​

Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. For so many people, allergy season is so much more than just a little bit more sneezing or irritation in the eyes and nasal congestion. It might be months of brain fog, poor sleep, missed work or school, and a feeling that your body is constantly overreacting to the world around you. It can also be hard to tell what's quote-unquote just allergies and what might be an infection and when it's time to seek help.

Beyond over-the-counter medications, there are a lot of other factors to consider as well. We know that climate change is making pollen season longer, earlier, and the pollen is so much more reactive in our bodies. Couple that with wildfire smoke, air pollution, and where you live— all of that can make allergies so much worse for you as well.

Today we're taking a step-by-step approach to what's really going on in your immune system when allergies flare, why symptoms can be so debilitating, and how factors like where you live, air quality, and indoor exposures can also shape the way you feel day to day.

We'll walk through what a thorough allergy evaluation actually looks like, from skin testing to figuring out your specific triggers. If you've ever thought my allergies are the worst they've ever been, or you're tired of cycling through medications without real relief, this conversation is designed to give you a clearer roadmap so you can breathe easier and take back some control.

First, let me introduce my guest, Dr Zachary Rubin. Dr Rubin is double board certified in pediatrics and is also an allergist-immunologist who practices at Oak Brook Allergists in the Chicago area. He's a nationally recognized medical educator and public health advocate. He shares evidence-based, accessible advice on allergies, asthma, and vaccines with over 4 million followers under the handle @RubinAllergy.

All About Allergies is his first book, offering a clear, compassionate guide to managing allergic diseases.

Welcome to the WebMD Health Discovered Podcast, Dr Rubin.

Zachary E. Rubin, MD: Thank you so much for having me. I'm so excited to be here with you.

Pathak: Well, I am super excited for our listeners, but also for myself because I have two tween teenagers who suffer from really significant allergies. And I will tell you, every year I'm like, I'm gonna do something about this proactively. And then we make it through the allergy season, and then we're back to thinking about it again in spring. So I am really looking forward to our conversation.

Rubin: Absolutely. You know, every year people come into my office and say, oh my gosh, my allergies are the worst that they have ever been. And this is becoming increasingly a problem for a lot of reasons, including the fact that our temperatures and carbon dioxide levels have been rising, which correlates to higher pollen counts, and they're also starting earlier and ending later.

And so more and more people are exposed to these grains released from plants like trees, grasses, and weeds throughout the spring, summer, and fall, causing a lot of different symptoms that people experience.

Pathak: So can you talk to us a little bit about some of the factors that can play a role in how you experience allergy symptoms?

Rubin: Absolutely. So location definitely matters. When you live further south, the pollen season tends to start earlier, and it's a longer season as you're in a warmer climate. In fact, if you live in many parts of Texas, they have something called cedar fever, where there are trees that release pollen as early as December and January.

So even though the pollen grain there is not highly allergenic—like it's not something that would be as bad as ragweed—it's produced in such large quantities that it kind of overwhelms your immune system and makes you have really just terrible symptoms that way.

If somebody lives in a city versus in a suburb, it makes a difference in terms of the types of indoor allergens you're exposed to, but also the amount of air pollution. And something that we have experienced, especially in the north more recently over the past couple of summers, is that because of those rising temperatures, as I mentioned earlier, we're also having larger, more robust wildfire seasons in Canada that we did not see before.

And now with the current wind patterns, it's blowing a lot of the smoke down into where I am practicing in the Chicagoland area, but also in the East Coast. It's in many parts which California's used to, that they have wildfires all the time and for many years. But we had about an 18% increase in the number of ER visits related to asthma in the summer of 2023 because of how severe the air quality was.

In fact, Chicago had the worst air quality in the world one day that summer. It was so bad that you looked at the sky and it was orange. And I know people in New York were also reporting that as well. So this is a major problem that is often underlooked and not talked about enough because it impacts so many facets of our health that I'm happy to get into with you.

Pathak: I'd love to pull on one of the threads you mentioned. So let's take a little bit of a step back and talk just about what is going on in our immune systems when we are experiencing allergy symptoms.

