Episode transcript
Time stamps
0:17 Introduction to Fall Allergy Season
1:31 Ragweed's Historical Impact and Public Health Campaigns
3:51 Mold Allergies in the Fall
6:16 Indoor Allergens and Fall Allergy Season
9:05 Tsunami of Allergy Triggers
11:48 Debunking the Egg Allergy Myth Related to Influenza Vaccines
Transcript:
Luke Lemons:
Spring often gets all the attentions when it comes to allergies. However, in this episode, we'll be shining a spotlight in giving fall allergy season the attention it rightfully deserves. From ragweed to moldy leaves to the beginning of viral season, you're going to want to stay tuned to gain some lesser-known insights on why patients with allergies shouldn't be forgotten this fall.
Gary Falcetano:
Hey, Luke, wait. Spoiler alert. We may discuss the Great Depression, urinary incontinence, and maybe even use a Disney character analogy before we're done.
Luke Lemons:
You're not going to want to miss this episode. Stay tuned.
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.
This episode, we're shining a spotlight into fall allergy season. There's really two big parts when it comes to fall allergy season. There's the allergens that are out, of course, in the fall and what differentiates it from the spring viral season.
Gary Falcetano:
Exactly. You may even say these are two sides of the same inflammatory coin.
Luke Lemons:
And so when we think of allergies in general, we often think spring. But this episode, we want to dive into those allergens that we do see in the fall, as well as talk a bit about viral season, what that means for patients who do have allergies this time of year. So why don't we start with the fall allergens, and specifically let's focus in on the outdoor allergens.
Gary Falcetano:
We're talking about ragweed and we're talking about mold, right. There really are two big fall allergens.
Luke Lemons:
So let's talk about ragweed first. When it comes to ragweed, ragweed actually creates an enormous amount of pollen. A single plant is capable of producing millions of small pollen grains, which often travel long distances, which means patients are going to be continuously exposed. In fact, in the US, 10% of the population is ragweed sensitive.
Gary Falcetano:
Yeah, ragweed is an enormous issue in the fall, but it always wasn't that way. As a matter of fact, ragweed flourishes in disturbed soil, and when we really started kind of the Industrial Revolution and the construction of railroads and highways in the early 19th century, we saw an explosive growth in migration of ragweed. As a matter of fact, in the 1930s and 40s, ragweed became, you might say, public enemy number one.
Weed ordinances and eradication efforts were the focus of major public health campaigns in metropolitan areas, including cities like New York City, where, during the Great Depression, people were put to work through the Work Projects Administration or the WPA to rid the urban landscape of ragweed. But you know what? Despite all these efforts, ragweed continues to be a major fall allergen.
Luke Lemons:
It's so interesting that, during this time, the government was really focused on dealing with the ragweed issue, and I think it speaks to this episode's main point, which we can't forget about fall allergy season. We think of tree pollen, and we think of springtime when patients have stuffy noses and watery eyes.
But ragweed season, which is really big in the fall, was so bad at one point that the government was putting people to work to get rid of ragweed out there. These symptoms that patients experience may be similar to that we've seen in the spring, but also when it comes to oral allergy syndrome, which is a syndrome where a patient's mouth may itch when they eat certain fruits. Ragweed does overlap there. Can you talk a little bit about that, Gary?
Gary Falcetano:
Yeah. Luke, we see cross-reactivity with grasses and trees in the summer and the spring and certain plant foods. We see the same thing in the fall with ragweed. As a matter of fact, we often see things like melons, soybeans, watermelon, citrus fruits, bananas causing oral allergy symptoms because of a ragweed sensitization.
Luke Lemons:
And that also includes apples. So if in the fall, if you have patients out there who love their candy apples or apple bobbing, and they're like, "Doctor, why is my mouth itching after this?" Well, it may be ragweed. So it's good to try to understand where those symptoms are coming from and testing them for that.
But also another big respiratory allergen during the fall is outdoor mold. And so, as leaves begin to pile up and decompose, whether it's on the lawn or in the street, there's opportunities for mold to grow and become airborne on windy autumn days.
Gary Falcetano:
Yeah, exactly. Patients may be raking their own leaves, exposing themselves to these airborne molds, which is why it's important to understand that if patients have a mold allergy, they may want to hire a neighborhood kid or take some-
Luke Lemons:
Yeah.
