one of multiple allergy seasons, right?
TODD: Yeah, spring is probably the biggest one we think of. But there's also a summer allergy season and fall allergy season, and then people can even suffer allergies in the winter. But that's much lower. People mostly just think of spring, summer and fall.
ZACH: Yeah, I have allergies to a certain extent, but I never…they don't really connect to pollen or anything like that, as far as I can tell. I've never really looked into that deeper, but perhap I should.
TODD: Yeah, I think it's important to find out what you're allergic to, what the trigger is, so you can avoid that or talk to a doctor about medication if it's enough of a problem.
ZACH: Yeah. Because you get something like the common cold, quote unquote, and then it's like, during allergy season, I feel like a lot of us, we just kind of put all these things together. I'm like, oh, you have your headache, your runny nose or your watery eyes, like you said, and it all just gets clumped together and you get over it quickly. And you really, I don't know, for me anyway, I don't really spend time wondering why exactly this happened, and perhaps digging deeper into it can help you prevent it happening in the future.
TODD: Correct. And one thing that you mentioned is it can be tricky to distinguish between infections and allergies. So that's another reason to really track this. And if it's bothering you enough to see a doctor about it.
ZACH: Yeah, because when you get sick, you think, oh, is it a viral infection, Is it bacterial infection? And allergies is something completely different. It's neither one of those categories.
TODD: Correct. Allergies are your body's immune system overreacting to what it perceives as a threat. Nothing to do with an infection, either viral or bacterial.
ZACH: And they're triggered by external forces, such as pollen, mold. You see on the weather reports on the news sometimes, like here's your allergy report, and they have the different categories. And if you don't suffer from them, you probably just tune out at that point. But those can be just as important as a weather forecast for some people who suffer greatly from allergies.
TODD: Oh, absolutely. And the city reports pollen count. So that's a good thing to keep an eye on. Mold is another thing that's reported by the city. So, keep an eye on that as well.
ZACH: I think everyone's allergic to mold, though, right?
TODD: Some more than others. But yes, it's a pretty common allergy.
ZACH: So, who do we talk to you about allergies today, Ted?
TODD: We talked to Dr. Mas Takashima, who's the director of the Sinus Center at Houston Methodist, and quite the expert on allergies.
ZACH: Yeah, Director of the Sinus Center sounds like just the guy we should be talking to.
ZACH: Let's get into it.
[Sound effect signaling beginning of interview]
TODD: Dr. Takashima, good to have you.
DR. TAKASHIMA: Great to be here. Thank you so much for the invite.
TODD: So, we here to talk about seasonal allergies. It's that time of year.
DR. TAKASHIMA: Absolutely.
TODD: First of all, what percentage of people suffer from seasonal allergies?
DR. TAKASHIMA: That's really a hard number to predict. And the reason for that is, you know, some people have really bad allergies, while some people just might have some sniffles that can be caused by allergies as well. And, so, the range, if you look at the data, the range goes from about 12 million Americans to 70 to 80 million Americans. I think it just sort of depends on how you define what allergies is. And if you really want to get more into, you know, is it allergies that you really want to treat medically or is it something that you want to treat holistically? And, so, there's a lot of different ways that we sort of categorize allergies. How much does it really affect patients? You know, is it just a minor annoyance? Is it something that really needs medications, or does it really need something more than medication? So, we can talk about that later as well.
TODD: It seems I've read something that it's becoming more of a problem. It's more common for people to have allergies. Is that true?
DR. TAKASHIMA: Well, you know, especially with the hot topic of global warming, we are seeing seasons lasting a lot longer than they used to. And, so, with longer seasons, unfortunately, people are exposed to allergens for a longer period of time. And, so, it sort of increases not only the duration, but also, with the increased number of pollens that are being produced, the severity as well.
TODD: And do you see this anecdotally in clinic?
DR. TAKASHIMA: You know, over the years, we definitely have been seeing a continued trend towards that direction. It's very interesting, though, with people wearing masks with COVID, we were noticing a significant decrease in patients complaining of allergies for a long period of time. However, one side effect of COVID or having COVID is actually postnasal drainage, which is, you know, a runny nose, and that can frequently be misconstrued as being a, quote, allergic type reaction. Well, in essence, it's more of a reaction to the virus and the body's defense mechanisms in treating that virus.
