Episode Transcript
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Speaker 1 (00:03):
Welcome to the Wellness and Healthy Lifestyle show on your VOCM. Now,
here's your host, doctor Mike Wall. Welcome to the show.
I'm your host, Doctor Mike Wall.
Speaker 2 (00:18):
Well, this is the season for barbecues, outdoor hikes, picnics,
and of course allergies. So today we're joined by doctor
Andrew O'Keefe and doctor David You, who are allergists from
the NL Allergy and Immunology Clinic in Saint John's. Together,
we'll explore the ins and outs of environmental and food
allergies and how they impact our daily lives and the
effective strategies we can use to manage them. We'll chat
(00:41):
about some common allergins during different seasons, ways to mitigate
their effects, and even some fascinating facts about how a
change in climate is influencing allergy patterns. Here in the province,
almost thirty percent of us grapple with allergies, so it's
something that either impacts us.
Speaker 3 (00:56):
Or someone we know.
Speaker 2 (00:57):
Let's start our show with our interview with doctor Andrew O'Keefe.
Hi Andy, Welcome to the show.
Speaker 3 (01:04):
Hi Mike, thanks for having me.
Speaker 2 (01:06):
It's a really timely topic right now. We're going to
be chatting about allergies today, and we're going to talk
specifically about Newfoundland and Labrador. But before we get into that,
can you tell me a little bit about yourself and
your clinic.
Speaker 4 (01:16):
Sure?
Speaker 3 (01:16):
Yeah, So I'm an allergist and clinical immunologist.
Speaker 5 (01:19):
I operate out of a community based practice in Saint John's, Newfoundland.
I was one of the first Sport certified allergists to
return to Newfoundland in twenty fourteen. So since then, I've
had two other allergists join me, doctor Khelia Farrell and
doctor David u And I understand you'll be speaking with
doctor you later. So now we have three of us
working here in Saint John's and we've been working to
(01:41):
promote excellence in the specialty of allergy since we came
to Newfoundland and helped to.
Speaker 3 (01:47):
Keep folks here in Saint John's and throughout the.
Speaker 5 (01:49):
Province healthy with respect to allergies, asthma and other sorts
of conditions that we treat.
Speaker 2 (01:56):
Okay, So, as a physician with a specialty looking at allergies,
what type of training do you have to go through?
Speaker 5 (02:02):
So an allergist is a physician who has completed medical school.
Obviously that's the first step and then has completed further
training either in internal medicine or pediatrics, so that training
can be either three or four years, and after that
it's at least another two years in training that's focused
specifically on allergy and clinical immunology. So that's an important distinction,
(02:24):
I think, because not everyone who does an allergy test
is an allergy doctor. So I think it's important for
folks to know who they're seeing and what their qualifications are,
because sometimes.
Speaker 3 (02:35):
These tests can be misused.
Speaker 5 (02:38):
The test itself is easy to perform, but it's not
always a great test, like we can see false positives
with it. So you want to use the appropriate test
for the appropriate person at the appropriate time, and we
want to give you the best advice that we can,
understanding the limitations of these tests to help you improve
your life. So when possible, my advice would be to
(02:59):
see a board sort of five allergists and we'll discuss
how to find one in a little bit.
Speaker 2 (03:04):
Yeah, that's definitely got to be a challenge, and it
is a specialty because it's not super easy to understand.
It's not the simplest of physiological processes how these happen
in the body and That's one of the things I
hope we can get down to today, is we can
tell people just how they work and who's susceptible to
these types of allergies. And I guess we should probably
just start off with the most basic, but it's probably
the most robust definition, and that is what actually are allergies.
Speaker 5 (03:30):
So the term allergy is used in a lot of
different ways by a lot of different people, and some
people I think would use the word allergy and reaction synonymously.
But when I'm talking about an allergy, I have a
very specific thing in mind, which is something different from
(03:50):
an intolerance or a sensitivity, or other types of non and.
Speaker 3 (03:55):
Une mediated reactions that people might have. So an allergy
is an.
Speaker 5 (03:59):
Immune mediated reaction against something that is foreign to your body.
And typically this foreign thing should be something that is benign,
so like protein from peanuts, for example, or pollen like
our bodies shouldn't have a bad reaction.
Speaker 3 (04:16):
To those things because they're not inherently dangerous to us.
But for whatever reason, the immune system goes off the.
Speaker 5 (04:21):
Rails and makes a reaction to one of those things,
which can result in different symptoms depending on what the
allergen is. So the symptoms of reaction to a food
allergen are quite different from reaction to an environmental allergen.
Speaker 2 (04:38):
Okay, so when these happen. Somebody in my family has
a very severe peanut allergy actually sort of one of
my best friends growing up, and they had to carry
like an epipin. So what actually happens when we get
to this stage of having these severe reactions.
Speaker 3 (04:50):
Yes, so we.
Speaker 5 (04:51):
Tend not to think about or I don't tend to
think about food allergies in terms of levels of severity,
like someone has a mild peanut allergy or a severe
peanut allergy, Because if you have a food allergy, which
is one of these immune mediated reactions to a food,
and the type of immune reaction is called IgE, any
of those could potentially be anaphylactic. And so we can't
(05:13):
necessarily predict how bad your reaction is going to be
with a skin test or with a blood test, and
you can have a milder reaction at one time and
then at a later time have a different reaction because
there are all these other factors that contribute to the
type of reaction that you could have at a given time.
So things like exercise, how active your immune system is
(05:35):
at a given time, So if you had a cold
or a flu, alcoholic consumption, use of medications like anti
inflammatory drugs can make these reactions worse. So there's lots
of different factors that can contribute to the severity of
a food reaction.
Speaker 3 (05:49):
So it's kind of a misnomer I think to think
of a.
Speaker 5 (05:52):
Food allergy as people ask me often like oh, why
am I anaphylactic to it? And if you have a
food allergy, you could potentially be anaphylac pick to it.
Now if you had a sensitivity or an intolerance like
lactose intolerance.
Speaker 3 (06:04):
Lactose intolerance is never life threatening.
Speaker 5 (06:07):
It can be really unpleasant, but it's not something you
need to carry a nepipens for.
Speaker 4 (06:11):
As an example.
Speaker 2 (06:12):
Ah, that's excellent. Okay, Well that's good because I think
there's a lot of clear to do this. And this
is one of the benefits of me doing this show
is that I get to learn things because it's not
something we're really taught about a lot. And it's also
something that can affect a lot of different people. What
populations can develop allergies and are there any common risk
factors among these people?
Speaker 5 (06:31):
So anyone can really develop allergies, and environmental allergies are
one of the most or rhinitis, we would say is
one of the most common chronic conditions experienced by people.
Speaker 3 (06:43):
So lots of folks do.
Speaker 5 (06:45):
Have allergies to things in their environment, so things like
dust mites or pets, or different types of pollen, and
we don't fully understand why some people develop allergies and
other people don't. There have been studies to show that
there is a components. So if you have a parent
who has some sort of allergic disorder, and that could
be something like asthma, exeema, a food allergy, or an
(07:08):
environmental allergy, then their.
Speaker 3 (07:10):
Children will be at higher risk.
Speaker 5 (07:12):
And if they have two parents who have those disorders
and they haven't even higher risk. So there is definitely
genetics playing a part there, but there are other factors
too in terms of exposure. So there are some interesting
studies done in Germany that looked at children who are.
Speaker 3 (07:25):
Raised on a farm and they're being exposed to.
Speaker 5 (07:28):
Different types of bacteria and infections, probably through that that
they might be less likely to develop allergies as they age,
versus children who are raised in a more urban center
without those same types of exposures in the burn might
be at higher risk to develop allergies, and other studies
have looked at you know, if you grow up with
a dog or.
