Finally spring is here, but what about those allergies?
Welcome to SBH Bronx Health Talk produced by SBH Health System and broadcast from the beautiful
studios at St. Barnabas Hospital in the Bronx. Hello I’m Steven Clark.
Runny nose, itchy and watery eyes, sneezing, congestion. Spring allergies are here and won’t be going
away anytime soon. With us here today to discuss the upcoming allergy season is Dr. Alyson Smith an
allergist at SBH Health System. Welcome Dr. Smith.

Thank you for having me.

I recently read that New York City is number 21 in a listing of the 100 most challenging places to live
with spring allergies. That’s not good news, right?

Not at all.

What makes a city number one or number 100?

You know I think there’s always a misconception that urban areas would probably have better pollen
seasons than the countryside but you know our patients really tend to suffer just as much if not more and
the thought is probably due to air quality, the pollution and actually the pollution causes stronger pollen
particles.

The allergy season has already started, right?

Yes. It has. It seems early, but we had some high pollen counts the other day.

Is this likely to be a bad season?
It’s hard to tell. Usually if we have a nice mild winter which we had and I appreciated that, that does tend
to lead to an earlier pollen season and probably higher pollen levels.

Are there certain people that allergies tend to hit hardest?

Well, any patient that tends to have more allergies, eczema or asthma, they are going to suffer more when
we have high pollen levels.

So what do you do you? Do you just stand up and take it or do something about it?

There’s some things you can do at home and when you go outside. You know little things like closing the
windows. The pollen counts are highest in the morning so if you don’t want to wake up with sneezing and
itchy eyes then just keep the windows closed. Try to limit your time outside, which is not always possible,
but try as much as you can, especially during those beautiful dry days with lots of wind where there’s
going to be really high pollen counts and then when you go home you should try to shower and change
your clothes to try to get all that pollen off of you.

Well, those are lifestyle changes. What about medicine? What about shots? That sort of thing.

There are a lot of medications to help with all of the symptoms of allergies so you may want to choose a
long-acting non-sedating antihistamine like a Zyrtec or Allegra and those are all over-the-counter for
allergies of the nose or allergic rhinitis. You want to stick with some nasal steroids so a nose spray again
there’s over-the-counter medications and for really itchy eyes there’s over-the-counter eye drops as well
and there’s also prescribed prescription strength medications.

Is there a downside to taking medication?

You know some of the medications can have some side effects. Typically, you know, dryness or sedation
but generally they’re really well tolerated.

I’ve heard that certain people go through much of their lives without allergies and all of a sudden they
reach a certain stage when they find themselves hacking away or sneezing.

It can it be sort of a late onset for people, Yes especially with conditions like allergic rhinitis or allergies
of the nose. It does usually present a little later in life as opposed to some of the other allergic conditions
like eczema and asthma where you know more children tend to suffer with it and so really at any point
you can develop allergy symptoms. That’s a question I get a lot in my office where patients will be eating
things like shellfish their entire life and all of a sudden develop a shrimp allergy so yes you can develop
allergies at any time.

Allergies, are they genetic?

In the majority of cases it is going to be genetic but you know I do have those patients where there’s no
family history of any allergic conditions and they often develop terrible seasonal allergies and the thought
is some of it is environmental.

I’ve always had this question. How do you know for sure you have an allergy or you have a cold?

That’s a good question. You know as a doctor I’d like to look up people’s noses and then I can usually tell
if it’s really red inside and especially if there is you know yellow-green mucus it’s a little easier but a lot
of the symptoms are the same where you have congestion, runny nose, you can have sneezing and itching
with both a cold and allergies it’s usually how long it’s lasting. You know these people who have
you know runny nose all the time no matter what it’s usually allergies versus if it’s about a week and then
it goes away it’s probably more of a cold. But I have to say it’s very difficult to tell the difference.

If you’re active, if you want to be outside if you jog or you go to the park is there a time of day that you
should stay away from because of allergies?

Usually the morning is the worst from about 5:00 a.m. to 10:00 a.m. A great time to go running is after a
rain so if you like today it’s raining tomorrow’s probably going to be a low pollen day because of that so if
you can try to plan your exercise based on that.

What percentage of people would you say are affected by allergies? Are you seeing more people
this time of year than you would say in the fall?

Definitely in the spring. Tree allergy is really prevalent around here and again it’s you know could be due
to where we’re living you know. There’s not a lot of grass or weeds but we have a lot of beautiful trees and
so we do tend to have really high levels of tree pollen and we have a lot of patients with allergies right
now.

We said earlier that New York is in 21st place when it comes to the hundred worth worst cities for spring
allergies. Is the Bronx worse because of the pollution we have here?

