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HOUSE CALL WITH DR. SANJAY GUPTA
Dealing with Allergy Season
Aired April 10, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
FREDRICKA WHITFIELD, CNN ANCHOR: Time for a look at our top stories.
A search is underway in Iraq at this hour for two U.S. soldiers and several civilian contractors. They are missing after an attack on a convoy near Baghdad International Airport. One U.S. soldier and an Iraqi driver were killed and another dozen people were injured.
In Tokyo, protesters are demanding their government pull its troops out of Iraq. Insurgents say they'll burn three Japanese hostages alive if Japan doesn't withdraw troops by tomorrow.
The U.S. is giving militants in Fallujah a chance to lay down their weapons. The coalition is extending a cease-fire offer to combatants in the Sunni stronghold.
HOUSE CALL WITH DR. SANJAY GUPTA begins right now.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. Welcome to HOUSE CALL. The seasons are changing. Flowers are blooming, grass is getting green and people are spending more time outside to enjoy the warmer weather. But spring isn't a welcome time of year for everyone. It's allergy season.
GUPTA (voice over): Spring is here. And with it comes...
UNIDENTIFIED FEMALE: Stuffy nose. Runny nose. Sometimes sneezing, itchy eyes, red eyes.
GUPTA: And 30 percent of people with allergies only suffer in the spring.
UNIDENTIFIED MALE: Usually just that miserable watering eyes. You just feel miserable. Sinus problems real bad.
GUPTA: The trigger for that misery, pollen. And this time of year, mostly from trees and grass.
If you are allergic to these tiny particles, your body will view them as invaders and your cells release histamines, which rev up your system to expel the pollen by coughing, sneezing and watering eyes.
DR. DAVID TANNER, ALLERGIST: One thing that is often not emphasized is the fact people actually feel bad with allergies. They have a lack of energy. They feel ill. They don't feel well. I liken it to having a low-grade cold, but it keeps going and going and going.
GUPTA: There are steps you can take to stay allergy-free this season. The number one way is to stay indoors. If you can't resist a spring fling, try these tips.
Stay inside when the pollen count is at its highest. Keep those windows up, no drive with the top down. And shower after spending time outside. Pollen can collect on your skin and hair.
Over-the-counter medications are another option, but can have side effects.
DR. ANN MARIE GORDON, WASHINGTON HOSPITAL CENTER: The problem with over-the-counter formulas is that they are -- they've got one major side effect and that's sedation.
GUPTA: If you are still sniveling and sneezing, head to the doctor's office. They can give you non-drowsy formulas, and if necessary, allergy shots. Finding what works for you is the most important thing. Because although tree and grass pollen are starting to kick up now, this summer will bring its own set of allergens.
GUPTA: Allergies are already a problem here in the south. If they haven't developed in your area already, they are going to soon. If you are sneezing with a stuffy or runny nose, have watering or itchy eyes, or have dark circles under those baby blue eyes, you may have seasonal allergies, known as allergic rhinitis. And you are not alone.
Amazingly, one of five Americans struggles with it. And it is estimated that 40 percent of children, as well, get those allergies every year. Don't forget about them. All this costs millions of dollars in drugs, doctors' visits, and missed days from school and work.
How did you work through all of this? Well, allergy specialist Dr. Paul Rabinowitz, is here to help us with our allergies. He's one of the planet's top docs. He's been around for some time.
First of all, congratulations on that. That's great.
DR. PAUL RABINOWITZ, ALLERGIST: Thanks very much.
GUPTA: Thanks for spending your time with us. A lot of questions coming in about allergies. I know it has been a nasty pollen season already here in Atlanta.
Can you predict how bad a particular area is going to be?
RABINOWITZ: You can tell this year how bad was going to be because we had a mild winter and then we had a very dry spring. There's been very little rain this spring. And as a result, there's a lot of pollen in the air that has not washed out of the air. And patients are experiencing tremendous allergy symptoms. GUPTA: Your practice is pretty busy. We had to drag you away from the clinic today, right?
RABINOWITZ: Actually, I almost didn't think I was going to make it today. They are so busy in the office.