Speaker 3 (07:46):
A cat at home, you might be less likely to
develop allergies.
Speaker 5 (07:50):
But there's lots of different puzzle pieces to this, so
we don't fully understand.
Speaker 1 (07:54):
It all yet.
Speaker 2 (07:55):
That's interesting. Yeah, I've always heard that some people's parents
clean more than others and they didn't play in the
dirt enough and that makes them sensitive. But it's nice
to know that there might be some link between the
aspects of the environment. Now when our body has this reaction.
You mentioned seasonal allergies, things like running noses and things
like hives in your skin or swelling in certain cases.
(08:15):
What's going on when some of these things occur when
we have this all reaction.
Speaker 5 (08:21):
So for an allergic reaction to occur, the protein that
you're reacting to has to get inside your body somehow,
so that could be through the mucous membrane. So for
environmental allergies, we think about the eyes, the lining of
the nose, and the lungs. So I'm allergic to dustmites,
for example, when I'm exposed to dust mites, and we
(08:43):
are all exposed to dust mite. Those symptoms could be
inflammation around the eyes, in the nose which causes itchy nose, sneezing,
running nose, and if I had asthma, that could cause inflammation.
Speaker 3 (08:52):
In my chest in my airways and make my asthma work.
Speaker 5 (08:56):
So what's happening there is that there's this protein coming
from outside. I am a susceptible individual because my immune
system has decided it's going to make this antibody IgE
against the dust MTE protein. So when those IgE molecules
are circulating throughout my body and they're getting attached to
(09:16):
different cells called mass cells inside the airways, they're kind
of all over, right, and so when those specific cells
meet up with the dust might protein, they cross link
and that sends a message down into the cell for
it to release all these different chemicals. So people have
(09:37):
often heard about antihistamines. So histamine is one of these chemicals,
but there's a whole bunch of others, and they cause
all these effects that result in the symptoms that we have.
So they dilate blood vessels, they recruit other inflammatory markers
around those sites, so you get all these effects of
inflammation around the sites where you were exposed to the
(09:58):
allergy and like the eyes, the nose ones.
Speaker 2 (10:01):
That's interesting. Okay, So this protein that normally doesn't have
an interaction with most people, if people are susceptible to it,
it turns on cells and starts to create process as
it would normally occur.
Speaker 4 (10:11):
I yeah, that's right.
Speaker 2 (10:12):
Okay, that makes sense. Okay, that's good because I've actually
got some allergies too. Can people grow out of allergies
or change or can it come more mild or more
severe over time?
Speaker 4 (10:21):
Yeah?
Speaker 3 (10:21):
And there are a lot of cofactors that can influence.
Speaker 5 (10:24):
You know, earlier we were discussing about different cofactors for
anaphylaxis that can make a reaction worse or better. There
are cofactors for environmental allergies too, So when someone says,
you know, I'm having an allergy, and maybe they're referring
to something going on in their nose and sinuses. Changes
in barometric pressure, in humidity, in air temperature can all
(10:44):
affect our nose and sinuses as well. So do viral
infections or bacterial infections of course too, So it's not
always just allergies that are contributing here, so they can
definitely change over time, they can change seasonally.
Speaker 3 (10:57):
Some people develop allergies as they go through life.
Speaker 5 (11:01):
Other people might lose them, and that's another bit of
the science that we don't necessarily understand, though we do
know that for many allergens that they require several exposures.
Speaker 3 (11:12):
That requires time before you develop an analogy to.
Speaker 2 (11:16):
Something that makes sense. Yeah, so you were allergs to shellfish,
but one day you're allergic to shellfish. Okay, yeah, and
for foods that.
Speaker 5 (11:23):
Like for foods, mostly we see children being affected with
food allergies more so than adults, but shellfish and tree
nuts would be two exceptions.
Speaker 4 (11:31):
Then.
Speaker 3 (11:32):
An interesting kind.
Speaker 5 (11:33):
Of bit about that is that the dust might protein
is quite similar to shellfish. So we think that's why
adults may be more likely to develop a shellfish allergy,
because they're getting they're sensitized to dust might and then
your body starts to recognize this other protein that looks
similar to the dust mighte as a problem. So it's
a little bit gross to think about, you know that
(11:53):
maybe our body thinks that shrimp and dust mites are
the same. But similarly for tree nuts, tree nuts have
a very similar kind of protein structure to birch pollen.
Speaker 3 (12:01):
So it's kind of like.
Speaker 5 (12:02):
This crosstalk that goes a little bit astray in terms
of our body is seen one thing as a problem,
to see something else that looks like it, it's like, no,
I don't like that either.
Speaker 2 (12:12):
Today we're learning all about allergens and how we can
navigate the summer as best we can even when the
air is full of grass and pollen. We'll be right
back after the break. Welcome back. Today we're learning all
about allergies and how we can navigate the summer as
best we can even when the air is full of
(12:33):
grass and pollen. Let's get back to the show. All
these different types of allergies you've sort of identified them
as like a food allergy and an environmental allergy. Are
there different categories do you guys use in a clinical setting?
Speaker 5 (12:47):
So yeah, in terms of the IgE mediated responses, so
those are IgE is the only thing that I would
call analogy. Anything else I would call a different type
of reaction. So in terms of IgE mediated reactions, those
things could be to foods, environmental things which you've discussed.
You can sometimes have IgE formation to medications to stinging
(13:10):
insects like wasps, bees.
Speaker 3 (13:13):
And hornets, and those will be the main ones.
Speaker 5 (13:15):
People don't tend to get IgE sensitization to chemicals. So
the idea of like scent allergy, A scent can be
an irritant, like anything you smell can be an irritant
and can give you the same symptoms that you would
have from exposure to an environmental allergy.
Speaker 3 (13:31):
But sense don't have.
Speaker 5 (13:32):
That same interaction with our immune system, so it's not
something that we can do like a scratch test for
on your skin for like perfume or for like cigarette
smoke for example.
Speaker 2 (13:43):
Well that's actually a perfect lead in to what I
was going to ask next, is that is the you
know what percentage of the population has different forms of
allergies and how do you actually assess that for somebody.
Somebody's thinking like maybe I do have an allergy and
I need to go get checked.
Speaker 5 (13:57):
Yeah, So the estimates for food allergy are about six
to eight percent of children and three to four percent
of adults that are affected by a food allergy. For
environmental allergies, I've seen some estimates.
Speaker 3 (14:09):
As high as thirty percent.
Speaker 5 (14:11):
So he said, this is a very common problem for
people to have, and it contributes hugely to people's.
Speaker 3 (14:17):
Quality of life.
Speaker 5 (14:18):
And there's a huge economic burden associated with that too,
So a lot of people will kind of downplay their
their symptoms or think that but something that they don't
need to get treated.
Speaker 3 (14:26):
Or they don't want to bother someone about it.
Speaker 5 (14:28):
But there's lots of things we can do to help
treat allergies, particularly environmental allergies, so it's always worth a
discussion if it's something that's having an effect on your life.
Speaker 2 (14:37):
Yeah, I've had seasonal allergies or different environmental allergies for
my whole life. So it's my mother and it's been
something that when I first got it, I was thinking
I had the flu or something. I felt really run down, tired,
headaches and things like that, and I've learned how to
control those over time. But if somebody's getting a test,
can you explain what you do when you're actually doing
this skin test, because we were chatting about that on
the plane today and my colleague said that he's solars
(14:58):
to cats when he did his arm just blue right up.