Rubin: Absolutely. So the most common way that the immune system abnormally responds to these foreign substances, like pollen or pollution, things like that, it's something called a type one hypersensitivity reaction.

Essentially what happens is your immune system is constantly trying to make sure that you're protected against infections and foreign invaders, but sometimes it gets confused and thinks that foreign substances like pollen grains are like parasites.

And so it starts to create this immune system response called sensitization, where your B cells of your adaptive immune system make antibodies, little protein tags specifically called IgE. The reason why it's called IgE is because when they first discovered it and they did skin testing, they found that your skin turned red or erythematous—hence the E in that kind of response.

And so you initially get that primed immune response, that sensitization. You have the antibodies present. They then coach cells of your immune system called mast cells, which contain a lot of chemicals like histamine. Many people are familiar with that chemical if you take antihistamines and block those effects.

So upon subsequent exposure, you start breathing in more pollen grains. Your immune system activates, releases histamine and other chemicals, and you get this initial phase reaction where you get sneezing, runny nose, itching. Your eyes may start to water and become red if it's a seasonal allergy.

Then you start, four to eight hours later, getting a late-phase reaction where white blood cells called eosinophils start to infiltrate that area and create more inflammation. That's where you get the congestion, the swelling in your nose, post-nasal drip, and just kind of a generalized malaise where you're just not feeling well. You're very tired because your immune system's activated and you're also not sleeping quite as well.

So this ends up leading to a cascade of events, like the swelling leading to problems with your sinuses draining. Because they produce fluid that, if it doesn't drain well, you could have viruses infect the sinuses and lead to sinusitis. Sometimes that leads to a secondary bacterial infection, so some people may need antibiotics for that.

The same thing is true of increased risk for ear infections. And if you have asthma, you're at higher risk, if you're exposed to these allergens, of having respiratory distress and seeking emergency medical care and possibly needing systemic steroids to calm your immune system down because it's overreactive and making it harder for you to breathe.

Those are just a few examples.

Pathak: I'm very curious for you as a pediatrician, allergist, and immunologist. Can you help us think through what you are asking your patients, what you're looking for when people come in with these types of symptoms?

Rubin: Absolutely, especially with the COVID-19 pandemic. This was a really difficult question to answer because viral infections and allergies look very similar. The immune system is responding fairly similarly from a clinical standpoint. You're going to have runny nose, stuffy nose, sneezing, coughing, even headaches with any of those things.

So the symptoms overlap. How do you figure out what the differentiating factors are?

The easiest one to help is if you have a fever. It's an infection until proven otherwise. You don't generally get a fever with seasonal allergies. Now the old term hay fever, and also even older than that rose fever, are misnomers. It doesn't actually mean that you have a fever. It's just what they described as allergies in antiquity, because allergies have been around since recorded history.

So fever is an infection until proven otherwise. There's also itching, which is more likely an allergy. There's more histamine being released, so you have more of that itch sensation. It's probably more likely an allergy.

And then timing. If you have symptoms that just happen abruptly and last for a few days, probably an infection. If it's more chronic, long-lasting, and it's just there all the time, probably an allergy.

But I often encourage my patients that if you're not sure, it's better to have a doctor evaluate you rather than going around trying to fight through this when you don't even know what the actual issue is—especially if the symptoms are severe and making it harder for you to do well at home, school, or work.

Pathak: So talk to us a little bit then about proactively managing. So if you are someone that had a really rough allergy season, now you're noticing that this is somewhat of a pattern for you. When does this rise to the level that you should connect with or be referred to an allergist versus managing with over-the-counter medicines proactively? What's your guidance around that?

Rubin: Right. So if we're talking about seasonal allergy specifically, because there's a lot of other conditions that we treat, but seasonal allergy specifically—if you've tried over-the-counter medications and it's not helping—that's easy. Definitely see an allergist, right? Because maybe we need to do further prescription treatments, testing, and all that. But I think it really actually comes down to: what is your quality of life? Like, living with allergies, even if you are pretty well managed, but you're taking a boatload of medications—don't you want to try to find ways to do more with less? I mean, we live in a day and age where we're really trying to be mindful of what we put in our bodies.