GUPTA: We're going to talk a lot about your individual practice. But lots of e-mails coming in. Not a big surprise. Let's start with one.
Allan from Florida asking: "I'm 38 years old with no previous history of allergies. However, over the past two years I seem to have moderate allergy attacks to oak trees. Is it more common for people to have allergies their entire lives, or to develop them in adulthood?"
RABINOWITZ: It is an excellent question. And what's interesting, we see the spectrum of people. We see children come in with allergy symptoms. We see middle age people coming in with allergy symptoms, and we see elderly people come in.
It turns out it is what is what is called a bell-shape curve of incidents. As a young child there's a low incidence of allergy going up to a higher incident in the middle years, into the late teens into the 20s and 30s, and to a lower incidence as you get into your 50s, 60s and 70s.
For someone 38 years old, not uncommon for the last two years having allergy symptoms.
GUPTA: The other thing is that just age-wise, if your child has allergies, somebody who is watching, does it mean for sure they'll have allergies as an adult?
RABINOWITZ: Typically once you've got allergy symptoms, it will stay with you your entire life. Although there are periods where it gets better or worse, just as we see with asthmatics, they'll have good times and bad periods with it.
GUPTA: All right, let's go to another e-mail question: Dell in Texas wants to know, "How can you tell you have a cold or if you have allergies?"
A lot of people are going to develop the sniveling and sneezing this time of year. But it might be the cold. How do you know?
RABINOWITZ: Correct. Well, the first year you will not know. When somebody has, the caller who called in, or the e-mail, of the first couple of years of symptoms, that first year, you will not know. You'll develop congestion, sneezing, runny nose. You'll think you have a cold. But the cold will last more than five to seven days. If that cold is lasting for a month, that is probably an allergy. One key symptom that you don't see with a cold and that is an itchy nose. If you have itchy nose and particularly itchy eyes, that is allergies, that's not a cold.
GUPTA: And medication-wise, if someone comes in to your office and says, I'm sneezing, I think they are allergies. What sort of things are you recommending to them? They still want to get on with their lives.
RABINOWITZ: The classic program we give patients, is a non- sedating antihistamine and a nasal steroid spray. That combination seems to be the best in controlling all the symptoms, the itchy eyes, the itchy nose, the congestion and drainage.
GUPTA: Nasal steroids sprays safe?
RABINOWITZ: Nasal steroid sprays are safe when used correctly. One of the problems we have seen over the years are patients who were never given advice on when to stop the nose spray. For example, if someone develops a nosebleed, develops a dry, crusty nose, that's a sign to lay off the nasal spray. They tend to dry out the nose. Use them as much as you need to, and then try to back down on the dose.
GUPTA: Let's get to another e-mail. Ellen from Minnesota: "My child has a runny nose and trouble breathing each year in early spring. She's had allergy tests but tested negative to everything in the test. How can we find out what she's actually allergic to? What criteria do allergists use in choosing what allergens to test for?"
First let's talk about the allergy test. Because a lot of people of all ages get this test. That is what their doctors recommend.
RABINOWITZ: The testing is standardized material that you buy from a laboratory and they have people actually go out into the environment and to the outdoors and find the various trees, grasses, weeds, molds, outdoors; and then indoors dust mites, cockroaches, cat and dog dander. So they find different materials and make allergy extracts.
The allergy extracts are purchased by the allergist and they are applied as a drop on the skin. After they applied to the skin you take a pin and prick them. After you prick them if you are allergic, and you have allergic anti-bodies, that local area will swell up like a mosquito bite within 15 minutes.
GUPTA: They make a grid on your back, right?
RABINOWITZ: Yes, right. They number down, read number one through 50. There are so many allergens in the Atlanta area. We've got 15 molds, 15 trees, 10 grasses, 12 weeds, cats, dogs, dust mites, cockroaches, all of that. And each one is put on. You prick it. If you are allergic, you'll know right away if that's present or not.
GUPTA: If it all comes back negative what do you tell them?