You know it probably is. It’s interesting they do pollen counts only in Manhattan so when we get a pollen
count for the Bronx it’s actually based on the pollen in Manhattan but you know in general we have worse
allergies and asthma in the Bronx and it is felt to be due to the pollution.

As a doctor, as an allergist, do you recommend that people do something about their allergies or just
sort of sniff and take it?

You know allergies of the nose and eyes are not going to kill you, but it really affects your quality of life
so I see patients that are completely miserable and can’t sleep and when they go to work they can’t
function. They don’t want to go out because they’re always sniffling or sneezing so I think if you’re
having continuous symptoms that you should treat it because it’s really going to improve your quality of
life.

If your health has been compromised because you’re asthmatic does this time of year make it worse?

You know it depends and again that’s a reason why I like to do skin testing on patients or blood testing to
see what their allergies are, especially for asthma patients. They need to know what their triggers are so I
have some asthma patients that the majority of their allergies are all indoor allergens. It’s, you know, such
as cockroach and dust mites, so those patients are actually worse in the winter time and they’re fine in the
spring. But I do have that subset of patients who are very highly allergic to trees and so spring can be
really dangerous for them when it starts to trigger their asthma.

You talk about skin testing. What’s involved?

So, it’s just a little device that I press on your skin. Usually in adults and older children it will be on the
arm and for smaller kids will be on the back and it’s a series of skin tests with different allergens
and so if you’re allergic to let’s say cockroaches when I press it on your skin and I leave it there for 15
minutes your body’s going to have a small little reaction, a little hive and that’s how I know you’re allergic

You know another question a little bit removed from what we’re talking about, but I know you also deal
with are other allergies whether it’s a food allergy or what have you. Are you finding more children have
food allergies today than maybe in the past?

Oh absolutely. You know rates of allergies and asthma are increasing everywhere and you know
there’s a lot of theories behind that but I’m absolutely seeing more allergies.

What are some of the theories behind it?

You know one is the hygiene hypothesis where we’re actually so clean of bacteria and parasites that the
body doesn’t know what to do so the immune system actually instead of you know fighting those
infections decides to go a little haywire and start developing allergies. There’s also some links to the
gut biome so you know we all have natural bacteria in our intestines and they’re finding that in some
patients those are abnormal or out of whack and again it’s probably linked to diet or other things in our
environment and so again you know you need a healthy balance between good bacteria and bad
bacteria so that’s another theory.

What are the most common food allergies that you’re seeing now?

So, in the younger kids it’s always you know things like milk, eggs, soy and wheat but as they get
older we see more peanuts, tree nuts and then in the older patients fish and shellfish and even though
these are patients who may have had no allergies or didn’t find this to bother them at all and then suddenly
later in life this happens.

Why is that?

When I started here we saw a lot of shrimp allergy in our adult patients you know even more so than
where I trained and when I started looking into it we found that we high rates of cockroach allergy and
dust mite allergy in the Bronx and the protein that you’re allergic to in cockroaches and dust mites are the
same protein that you’re allergic to in shrimp and so you know that’s our current thought is why so
many people around here develop a shrimp allergy is because of the cockroach and dust mite allergy.
You know again moving, a little bit astray from where we started, I know you’ve been very involved with
treating asthma here at the hospital especially with children who have serious cases of asthma.

What is biologic therapy?

So biologic therapy is taking their antibodies that are made in a lab and they fight certain abnormal
pathways in your body so we have a great program here where patients that have allergic asthma
they receive a drug called Xolair which blocks the allergic antibodies from triggering their asthma. We
also have other medications like Nucala which target eosinophils which can be in very high numbers in
patients with eosinophilic asthma. These are for patients who really have failed standard therapies like
pumps, the inhalers, the pills and it’s you know it’s really been amazing for our patients.

Give us an example of what kind of response you’re seeing with this?

These patients are ones that were in the hospital all the time. I had one patient, he was pretty much
monthly hospitalized for his asthma and was not able to play sports, he was missing school and we
started him on a medication called Xolair and you know within a month or two his asthma symptoms
improved significantly. He was never hospitalized again and he’s actually doing great today so this is
really life changing. And it’s been life changing for us as physicians because we really hit our limit with
some of these patients. We didn’t know what else to give them because we had tried everything and so it’s
been great for us.

If someone wanted more information either on allergies or on asthma and they wanted to speak to you
is there a number they could call you at?

Yes they could call the hospital at you know our asthma clinic is 718-960-3100 and so we have
pulmonologists, lung doctors, I’m there as well and we’d be happy to talk to them.

OK, thank you Dr. Smith for joining us on SBH Bronx Health Talk. again for more information
on allergy treatment or other services available at SBH Health System visit www.sbhny.org. Thank you
for listening.