Speaker 5 (15:01):
Yeah, So when we do the allergy test, what we
do is we put a drop of the protein that
we want to assess for. So we have a mix
of dust mite proteins that we can kind of drop
on your skin, and then we really lightly scratch that
drop with a sterile lancet and that lets some of
(15:22):
this underneath the very top layer of your skin. So
if you have these pre formed antibodies, these IgE antibodies
pre formed against the dust might the cells in that
area are going to recognize it and they're going to
make a red welt like a little hive kind of
thing where we did the scratch test. So we do
the scratch, we wait for ten minutes, and then we
come back and assess to see if you've got a bump.
Speaker 3 (15:44):
There on your skin.
Speaker 2 (15:46):
That's interesting. Yeah, that would be a really interesting test.
I'm sure there's things that people have all these aha
moments where they never realized that they were alerged to something.
Here it's somebody like yourself, you know.
Speaker 5 (15:56):
It's pretty It's a pretty nice test because it gives
us results within ten to fifteen minutes. So it's nice
to be able to have that discussion with the patient
kind of like we get that in real time, we
get that information.
Speaker 2 (16:09):
Cool, excellent, that's interesting. Well, let's get into some of
the things that are specific here. What are some of
the primary environmental allergens we're going to see here in
Newfoundland and Labrador and we can maybe if it's easier
to go by season, then we would take it that way.
Speaker 5 (16:28):
Yeah, So in terms of environmental allergens, I tend to
think about indoor allergens, so dust might would be the
big one there.
Speaker 3 (16:35):
And dust mights are these.
Speaker 5 (16:35):
Little tiny creatures that live in They mostly like to
live in soft things. We get most of our exposure
through mattresses, pillows, things like that are betting because we obviously.
Speaker 3 (16:46):
Spend a lot of time in our bed.
Speaker 5 (16:47):
There's nothing you can do to get rid of dust
mites altogether, so it's not an issue of like friendliness
or anything like that.
Speaker 3 (16:53):
And dust mites are different.
Speaker 5 (16:54):
From like house dust, like those kind of fine particles
that you.
Speaker 3 (16:58):
See collecting on surfaces.
Speaker 5 (16:59):
So it's not something Okay, well, I'll just be really
diligent with my cleaning. That's not going to remove the
dust mites. And they would be probably the biggest exposure
for people because it's something you can't really control. Then
we also think if someone has pets at home, like.
Speaker 3 (17:11):
Cats or dogs that can be an issue.
Speaker 5 (17:13):
Feathers in bedding would be another indoor or perennial, year
round allergen.
Speaker 3 (17:19):
That people can be exposed to.
Speaker 5 (17:21):
In terms of seasonal allergens, we tend to think of
things like trees, grasses, weeds, and molds, so we can
react potentially to pollens from those different species of plants.
Trees would be the first things to pollinate, so in
Eastern Canada we typically see that between April and May.
Speaker 3 (17:40):
Then we go into grass pollen season where we are now,
which is typically June and July.
Speaker 5 (17:45):
Here in Newfoundland, we tend to have a shorter weed
pollen season because they pollenate kind of at the end,
so August and early September, and then once there's kind
of piles of decaying vegetation and things like that, then
we can see that the mold can be an issue
for some people.
Speaker 2 (18:00):
And you talked about the effects that can have. You said,
like there's a cost to it and the quality of
life issue. How debilitating can it be if somebody is
suffering from really bad allergies.
Speaker 5 (18:09):
So I have patients who tell me that they basically
can't go outdoors during the summer months, and so it's
been really satisfying to work with these patients and to
use some of the different therapies that we have to
help give them some more control over their symptoms so
they have better quality of life, they can participate more
fully in what they like to engage in. And the
(18:31):
flip side to that is sometimes people are using medications
like benadru which can have really bad effects that are
not recommended anymore. So there have been studies to show
that kids who suffer from allergies when they go to
write exams, compared to kids who did not have allergies,
were a full grade.
Speaker 3 (18:48):
Level like an A to a B below others.
Speaker 5 (18:52):
And the thought is probably that some of that was
contributed from some medications like benadryl, which have really nasty
kind of sedating side eye effects which can last even
until the next day. I was reading a tweet from
an allergius colleague who talked about an experiment They did
not them personally, but that was done maybe twenty twenty
five years ago, and they gave people either a non
(19:15):
drowsy antihistamine benadrill, which is a drowsy antihistamine, or some
alcohol and then they tested their reaction time in a
driving simulator and they found that the bena drill was
actually worse than alcohol for delayed reaction times and impairment.
Speaker 4 (19:32):
And it's interesting.
Speaker 2 (19:33):
So I knew that people used to use a lot
of benadrill in shift work settings to go to sleep
because of that drowsy thing, and so it just it's
kind of scary when you think about operating vehicles. Now
somebody's listening to this and they've learned a lot and
to thinking this could be me. I think I need
to seek some help or somebody they know could use
some advice. How can they reach out to you, guys?
Speaker 3 (19:52):
So in order for us to accept a patient, they
need to be referred to us. So we can accept
referrals from different types of health practic.
Speaker 5 (20:00):
And that's kind of a moving target these days, but
generally speaking, any physician, medical doctor could refer to us,
Nurse practitioners can refer to us, and sometimes dentists refer
to us as well.
Speaker 2 (20:11):
And there are there any resources that are out there
or associations or websites people could go to to get
some information for themselves if they don't have an opportunity
to get into see you guys.
Speaker 5 (20:21):
Yeah, with respect to food allergies, Food Allergy Canada is
a good resource, so folks could just google that if
someone is looking for an allergist in their area, that
they would like to speak with their primary care provider
about being referred to. The Canadian Society for Allergy and
Clinical Immunology or CSACI dot CA has a tool there
(20:43):
called find an Allergist, so you can look up in
your own locality and that's available all throughout Canada and
they can help direct you to a board certified allergist
who can hopefully help with your problem.
Speaker 2 (20:56):
Well, doctor Keith, thank you so much for joining me today.
I really appreciate it. I'm sure everybody listening got a
lot out of our conversation.
Speaker 4 (21:02):
Thanks.
Speaker 5 (21:03):
It was wonderful to be here and I hope everyone
can manage their allergies well throughout this grass pollen season.
Speaker 2 (21:10):
Today we're learning all about allergens and how we can
navigate the summer as best we can, even when the
air is full of grass and pollen. We'll be right
back after the break. Welcome back. Today we're learning all
about allergies and how we can navigate the summer as
best we can even when the air is full of
(21:31):
grass and pollen. Let's get back to the show. Hi,
doctor you welcome to the show.
Speaker 4 (21:37):
Hi, nice to be here.
Speaker 2 (21:39):
That's great to have you here. It's an important topic
because we have already talked to your colleague, doctor O'Keefe
and we were looking at the how and the what
of allergies. But now we're going to look a little
bit more at probably what people come into your office
to talk about on a day to day basis. That's
allergies here in New flann Laboratory. Can you give our
audience a bit of a background on yourself.
Speaker 4 (21:58):
Yeah, So originally born in Ontario.
Speaker 6 (22:01):
Then I met my lovely wife in school and once
we had kids, we moved back to the Rock, which
is where she's from, to be close to family. Other
than that, most of my training in Ontario, so like
my undergrad masters at Western in London, that's school and
Queens and Pediatrics in London, and then allergy immunology training
(22:25):
in Hamil Pandemic Master and then left Ontario live on
the Rock and the rest is history.
Speaker 2 (22:32):
Well that's a good move. Actually go there and get
that training and then bring it back here because you're
one of what only five allergists in the province.
Speaker 6 (22:39):
Right, Yeah, Yeah, there's like three of us here on
the east and then one in central one west.