RABINOWITZ: That's good news and bad news. They then have non- allergic rhinitis, which is almost 50 percent of the patients. No cause found. But yet they still have the symptoms. They are glad because they don't need allergy shots. They don't have to get rid of the cat or dog. But we don't know why they've got it.
GUPTA: So medications for them, for a while.
RABINOWITZ: And then it is medications, yes.
GUPTA: We are going to talk a lot more about that in a minute. But in the meantime, are your eyes feeling the sting of spring?
ANNOUNCER: When HOUSE CALL returns, we'll try and give your eyes some springtime relief. Plus, how do you know when it's time to change your allergy drugs? We'll get some common sense advice from our expert.
First, our "Daily Dose" quiz. Is it possible to build up a tolerance to asthma and allergy medications taken regularly? We'll have the answer after a break.
ANNOUNCER: Before the break we asked: Is it possible to build up a tolerance to asthma and allergy medications taken regularly? The answer is, no. You can't build up a tolerance to any asthma or allergy medications.
If your medicine does not seem to be working well or your symptoms are worse, see your doctor.
GUPTA: Welcome back. Well, if spring allergies have you closed up inside your house this time of year, there is help. From over-the- counter drugs to prescription medicines, new medicines act faster and make you less drowsy. So here are some types of treatments you can pick up at your local drug store. Anti-histamines like Benadryl and Claritin help with your sneezing and itchy eyes and throat.
Decongestants help with that stuffy nose. And then there are anti-inflammatory medications, most nasal sprays, that help you breathe easier.
Doctor Rabinowitz is already telling us a little bit about that. He is one of Atlanta's top docs, in the field of allergy. Lots of questions coming in here. No surprise. You deal with these questions all the time. Let's get to -- first question I have for you is what point should someone be coming to see you?
RABINOWITZ: If somebody is not responding to medications alone, if they've tried over-the-counter medications and they're not working. If they've gone to their primary doctor and they have received the classic medicines that an allergy patient should get, an antihistamine and a nasal steroid spray. And they are still not responding, then they should come to the allergist to find out why they are having symptoms.
GUPTA: A lot of people get allergy shots to try to protect them long-term. Do you give everybody allergy shots?
RABINOWITZ: No, I'd say about 25 percent of patients who are allergic get allergy shots.
GUPTA: Who are those patients?
RABINOWITZ: Those are the worst of the worst. If I have somebody who comes in and they react to everything I skin test them to, animal danders, dust mites, mold, tree grass and weed pollens. Those patients cannot possibly avoid everything unless they live in a bubble.
GUPTA: Do you stay on these allergy shots for the rest of your life?
RABINOWITZ: Typically you do not. What we tell patients is you go through a build-up phase over one year and then a maintenance phase for three to four years. That should be the complete course of therapy, at which time your body's immune system should change. And you should no longer be allergic to those allergens.
GUPTA: Still a lot of shots, though, right?
RABINOWITZ: Well, we tell them it is that once a month. Once a month is enough, once you build up.
GUPTA: Once a month.
Let's get some more e-mail questions in here. Jodi from Ohio asking: "Do all allergy medicines work the same? How do you know when to give up and to try another?"
Do you need to build up a tolerance?
RABINOWITZ: First off, all allergy medicines -- the only thing you develop a tolerance to are decongestants. That is why I don't like to use products like Sudafed, or pseudoephedrine on a regular basis. Because you'll build up a tolerance to those products.
The antihistamines that we typically use, Allegra, Claritin, Clarinet, Zyrtec, you don't build up a tolerance to the product, but it may not work as well as another one. So if you give somebody one of those antihistamines, and they are not responding, you can try another antihistamine.
Or the antihistamine may not be doing the job. They may need a nasal steroid spray. They may need Singulair, which is an antileukotriene agent that also is indicated for allergic rhinitis. Depends on which chemical mediators are released in large quantity that is causing their symptoms.
GUPTA: Here's a simple question. At what point do you start any of those medications. A lot of people get some symptoms this time of year. Should you just try to stay indoors more if that's happening?
RABINOWITZ: Well, it's part of a basic program. Environmental control is very important. I would say, yes, definitely. If it is like, today in Atlanta, it was a warm, windy blustery day. Lots of pollen flying everywhere, this is the kind of day you want to stay indoors.