And so if you're overloading yourself with medications, that may not be the best way to go, right? And there are ways to figure out, okay, what are we exposed to that's causing the symptoms? What are the actual potential allergens that we're sensitive to? We can do testing for that, either through skin or blood testing. We can then counsel our patients on ways to reduce exposure to those things. We can have a better understanding of what medications work best and when do we actually use them.

And then, immunotherapy—this is the actual way we treat the underlying process that is disease-modifying. It's not technically a cure because it won't last forever, but it is the closest thing that we have to that, right? We're giving what you're allergic to in small, incremental doses, either through shots or drops, which are different ways that the immune system looks at it, and it slowly trains the immune system to be less reactive. It's kind of like taking your immune system to school, showing it the same thing over and over again, and boring it to death so that we could potentially have fewer symptoms and less medication burden.

Pathak: Can you walk us through what a typical evaluation looks like? And to your point, we're focusing really just on seasonal allergies right now.

Rubin: When we talk about seasonal allergies, just like any specialist, they're going to give you a bunch of paperwork that you need to fill out. And sometimes we ask the same questions because we may tease out some more information. We want to verify things. So don't think that we're not paying attention to what you write down—we actually are. We just want to also streamline the visits. So if you get that paperwork done early, that's great. If you had previous labs, bring those in. We will look at that and get a detailed history to figure out what are the symptoms that bother you the most.

When are they occurring? What are the potential triggering factors? What are the potential relieving factors? These are all standard questions that any doctor will ask, just for a different problem list, right? And medical students who are listening will attest to that—that they're taught early on how to take a history. And so our history is mostly focused on what are these triggers, and then also quality-of-life issues, like how is this actually impacting you and what can we do to help alleviate those issues?

And then we do testing. In the office, we do a skin test, where in my practice I do one or two steps depending on how old the patient is and what their underlying issues are. So the first step is what we call a percutaneous skin prick test, often referred to as a scratch test, where I take pieces of plastic with little tiny prongs and put drops of allergy extracts. So that's going to include things like pollen grains from trees, grasses, and weeds; mold; cats; dogs; and dust mites. We also do some horses and guinea pigs as well.

We put that on the skin, either on the forearms or on the back, and we let that sit there for about 10 to 15 minutes after we lightly scratch the skin. And we put some control tests on to make sure it's a validated test. A positive control—we have histamine, which is the chemical that causes hives—so we want to make sure the skin is properly reactive and that they didn't take any antihistamines too close to the appointment and potentially blunt the effects of the test.

And then we have a negative control called glycerin, which should not react. If it does, then you probably have something called dermatographism, which means "skin writing." That means your skin is exquisitely sensitive to even light touch, and we can't interpret the test necessarily that well.

And so after that 15 minutes are up, we wipe off the extracts, we read it, and see how many of those bumps there are and measure their size. Then we correlate the history that we took to the test results to see, all right, how likely is it that this particular allergen is truly something they're allergic to? Or maybe there's a false positive test, or maybe there's a false negative test. A false negative test means that we may not have gotten deep enough into the skin to create a reaction.

So the second step in testing for some people—which I usually reserve for teenagers and adults—is where I take a tiny needle with some of that allergy extract and do an intradermal injection. We just put that right under the skin and make a little bubble, kind of like a TB skin test, for those who are familiar with that. We let that sit for another 10 to 15 minutes, and if we get a similar reaction like we had in the first test, then we would call it positive.

And the reason why we don't do that intradermal test for every single allergen is because, one, it's time-consuming; two, it's painful; and three, there is a risk of false positive tests. If we irritate the skin enough, it could say you have something when you really don't.

So with all that knowledge, we talk about ways to reduce exposure, as I mentioned; the medications that may be involved to help treat it, whether it's over-the-counter or prescription-based; and then the allergy immunotherapy, those injections, which we offer in my clinic.