Speaker 2 (22:45):
Yeah, well that's great. I'm glad we could get two
of you guys in one episode as well, because it's
really helpful information. Doctor keep is saying that allergy is
cand affect up to thirty percent of people when it's
talking about the environmental allergies, and we want to talk
a little bit about the ones that are out yours
this season in our region Newfland, Labordor. We have a
challenging environment and the best of times, but it can
(23:06):
also get challenging for people with allergies. What are the
primary allergic reactions or allergens you're having people come into
your clinic to talk about.
Speaker 6 (23:15):
Yeah, so like this time of the year definitely, Like
pollen season is kind of the big thing, right, So
come like March April, sometimes a bit later here, and
that's kind of one of the things, like pollen season
typically starts a little bit later here compared to the
rest of Canada. But you get the whole gamut of
eye symptoms, no symptoms, so itchyis running, no sneezing, running,
(23:37):
post nasal drip, snoring, all of that, and then stemming
from a lot of like the pollen symptoms, you can
also get some of like the cross reactive symptoms with
life fruits and vegetables and such like that. So kind
of that whole home mix of things.
Speaker 2 (23:52):
Yeah, it's funny because it's not just the environmental ollogens outside,
but there's also year long allergens inside that we're facing
in our own living environment, right.
Speaker 6 (24:03):
Yeah, definitely right, And those are particularly important too when
we're in heat waves and some of us are trying
to enjoy the sun, but at the same time we're
spending a good time indoors because you know, went.
Speaker 4 (24:11):
Overheat as well.
Speaker 6 (24:12):
So in terms of dust might, especially here in Newfoundland,
the dust mights are a very prominent allergy. And then
like pet danders as well, and those definitely play a
role all year round.
Speaker 2 (24:24):
If I was thinking about the ones outside, you see
commercials and you don't know if the commercials are actually
relevant to hear you, like it's rag weed season or
dandelions or whatever. What are some of the specific things
that people would be really triggered by and they kind
of change shout the season. I'm guessing as they grow
and shed their pollen whatever exactly. Yeah, so there's like
a typical.
Speaker 6 (24:44):
Like progression in terms of pollen, and this is kind
of like throughout Canada, but just like I said, the
timing's a little bit different. So typically treat pollen picks
up in the springtime, then grasp allen over the summer,
and then we pallen towards the end of the summer.
And then there's the mold spores, which are typically like
kind of early spring, but most prominently kind of like
end of summer in the fall, when everything's kind of
(25:06):
damp and wet, that sort of humidity aspect of things.
Speaker 2 (25:10):
It's funny talking to some people, I think that, you know,
I don't know if it was exceptionally bad this year
with all the rain, but a lot of people were
suffering with a lot of like it seems like allergic
symptoms because it was just so wet. You'd think that
is that actually causing mold and things like that's it
that can bother a restoic system.
Speaker 6 (25:26):
Yeah, so definitely, like the outdoor molds can kind of
fluctuate and typically like the damp, cooler kind of temperature.
So that's like when the freeze fall in the spring
and then in the fall when like the leaves and
that sort of thing, probably what a lot of people
suffering from. And this is kind of anecdotal, but historically
it seemed like Newfoundland had milder and shorter seasons, like
(25:47):
you know, it was kind of like the cooler climate
kind of thing. But you know, you've probably noticed in
the last few years the summers have definitely been hotter
and they're only getting hotter, right so, at least like
in the clinic in the last probably two three years,
definitely seen a lot more patients for more severe kind
of fallen symptoms as compared to the previous years. You know.
Speaker 2 (26:06):
And I think about it too, like you think about
the spring and even the following starts getting colder in
the summertime. If you're an outdoors person, you are in it,
Like you know, I hike these colost trail every opportunity
I get. Does it work like that, like if you're
actually closer to the potential allergen or is it just
so saturated in the air around us that it doesn't
really matter if we're like in it or not.
Speaker 4 (26:28):
Yeah, it's a good question.
Speaker 6 (26:30):
I think what you're maybe getting at is like if
I expose myself a lot to it, will I get
used to it, will kind of lessen my allergies kind
of thing. And I think there's kind of a couple
of parts to that. So one part is yes in
the sense that you can be sensitize yourself and like
kind of change your allergies. But that's usually when we
(26:51):
talk about allergy shots or ammuno therapy because you usually
use much higher doses to actually be sensitize yourself. So
like from a like objective allergy perspective, like you need
mega doses. What being outdoors is not enough, Like in
order to kind of insensitize, you retrain your immune system
aspect of things. And that's like allergy shots you continue
(27:12):
for three to five years to kind of like sa
retrain your immune system in terms of getting used to things. Definitely,
like as human beings, we definitely habituate to different symptoms, right,
So like lots of people with like cats and cat
allergies or us mites and like thus mites are all
year round or like you know, like it's bad at
the beginning of the pol season, but by the end
(27:34):
of it, you're kind of acclimatized to it, so you
get used to, like, I'm a little bit stuffy, a
little bit itchy, but that's kind of my baseline, and
you kind of get used to it and it's not
too bothersome, So there is truth to that, and like
kind of like the classic kind of story is oftentimes,
especially with like pet allergies, that you know, someone grown
up with a cat or dog, their entire lives, no problems.
(27:57):
They go off like on trip or school or work
or like on for a couple of weeks and then
come back and then all of a sudden they're like,
what's going on? Why do I suddenly like start reacting
to patents? Partly because like you know, when you're living
with the animal, say your your allergies are hovering at
say fifty percent all the time and like fluctuating forty
to sixty, you don't really notice it. You're a little
(28:18):
bit stuffy. But if you go away for a period
of time and you go from zero sixty, you definitely
notice that kind of change, right, So I think that's
the aspect in that regard.
Speaker 2 (28:27):
It sounds like being in a rock concert and not
realizing how loud is so you walk out the music's off. Yeah, exactly.
Speaker 4 (28:32):
That's a great analogy.
Speaker 2 (28:33):
Yeah, okay, cool, that's good. Okay, So somebody has allergies,
you don't say, oh your lyrics to grass, go cut
the lawn, it's going to make you better. It's probably
gonna make them worse. Okay. So I'm thinking if that's
the case, and somebody can't unless they've got special medical
treatment to be able to like again desensitize them to this,
is there is there conditions that can exacerbate it them.
So like you know, being and being mowing the lawn
(28:56):
or you know, being outdoors in the woods, does that
make it actually worse for people?
Speaker 6 (29:01):
There's not a like a one answer to that, I think,
like so as you probably can imagine, like there's a
whole range of severity from patient to patient, And when
you talk severity, it depends on objective symptoms as well
as perception of symptoms. Right, So someone might have a
running nose and it's the worst running nose in the world.
Speaker 4 (29:18):
Other people like running.
Speaker 6 (29:19):
Nose, But like I love my cotter dog and that's
totally fine. I love my hike in I'm just going
to do it and that's fine, right, So so that
part of it, and then I guess when we talk
about pollens, at the end of the day, there's no
avoiding these things, right, So whether it's dust mites, pets, pallen,
you're never going to one hundred percent avoid them, right, So,
like you can't avoid the outdoors. Dust mites are everywhere.
(29:43):
Even if you don't have pets. Half the people who
you can let have pets. So any public place you're
going to be exposed to some dandard. Right, So I'll
just say you don't need to live in fear and
worry that it's going to necessarily working you because to
some degree the allerges themselves are unavoidable. So it's kind
of you know, our goal I think at least Michael
and I suspect this a like doctor O'Keefe as well
(30:04):
or Andy, is that you know, we're going to try
to improve your quality for right, Like oftentimes you're going
to have some symptoms, but we ideally want you to
be able to carry on with the things that you
want to do, whether that's hyping, having pets, doing whatever
you need to do.