TODD: But now that people are not wearing masks as much, are you starting to see allergy patients picking up again?
DR. TAKASHIMA: It is booming, unfortunately. And over the years, you know, if you look at the overall trends, we definitely are seeing more and more every year. And part of that, I think, is due to the increase in temperatures, but also with the increase in flooding as well. Unfortunately, here in Houston, where it's so humid, mold allergies is a very common problem. And unfortunately, there are some patients I have to tell them, hey, you know, you would do much better living outside of Houston in a drier climate, especially if mold is a huge problem. And now with all the rains and floods that we've been having at a more frequent basis, it seems like, you know, every five or six years we're having a 100-year floods. And with that we are seeing a significant more of allergies playing a larger role in patients’ discomfort.
TODD: Okay, so, break down allergies a little for me. What actually happens when an allergy attacks?
DR. TAKASHIMA: It's sort of interesting because if you holistically look at what exactly is allergies, allergies, it's thought — and to be frank here, we really have only touched the surface in in figuring out why we have allergies and why some people are more predisposed to having a greater degree of allergy-type symptoms — but the whole thought process behind allergies is that, you know, our ancestors, the way we stayed alive, the way we're able to combat parasites, is that the body has a unique immune system that are geared towards the proteins on parasites. And obviously in this modern age where, you know, in industrial cities such as Houston, the United States, we don't really have to worry too much about parasites, but the same proteins that reside on the parasites are also on a lot of other things as well. And, so, the body is now reacting to things that aren't as dangerous to them in an exaggerated fashion. And so in essence, that exactly is what allergies is. It's the body's immune system overreacting to certain substances in the air that get trapped inside our noses, our sinuses, our airway.
TODD: And you refer to that as we’re just starting to understand this. But do we know anything about what shapes what a person's allergic to? Is it mostly genetic or is it mostly a product of your environment?
DR. TAKASHIMA: You know, it's a combination of both. Clearly, if your parents are both highly allergic, the chances of you being allergic is actually quite high. And, so, there's definitely a genetic component there. But there's also other factors involved too, such as your environment. If you live in a certain area where you're constantly exposed to a certain allergen that your body reacts to, then you're more predisposed to getting that allergy. And what I mean by that is that the first time you're exposed to something that you may eventually become allergic to, you really don't have a reaction to it. But the body gets sensitized to that pollen or whatever allergen that your body encounters. And once your body becomes sensitized to that, then the next time you're exposed to that allergen, the body reacts to that with your immune system. And so that's when you get all the cell mediators — the mast cells, the granulocytes, the histamines — being sort of released into the body that causes all the allergic reactions, such as you know, coughing, sneezing, sniffling, nasal congestion, and even also skin manifestations as well, such as hives. And so that's sort of the body reacting to the pollens, the antigens that your body is exposed to. But let me be clear here, in regards to how this whole system works. Take, for example, the sensitization part of allergies. The immune system is like a defense system for the body, like I mentioned before. And, so, the first time you're exposed to that, the immune system sort of doesn't know how to handle this for an invader that's inside your body. And so then it starts learning more about it so that the next time your body is exposed to that same allergen, it's prepared to mount its defenses at a rapid fashion. So, sort of like a pattern recognition sort of thing for the body. And, so, the whole thought process is, at some point, if you're constantly exposed to a certain allergen or at a high level, your body becomes sensitized to that allergen. And so then the next time you're exposed to that allergen, even at a much smaller scale, your body's ready for it and then it reacts to it, causing all the immune system to go haywire.
TODD: And it's not like at some point your body becomes more tolerant to something you're around that much, kind of recognizes at some point that it's not that much of a threat? That never happens?