Gary Falcetano:
... precautions, like wearing an N95 mask while they're doing outside activity.
Luke Lemons:
And speaking of kids in the neighborhood, trick-or-treating is happening this time of year, so kids are going to be outside, and if they do have fall allergies, let's say again, ragweed and mold, that night of collecting candy may be a bit difficult for them.
So understanding respiratory triggers is really important in the fall, just like you would in the springtime. And speaking of Halloween, little teaser. Next episode, we'll be talking about Halloween and food allergies. So be sure to tune in the next few weeks.
Gary Falcetano:
You talk about trick-or-treating usually taking place in the evening, that's another fact about ragweed, right. Those warm autumn days followed by cool nights cause the ragweed to be released, the ragweed pond. So it really is an especially susceptible time of day.
Luke Lemons:
And once you do identify, using specific IgE blood testing, what a patient may be allergic to outside, we can really start to do some management. And we mentioned before, if you have an outdoor mold allergy, you might want to wear a mask. Well, raking leaves, maybe getting somebody else to rake those leaves for you. It's also taking your shoes off when you go inside.
You don't know if you've tracked in some of that mold from the lawn. It's making sure windows are closed, and it's wiping down pets if they've been outside rolling around in the leaves. I've seen countless videos of dogs jumping into leaf piles, and if you have a mold allergy, that might not be best to bring that pet back inside.
Gary Falcetano:
Exactly. At least not without wiping them down, right-
Luke Lemons:
Exactly.
Gary Falcetano:
... and trying to decontaminate them a little bit. You and I mentioned this before, a little follicly challenged, right.
Luke Lemons:
Yes.
Gary Falcetano:
But for those that aren't really washing their hair right after they've been outside doing any outside activities before they put that head full of, whether it be ragweed, pollen, or mold spores, right into their pillow and sleep with it all night.
Luke Lemons:
I'm glad you mentioned bringing inside because indoor allergens are also a big factor in fall allergy season. And I would say maybe, in my opinion, a little bit more, just because patients want to cozy up inside when it's autumn. They want to sit inside with the fireplace and their pumpkin spice latte and their furry friend, which hopefully they wipe down. And so patients are exposed maybe to more indoor triggers.
Gary Falcetano:
Yeah. And we discussed this when we had our Asthma Peak Week episode. It really is a tsunami of triggers, right. The indoor allergens that they're increasingly exposed to those outdoor allergens like ragweeds and pollens. And then, as we're going to talk about in a minute, the viral season as well. But again, Luke, those indoor allergens aren't easy to identify through history alone.
Luke Lemons:
There could be pet dander, there could be indoor mold, there could be dust mites, cockroaches, mice, urine, which I know you have a fun fact about, Gary. You have to have something.
Gary Falcetano:
Well, two things, right. It's fall. I used to live in a suburban area. The amount of mice that enter the house in the fall to try to keep warm, find some winter habitat is really pretty large. So we start to see mice increasing in our homes this time of year. My fun fact goes back to that teaser in our introduction is urinary incontinence.
So what we know about mice, a kind of disgusting fact that we know about mice, is that they pretty much urinate all the time, and wherever they're walking, they're urinating. So we have urine trails when there's mice in our home throughout, and the major allergen to mice is actually found in mouse urine proteins. That mouse urine dries up, becomes airborne, and causes allergy.
Luke Lemons:
That's just great to hear.
Gary Falcetano:
I thought-
Luke Lemons:
It's good...
Gary Falcetano:
... you would like that.
Luke Lemons:
Yeah. No, that's fantastic. But the point being that there is so many different indoor triggers that a patient may be suffering from. And because these triggers can stack outdoor allergens, it may be hard to understand what's causing symptoms in patients. They may just be reacting to ragweed outside, and it may be actually a combination of four or five different things. It's a little easier to manage these indoor allergens than the outdoor allergens. So that's why it's so important to test patients to know where they can reduce exposure when they can.