Pathak: And can you give us sort of broad classes of over-the-counter treatments you would start with? Is there sort of a stepwise approach, or is there a certain situation where you would go straight for immunotherapy options, given potentially how severe someone's symptoms are?

Rubin: So when we talk about over-the-counter remedies, there are quite a few. The number one that I'm a big fan of for most people is not even a medication. Actually, it's cleaning your nose. So there are different ways to do it. There are bottles that contain saline water that is a spray canister. There are neti pots, there are basic rinse bottles, and then there's like the Navage, which is the mechanical.

We're gonna, you know, flow it through one nostril out the other, and you never really can— that stuff doesn't drip out, it just goes into a canister, right? So there's different levels to doing this, but it's really important to do this at least once a day if you have allergies, because when you're breathing, your immune system is naturally making mucus to act as a flypaper trap and capture all those irritants and allergens, and that mucus has to go somewhere.

It's either gonna sit there and create more inflammation, or it's gonna go to the back of your throat and cause postnasal drip, which can cause coughing and sore throat, or it'll run out the front, cause a lot of sneezing, right? So all these symptoms are related to the fact that that foreign material is just stuck there.

And so if you can rinse that out before you go to sleep, you will be able to not only breathe a little bit better, but also when you use nasal sprays, they're more effective because you just rinsed off the mucus that was sitting there. The medicine will penetrate more deeply into your healthy tissue and make the medicine more effective.

So if you're doing well, you should be doing this anyway. In fact, there's now evidence to suggest that let's say you have a viral infection, we're getting more evidence that if you do nasal rinses twice a day, you may decrease the severity and the duration of that cold because, again, it's that concept of when you get sick, you make more mucus and it traps all of the different foreign materials.

And if you get rid of that, that could potentially improve your immune system's chances of fighting off the infection more effectively. So that's just talking about rinses. We also have several medications—antihistamines—and there are different types. There's first- and second-generation in terms of how old they are.

I prefer people to move away from the first-generation ones like diphenhydramine, also known as Benadryl. I prefer the second-generation, the newer ones like cetirizine, which is Zyrtec; levocetirizine, Xyzal; fexofenadine, which is Allegra; loratadine, which is Claritin. Those medications have less side effects and work just as well based on our current best available evidence in clinical trials where we've compared first- and second-generation antihistamines.

Benadryl is the oldest one that's been readily available since the 1940s, so everybody knows it's a household name. It has quite a few side effects. You can overdose on it if you're older. You could have anticholinergic side effects. You can get a dry mouth, blurry vision, constipation, even urinary retention. People can overdose and cause cardiac arrhythmias.

We've seen social media challenges encouraging people in the past to take a lot of Benadryl to hallucinate, so that's never a good idea, and it shouldn't be used as a sleep aid even though it's marketed that way because it doesn't actually improve your sleep quality. It makes you more drowsy. Mm-hmm. So you might fall asleep, but it kind of has similar effects to alcohol, and you end up feeling more groggy in the morning.

And obviously, any of these things we're talking about, you talk with your doctor specifically for your health needs. There's also nasal sprays that contain antihistamines—that's azelastine—over the counter. There's nasal steroids like fluticasone, which is Flonase, and there are several other types that are similar.

And you can use both of those nasal sprays in conjunction, which can be highly effective for people. There's decongestant pills and sprays. So pseudoephedrine is the one that you can get behind the counter. The Combat Methamphetamine Act of 2005 moved pseudoephedrine from over the counter to behind the counter to control the amount of potential illicit substances that could be made.

So when you see a decongestant that's oral over the counter, it's not effective. So that's phenylephrine. The FDA ruled recently that they're not effective. So any medicine that contains that, it's more of a placebo than anything at this point. It really should be pulled.

But there's nasal sprays containing decongestants, like phenylephrine nasal spray or oxymetazoline, which is Afrin, and it can be very effective at causing your stuffy nose to go away quickly. But if you use it for more than three to five days in a row, you could end up getting something called rhinitis medicamentosa, where you end up having to use the medicine more and more and more because you get a rebound congestion, and it's almost like an addiction.