DR. TAKASHIMA: You know, the whole basis of allergy testing and shots is sort of based on that theory. Allergy testing is typically done on the skin and small amounts of allergens are deposited right underneath the skin with the needle. And then we just sort of watch to see how your body reacts to that allergen. And, so, depending on how sensitive you are, we might start off with a very small amount underneath your skin to see what kind of skin reaction you get. And sometimes we have to go to a much more concentrated level because you might just be partly allergic to that antigen. And so, you know, from the standpoint of what are we trying to accomplish there, we're trying to see exactly how allergic you are so that when we start allergy testing, if you're highly allergic, we don't want to give you a big dose or a highly concentrated amount of allergens in your allergy shots. Allergy shots, all they are are whatever you're allergic to at a dose that does not cause any kind of clinical manifestations. And then we just try to continue to increase that dose at a higher and higher level. Still staying under that subclinical level, meaning that your body doesn't react to it. And so we're trying to build tolerance to the specific allergen. And so when you ask, do you get tolerant to it, you do. But the problem with tolerance, especially in the environment, is that it's very unpredictable at what dose you're going to get, that allergen exposure. Take, for example, you know, during pollen season here in Houston, which is so rampant you're going to be exposed to high dose of allergens. And when that occurs, your body's going to react because it's at such a high concentration. If you can keep that concentration at a low level and slowly build up, then you'll build tolerance. But unfortunately, that's not the way it works in the real world.
TODD: Are allergies ever dangerous? I hear so much about inflammation being a bad thing, chronic inflammation being a bad thing for you as you age — or are [allergies] mostly just kind of a nuance quality of life thing?
DR. TAKASHIMA: Yeah. So, you know, any inflammation in the body is typically not beneficial. And, so, if you can decrease that, people will definitely feel better. And, so, there is a syndrome called allergy fatigue, meaning that people who are exposed to allergens at a regular interval, your body's mounting a response to that on a regular interval, as you can imagine, it takes a lot of energy to mount that kind of a response, and it's that response that causes that inflammation. And so we do have some allergy sufferers who are just chronically tired during allergy season and they just cannot function at all. And, so, in that fashion, sure, an overactive immune system that causes that kind of response can definitely sap the energy and make you a lot less productive.
TODD: So what are the most common seasonal allergy symptoms?
DR. TAKASHIMA: Most of the listeners here probably experience some of the allergy symptoms, such as a runny nose. We hear that all the time. But you also have to think about the fact that, in order to get a runny nose, the nasal tissues, the sinus tissues has to swell up to produce all that mucus. And, so, in the fashion of making all that mucus, patients also complain a lot of nasal congestion. But on top of that, they get a lot of post nasal drainage from that runny nose that can irritate the throat. So, it can cause hoarseness, it can cause coughing, sneezing, itchy eyes or burning eyes, as well as skin rashes, too, that we commonly see.
TODD: And the most common allergy triggers.
DR. TAKASHIMA: It sort of depends with each individual, depending on what they're allergic to and how sensitive they are. As you know, here in Houston, you know, the seasons are long. The pollen count, the mold counts are so high. You know, some people think that during the wintertime, you know, it gets better. And it does definitely. But without that hard freeze to sort of sort of eliminate a lot of the allergens out there, you know, especially here in Houston, it seems to be more of a perennial thing than a seasonal thing.
TODD: But, classically, spring, summer fall, what are the allergies like pollen in the spring?
DR. TAKASHIMA: Yeah. So typically in the springtime, it's more trees. But, you know, what is spring here in Houston, right? So it can go from January until really even up to about September. Sometimes when it comes to tree pollination, it's really in the hotter months, though, that you get an overlap of the tree pollens with grass pollens, because it's the really hot months that we tend to see a lot of patients suffering from the grass pollen allergies. And then in the fall times when it gets a little bit cooler, we start seeing more the weeds like ragweed come into play, as well as the molds. Typically, right before a winter freeze is when we typically see the mold here in Houston, usually in the fall to November, December. But it stops right around the wintertime and with the cold freeze, you know, mold, they just go dormant. So it's not like they die. And we're good for a long period of time. They just, you know, remain dormant until the environment is suitable for them to once again propagate.
TODD: For the average patient, can it be difficult distinguishing between allergies and infections? Are there telltale signs that tip them off? Should tip them off?
DR. TAKASHIMA: You know, that's a great question, because even for physicians who've been treating this for many years, that can be a very difficult thing to sometimes differentiate because sometimes really bad allergies can mimic a sinus infection. You get the nasal congestion, you get a lot of drainage. And then on top of that, with all that nasal congestion, what ends up happening is the openings to the sinuses get blocked because inside your nose you get all that swelling and all that drainage and so the sinuses can't drain appropriately. And so not only are you having symptoms of an allergic attack, but then that propagates more into a sinus infection. Then you have to also deal with the sinus infection as well, because the sinuses don't like to get blocked. You know, they are created to constantly move mucus out the sinuses and down the back of your throat. And so when that doesn't happen, what you end up with is stagnation of mucus in the sinuses and just like a running river, you know, if you drink out of a running river, it's a lot safer to do that than a stagnant pond. The same analogy applies to the sinuses, where as long as the mucus is flowing, you know, the sinuses will remain healthy. It's when they stagnate, that's when you run into problems.