Speaker 4 (30:19):
Kind of.
Speaker 2 (30:21):
Today we're learning all about allergens and how we can
navigate the summer as best we can even when the
air is full of grass and pollen. We'll be right
back after the break.
Speaker 1 (30:32):
You're listening to what we broadcast of the Wellness and
Healthy Lifestyle Show with Doctor Mike Wall. Listen live Thursday
nights at seven pm and Sunday's at four pm.
Speaker 2 (30:43):
Welcome back today, we're learning all about allergies and how
we can navigate the summer as best we can even
when the air is full of grass and pollen. Let's
get back to the show. So if you were to
give and I know you can't. Obviously, everybody's unique, Every
symptom is unique, every case is unique. But there's some
general advice to people listening. What would you tell the
average person on managing alleviating allergies.
Speaker 4 (31:04):
This time of year.
Speaker 6 (31:06):
Yeah, So typically when I chat with patients about environmental allergies,
I talk about it.
Speaker 4 (31:11):
It's like a threefold approach.
Speaker 6 (31:13):
So there's kind of avoidance, there's medication, and then there's
you know, therapy. So generally avoidance wise, like I said,
is minimizing your closure knowing that you can't one hundred
percent avoidant, right so from a Pallen its outdoors kind
of thing. So the main kind of avoidance thing you
can do is typically try to sleep with your windows
closed during pollen season, so whenever you're symptomatic, so that's
six eight hours when you're sleeping is kind of like
(31:35):
a time when you get a break. When you're awake,
you're going to be outdoors, and like I said, you're
not going to be able to avoid all that, all
the different explosion.
Speaker 4 (31:42):
We don't want you.
Speaker 6 (31:43):
We want you to be active, want you to do
all those different things. Depending on the severity pollen wise,
sometimes people are more sensitive if you have other skin
disorders like zeema and different things like that clothing if
you dry it outdoors, you can imagine see the pollen
on your car, you can see the pollen on your clothes,
and that'll make you itchy. Bully doesn't bother as much.
So if that's while there's something like you know, I
(32:03):
don't hand your clothes outside on high pollen days and such.
And it's not a perfect thing, but why I talked
a lot of patients about looking up like the Paullen counts,
so you can go like Paul on count out set
John's Toronto, wherever you are, and the weather network is
usually that first link and you can kind of get
a rough age of what's in the air and if
it's low, moderate, or high and kind of gauge your
(32:24):
activity there. So maybe I won't go for my twenty
k run that day. You know, if the holling caounts
are high, it's kind of.
Speaker 2 (32:31):
Like a UV rating, or even look at humidity or
anything like that wind chill in the winter, okay, after you. So,
one of the things is I think sometimes people may
confuse allergies with other symptoms. It could be a congestion,
or it could be a skin rash or something along
those lines. Can you walk me through some of the
signs and symptoms that somebody may actually have an allergy
not something else.
Speaker 4 (32:52):
Yeah, for sure.
Speaker 6 (32:54):
Kind of a couple of the symptoms that we look at.
We kind of categoricalize the different allergic diseases that we see.
So if you have a lot of the itchyis runinose, sneezing,
post nasal drip, you know, we definitely kind of think
about environmental allergies or allergic rhinitis. So kind of like
the upper air waste sort of things, sometimes during pollen
(33:14):
season and otherwise if you start to have like coughing, wheezing,
shortness of breath, exacerbations with viral infections or exercise, you
start to think about asthma and that aspect different rashes.
So typically there's kind of the two main rashes that
we see oftentimes are hives and then also exemo type rashes.
(33:35):
So I've typically they're smooth, very itchy, blotchy, it can
be a little bit raised sometimes kind of like welts,
whereas the exemo type rashes are typically rough, bumpy. Sometimes
there can be a little bit of oozing in secretions.
And then we think about exema in terms of the
exemo type rashes, and that can be kind of the
way your skin is, like called atopic dermatitis, or it
(33:57):
could be like contact triggers, so like sometimes people.
Speaker 4 (34:00):
React to like metals, creams, sun.
Speaker 6 (34:02):
Blocks, hair dyes, different things like that. And then in
terms of hives, there's a whole variety of different reasons
to get hives, which is one of the things that
we see a lot of. So one is probably the
most common that we see is something that was often
called idiopathic or like acute verticarias, so hives that we
don't really have a good reason, and a lot of
people might have experienced this, Like you know, you're stressed,
(34:22):
you have a deadline, you break down a couple of hives,
or or you have an infection, you break out in
a few hives. Sometimes you just have an itchy spot
and you look and there's a few hives, or like
something swollen and there's no clear cauds. And that's probably
the most frustrating but also one of the most common
things that we see from the HIGHS perspective. A small
proportion of hives are usually directly allergy related, right, so
(34:45):
typically they come in one of two flavors. So if
you're thinking antiphlactic galleries and everybody oftentimes thinks about antiflact
galleries when you think about hives, the typical triggers for
those are foods, medications, seeing insects. Typically, for those reac
actions to work, the allergen's got to get into your blood. Right,
So if you think about a food, a medication, a
stinging insect, food or medication, you're ingesting stinging, it's like
(35:09):
you're stinging gets into the bloodstream.
Speaker 4 (35:11):
Circulates.
Speaker 6 (35:12):
Once it circulates, moves around, and that's when you get
those systemic reactions, right, So reactions in multiple places what
you see in the movies kind of thing. Right, So, stomach,
you're vomiting, diarrhea, lungs, trouble breathing, heart and blood vessels, skin, hives,
and swelling reactions.
Speaker 4 (35:28):
Those ones are typically very fast, very reproduced.
Speaker 6 (35:31):
So and you think like peanut allergy, you know, reaction,
you know reaction, you know, reaction, very fast, very reproducible.
Speaker 4 (35:38):
Kind of thing.
Speaker 6 (35:38):
So oftentimes the all tail of that is that one,
like you can imagine there's a they're clearly patterned and
oftentimes like you know, I just ate that cookie that
had been out and like I had a reaction, it's
not as subtle and hidden kind of thing. So that's
one subset of hives that would be allergy pause. And
then the other one typically is when you're in contact
(35:59):
within it environmental allergen. So classic thing being like you know,
say someone cat allergic, a pedicat r rash, Touch your eye,
your eye.
Speaker 4 (36:08):
Swells up, Rub your lip, your lip swells up.
Speaker 6 (36:11):
Or save grass pollen allergy fresh cut grass. You sit
on it wherever you're in contact, you get like high swelling.
So one once again, allergy wise, if it's allergies driven,
hives typically very fast and very predictable. So you know,
you just bet the cat, you know, you just sound
on grass, and it's typically more than just the hives. Right, Yeah,
(36:31):
So you're close to a cat or pollen, you're sneezing,
your eyes are water, all that sort of thing. And then,
like I said, the anaflat galergies, you also get the
other symptoms like breathing, fainting, bombing in addition to the
hives kind of thing. Right, So, the the hive like aspect,
like I said, is a whole can of worms. And
then there's a lot of different rashes that are not
(36:51):
allergy at all that look like the hives but behave
differently and it's one of the things that we see
a lot of, and there's a big differential in terms
of considerations.
Speaker 2 (37:03):
That's the point though, That's why you're on the show,
is that we need to have experts. It's never ever
that simple, and I think that's one of the appreciations
we try to give to our listeners is that there
is obviously a tremendous amount of training that goes into
your specialty. But that's why we have experts like you
on here. So one of the things is you chose
this field for a reason. You're a physician. You get
to help people every single day. What's the most rewarding
(37:23):
part of your job as somebody who deals with this
area of medicine.
