Episode transcript
Time stamps
1:29 - Impact of Allergic Rhinitis on Sexual Functioning: Discussion on how allergic rhinitis affects sexual functioning due to symptoms.
5:08 - Allergic Asthma and Sexual Interest: Research findings on the increased loss of sexual interest in individuals with allergic asthma.
8:32 - Managing Allergies and Environmental Control: Strategies for managing perennial allergic rhinitis through environmental control and allergen identification.
10:45 - Impact of Allergic Rhinitis on Daily Life: Insights into how allergic rhinitis affects daily activities, including sleep and fatigue.
13:47 - Experience of Care in Allergy Treatment: Discussion on the varied experiences of care for allergy patients and the importance of comprehensive treatment.
15:19 - Quality of Life Tools in Healthcare: The potential benefits of using quality of life tools like Rhinosinusitis Disability Index (RSDI) in patient care.
19:30 - Impact of Immunotherapy on Allergy Patients: The effectiveness of immunotherapy on improving sleep, fatigue, and productivity.
21:15 - Importance of Identifying Sensitization to Multiple Allergens: Emphasis on identifying sensitization to as many allergens as possible to manage symptoms effectively.
Transcript:
Announcer:
ImmunoCAST is brought to you by Thermo Fisher Scientific creators of ImmunoCAP™ Specific IgE Diagnostics and Phadia™ Laboratory Systems.
Gary Falcetano:
I'm Gary Falcetano, a Licensed and Board-Certified PA, with over 12 years experience in allergy and immunology.
Luke Lemons:
And I'm Luke Lemons, with over six years experience writing for healthcare providers and educating on allergies. You're listening to ImmunoCAST, your source for medically and scientifically-backed allergy insights.
Hello and welcome to ImmunoCAST, where we discuss the latest in allergy and immunology. I'm your host Luke, and I'm joined by my co-host, Gary Falcetano. How are you doing today, Gary?
Gary Falcetano:
I'm doing just great Luke and I'm really excited for our first ImmunoCAST guest.
Luke Lemons:
Yeah, that's right. Today we're thrilled to welcome Dr Michael Benninger, who is an otolaryngologist from the Cleveland Clinic and past chair of the Head and Neck Institute.
Gary Falcetano:
I've had the pleasure of calling Dr. Benninger, a friend and a colleague. I've had the unique privilege to actually collaborate on several publications with him and Dr. Benninger, we're really excited to have you join us.
Dr Michael Benninger:
Well, I'm excited to be here and we get to talk about a really important subject.
Gary Falcetano:
Absolutely. This is an after dark episode of ImmunoCAST, and we're going to be talking about sexual function and allergy, specifically allergic rhinitis, maybe a bit about allergic asthma as well.
Luke Lemons:
And to start off, I think it's important to let our audience know that allergic rhinitis affects 10 to 40% of the population, and rhinitis itself is the 5th most common chronic disease. And so Doctor, you have actually a really interesting paper out The Impact of Allergic Rhinitis on Sexual Activity, Sleep and Fatigue.
This is something that isn't normally talked about in the field of allergy, sexual dysfunction and sexuality. Can you start a bit on what's the motivation behind this research and why is it important to patients?
Dr Michael Benninger:
Well, you started out with saying that rhinitis is the 5th most chronic disease, most common chronic disease. And most of people don't even think about it as such. They don't even think about it as a disorder or disease. And disorders and diseases cause an impact, but not specific only to the symptoms that people experience, but their overall quality of life.
And there are many factors, particularly in relationship to allergic rhinitis and chronic rhinitis, that impact other parts of their well-being including fatigue, sleep, work productivity is a big impact. And we started to question people in relationship to does it impact your sexual function? It got to the point that we actually developed an instrument back in the mid-1990s called the Rhinosinusitis disability index, and it's the only validated inventory that looks at one question on sexual function.
And so we look back at our data and a number of patients with allergic rhinitis, with non-allergic rhinitis, or vasomotor rhinitis. And then in a group of patients with other nasal obstructive disorders such as septal deviation, turbinate hypertrophy, and tried to see if there was a difference in the impact of these various disorders on their sexual quality of life.
It actually surprised us a little bit that it was as big an impact as we saw, and that all three groups were more impacted than a population of general subjects. And nasal obstructive diseases were less impactful than either vasomotor rhinitis or allergic rhinitis. And allergic rhinitis was even more impactful than people with vasomotor rhinitis. And 20% of people felt that it had a significant impact on their sexual function and sexual quality of life.
Gary Falcetano:
So that really surprised me, Mike. Why do you think allergic rhinitis had so much more impact on sexual functioning than non-allergic rhinitis?
Dr Michael Benninger:
Well, I think if you look at vasomotor rhinitis and allergic rhinitis, you have the combination of rhinitis and a runny nose and nasal obstruction. Smell is more impacted in people with allergic rhinitis than it is in vasomotor rhinitis and allergies in general tend not to be isolated to a specific organ. They tend to be more systemic.