TODD: And how about asthma? Is that also tricky to distinguish between the two.
DR. TAKASHIMA: From an asthma standpoint? I mean, that's not really that hard to distinguish, partly because it's more of a dry cough as well as associated with wheezing. And so usually you're able to differentiate, you know, restrictive breathing from a problem such as pneumonia.
TODD: Is there a way to pinpoint your particular triggers? I mean, do you do a lot of skin testing or is it pretty much obvious allergy system allergy sufferers are reacting to the obvious culprits of the season?
DR. TAKASHIMA: I think you have to think of it as if something is really bothering you to a certain degree, let's get the diagnosis, you know, because with the appropriate diagnosis then we can gear the treatment towards that appropriate diagnosis. So I always tell my patients, you know, when they're like, is this more of a sinus issue? If it's more of an allergy issue, you know, we really try to define that problem to a much greater degree. Sometimes when patients are having a really bad allergy attack and they think that it's a sinus infection, we'll get a quick CT scan of their sinuses just to see if the sinuses really are involved. And, most of the time — when we're suspecting that this isn't a sinus infection, this is more of an allergy issue, very difficult to discern — sometimes imaging really will help us decide, is this an allergy attack or is this a sinus infection? And so getting that diagnosis is also very important because the treatment for sinus infections versus the treatment for allergy is so different. You know, that's just one example to an extreme. Now, going back to your question about allergy testing, it follows the same philosophy in that if you're suffering from a symptom, let's get to the diagnosis of what that symptom is. Okay? And so if you allergy test somebody, you can at least see, you know, how allergic they are. You know, to what degree they're allergic. And then we can come up with some good solutions, because the solutions may not be allergy shots or allergy drops or anything like that. The solutions might be pure avoidance. There are certain things that you can do if you have a bad dust mite allergy. You know, you might think about utilizing dust mite covers that prevents the proliferation of dust mites from getting to you. You know, if you're allergic to certain animals. You know, I have many patients who, let's say they're allergic to their pets, you know, their cat, their dog, but they can't get rid of their cat or dog or they're unwilling to do so. And so we have to sort of manage, you know, certain areas of the house, such as the bedroom, keep the animals outside of the bedroom. Because if you think about it, you know, we spend what, 6 to 8 hours in the in our bedroom every day. And if you're constantly being exposed to that pet dander on a on a continuous basis, you're obviously not going to do well. And so there are certain things that we can mitigate rather than using medications. And so holistically, obviously, if we can treat patients, you know, for their symptoms that way, that's always the best way. Because, you know, with medicines, although it's great, there's always side effects to continuous use of medications. And so we do like to try to limit the use of that as well.
[Music begins to play to signal brief interjection]
ZACH: Dr. Takashima mentioned climate change’s effect on allergies. Here's what one recent study tells us. The study, published in Proceedings of the National Academy of Sciences in 2021, analyzed long term pollen data. It found that pollen seasons now start 20 days earlier and continue longer than they were in 1990. They also feature 21% more pollen. The greatest increases were recorded in Texas and the Midwest. To conduct the study, researchers analyzed changing pollen counts across six North American stations from 1990 to 2018. They also looked at several climate models to determine the role global warming played and found that human caused climate change was the main driver of longer, more intense pollen seasons. The reason for climate change is, in fact, many trees and other plants use temperature as signal timing their bloom to warmer spring days. The tiny grains fill the air, some carried by insects and others simply wafting in the breeze, to pollinate nearby flowers in the fall, many weeds produce pollen until there's a winter chill increase. Pollen counts aren't the only things that might have you sneezing and reaching for the tissues. Scientists have also found that climate change has made pollen more potent, so less pollen could trigger a reaction comparable to a higher concentration of pollen. And it may only get worse. A 2022 study published in Nature Communications projected that because of global warming, by the end of the century, pollen season could begin as much as 40 days earlier than it has in recent decades. And that annual pollen counts could climb by up to 250%.
