Why Allergies Are Getting Worse

You know for many people this means there are beautiful blooming flowers, there's warmer weather,

great stuff, but for others we know it can also be the dreaded start of allergy season. Here in Atlantic can get bad, in fact they call it the Polyming. Now if you're someone who has experienced a major or even minor allergic reaction to pollen or to foods, it can sometimes be irritating, but it can also be downright dangerous. It's happened to me, it's happened to my wife.

I want to share those stories today because frankly they taught me a lot about allergies

“and I think they might be able to help you as well.”

Questions being what exactly are allergies? Why do we have them? Why does our body do this? Are they the same as intolerance to things and how do you know the difference? My guest today is Dr. Zachary Rubin, he's a pediatric allergist, clinical immunologist,

and he just recently released his book called All About Allergies. So today we're chasing down the answers to allergies from pollen to peanuts, symptoms and nits, we're going to break it all down, connect the dots between the environment, between our exposures and even our own genetics. Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is chasing life.

First of all I want to welcome you to chasing life and just tell you that I'm a fan of yours.

I have been following you on social media for some time. I've read your book, which I'm anxious to talk about. I congratulate you today, but let me ask you, if someone is listening and they say look, I am someone who has allergies concerned about allergies and what point should they be seeing in allergists?

Right. So there's several reasons. The first is if you have just seasonal allergies or hay fever and you've tried over the counter medications, they're not really working well.

“You need to get a formal test from an allergist to figure out what is bothering you and”

then immunotherapy, which is actually a disease modifying treatment.

We can train your immune system to become less reactive through a controlled exposure.

So that can significantly improve somebody's quality of life and reduce the risk of developing new allergies if they're young child or even potentially developing asthma. It is something that we have been doing for about a hundred years now and we know a lot about how it works, but all of the molecular mechanisms were still trying to figure out why this older therapy is so effective.

Why do people have allergies? I mean, do they exist for some evolutionary reason or they protect it in some way? Yeah, we do think there is a bit of a protective nature to it. So as an example with food allergies, we know that that's been around for thousands of years, but just described differently, right?

There's even ancient Chinese texts that talk about avoiding specific foods during pregnancy or different parts of life. So there's definitely evidence that it's been around and it's probably as a protective measure against toxins or parasites that were found in food and it became this more exaggerated response.

If people feel like their symptoms are bad enough that they need to see someone like Zachary Ruben, what would those symptoms be?

“At what point do you think, hey, look, this is bad enough that I need to go see an allergist?”

Right. So from the seasonal allergy side, this is somebody who's having chronic sinus headaches, pain, and pressure, terrible nasal congestion, they're not sleeping well, they've tried all the over-counter medications that they're not getting quite relief from it. That's just the seasonal allergy side, but we take care of a lot more than just allergies.

You can see a dermatologist as well, depending on what your availability is, but we would look at it from the standpoint of if you have severe asthma, what are the potential triggering factors for it? And now we have these biologic medications that have exploded over the past 10 to 20 years that actually will treat a very small portion of the immune system that's causing this abnormal

response, leading to severe asthma or severe asthma. We take care of patients who have been on high doses of inhaled steroids and have had multiple asthma attacks. And we look at what are the triggering factors and how do we manage this appropriately? And we fill a niche throughout all these different specialties where we look at the immune

system and say, why is it abnormally responding to these foreign substances and how is this impacting people's lives, they're ending up in the ER, they're ending up in urgent care in the hospital, not exactly sure what's going on or the treatments given by their primary care physicians are just not quite enough. Is the problem getting worse?

It is, unfortunately. Why do we think that is? So there are several factors for it and I discuss it in my book, but one of the issues when we talk about chronic sinus infections or allergies is the fact that our global temperatures

as an example.

And we know that when you have higher CO2 in the atmosphere that causes pollen grains to

be released more earlier and stopping later in the season. So if you look at the general trends or pollen counts have been steadily rising, so people expose to more of these allergens, therefore more people are developing allergies. If you look at all the allergic diseases put together, it's one of the top 10 most common chronic diseases in the United States are these different allergic diseases.