And this is keeping the pet out of the bedroom. This is maybe hiring an exterminator to deal with the mice and all the urine you just mentioned, Gary. Dust mite covers are a big help as well. So these are the respiratory triggers that we see mostly in the fall. And I think when it comes to comparing fall to spring allergy season, the biggest thing that separates it or differentiates it is the fact that we also have respiratory viral illnesses going around during this time. And you had mentioned the Asthma Peak Week episode that we had. We spoke a little bit about this idea called the unified airway.
Gary Falcetano:
Yeah, exactly. So when we discussed Asthma Peak Week, we talked about this tsunami of triggers. The allergic triggers, the viral triggers, the indoor allergens, outdoor allergens, all of that combining to really dramatically increase airway inflammation and cause symptoms.
I mean, the same is true when we're not talking about asthma, though, Luke. When we're talking about rhinitis, all of these factors come into play, whether we're talking about viral illness of rhinitis and then adding to that, the allergic inflammation, if we're sensitized and allergic to both indoor and outdoor triggers that are present at this time.
Luke Lemons:
All of this can cause patients to really have a bad time in the fall and have difficulty breathing. So it's important to remember that when flu season really starts going off, and you're starting to see more patients with flu symptoms, that patients who do have allergy symptoms need to be evaluated as well.
Gary Falcetano:
And as you remember, we talked about a study done by Murray in our Asthma Peak Week episode that actually discussed patients who are sensitized to an allergen, exposed to that allergen, and then have a viral illness. They have a 20-fold increase in hospitalizations among those patients with all three of those factors.
We can really look at that same concept when it comes to people with just allergic rhinitis, right. When you have allergic rhinitis, and then you're exposed to a respiratory pathogen that causes a viral rhinitis, all of that inflammation adds up to make symptoms even more severe than either one alone.
Luke Lemons:
During this time of year, what can clinicians do to help their patients who are experiencing maybe some respiratory difficulties on these autumn days?
Gary Falcetano:
The first thing is to be proactive, right. To identify those allergic triggers that can be causing symptoms in the fall. When we look at that, we don't want to look at just the outdoor triggers, but we need to assess for both the indoor and outdoor allergen triggers, and that's best done using a respiratory allergen profile that looks at indoor and outdoor triggers in your specific geography to really give you a good idea if allergies is playing a part in your symptoms.
Luke Lemons:
And we'll have a link on this episode's page to our lab ordering guide, which has the lab codes for these labs based on your zip code and based on the labs that you already use that provide these respiratory allergen profiles that include the mouse urine that we talked about, the pet dander, the ragweed, the outdoor mold. It just is really helpful to evaluate those patients all at once.
Gary Falcetano:
Yeah, and we'll have a link also to the patient education materials that you can use to really empower patients to reduce the exposure to those things that they're sensitized and allergic to, as well as some interpretation guides.
Luke Lemons:
That's one of the big things that a provider can do during the fall allergy season is to understand the allergic triggers and to test accordingly. What else can they do related to the other big half of fall allergies?
Gary Falcetano:
I think it goes without saying, making sure that we're offering appropriate vaccines, including influenza vaccines. I do have another little nugget here, right. I think most providers know this now, but it really has been one of those ongoing myths or dogmas that people who are egg-allergic cannot receive an influenza vaccine because most of the influenza vaccines are produced using an egg medium, and that's just not true. And the CDC has come out with guidance now for several years. It's very clear that having an egg allergy is not a contraindication to any of the influenza vaccines.
Luke Lemons:
I think that's really important to know just because the influenza vaccine can be so helpful to a patient who does have respiratory allergies, that we shouldn't be stopping another group of people with allergies from getting the shot because of that. So it's good to know that the CDC out there is saying, "No, it's not a contraindication."
Gary Falcetano:
So really, Luke, to wrap it up and to bring in that Disney character analogy that I promised you, right. Spring is often like the bell of the ball when it comes to allergy seasons, but let's not forget about the Cinderella of allergy seasons, right.
Pumpkin and all, the fall and its allergy triggers, as well as the viral illnesses that are becoming more predominant, all of those patients that may have fall allergies, it's really important to not negate fall allergies when we're thinking about warm evenings by the fire and pumpkin spice lattes.
Luke Lemons:
Exactly, Gary. Again, thank you for listening to ImmunoCAST, and be sure to listen to the next episode, where we talk about food allergies and Halloween.
Gary Falcetano:
Thanks so much. 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.