Speaker 4 (37:29):
Oh, that's a tough one. I think there's multiple parts.
I guess that I really love about my job.
Speaker 6 (37:38):
So I think from a personal level, I love diving
into the underlying mechanisms and understanding the path of physiology
of the different diseases and with the newer medications where
the different treatments are targeting, you know, and those pathways
are always expanding, and I find that very intellectually stimulating.
Speaker 4 (37:58):
From a clinical perspective, probably the.
Speaker 6 (38:01):
Most satisfying parts are with food allergies patients that are
able to outgrow or if it's uncertain and then we
do food challenges and are able to clear allergies. Changing
that quality of life for patients is very rewarding, right, So,
you know, they start off with typical you know, you
avoid it, it's life threatening, you could die. There's lots
of anxiety around it. And then seeing that transition if
(38:24):
you're able to, like in that minority, be able to
clear the allergy or roule it out, is like a
very satisfying part. And then I think the environmental allergies
I get a lot of joy from too, right, because
it's a very testable, treatable, satisfying kind of approach to things.
Like I said, from medications, fortunately, they're very safe. We
(38:45):
have a number of options, and if that doesn't do it,
then we have therapy, which is a little bit more
of a commitment. But also you see the difference in
those patients that start the allergy shots and it's night
and day. Obviously it doesn't work for everybody, but I
find that very rewarding and kind of that variety right
like kind of as we've touched upon, the good thing
about the specialty is there's a whole.
Speaker 4 (39:05):
Gamut of things.
Speaker 6 (39:07):
Then this is just the allergy part, there's also the
immunology part, right, so like your immune system and all
that aspect.
Speaker 4 (39:12):
I thinks, too that's great.
Speaker 2 (39:14):
Now there seems to you a very clear pass reaching
yourself and at doctor O'Keefe as well, and I really
appreciate you guys taking the time to get with your
busy clinic and spend some time helping all of us
understand something I didn't know much about it. Be honest, you,
I learned a lot during this episode and I always
love that. So thank you so much for joining us today.
Speaker 4 (39:32):
Yeah, no, it was great darting with you.
Speaker 2 (39:37):
Thank you to doctor O'Keefe and doctor you for joining
me today. We hope you found today's episode on allergies
helpful as we try to make the most out of
our summer. Understand the environmental allergens that affect us in
New Fland of Laborador is crucial for managing our symptoms
and enjoying the outdoors to the fullest. Remember, allergies can
be diverse and can impact each individual differently, So if
you suspect you might be dealing with allergies, don't hesitate
(39:59):
to speak to your medical team. Seeking out professional advice
can help you identify ologens, explort treatment options, and improve
your quality of life. We're really fortunate to have such
knowledgeable experts who share their insights with us on the show.
Their expertise allows us to navigate and gain valuable knowledge
that's important on different subjects. So if you have a
topic you want to learn more about. You can find
(40:19):
us on social media or email us at Wallshow at
vocm dot com and let us know what you want
to hear about. Well, thanks for tuning in today. I'm
your host, Doctor Mike Wall. We'll be back next week
with another episode of The Wall Show on your VOCM
Welcome to the Wellness and Healthy Lifestyle show on your VOCM. Now,
here's your host, doctor Mike Wall. Welcome to the show.
I'm your host, Doctor Mike Wall.
Speaker 2 (00:18):
Well, this is the season for barbecues, outdoor hikes, picnics,
and of course allergies. So today we're joined by doctor
Andrew O'Keefe and doctor David You, who are allergists from
the NL Allergy and Immunology Clinic in Saint John's. Together,
we'll explore the ins and outs of environmental and food
allergies and how they impact our daily lives and the
effective strategies we can use to manage them. We'll chat
(00:41):
about some common allergins during different seasons, ways to mitigate
their effects, and even some fascinating facts about how a
change in climate is influencing allergy patterns. Here in the province,
almost thirty percent of us grapple with allergies, so it's
something that either impacts us.
Speaker 3 (00:56):
Or someone we know.
Speaker 2 (00:57):
Let's start our show with our interview with doctor Andrew O'Keefe.
Hi Andy, Welcome to the show.
Speaker 3 (01:04):
Hi Mike, thanks for having me.
Speaker 2 (01:06):
It's a really timely topic right now. We're going to
be chatting about allergies today, and we're going to talk
specifically about Newfoundland and Labrador. But before we get into that,
can you tell me a little bit about yourself and
your clinic.
Speaker 4 (01:16):
Sure?
Speaker 3 (01:16):
Yeah, So I'm an allergist and clinical immunologist.
Speaker 5 (01:19):
I operate out of a community based practice in Saint John's, Newfoundland.
I was one of the first Sport certified allergists to
return to Newfoundland in twenty fourteen. So since then, I've
had two other allergists join me, doctor Khelia Farrell and
doctor David u And I understand you'll be speaking with
doctor you later. So now we have three of us
working here in Saint John's and we've been working to
(01:41):
promote excellence in the specialty of allergy since we came
to Newfoundland and helped to.
Speaker 3 (01:47):
Keep folks here in Saint John's and throughout the.
Speaker 5 (01:49):
Province healthy with respect to allergies, asthma and other sorts
of conditions that we treat.
Speaker 2 (01:56):
Okay, So, as a physician with a specialty looking at allergies,
what type of training do you have to go through?
Speaker 5 (02:02):
So an allergist is a physician who has completed medical school.
Obviously that's the first step and then has completed further
training either in internal medicine or pediatrics, so that training
can be either three or four years, and after that
it's at least another two years in training that's focused
specifically on allergy and clinical immunology. So that's an important distinction,
(02:24):
I think, because not everyone who does an allergy test
is an allergy doctor. So I think it's important for
folks to know who they're seeing and what their qualifications are,
because sometimes.
Speaker 3 (02:35):
These tests can be misused.
Speaker 5 (02:38):
The test itself is easy to perform, but it's not
always a great test, like we can see false positives
with it. So you want to use the appropriate test
for the appropriate person at the appropriate time, and we
want to give you the best advice that we can,
understanding the limitations of these tests to help you improve
your life. So when possible, my advice would be to
(02:59):
see a board sort of five allergists and we'll discuss
how to find one in a little bit.
Speaker 2 (03:04):
Yeah, that's definitely got to be a challenge, and it
is a specialty because it's not super easy to understand.
It's not the simplest of physiological processes how these happen
in the body and That's one of the things I
hope we can get down to today, is we can
tell people just how they work and who's susceptible to
these types of allergies. And I guess we should probably
just start off with the most basic, but it's probably
the most robust definition, and that is what actually are allergies.
Speaker 5 (03:30):
So the term allergy is used in a lot of
different ways by a lot of different people, and some
people I think would use the word allergy and reaction synonymously.
But when I'm talking about an allergy, I have a
very specific thing in mind, which is something different from
(03:50):
an intolerance or a sensitivity, or other types of non and.
Speaker 3 (03:55):
Une mediated reactions that people might have. So an allergy
is an.
Speaker 5 (03:59):
Immune mediated reaction against something that is foreign to your body.
And typically this foreign thing should be something that is benign,
so like protein from peanuts, for example, or pollen like
our bodies shouldn't have a bad reaction.
Speaker 3 (04:16):
To those things because they're not inherently dangerous to us.
But for whatever reason, the immune system goes off the.
Speaker 5 (04:21):
Rails and makes a reaction to one of those things,
which can result in different symptoms depending on what the
allergen is. So the symptoms of reaction to a food
allergen are quite different from reaction to an environmental allergen.