Air pollution plays a role. The microbiome we're still trying to learn more about and it's impact through early antibiotic use, early antacid use to treat reflux and babies. Sea sections we know that the babies are exposed to the bacterial milieu and the birth canal. Because these are bacteria that help process whatever you're consuming and whatever you're

exposed to, it's also on your skin, we have a flora on her skin as well and so there's

a lot of healthy bacteria but we often alter it through antibiotics or antacids, thereby presenting these different proteins to the immune system differently and that could increase the risk of developing these problems. So are there chemicals in the environment we're exposed to so many questions that we're still trying to answer?

We just don't quite have a handle on it yet. So what can someone expect? They show up at an allergy's office. What usually happens is they'll get a bunch of paperwork ahead of time just like with any other physician or specialist that they fill out their general history before they

come in and then when I see them, I take a detailed history trying to figure out what are the specific symptoms that are bothering them, when are they bothering them, what are the potential triggers, what are they try to make it better or worse and then we talk about allergy testing, whether that's going to be by blood testing or skin testing, I typically will do skin testing for most of my patients because we get an answer very quickly.

We'll put the extracts of these allergens like pollen, dust or mold on their skin, let that sit for about 15 minutes to see if they get what looks like mosquito bites, we call them wheels, they're like little mini hives and that tells us that there's an indirect measurement of an antibody, a protein called immunoglobulin E or IGE for short. That is something that your immune system makes in a process called sensitization where it thinks

it's basically a parasite and that when you have subsequent exposure would lead to these

allergy symptoms that people are experiencing and so when we get that test result, we can then talk about ways to reduce exposure, what are the appropriate medications to take and when

“you should take them because I try to minimize the amount of medications they're using and”

then we talk about immunotherapy as a potential option so those allergy injections. How bad can this be, how life altering can allergies be, we know that they can potentially be deadly, someone might have an anaphylactic reaction which you are just describing, but just in life, how bad are we talking about? So it depends on which condition we're talking about, if we talk about seasonal allergies

as an example, some people consider just a minor nuisance and you have severe symptoms where you're not breathing through your nose throughout the day and so you're not sleeping well in life. So I often talk about the nose being the gateway to your overall health and so when you have a situation where you have a lot of inflammation your nose and mucus production that increases your risk of having ear infections, sinus infections, you spend a lot of

time talking about allergies, you also spend a lot of time talking about misinformation online. Is there a lot of allergy misinformation out there? There is actually in different ways, so I'll give a couple of examples. Food allergy is the butt of a lot of jokes. It's not taken seriously online.

“And there's a story I think about that happened fairly recently about a year or so ago”

where a varsity high school football player in Texas had a peanut allergy that was very severe and he told his teammates they didn't take it seriously and they stuffed a bunch of peanuts in his clothes and in his locker and he ended up getting hives from it and he was being bullied because of it and nobody got in trouble at the school and his parents were very upset by it and they kept getting bullied so he had to leave that school district, move to another school

and thankfully there was a little bit of a redemption arc because his team that he went to won the state championship that year to see so many kids bullied over their physical ailments when people don't really understand it well really bothers me and I am very passionate about it. You know we see these jokes seem like it's not a big deal or it's funny to look at somebody having facial swelling or tongue swelling and I'm here to say that people living with food allergies

should take this seriously that your story matters, that we need to help educate and advocate for folks living with these conditions because it's not a bad diet, it's not some type of choice

“but I think the problem is that many communities have to provide accommodations that affect”

people who don't have food allergies and it's hard for them to understand how could something

but this does happen in effects close to 10% of Americans and about half of the cases are in

“adults and it's new to them. Okay how you doing? I know we're throwing a lot of information at you,”

a lot of big words but we're going to explain all this plus exactly what point does something go from being a food intolerance for example to something being a true allergy will be right back.