People have several sprays in their car. They're just trying to keep up with it. It's very difficult to treat once someone becomes dependent on that medication. And the oral pseudoephedrine over-the-counter—behind the counter—can be very effective, but if you have high blood pressure, diabetes, thyroid problems, you gotta be careful with the potential side effects of it.

So that's sprays and pills. There's also eye drops, too, that you can get. I like artificial tears that you put in the fridge and leave cool so that when you come home, you can just put a few drops in. That cooling effect really helps decrease the inflammation. It feels nice in the eyes and also just washes out any irritants or allergens in your eyes.

And then there's a few over-the-counter eye drops I like, like Zaditor, which is ketotifen, and Pataday, which is olopatadine. So they have both antihistamine and mast cell–stabilizing properties. The problem with eye drops is that they're very expensive, and even if you prescribe them, they're very expensive.

So I like to focus patients on their nasal symptoms because we know that nasal symptoms are connected to the eye symptoms, whether it's from the direct plumbing, as I call it, because the vessels are kind of shared, and if your nose is congested, it can cause congestion in your eyes and itching in your eyes.

But then there's also a neurological reflex called the nasal-ocular reflex, where if your nose is having irritation, it can lead to your eyes reflexively having similar symptoms because the immune system is trying to prime itself to protect against that whole apparatus, thinking that if there's something in your nose, your eyes might be affected as well.

Pathak: A lot of patients have questions around barriers, so wearing masks or, should I wear sunglasses when I go out? Can you talk a little bit about what we know around the evidence for those types of methods?

Rubin: Right. So because of the COVID-19 pandemic, more people have been wearing masks, and our understanding of how that reduces transmission has evolved over time. And what I have found from the studies that have looked into this is that people have reported significant improvement in their allergy symptoms when they wear a surgical mask or something that's a little bit more robust, like a KN95 or N95 mask.

And so all of these particular allergens are large enough that those kinds of masks will get filtered very effectively. So if I have a patient allergic to something in the outdoors and they have to do garden work, I'll tell them, wear eye protection and a mask—a surgical mask or better. You will feel so much better.

You won't have that same level of illness if you are out and about like you normally do. A lot of patients who clean their house to try to reduce allergen exposure end up having worsened symptoms temporarily because as you're cleaning, it aerosolizes everything, right?

If you vacuum or you dust, you're not just trapping a lot of the dust—you have some of it released. So having a mask and eye protection can be very effective. There's also some companies who are trying to sell these products where they put a direct nasal barrier, and I find that to be more expensive and potentially doesn't fit well.

The concept makes a lot of sense, but the question is, does it really work in practice? And I think masks are a cheaper, more effective alternative.

Pathak: That's really helpful. Let's talk a little bit around timing of when we should start some of these therapies. So if you're someone who knows, I have seasonal allergies, they generally start around this time, how do you advise and counsel on when to start?

Rubin: Right. So once we know what they're allergic to, we can then give them better counseling on it. So let's say you are just a springtime tree pollen allergy sufferer. We know, at least where I live, pollen starts coming out in March, and it's hard to predict exactly when. Usually, it's starting earlier and earlier and earlier.

And so we have a general sense of when it's gonna happen. And you don't wanna start medicine right as the season starts or right when you start getting symptoms because, as I mentioned earlier in the episode, you not only have this kind of acute reaction, this short-term, very quick onset where you get exposure—you get a late phase where the inflammation ramps up.

Those eosinophils ramp up, create the swelling, and once that machinery starts going, it's harder to turn it off. So I tell patients, start your medicine about two to four weeks early so you get in the habit of doing it, but then your immune system is ready to handle this better.

And so my joke is I'll tell patients, alright, Valentine's Day is now a date with your nose. That's gonna be when you're gonna start. That's not true for everybody and wherever you live because, again, if you're in the South, your season starts much earlier.

So again, you need to know when the season starts, generally speaking, and then start your medicine about two to four weeks earlier so that you are less likely to have severe symptoms during that pollen season.