And so people with allergic rhinitis may frequently have allergic asthma or allergic laryngitis. They can have dermatitis, they can have just generalized feeling related to allergies. So I think it's the combination of smell, nasal obstruction, rhinorrhea, not very amorous when you're trying to kiss somebody when your nose is running and you can't smell and sexual function is in a large part smell.
And then you add on this, the kind of generalizable symptoms of allergic rhinitis of fatigue and not sleeping well and just don't feel well. So I think it's a more global impact of allergies have on people than just straightforward non-allergic rhinitis.
Luke Lemons:
You had mentioned asthma, and there's other research out there to that suggests that those with allergic asthma also have a loss of interest in sex. Actually, it's about 3.8 times, it's higher in asthma patients. It's not just allergic rhinitis, but it goes even to the lower respiratory system as well.
Dr Michael Benninger:
But you can imagine the similar kind of thing. You're wheezing, you're coughing, all those things don't make people very amorous. And it was interesting that the study that was out there looked at a more global depression index of which sexual function was one of the questions. It's a bigger impact again than the specific symptoms related to their asthma.
Gary Falcetano:
Yeah, for sure. And when you think about the treatments for allergic rhinitis and even non-allergic rhinitis, some of them can actually impact sexual function as well, do you want to speak to that?
Dr Michael Benninger:
Well, the sympathomimetics and the antihistamines both are quite sedating. I don't think people, when they pick up a diphenhydramine, the first thing they say is, "Gee, I wonder how this is going to affect my sexual function." They're thinking, "How's this going to affect my sneezing and my nasal irritation and my generalizable allergic symptoms?"
So it is important for us as clinicians to remember that the side effects of the medications may be more significant in terms of a patient's overall quality of life than the specific individual side effects of the medications. And now we have so many medications that don't cause those side effects. The non-sedating antihistamines, to some extent, and the intranasal antihistamines all have less effect and intranasal steroids pretty much don't have any significant side effects.
Gary Falcetano:
But of course when we talk about preventative medicine, really preventing the symptoms is really optimal. Treating the symptoms, as you mentioned, we have some very efficacious medications out there with minimal side effects, but we should discuss as well identifying the cause of these symptoms, getting to some of those root causes.
Dr Michael Benninger:
When patients come into my office, 80% of them tell me they're allergic. And my first question is, "Have you ever been allergy tested? Do we know if you're truly allergic?" And most of them haven't. And in my practice where I don't do skin testing in the office, my first step is to send them off and get blood testing and make a determination as to whether or not based on in vitro testing that they truly do have allergies and to some extent get an impression of how significant they are.
That clearly helps guide me in terms of their treatment. I'm one of those proactive people when it comes to seasonal allergic rhinitis where I really like people to be on the intranasal steroids or their intranasal antihistamines and maybe three weeks before the start of the season, enough time that they're really pretty effective. And then they can use their non-sedating antihistamines for rescue if they have really bad season.
Gary Falcetano:
And you bring up a good point. When we talk about seasonal symptoms, they're often not the only symptoms that patients experience. We know that up to 90% of patients who are sensitized to one allergen have a sensitization to another one. And often those are perennial or indoor allergens. Maybe speak to the importance of identifying all of those allergens because they all add up to push us past what is termed as symptom threshold.
Dr Michael Benninger:
Yeah. And the symptom threshold can be decreased if they really look at the environment and ways of controlling their allergies in their environment. To some extent, the perennial allergic rhinitis patients can control their environment. They can do all the appropriate things for dust mites and molds and pets.
And what classically happens in my patients that have both is they're percolating along under moderately good control or fairly good control with their medications and their environmental control. And then they hit that season, particularly by us ragweed season starting. Ragweed tends to be a terrible season for patients, and they're already on medications to control their perennial allergies and now they're sick and now their general quality of life is worsened or their sexual function worsens.
And they're sitting there going, "Well, what do I do now?" But identifying those allergies is critically important because then we can proactively treat them. And if you are person that feels better referring to an appropriate provider, a general allergist, an ENT allergist, even general ENTs in many cases will manage and treat allergies for patients. And if they have really bad pulmonary disease, either the allergist or a pulmonologist can manage that component of their problem.
Gary Falcetano:
Exactly. And I think we know that by identifying a topic or not can really help guide that informed referral to the appropriate specialist.
Luke Lemons:
I think when it comes to reducing exposure to those allergens that you get test results back and you go, "Hey, you're allergic to ragweed, but also dust mites." Especially when it comes to this topic, sexual function, it's often in the bedroom. And so you want to really especially reduce exposure to triggers in that space for sleep reasons for pure sex, everything. And I think that that's where patients who do come to their providers saying, "Hey, I have allergic rhinitis." There may be a gap in the provider perhaps not asking how do they experience any sort of sexual dysfunction. In your experience, when a patient does come in, is that a big part of your conversation with them?