TODD: Okay, so let's turn to what people can do, what people who suffer from seasonal allergies can do first to prevent and then to treat.
DR. TAKASHIMA: So, our first step, identify what you're allergic to. And so allergy testing would be a great way to actually start off with that. But there are certain things that you can do also when you're outside during allergy season, you know, wear a hat, wear sunglasses, trying to keep some of the allergens from blowing directly into your eyes.
TODD: Or wear a mask?
DR. TAKASHIMA: Wear a mask. Absolutely right.
TODD: Are you telling people now that we have this evidence, firsthand evidence from COVID, that maybe they should think about that?
DR. TAKASHIMA: There's definitely some really bad allergy sufferers that I do. Maybe I should be recommending to all my patients? You know, it's very hard for people to constantly wear masks. You know, there's certain societal stigma, I guess I should say, about wearing masks everywhere. And I see that although it's getting better now, now that especially with COVID people are more apt to wear masks, especially in public. But, that being said, clearly, we have seen a decrease in allergic symptoms if you wear a mask. And it makes sense, right, because the mask will filter out a lot of the pollens from getting into your nose. And the nose is a defense mechanism for the for the lungs, right? So that filters out, you know, particulates, it filters out air pollution, it filters out, you know, pollens. But the problem is the nose, with all the hairs and sticky mucus, it traps it inside the nose. And, so, if you're allergic to that particulate that it was trying to filter out from your lungs and it's stuck inside your nose for a prolonged period of time, then it's going to incite an allergic reaction, cause congestion, nasal drainage, runny nose. Although the nose is a great defense mechanism for the lungs, you know, the sticky nature of the mucus and the defense mechanism can keep it inside your nose. And that's a problem, too, which, you know, nasal irrigations, saline irrigations can help sort of flush that air filter, so to speak, too, so that it'll be less irritating for the nose.
TODD: Are you recommending all your allergy patients to do saline irrigations now?
DR. TAKASHIMA: Yeah, absolutely. Saline irrigations at least once a day. Some really severe allergy sufferers, I'll tell them right after they get back in from outdoors, especially if they are allergic to outdoor pollens to go ahead and irrigate as well. The other thing I also tell my patients, especially if they are allergic to a lot of outdoor environmental things, rather than taking showers and baths in the morning, they should take it at night. So before they get into bed, because if you can wash away all the irritants on a nightly basis before you get into bed, then your bedroom could be the safe haven because you don't want to be rolling around and a lot of pollens that sort of attach to your body and sleep with that throughout the night.
TODD: How about over-the-counter remedies? Anything there that people can get that help them?
DR. TAKASHIMA: Definitely. So besides the saline irrigations, you know, one of the first line therapies is a nasal steroid spray such as Flonase and frequently we'll have patients on Flonase for many years. It's a very safe medication. It is something that can be used on a daily basis as opposed to other nasal decongestants, which you can only use for a few days. And so Flonase or any other nasal steroid sprays are very safe to use. And majority now are over-the-counter. And there are certain steroid sprays that still require a prescription. But as we escalate the treatment process of our allergic treatment for our patients, we may end up using something with a higher dose or something that requires a prescription. But a nasal steroid spray would be a good first line therapy. Some people will also combine that with an antihistamine to take, such as the Claritin, Allegra, Zyrtec type medications. And those medications are great. Those are called second generation medications, as opposed to the first generation such as Benadryl, which causes a lot of drowsiness. And so the second generation medications typically don't cause a lot of that drowsiness. But they are slightly less effective than Benadryl as well. And so if you have a patient with really bad allergies, sometimes we will try to get them on Benadryl if they can tolerate that and still function with the Benadryl. Studies have recently shown that if you combine the utilization of a nasal steroid spray along with a nasal antihistamine spray that works much better than taking a nasal steroid spray, along with an oral antihistamine. And so these days, we are now combining the two, the nasal steroids and the nasal antihistamines. But that has to be done twice a day. And so, as you can imagine, you'll spray some nasal steroid sprays into your nose immediately, followed by a nasal antihistamine spray. But you do have to do that twice a day, and that can get somewhat cumbersome. And so, you know, some people will fall off from doing it on a pretty regular basis. But these allergy sprays, you really have to be honest, on a regular daily basis for it to function and at its best.