Pathak: What do you generally recommend folks start two weeks in advance?

Rubin: Usually the nasal steroids, because that takes more time. But I honestly have them take everything because, uh, whenever you're trying to do something for your health and you have a chronic disease—'cause allergic rhinitis or hay fever, that's a chronic disease—whether we like it or not, it really is. It comes and goes, and it's long term, generally doesn't go away.

It's hard to have behavioral health changes where you have to change your routine and do that, and do that for quite a long time. And so, if we can get people in the habit of doing it, they're less likely to also forget to take their medicine or, you know, they're gonna start late on certain things. And if I give them too many instructions, that's gonna be confusing. So I try to keep it simple, understandable, but empower patients to have a better chance at success with dealing with these allergy issues.

Rubin: How do you counsel patients around immunotherapy?

Yeah, so whenever I have a patient who has tried antihistamines or other over-the-counter medications and they found really no relief, we introduce the concept and we talk about it, or their quality of life is significantly impacted. They'll tell me, “When I work as an electrician, I go into these homes. I'm constantly sneezing and it's really embarrassing,” or “I can't focus at work,” or “School has been a real drag. I'm not sleeping that well.”

We talk about it earlier. So a lot of my patients, I will introduce those concepts, and typically I see a spike in people wanting allergy injections in spring and summer, because that's when the worst time of the year is. But it really comes down to if they've failed over-the-counter therapy or if it's really impacting their quality of life.

Pathak: And can you talk a little bit about access issues and what it looks like to be on an immunotherapy regimen? So is this something where someone's gonna have to plan to come to an allergist regularly at certain intervals? How do you sort of counsel around that?

Rubin: Right. So every allergy practice does it a little bit differently, just to have a caveat to it. But I'm just gonna speak in broad strokes. So usually people start off getting injections once a week. Then at some point, you know, we're building up the injections in terms of the dosage. It'll get spaced out further and further and further until you're eventually only coming in once a month.

But most allergists will do it in the office because there's a small risk—it happens from time to time—of a severe allergic reaction known as anaphylaxis. So you could have hives that are generated all over your body, you could have problems breathing or wheezing, and so we'd have to give you epinephrine in the clinic.

And so I can't even count on one hand in the last couple of years that's happened from my patients personally, but, you know, we take the proper precautions. So it is a time-consuming process, and I know it can be a little bit inconvenient, 'cause some people have to travel a distance to do that and come in once a week.

So sometimes we may actually give the serum that we make for the patient and have them get it closer to home, whether they're in college and have a student health center, or there's another doctor willing to give the injections that's closer to home. Or I have people who move, who are snowbirds—they live here during the spring and summer, but when it gets to fall, winter, they go down to, like, Florida. And so we'll give that to them, and then they'll have a doctor down there give it to them.

Pathak: I wanna thank you so much for this conversation, because there's just been such a level of comprehension and clarity that has been so helpful. So I'd love to cede the floor to you in our last few minutes together for the listener who's recognizing themselves in this conversation that we're having.

What are some of the key questions that you think that they should start asking themselves right now and be prepared to go into their doctor's office to start this conversation?

Rubin: So I always encourage my patients to write down what they're experiencing, start getting in the habit of journaling, because it is so important when we try to gather the information that we have a concrete story and history that tells us what may be going on. Because in most fields of medicine, 90% of the issues can be solved by history and physical exam alone.

That's an older-school way of thinking, but I still think that's pertinent today. Even if you're a specialist, that story is so important for so many reasons. And so, when you go and see an allergist or a doctor, I always encourage people that if you're being offered testing, ask them, “Why are you getting this test? What is the differential diagnosis that you have right now?” Meaning, what are the possibilities of what you think is going on, and how does this test rule in or rule out those different things that you're thinking about, and the accuracy of the testing?

These are all things that we think about internally as doctors, but we don't necessarily communicate them. And I try to do that in my practice because I know we didn't touch on some of the other allergic diseases as much, but when we talk about food allergies as a prime example, if I was to test everybody under the sun, I would be causing more harm than help because there's a higher rate of false positives if you don't have that history to back up doing the testing.