Speaker 2 (04:38):
Okay, so when these happen. Somebody in my family has
a very severe peanut allergy actually sort of one of
my best friends growing up, and they had to carry
like an epipin. So what actually happens when we get
to this stage of having these severe reactions.
Speaker 3 (04:50):
Yes, so we.
Speaker 5 (04:51):
Tend not to think about or I don't tend to
think about food allergies in terms of levels of severity,
like someone has a mild peanut allergy or a severe
peanut allergy, Because if you have a food allergy, which
is one of these immune mediated reactions to a food,
and the type of immune reaction is called IgE, any
of those could potentially be anaphylactic. And so we can't
(05:13):
necessarily predict how bad your reaction is going to be
with a skin test or with a blood test, and
you can have a milder reaction at one time and
then at a later time have a different reaction because
there are all these other factors that contribute to the
type of reaction that you could have at a given time.
So things like exercise, how active your immune system is
(05:35):
at a given time, So if you had a cold
or a flu, alcoholic consumption, use of medications like anti
inflammatory drugs can make these reactions worse. So there's lots
of different factors that can contribute to the severity of
a food reaction.
Speaker 3 (05:49):
So it's kind of a misnomer I think to think
of a.
Speaker 5 (05:52):
Food allergy as people ask me often like oh, why
am I anaphylactic to it? And if you have a
food allergy, you could potentially be anaphylac pick to it.
Now if you had a sensitivity or an intolerance like
lactose intolerance.
Speaker 3 (06:04):
Lactose intolerance is never life threatening.
Speaker 5 (06:07):
It can be really unpleasant, but it's not something you
need to carry a nepipens for.
Speaker 4 (06:11):
As an example.
Speaker 2 (06:12):
Ah, that's excellent. Okay, Well that's good because I think
there's a lot of clear to do this. And this
is one of the benefits of me doing this show
is that I get to learn things because it's not
something we're really taught about a lot. And it's also
something that can affect a lot of different people. What
populations can develop allergies and are there any common risk
factors among these people?
Speaker 5 (06:31):
So anyone can really develop allergies, and environmental allergies are
one of the most or rhinitis, we would say is
one of the most common chronic conditions experienced by people.
Speaker 3 (06:43):
So lots of folks do.
Speaker 5 (06:45):
Have allergies to things in their environment, so things like
dust mites or pets, or different types of pollen, and
we don't fully understand why some people develop allergies and
other people don't. There have been studies to show that
there is a components. So if you have a parent
who has some sort of allergic disorder, and that could
be something like asthma, exeema, a food allergy, or an
(07:08):
environmental allergy, then their.
Speaker 3 (07:10):
Children will be at higher risk.
Speaker 5 (07:12):
And if they have two parents who have those disorders
and they haven't even higher risk. So there is definitely
genetics playing a part there, but there are other factors
too in terms of exposure. So there are some interesting
studies done in Germany that looked at children who are.
Speaker 3 (07:25):
Raised on a farm and they're being exposed to.
Speaker 5 (07:28):
Different types of bacteria and infections, probably through that that
they might be less likely to develop allergies as they age,
versus children who are raised in a more urban center
without those same types of exposures in the burn might
be at higher risk to develop allergies, and other studies
have looked at you know, if you grow up with
a dog or.
Speaker 3 (07:46):
A cat at home, you might be less likely to
develop allergies.
Speaker 5 (07:50):
But there's lots of different puzzle pieces to this, so
we don't fully understand.
Speaker 1 (07:54):
It all yet.
Speaker 2 (07:55):
That's interesting. Yeah, I've always heard that some people's parents
clean more than others and they didn't play in the
dirt enough and that makes them sensitive. But it's nice
to know that there might be some link between the
aspects of the environment. Now when our body has this reaction.
You mentioned seasonal allergies, things like running noses and things
like hives in your skin or swelling in certain cases.
(08:15):
What's going on when some of these things occur when
we have this all reaction.
Speaker 5 (08:21):
So for an allergic reaction to occur, the protein that
you're reacting to has to get inside your body somehow,
so that could be through the mucous membrane. So for
environmental allergies, we think about the eyes, the lining of
the nose, and the lungs. So I'm allergic to dustmites,
for example, when I'm exposed to dust mites, and we
(08:43):
are all exposed to dust mite. Those symptoms could be
inflammation around the eyes, in the nose which causes itchy nose, sneezing,
running nose, and if I had asthma, that could cause inflammation.
Speaker 3 (08:52):
In my chest in my airways and make my asthma work.
Speaker 5 (08:56):
So what's happening there is that there's this protein coming
from outside. I am a susceptible individual because my immune
system has decided it's going to make this antibody IgE
against the dust MTE protein. So when those IgE molecules
are circulating throughout my body and they're getting attached to
(09:16):
different cells called mass cells inside the airways, they're kind
of all over, right, and so when those specific cells
meet up with the dust might protein, they cross link
and that sends a message down into the cell for
it to release all these different chemicals. So people have
(09:37):
often heard about antihistamines. So histamine is one of these chemicals,
but there's a whole bunch of others, and they cause
all these effects that result in the symptoms that we have.
So they dilate blood vessels, they recruit other inflammatory markers
around those sites, so you get all these effects of
inflammation around the sites where you were exposed to the
(09:58):
allergy and like the eyes, the nose ones.
Speaker 2 (10:01):
That's interesting. Okay, So this protein that normally doesn't have
an interaction with most people, if people are susceptible to it,
it turns on cells and starts to create process as
it would normally occur.
Speaker 4 (10:11):
I yeah, that's right.
Speaker 2 (10:12):
Okay, that makes sense. Okay, that's good because I've actually
got some allergies too. Can people grow out of allergies
or change or can it come more mild or more
severe over time?
Speaker 4 (10:21):
Yeah?
Speaker 3 (10:21):
And there are a lot of cofactors that can influence.
Speaker 5 (10:24):
You know, earlier we were discussing about different cofactors for
anaphylaxis that can make a reaction worse or better. There
are cofactors for environmental allergies too, So when someone says,
you know, I'm having an allergy, and maybe they're referring
to something going on in their nose and sinuses. Changes
in barometric pressure, in humidity, in air temperature can all
(10:44):
affect our nose and sinuses as well. So do viral
infections or bacterial infections of course too, So it's not
always just allergies that are contributing here, so they can
definitely change over time, they can change seasonally.
Speaker 3 (10:57):
Some people develop allergies as they go through life.
Speaker 5 (11:01):
Other people might lose them, and that's another bit of
the science that we don't necessarily understand, though we do
know that for many allergens that they require several exposures.
Speaker 3 (11:12):
That requires time before you develop an analogy to.
Speaker 2 (11:16):
Something that makes sense. Yeah, so you were allergs to shellfish,
but one day you're allergic to shellfish. Okay, yeah, and
for foods that.
Speaker 5 (11:23):
Like for foods, mostly we see children being affected with
food allergies more so than adults, but shellfish and tree
nuts would be two exceptions.
Speaker 4 (11:31):
Then.
Speaker 3 (11:32):
An interesting kind.
Speaker 5 (11:33):
Of bit about that is that the dust might protein
is quite similar to shellfish. So we think that's why
adults may be more likely to develop a shellfish allergy,
because they're getting they're sensitized to dust might and then
your body starts to recognize this other protein that looks
similar to the dust mighte as a problem. So it's
a little bit gross to think about, you know that
(11:53):
maybe our body thinks that shrimp and dust mites are
the same. But similarly for tree nuts, tree nuts have
a very similar kind of protein structure to birch pollen.