This week on the assignment with me, Audie Cornish. I have always believed about myself and told

people that I don't have an addictive personality because I don't have a lot of biases. I'm a Mormon, I don't drink, I don't smoke, I've never tried drugs, anything like that. I guess today is a staff writer for the Atlantic because name is McCake Hopkins. He spent $10,000 of his employers money and an entire NFL season diving into the world of online sports bedding. I just believed that it would be a funny little side plot in my broader investigation of the sports bedding industry.

I genuinely did not expect that it would kind of take over my life. Listen to the assignment with me, Audie Cornish, streaming now on your favorite podcast app.

It's wild to see just how much the world has changed since we last saw her.

My wife deals with pretty severe food allergies and to be quite honest, I agree. In the beginning,

“I did not understand them and with hey fever or seasonal allergies, I think maybe it's clear”

maybe because people understand they get the sneezing, the sniffling, things like that. With food allergies, it seems like it can be more challenging. At what point does something actually become a food allergy, a diagnosable food allergy? Right, so a lot of people who think they have a food allergy don't, like you mentioned, intolerance is very common. So what that means is that you're having trouble digesting the food because you may not have the right enzymes in your gut to break

down. And so that can cause bloating, abdominal pain and diarrhea, it's not life threatening. It's not an immune system problem that's a digestive problem. Versus an allergy to food comes in different flavors. Actually, there's multiple subtypes. The one that's most common that people see is one where you eat a particular food, even small quantities like peanut butter as an example. And it causes immediate symptoms. It could be as minor as itching or it could be hives,

swelling, which the swelling can occur around your lips or tongue or throat to make it difficult to breathe. You could have repetitive coughing, wheezing, severe vomiting. You could have a combination of those symptoms I just mentioned, or anaphylactic shock, which is when the blood pressure drops. And so there are also other kinds of food allergies that don't follow that pattern. And so you can have very severe unusual symptoms that are related to food and it can

interact with your body in different ways. And we've learned a lot about it again over the last 10 to 20 years or knowledge has exploded on these issues. But you're a specialist, but for the average person or even the average doctor, can they easily distinguish these two things? Usually you can when we talk about the severity of symptoms and what are they specifically doing, right? So an intolerance is if you're eating something at a larger amount, you may start having symptoms with an allergy.

It's a very tiny amount one bite could cause these symptoms with an intolerance. It's much more than that. There's also another term that gets this confusing, though, which is that you hear a lot of people talk about sensitivities with foods. And the problem with that is it's an unscientific term. It's not validated. And so I can tell you the immune systems abnormal response when somebody's having an anaphylactic reaction. We can actually map that out on a board and talk about it.

But a sensitivity is a non-specific term where people will attribute this particular food and I will get headaches or nausea or joint pain or fatigue. And it's not to say that it's not real.

The problem is is that I can't get a test to then verify that this is a sensitivity because we don't

“know the underlying pathway. I believe my patients, if they know that this particular food is causing”

them symptoms, even if it doesn't fit in any pathway, I'll tell them, yeah, you probably shouldn't eat that and be careful. But I'm not going to prescribe an api pen for them, right? So we often like to have tests to validate our concerns. But I think doctors need to also validate people

understand the risks and benefits of what are intervention they want to do and and help them through that. I'm curious about the sort of the commonalities between allergies and autoimmune diseases. What is happening in the body when someone has an allergic reaction? There are definitely connections between the two and I'll get more into that in a second. But we talk about an allergic reaction.

“It is actually a longer story than people think because you have to have an initial exposure to”

something. So let's say I like using peanut butter as an example because it's a common one. You've been eating peanut butter your whole life and you're in adults and one day your immune system is shown peanut in a different way. Basically, your T and B cells as a part of your adaptive immune system aren't creating a different pathway called sensitization. We're now your B cells are making these antibodies called IGE that are very specific like a lock and key to that

peanut protein. And then they'll sit on a cell of your immune system called a mast cell. That is the process of sensitization. You're now primed to potentially have an abnormal allergic reaction later on. So then later on you have an exposure to it. Maybe you were exercising or you got sick and your body temperature is elevated. And you eat peanut butter and you didn't know it, but all the sudden now your mast cells are activating the releasing histamine and other chemicals. And it's causing

this cascade of events that can lead to the symptoms we mentioned before. It could just be hives or it could be problems breathing or multiple symptoms. And it happens within minutes to maybe an