So you have to be very careful about how you do these things. And I always communicate with patients, tell them what the risks and benefits of doing this test are, and giving them that knowledge gives them peace of mind of whether they feel comfortable doing the test or not. Many times, I'm trying to convince people not to test for certain situations.

And so if they understand that and they know the risks, I won't say, “You can't get this.” I wanna make sure people are well-informed with their decisions. And that comes down to how do we guide that informed consent process. And that does come down to the questions I mentioned: differential diagnosis, the accuracy of the testing, how is it gonna change the management? And I think those are all fair questions for patients to ask.

Pathak: Dr Rubin, you wrote the book on this—All About Allergies. Can you tell us a little bit about how this book might help guide us through a step-by-step approach for understanding our allergies and being able to manage them in the best possible way?

Rubin: Absolutely. So we talked a lot in this episode about food allergies and seasonal allergies, but there's a lot more that allergists do and a lot more that people suffer from, whether it's asthma, medication allergies, even allergic reactions to vaccines, chronic hives, mast cell problems. So there's a lot in this book that's for a wide audience because millions of people suffer from allergic diseases.

It's one of the most common chronic diseases that we face in the United States and abroad. When you look out there, there's really not a lot of resources that are geared toward as many people as possible to get a really deep understanding of these various issues. So I formatted the book so that it's three parts.

The first part sets the stage where we learn about the history of medicine. You learn about immunology, anatomy, and what to expect when you go into an allergist's office and the testing that's done. And I do it that way because I respect people's intelligence, and I want to give them some higher level of understanding on these different topics that you can Google and ask for certain things, but you're not gonna get the necessary scientific context to really supplement the knowledge.

The terminology can be very confusing, and I think people need to get that base level, which I even say multiple times in the book. I know this is gonna be a little bit of a slog—it's not gonna be like the rest of the book—but you need to have this to have the language of being able to have a conversation about this.

So you set the stage. Part two goes into each of these disease states more specifically in a narrative format, where I talk about my encounters with patients, or I interviewed followers of mine from social media who live with these issues to help tell that story. In medical school, it's now about case-based learning—you learn through not only seeing patients, but reading about them in context.

So I tell a bunch of stories in that second part related to those diseases. And then the third part is more about managing your health—learning about the different therapies, whether it's prescription or over-the-counter medications, immunotherapy, or biologics.

And then the end kind of brings us back to the beginning, where I talked about the history of medicine and what we knew back then. Now, how are we gonna evolve? What is the research right now into potential treatments or diagnostic and management strategies for each of the diseases we talked about in the book, to help us look forward and have a more hopeful future?

Pathak: I wanna thank you so much for your time. This was just filled with so much useful and actionable information, and again, thank you so much for the conversation.

Rubin: Thank you so much for having me.

Pathak: I'd like to share my three key takeaways from our discussion. First, seasonal allergies are more than just a minor nuisance. For so many of us, they can impact how well we sleep, how well we perform at work, and whether or not we can actually go to school the next day. And just because they're common does not mean we should ignore their impact.

Longer pollen seasons are happening earlier. Combine that with poor air quality—all of that adds extra strain on our immune systems. And we know allergies disrupt sleep, schoolwork, affect our mood, and even raise our risk of sinus infections, ear infections, and asthma flares. So it's something we should take more seriously.

Second, over-the-counter options are most effective when used strategically and early. That means regular saline nasal rinses, using newer antihistamines, and correctly using nasal sprays. All of that can significantly cut symptoms, especially when you start using them a few weeks before allergy season begins.

Finally, make an appointment to see an allergist if your quality of life is taking a hit, even with good results from over-the-counter medications. An allergist can help identify your triggers and discuss longer-term options like allergy shots or drops that can lessen our immune system's overreaction and reduce our dependence on daily medications over time.

To find out more information about Dr Rubin, learn more about seasonal allergies, and to find his book, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered Podcast.