Dr Michael Benninger:
We have them do the Rhinosinusitis disability index, and if that question is answered, then I will typically follow up and say, "What can we do? Do you think your symptoms in general are under good control?" We can be really proactive. If you look at, for example, we're doing a study on chronic cough, both asthmatics and unexplained chronic cough.
And we find in that study and using a very sophisticated quality of life measure on function of sexual function, that their sexual function is dramatically impacted by these patients having a chronic cough. The name of the survey is Change in Sexual Function Questionnaire, which is a 10 question survey, and it actually gets into a lot more depth than our one question survey or the one question survey in the asthma depression score.
And they actually ask things like, "Does it impact direction or orgasm?" And so it paints a broader picture of how these disorders, chronic cough, asthma, allergic rhinitis, affect people.
Gary Falcetano:
I think all of these impacts that allergic patients are experiencing are not ones that we typically think about in a primary care practice when someone comes in with rhinitis symptoms. So I love the fact that we're looking at the whole patient here and really looking at what some providers really push off as almost innocuous symptoms can really have a dramatic effect on their quality of life.
Dr Michael Benninger:
Tim Smith, who's a Rhinologic out in Oregon is a large NIH grant just looking at patients with chronic rhinosinusitis. And we know that patients with chronic rhinosinusitis, particularly those with nasal polyps, are much more likely to be atopic number one, and number two have significant pulmonary problems such as asthma.
And we actually found in a group of patients that didn't respond to medical therapy, who actually reported sexual dysfunction based on the Rhinosinusitis disability index improved following sinus surgery. So we talk about medicines to modulate a person's disease and improve their function, but in that selective group of patients, we know that doing surgery improves sexual function, it improves their sleep and it improves their fatigability. So all those things are so dramatic and a patient's general impression of how they feel and what they feel their quality of life is.
Luke Lemons:
And going back to a past episode that we had on the Triple Aim and looking at allergy through that framework, one of the subjects that we zero in on is the experience of care. And for patients who have allergy, the experience of care can be all over the place. From getting inappropriate referrals to not feeling like they're getting treated right or just being confused on what's causing symptoms.
And I think that when it comes to this specific subject too, it may be a little more difficult to address for a mental, because we talked about physical health, but also mental health as well.
Dr Michael Benninger:
And I think if their experience of care also is how likely is the primary treating physician, particularly in primary care, to say, "Well, listen. I've given a trial of X, Y and Z in intranasal antihistamine and intranasal steroid, some non-sedating antihistamines." We know this person's allergic because we've done testing to do so, are there other options? And then a referral to an allergist or an ENT allergist or ENT is a very reasonable thing to do.
It'd be interesting at some point to look at the impact of immunotherapy, group of allergic patients in terms of these other factors. We know that immunotherapies are very effective in terms of sleep and fatigability and for work productivity, it's fairly effective. And given that these tend to be our worst patients, the one that end up in immunotherapy, I think in the future it'd be great to look at whether or not immunotherapy affects their sexual function.
Gary Falcetano:
It sounds like we've got a great suggestion for some future research.
Luke Lemons:
Well, thank you again for joining us on ImmunoCAST. This is a really interesting subject that I don't think it's talked about a lot. And so the research that you're doing is incredible, and I hope that in the future, this is going to become more of a common thing to discuss with patients who do have allergies because when they come in, they might not be even thinking about how it's affecting their sexual dysfunction if they weren't prompted and that wasn't explored.
And so I will be linking here on this episode's page in the description below, if you click that link, you will be able to read some of this research and explore a little more on how allergies may impact sexual function.
Dr Michael Benninger:
I think that there's so many really good quality of life instruments, and they tend not to be used very much even in specialty settings, but not in primary care settings. And it might be reasonable to use something like the RSDI or the SNOT-20 to get an impact of how much is this affecting the patients and guiding the treatment path and potential referrals in the future.
Gary Falcetano:
I think we just might have to do a future episode on those validated assessment questionnaires and how primary care can incorporate them to take better care of their patients.
Luke Lemons:
Again, thank you for joining us, and thank you everyone for listening.
Gary Falcetano:
We'll see you next time.
Announcer:
ImmunoCAST is brought to you by Thermo Fisher Scientific, creators of ImmunoCAP™ Specific IgE diagnostics and Phadia™ Laboratory Systems.
For more information on allergies and specific IgE testing, please visit thermofisher.com/immunocast.
Specific IgE testing is an aid to healthcare providers in the diagnosis of allergy and cannot alone diagnose a clinical allergy. Clinical history alongside specific IgE testing is needed to diagnose a clinical allergy. The content of this podcast is not intended to be and should not be interpreted as or substitute professional medical advice, diagnosis, or treatment. Any medical questions pertaining to one's own health should be discussed with a healthcare provider.