“hour. And so that's again an abnormal immune system response to a foreign substance. That's what”

allergy is. Autoimmune disease is an abnormal immune system response to your own healthy tissue. And it's generally caused by again antibodies. These protein tags that your B cells make instead of latching onto a foreign substance, it may be to DNA fragments that are released from cells that have the normal cellular turnover because their cells don't live forever. So allergy autoimmunity oncology cancer, all of it is connected and it's truly incredible. As we learn

more about our immune system, we're going to be able to unlock a better understanding of disease and how to manage and treat it. I want to share something with you. And you just said something that I actually didn't realize. You said if your body temperature is elevated, you may have a reaction that maybe you otherwise would not have had. When I was a resident and in surgery, you'll appreciate

this. I'm an Indian family. We ate mangoes my whole life. It's just one of those things. We always

“had bowls of mangoes, especially in the summer. When for a long run one day, I was at home,”

came home, bowl of mangoes sitting on the kitchen counter and I had several pieces of mangoes. As I had been doing my entire life and I was in my early 20s at this point. And it was the weirdest things that I was sitting down on the chair, watching television with my dad. And all of a sudden, I couldn't see the bottle out of the screen. And I was and I kind of like tilting my head like this too. Like what's going on with my eyes? I thought this was an eye problem. Went into the bathroom

and my face was swollen, including my lower eyelids, which were now obstructing my vision to some extent. And I had itchiness of the hands and all this sort of stuff. But again, the sequence

of events, the needing mangoes my whole life never had a problem. When for a long run, now in my early

20s, eat that bowl of mangoes and now I'm having a significant problem. That tracks based on what you were just saying, the run and the elevated body temperature maybe had something to do with this. Right. So there's actually a disorder called food dependent exercise induced animal access, where you eat mangoes all the time, no problem. But if you exercise intensely, like right after eating it within an hour or two because you're still digesting it, your immune system may

all of a sudden start to react to it like never before. And so there are a lot of, we call co-factors for severe andaphylactic reactions. It's not just elevated body temperature. But illness, as we mentioned earlier, it could also be taking non-storidal anti-inflammatory drugs and said, like motrin and ibuprofen or advil or even a leave, those can modulate the immune response and make it worse.

Alcohol does the same thing. So I always counsel all my patients with food allergies when they're

about to go to college that you got to be careful if you're going to go to college parties because it could cause you to have a severe reaction if you're drinking and not thinking about what you're eating. Get us a go both ways. Kind of food that I've had trouble with for, you know, a significant chunk of my life suddenly be presented in a way that's okay, that's favorable, not going to cause an allergy? Yeah. It depends on the type of food that we're talking about. So if

you developed a milk allergy as a young child, which I did actually add a milk allergy as a baby, it can result most of the time it does. Ag allergy is now the most common food to be allergic to as a baby. It outpaced peanut recently and that is one where over half of babies it'll it'll

certain foods have the ability that when you cook them, the protein breaks down enough

that your immune system doesn't get confused anymore. It's a different protein but there's certain similarities that when you regularly expose yourself, it'll train your immune system to be less reactive and eventually it can resolve. But foods like peanuts, trainats, shellfish, they tend to be more persistent and less likely to go away. What would be the guidance for someone who had the sort of story that I did? Find most of their life early 20s now. Have a pretty significant reaction.

I had to get up an effort. By the way, I'll tell you right quickly, my mom and it'll drive you to the hospital. I looked terrible. I was swollen. My hands were itching the whole thing in my mom.

“I never forget. She's like, you'll be fine. Don't worry about it. You know, I'll take you to the”

hospital if you want. We get to the hospital and they recognize immediately and they give me a

shot of epinephrine. It's kind of remarkable how quickly that works and how I felt better immediately. On the board, I guess, outside my room and the ER, it said respiratory distress. So all of a sudden, the curtain flies open. The attendings there, and I'm fine at this point, exactly. I'm kind of, I think I'm reading the newspaper, whatever. And he says to the resident, he goes, why isn't this man intubated? Why? Yeah, and I was like, hang on. I'm okay. And it's attending.