TODD: And when are shots called for?
DR. TAKASHIMA: If the allergy medications fail to provide sufficient relief from allergens, then that's when the allergy shots come into place. And so, like we briefly mentioned before, the allergy shots themselves, all it is is whatever you're allergic to is placed into that vial of allergy serum that you will then place into your body. And it is at subclinical levels, meaning that the amount that we place into the vials should not cause a symptom. Sometimes, however, if you're constantly being exposed in the environment to that allergen, then you give yourself the shot that can actually cause some allergy symptoms. Because overall, you know, I think of it like a bucket. At some point as you're piling allergens or things that you might be allergic to into this bucket, at some point the body can't handle it and then it overflows. And that overflow is the symptoms that patients experience. Although, you know, we try to manage allergies to the point where we like to start shots and everything, you know, outside of the season as we continue to build up. But there are some times, especially during bad allergy seasons, that the shots can exacerbate symptoms. So that's something that will we'll watch out for as well. But in the end, if we can continue to build up the patient's tolerance to a certain allergen, then when they are exposed to that allergen in the environment, their body doesn't react to it. And so really allergy shots, it is really the only true treatment for allergies. Everything else, such as the nasal saline, the nasal steroid sprays, the nasal antihistamine and all those are more treating the symptoms of allergies, not treating the cause.
TODD: I see apps to track your allergy symptoms. Is there a need for that?
DR. TAKASHIMA: You know, if you're unsure what you're allergic to, I think that would be helpful. So someone that's really trying to delve initially into identifying what the problem is, I think that can be a useful tool. I think what's more useful for my patient is logging on to the Houston Health Department's website where they have a list of all the allergen and the counts. And so if you know that you're allergic to ragweed and the ragweed counts are, you know, sky high, you know, that might give you an idea that you probably shouldn't be out that day. Windy days typically are worse. Usually in the morning time allergens are typically worse. And so if you can delay outdoor activities to the afternoon, sometimes that might also be better. It's also better after a rain and, you know, a rainstorm will sort of clean the air to get all the pollen out of the air. And so patients typically do much better in that scenario, too. And so there are certain things like that that we would advocate, especially when the counts are really high.
TODD: Do allergies get better or worse with age?
DR. TAKASHIMA: Typically, allergies are worse during childhood. And as you can imagine, you know that the immune system tends to be a little bit more robust in the younger population. So that's sort of the thought process behind why we think that allergies are worse in the younger population. You know, there's an interesting theory out there also, which I failed to mentioned earlier, called the hygiene hypothesis. And what that is, is as we live in this modernized industrial country, our children are not being exposed to a lot of germs, a lot of allergens, a lot of pollution, things of that nature. And so the body doesn't learn as it's developing. And so if they're not exposed to those elements, then later on the allergens and the symptoms of allergies or the triggers for allergies can be a lot worse than people who live in a third world country, for example. And studies have shown that people who live in third world countries typically don't have as much allergies as we do. And so, you know, that hygiene hypothesis is very interesting and that we never really can build any tolerance to these things if you're not exposed to it at a younger age.
TODD: But when you get old, allergies don't lessen just because your immune system seems less active or a little more sluggish then? That doesn't seem to happen?
DR. TAKASHIMA: Yeah. So the older you get, definitely we start seeing a decrease in allergy symptoms. Especially over 65 or so, we start seeing a significant decrease in allergy symptoms. And so frequently, you know, if we're considering allergy testing, somebody usually it's in those younger than 65. But that being said, obviously, you know, there are exceptions to everything. And so if I have a patient who is slightly older but manifesting clearly symptoms of allergies, we definitely would still test those patients as well.
TODD: So what can we expect of this year's allergy season this year?