That's your basic ingredient to allowing the medicines to work. Because if you go outside on a day like today, your antihistamines may not be sufficient to control symptoms.
GUPTA: Good points here. Let's get another question here. Louise in Maine e-mailing us with this question: "I'm having a significant allergic reaction to pollen in my eyes." Specifically, it sounds like. "Do you recommend over-the-counter eye drops or asking my doctor for a prescription? What are the most effective ingredients in non-prescription eye drops?"
It is a little bit more serious there, affecting her eyes.
RABINOWITZ: Well, first off I would not recommend an over-the- counter eye drop as the preferred product. The prescription eye drops are better today than what was available before. What's interesting is that what we used to use are now over-the-counter. And the old eye drops, the Nafconase (ph), the Alconase (ph), only lasted four to six hours.
And the antihistamine that was in those particular products had drying properties so they tended to dry out your eyes. The newer products, Patanol, Optivar, Zatador (ph), last longer, last eight to 12 hours. And they have less drying properties so they are better tolerated by the patient. If given the opportunity, I'd recommend call your doctor and going with the prescribed medications.
GUPTA: We are talking with Dr. Paul Rabinowitz, lots of good information.
Pregnancy and allergies. What drugs are safe? That's coming up.
(BEGIN VIDEO CLIP)
HOLLY FIRFER, CNN ANCHOR: When we come back, we'll tackle the ever-increasing problem of kids and allergies. What drugs are safe and when do you take them. What about alternative treatments? Are there any for allergies?
First, here's a tip to help you keep feeling fit.
With springtime weather here, you may be tempted to take your workouts outdoors. But if you are among the millions of people who suffer from seasonal allergies, the pollen-rich spring air can wreak havoc on your routine.
Health experts suggest low exertion activities. But if you can't live without your daily run or bike ride, avoid being outdoors between 5:00 and 10:00 a.m. when pollen counts tend to be the highest. Prevent itchy, watery eyes by wearing goggles or sunglass. Think about an over-the-counter allergy medication to ease your symptoms.
And avoid exercising out doors if you feel tired or stressed, since you're immune system is likely to react more swiftly and more severely to an allergen. For feeling fit, I'm Holly Firfer.
GUPTA: How about them facts? Pretty interesting?
We're talking about surviving the allergy season this spring. To help us survive, Dr. Paul Rabinowitz, an allergist, with a practice here in Atlanta, a city that has record-breaking pollen counts year after year.
So, you are a busy guy.
RABINOWITZ: This year, the highest pollen counts of all time.
GUPTA: One of Atlanta's top docs as well, helping us answer e- mail questions. Let's go straight to an e-mail now from Nick in Tennessee, who wants to know: "My wife is pregnant and suffers from seasonal allergies. What medicines can she take?"
Let's start with the over-the-counter stuff. Anything a pregnant woman can take over the counter that is safe for her?
RABINOWITZ: Claritin is safe, Benadryl is safe. Any product with clorpheniramine is safe.
GUPTA: She's not responding to those though, Doctor. The over- the-counter stuff is not working. She's still pregnant?
RABINOWITZ: Let me give you one more, there is NasalCrom, an over-the-counter nasal spray is also safe during pregnancy. If it doesn't work on some level you've got to make a decision, do you tough it out or do you go on to other medications?
The other products don't have the safety rating of those products I mentioned, but we may give patients a short burst of oral steroids. We may give them nasal steroids as a product to use, might use some decongestants. Don't like to use decongestants all the time.
GUPTA: Not a big problem in pregnant women? You can probably find something that's going to work?
GUPTA: Some interesting studies that I've read about recently. Some recent studies examining children and allergies. One should showed exposure to dogs in the first year of life helped the immune system. And other researchers found that children under the age of one who had fevers also had a lower chance of developing allergies. How big a problem are allergies for kids?
RABINOWITZ: Allergies are present 40 percent of children. Allergy in kids is a big problem, but so are colds, so are upper respiratory infections. It's part of childhood.
GUPTA: Would you start allergy shots on a kid?