He was very reactionary. I think said, no, no, no, respiratory distress. Those patients go sideways in a hurry. You have to be on top of it. You know, and at this point, I raised my hand as a resident in surgery and say, hey, just just FYI, I think I'm okay. I'm breathing fine. I don't think I need to be intubated. And by the way, I'm a doctor. Yeah. You know, I'm a surgeon. And my mom is sitting there

“and she goes, oh, no, but he's just a resident. Do what you have to do. You got it. You got it.”

Yeah, it's something like, they're going to put a tube down my throat. Should I no longer eat mangoes? Well, so if you were to come into my clinic, what I would do is get some testing, see, do you have those antibodies to mangoes? This happens sometimes. They'll have a reaction, and then they eat it again, have no problem. And if we see that exercise is that trigger, when we talk about that food, dependent exercise, and do Santa Flaxis, I would say, okay,

you're always going to have an epipendometer one. And you should always have a buddy to exercise

with just in case, right? You don't want to take that risk that there's an excellent gestion and you pass out. There's nobody there to give you epidephrine, right? But if you eat mango and wait about four to six hours, you probably are okay. I do love my mangoes. So I want, I have to eat them if I can. How do you think we do as a society in terms of requiring labeling of potential allergens and food? I read an article, maybe it was a couple of years ago about

“Sesame. And I think Sesame is now, there's required labeling around Sesame. But it seems to me that”

there may be things out there that are problematic that have no required labeling. Right. So there's a lot of issues in this area. You know, when you talk about the Sesame label, I was a big proponent for it. It was called the faster act that was made into law. And it required Sesame to put on the label so that if you have it, has to contain Sesame before, it might have said spices, medicine may contain. It wasn't really clear whether was there or not. So what a lot of companies

did that were making different food products where there might have been a little bit of cross-contamination there, but not to an effect that would have caused reactions for most people. One of the biggest challenges that we have right now is that the label may contain or process an facility or may contain trace amounts. Those are called precautionary labels that companies use to try to say, well, we think there might be something in there. We're not actively adding it. But when you're

in a food processing facility with six different production lines, you don't know if peanut dust is going to spread to another production line. So we'll say it's made in the same facility. And from an allergist perspective, it's really hard to counsel patients on whether that's safer not. That's interesting. That's counterintuitive for me because I would have thought, you know, they're just just the precautionary principle would apply here. And so for the vast majority of

people would not be a problem, but you might have a small subset of people who would have a significant problem with that. It's a real challenge because it creates unnecessary anxiety for a lot of people. But we're getting more data to suggest that if you have these labels that are precautionary, many folks can tolerate it. There was a study where they looked at about 200 kids with peanut allergies. They gave them a milligrams of peanut protein and over 90% of them didn't have a

reaction. And even if they did, there was no antiflexus. So we need to really work hard at risk calibration here. And a lot of what I do in my specialty is thinking about what is the risk of doing this or that? We're taking this medication or reading this label. And this impacts

specifically and the idea that maybe there was an overtilt in terms of how moms, pregnant moms, baby should reduce exposure to peanuts. And now it seems to be tilting the other way. I'm just curious to your take on this. Was it wrong? Was it an overreaction? How many years ago to start limiting exposure to peanuts so young into pregnant moms? Or was that based on the best available evidence

“at the time? So the way I think about it is that our understanding of science and medicine evolves.”