DR. TAKASHIMA: I am a little concerned. And the reason why is the heating of the entire environment in not just Texas but throughout the world. The National Oceanic and Atmospheric Administration stated that last year was the fifth warmest on record, and after looking at all the data for January of 2023, it is projected that it will become the seventh warmest on record for the globe. Now, the reason why this is important is because these are records that have been kept since the 1880s. And with hotter temperatures, we're going to have worse pollen. Not only are the seasons going to get longer, but on top of that you'll have more vegetation growth, which portends to a higher pollen count, which then will wreak havoc on patients allergies. And so something to be concerned about. Even Texas is predicted to be probably one of the worst allergy seasons this year as well. And really, if you look at the last couple of years here in Texas, it's also in the top ten warmest temperatures that Texas has experienced. And so, you know, we're trending poorly when it comes to increasing pollination and an increase in allergy symptoms. And so if the temperatures continue to rise as predicted, we all need to be a little bit more careful about checking daily pollen counts, avoiding windy days or avoiding being out in the mornings. We should also think about keeping trees trimmed grasses, mown weeds pools so that they can't really pollinate as profusely as they would like and, you know, use common sense. Don't plant Bermuda grass if you have an option, because many people are allergic to Bermuda grass. Wear masks outdoors, utilize HEPA filters inside the house, keep the windows closed and wash yourself regularly. I you're outdoors and, you know, it's windy and there's a lot of pollen out there, get a shower, get all the pollen off of you, you'll feel lot better, too.
TODD: Well, I think that's about all I have. Is there anything I haven't asked you or anything in conclusion you'd want to say?
DR. TAKASHIMA: Well, I guess I would like to add the fact that, you know, we live here in Houston and there's a lot of great things about Houston to love. You know, we have the Astros. We have amazing shopping, amazing foods. But, you know, the good comes with some bads. I guess I should say, with the high pollen counts, high mold counts, especially if you're a bad allergy sufferer, this could be a somewhat tough place to live. But that being said, hey, who wouldn't want to live in Houston?
TODD: All right. Very good. Well, I enjoyed our conversation, learned a lot.
DR. TAKASHIMA: Great. Thank you so much for having me on.
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ZACH: So, Todd, you don't have allergies, or so you claim. Have you ever thought maybe you did when you got an infection or did you ever get them maybe confused? You had a cold. Did you ever think to yourself, maybe this is allergies?
TODD: You know, well, I do suffer from sinus problems. And I can tell you, in working on them, that's always the first thing the doctor suspects, right? So I've taken a number of medications, antihistamines, steroids for allergies and it had no effect on my issues. So, if not me, at least the doctors thinking that way.
ZACH: Yeah, Sinusitis. I've had that before.
TODD: Yeah, that's what that is, sort of chronic.
ZACH: It's all the same symptoms as someone who's suffering an allergy attack would have.
TODD: Yeah. I mean I don't get the congestion and runny nose, that sort thing, but there is a lot of inflammation there that the, it's the first thing they think of. Yeah. I was surprised that in this day and age we don't know a little bit more about allergies that he was says it's still an ongoing science that they're still learning. I wasn't really surprised that it was environment as well as genetics you're reacting to, so that changes or stays the same can affect that.
ZACH: Speaking about mold for example, you know whenever people are cleaning out houses and there's a potential for there to be mold around people wearing masks. Right. And that's to protect you from the mold. So if you follow that through. Right. If there's pollen in the air, mold in the air, perhaps, you know, you should be wearing a mask as well to protect yourself from those things if you're more susceptible.
TODD: Yeah, I think that's definitely a good idea on days where the threat is high. You know, when I fly in an airplane, still, I'm going to wear a mask. So if there's a pollen counts or mold counts are high, I think a mask might be appropriate.
ZACH: Yeah, we've kind of shifted our mentality as a society now to be a little more just accepting towards masks. I mean, a few years ago, a lot of people who probably might wear them now to just protect themselves from, you know, from the allergies out there on the air might not have considered it might have seen as a rather extreme, uh, course of action. But now it's like, well, allergies, you know, if they're going to be bad, we saw the effects during COVID during the height of the pandemic of like, oh, yeah, everybody's wearing masks. Then allergies and sinus infections are going to go down, right?
TODD: And that that's exactly what happened. I got to tell you, though, I'm not real optimistic that the average allergy sufferers will be wearing a mask much.
ZACH: All right. Well, that's going to do it for us this week. And be sure to share, like, and subscribe On Health with Houston Methodist wherever you get your podcasts. If you enjoyed this conversation, for more topics like this, visit our blog at houstonmethodist.org/blog. Stay tuned and stay healthy.
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