RABINOWITZ: Typically, I don't.
GUPTA: You wait until how old?
RABINOWITZ: Well, I'll give you two. One, I would not do them when they are so young they cannot tell you they are having a reaction. When you give someone a allergy shot you have to know if they are developing symptoms and reaction. They start to have some itching and swelling at the site, difficulty breathing.
So, if a child is too young to tell you that, you won't give them allergy shots. If they are six, seven, eight, and still having problems, particularly if they are developing asthma, I'll be more likely to give them allergy shots.
GUPTA: We're going to talk more about that, allergies and asthma.
Let's get to another e-mail first. Mary from New York writing, "My six-year-old daughter has seasonal allergies. I don't want to put her through allergy testing, but how can I safely medicate her with over-the-counter medications? Also, should I start before the allergies appear and continue throughout the season or should I medicate her when symptoms appear?"
Good questions, part one, first of all, are those over-the- counter medications safe?
RABINOWITZ: Yes, they are safe. They've been around forever. Benadryl, been around for 30, 40 years, very safe products. The only issue is sedation and children hopefully are not going to be out driving. Claritin has been now over the counter for the past year or two. That's also a safe product and of course, it is non-sedating. So, those products are safe for children.
GUPTA: The second part of that question, a good question is, you know you develop allergies every season. Your allergy symptoms haven't started yet. Should you start taking the medication to prevent the symptoms from ever appearing?
RABINOWITZ: The answer is, yes. That was a very good question she asked. Ideally one to two weeks before the season begins, if you know your symptoms start April 1st, then March 15th, start taking the medication to get the best results.
GUPTA: More and more people -- these are interesting questions -- more and more people are seeking alternatives to mainstream treatments and that extends to allergies as well. So, this question from Evelyn in North Carolina. "What is the best alternative therapy for allergies?"
Well, Evelyn, a couple of points, as with many alternative therapies there is conflicting information out there. We found supplements like bioflavonoids, for example, which are like natural antihistamines and vitamins A, C, and E, along with herbal remedies, like butterbur and grape seed have been linked with treating allergies. Doctor, do people ask you about this? Alternative therapies?
RABINOWITZ: Fortunately, they do not. The idea of an alternative therapy is something that's going to be safe and natural. You know what's safe and natural? Avoidance. Avoid your allergies. That's the best thing you can do as an alternative method.
GUPTA: And again, you, sort of enforce these environmental restrictions before you put someone on medication.
RABINOWITZ: Or before you do allergy shots. You do the environmental controls with medications, if someone is allergic to dust mites give them specific measures for covering their mattresses and pillow cases and how to wash the sheets in hot water and take medication.
GUPTA: We're not finished with you yet. We're not finished with you yet, either. Stay tuned.
ANNOUNCER: Grab a pen. We'll show you good sites you can surf for allergy information from today's pollen count to specific questions about your medications. It is all just a click away.
First, some of this week's medical headlines in today's edition of the "The Pulse."
Watching TV may be hurting your kid. A new study in a "Journal of Pediatrics" says watching TV may contribute a child's risk of developing attention deficit hyperactivity disorder. Investigators found that one-year-olds who watched more than 2.2 hours of TV a day were 28 percent more likely to develop attention problems later in life.
Also giving too many breaths while doing CPR is hurting cardiac arrest victims. An American Heart Association study shows patients were given an average of 37 breaths a minute, far beyond the recommended maximum of 20, and that could be increasing a patient's risk of death.
GUPTA: To help battle your allergies, go to www.aaaai.org . That is the American Academy of Allergy, Asthma and Immunology where you are going to find a special spring allergies link. Also, try the Asthma & Allergy Foundation of America. That is at www.aafa.org. Click on allergies, and find a list of facts and resources for treating allergies.
And before you go outside today. Surf the CNN Web site and check CNN.com/allergies. There you will find today's pollen report and even air quality.
That is all the time we have for today folks. Thanks for sending in your questions. Also thank you to Dr. Paul Rabinowitz, one of Atlanta's top docs, so much.
Remember, this is the place for all the answers to your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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