That's part of the scientific method. Our understanding of science and medicine evolves. So we weren't able to really get a good study at that time when the recommendations in the early 2000s were delay introduction of highly allergenic foods for those who were at high risk. And the problem was that high risk part of the recommendation I felt got lost in it where it became more of a general recommendation rather than saying, look, if you have severe axima, we do know that that's

a higher risk of developing food allergies. And so that's not the only reason why we have more food allergies today. Because even if you look at the leaps study where they randomized kids to say, all right, parents feed peanut protein before they turn one or wait until they're five,

we know that the early introduction group was reduced by 80 percent. That doesn't completely tell

“the whole story, right? That's an 80 percent risk reduction in peanut allergies. And we're now”

starting to see the benefits of that recommendation change about 12 years later where peanut allergy rates are starting to go down. So that wisdom now that we're hearing that is what you would advocate as well early exposure. Absolutely. Yeah. The only exception is if we already know somebody as an ag allergy or severe axima, they need to talk with an allergist first to get formally evaluated inside. Is it safe to introduce these or not? That's the current evidence-based

guidelines. My wife and I'll just tell you quickly, she went through the gamut Zachary. She was diagnosed with autoimmune diseases. She was diagnosed with psoriatic arthritis. She was put on drugs like humera. For example, there was no good biomarker, meaning blood tests for her to take. It took years to travel around the country and was ultimately diagnosed with a bosom of Peru food allergy. Something you've heard of? Yeah, I have. I mean, it's often referred to a systemic

contact dermatitis where, you know, nickel is the more common one. I haven't personally seen bosom of Peru being the causative one, but I have seen nickel. Like there's nickel containing foods that can cause severe reactions for people. So you develop this contact allergy that becomes more systemic and very problematic. So it takes a really good, allergist, a good detective to try to tease all of that out. It takes time. And that's the

one thing I always tell my patients and my followers and social media. Sometimes it takes a while to

really figure it out because our testing is limited, our understanding is limited, and we're learning a lot more now than ever before, but we don't know everything yet, and we still have a long ways to go. So we need to preach patients. Shout out to Dr. Baker who was that allergist, you're describing, who was ultimately able to piece it together for her. I mean, it was bad. I'd get home, and she couldn't move. I would have to carry her up the stairs. And there was times and I'd say,

what hurts? And she'd point to a specific place on her body and say, this is the only place that doesn't hurt. It's like every joint or skin, everything. So, but doing a lot better, you know, and, you know, thankful to doctors like you for figuring that out. What is your advice for someone who wants to lead a fulfilling life without constant worry or anxiety about out of it?

Yeah. So the first thing is really getting yourself educated about

what food allergies is, what is the mechanisms behind it? How does it impact your life? What happens if a reaction happens? The knowledge portion, I think, decreases a lot of anxiety for people,

“because it starts out, you're told, you have to change your life for something like this. And it”

can really impact every aspect of it. It really does. But when you learn more about it, you're able to take that knowledge and apply it to everything. And now, if people are developing anxiety from food allergies, there are actually specialized therapists who deal with this, day in, day out, help families navigate situations. Oftentimes, you only see the doctor once or twice a year, then you have somebody who can really help you navigate and have these coping

strategies, which I think everybody can benefit from some form of therapy in their lives. Zachary, Dr. Ruben, thank you very much for your time. I learned a lot, actually, and I think the audience will as well really appreciate it. And again, thank you for all you're doing not only in writing this book, but just just being a voice out there, I hope more people will

Who's really nice to meet you. Thank you. That was my conversation with Dr. Zachary Ruben.

He's a pediatricologist and author of the new book called All About Allergies,

“everything you need to know about asthma, food allergies, hay fever, and more. Thanks so much for listening.”

But what I want to tell you, you don't want to get into the studio.

The Master by Dr. Gleptor Bücher Soft behind the internet.

“I'm so excited that I'm really excited. Zachary, you can say that you're going back to school.”

Yes, you're going back to school, right? But you don't understand anything.

Egael, Thauberwood, Verlustvortrag, make the whole thing just like this. And when they then work, he says, "Catching?" - "That's good?" - "Safe." Like this. - "Holy dangle zurück." Now it's cosnose out for me. Elvis, beat up Trump, or would Trump have the better of Elvis.

And what is Trump's take on Bruce Lee?

“All of this and more. Have I got news for your ears?”

Check us out on Apple, Amazon Music, wherever you get your podcasts. Even better, you can watch the podcast on Spotify.