Speaker 3 (12:01):
So it's kind of like.
Speaker 5 (12:02):
This crosstalk that goes a little bit astray in terms
of our body is seen one thing as a problem,
to see something else that looks like it, it's like, no,
I don't like that either.
Speaker 2 (12:12):
Today we're learning all about allergens and how we can
navigate the summer as best we can even when the
air is full of grass and pollen. We'll be right
back after the break. Welcome back. Today we're learning all
about allergies and how we can navigate the summer as
best we can even when the air is full of
(12:33):
grass and pollen. Let's get back to the show. All
these different types of allergies you've sort of identified them
as like a food allergy and an environmental allergy. Are
there different categories do you guys use in a clinical setting?
Speaker 5 (12:47):
So yeah, in terms of the IgE mediated responses, so
those are IgE is the only thing that I would
call analogy. Anything else I would call a different type
of reaction. So in terms of IgE mediated reactions, those
things could be to foods, environmental things which you've discussed.
You can sometimes have IgE formation to medications to stinging
(13:10):
insects like wasps, bees.
Speaker 3 (13:13):
And hornets, and those will be the main ones.
Speaker 5 (13:15):
People don't tend to get IgE sensitization to chemicals. So
the idea of like scent allergy, A scent can be
an irritant, like anything you smell can be an irritant
and can give you the same symptoms that you would
have from exposure to an environmental allergy.
Speaker 3 (13:31):
But sense don't have.
Speaker 5 (13:32):
That same interaction with our immune system, so it's not
something that we can do like a scratch test for
on your skin for like perfume or for like cigarette
smoke for example.
Speaker 2 (13:43):
Well that's actually a perfect lead in to what I
was going to ask next, is that is the you
know what percentage of the population has different forms of
allergies and how do you actually assess that for somebody.
Somebody's thinking like maybe I do have an allergy and
I need to go get checked.
Speaker 5 (13:57):
Yeah, So the estimates for food allergy are about six
to eight percent of children and three to four percent
of adults that are affected by a food allergy. For
environmental allergies, I've seen some estimates.
Speaker 3 (14:09):
As high as thirty percent.
Speaker 5 (14:11):
So he said, this is a very common problem for
people to have, and it contributes hugely to people's.
Speaker 3 (14:17):
Quality of life.
Speaker 5 (14:18):
And there's a huge economic burden associated with that too,
So a lot of people will kind of downplay their
their symptoms or think that but something that they don't
need to get treated.
Speaker 3 (14:26):
Or they don't want to bother someone about it.
Speaker 5 (14:28):
But there's lots of things we can do to help
treat allergies, particularly environmental allergies, so it's always worth a
discussion if it's something that's having an effect on your life.
Speaker 2 (14:37):
Yeah, I've had seasonal allergies or different environmental allergies for
my whole life. So it's my mother and it's been
something that when I first got it, I was thinking
I had the flu or something. I felt really run down, tired,
headaches and things like that, and I've learned how to
control those over time. But if somebody's getting a test,
can you explain what you do when you're actually doing
this skin test, because we were chatting about that on
the plane today and my colleague said that he's solars
(14:58):
to cats when he did his arm just blue right up.
Speaker 5 (15:01):
Yeah, So when we do the allergy test, what we
do is we put a drop of the protein that
we want to assess for. So we have a mix
of dust mite proteins that we can kind of drop
on your skin, and then we really lightly scratch that
drop with a sterile lancet and that lets some of
(15:22):
this underneath the very top layer of your skin. So
if you have these pre formed antibodies, these IgE antibodies
pre formed against the dust might the cells in that
area are going to recognize it and they're going to
make a red welt like a little hive kind of
thing where we did the scratch test. So we do
the scratch, we wait for ten minutes, and then we
come back and assess to see if you've got a bump.
Speaker 3 (15:44):
There on your skin.
Speaker 2 (15:46):
That's interesting. Yeah, that would be a really interesting test.
I'm sure there's things that people have all these aha
moments where they never realized that they were alerged to something.
Here it's somebody like yourself, you know.
Speaker 5 (15:56):
It's pretty It's a pretty nice test because it gives
us results within ten to fifteen minutes. So it's nice
to be able to have that discussion with the patient
kind of like we get that in real time, we
get that information.
Speaker 2 (16:09):
Cool, excellent, that's interesting. Well, let's get into some of
the things that are specific here. What are some of
the primary environmental allergens we're going to see here in
Newfoundland and Labrador and we can maybe if it's easier
to go by season, then we would take it that way.
Speaker 5 (16:28):
Yeah, So in terms of environmental allergens, I tend to
think about indoor allergens, so dust might would be the
big one there.
Speaker 3 (16:35):
And dust mights are these.
Speaker 5 (16:35):
Little tiny creatures that live in They mostly like to
live in soft things. We get most of our exposure
through mattresses, pillows, things like that are betting because we obviously.
Speaker 3 (16:46):
Spend a lot of time in our bed.
Speaker 5 (16:47):
There's nothing you can do to get rid of dust
mites altogether, so it's not an issue of like friendliness
or anything like that.
Speaker 3 (16:53):
And dust mites are different.
Speaker 5 (16:54):
From like house dust, like those kind of fine particles
that you.
Speaker 3 (16:58):
See collecting on surfaces.
Speaker 5 (16:59):
So it's not something Okay, well, I'll just be really
diligent with my cleaning. That's not going to remove the
dust mites. And they would be probably the biggest exposure
for people because it's something you can't really control. Then
we also think if someone has pets at home, like.
Speaker 3 (17:11):
Cats or dogs that can be an issue.
Speaker 5 (17:13):
Feathers in bedding would be another indoor or perennial, year
round allergen.
Speaker 3 (17:19):
That people can be exposed to.
Speaker 5 (17:21):
In terms of seasonal allergens, we tend to think of
things like trees, grasses, weeds, and molds, so we can
react potentially to pollens from those different species of plants.
Trees would be the first things to pollinate, so in
Eastern Canada we typically see that between April and May.
Speaker 3 (17:40):
Then we go into grass pollen season where we are now,
which is typically June and July.
Speaker 5 (17:45):
Here in Newfoundland, we tend to have a shorter weed
pollen season because they pollenate kind of at the end,
so August and early September, and then once there's kind
of piles of decaying vegetation and things like that, then
we can see that the mold can be an issue
for some people.
Speaker 2 (18:00):
And you talked about the effects that can have. You said,
like there's a cost to it and the quality of
life issue. How debilitating can it be if somebody is
suffering from really bad allergies.
Speaker 5 (18:09):
So I have patients who tell me that they basically
can't go outdoors during the summer months, and so it's
been really satisfying to work with these patients and to
use some of the different therapies that we have to
help give them some more control over their symptoms so
they have better quality of life, they can participate more
fully in what they like to engage in. And the
(18:31):
flip side to that is sometimes people are using medications
like benadru which can have really bad effects that are
not recommended anymore. So there have been studies to show
that kids who suffer from allergies when they go to
write exams, compared to kids who did not have allergies,
were a full grade.
Speaker 3 (18:48):
Level like an A to a B below others.
Speaker 5 (18:52):
And the thought is probably that some of that was
contributed from some medications like benadryl, which have really nasty
kind of sedating side eye effects which can last even
until the next day. I was reading a tweet from
an allergius colleague who talked about an experiment They did
not them personally, but that was done maybe twenty twenty
five years ago, and they gave people either a non
(19:15):
drowsy antihistamine benadrill, which is a drowsy antihistamine, or some
alcohol and then they tested their reaction time in a
driving simulator and they found that the bena drill was
actually worse than alcohol for delayed reaction times and impairment.
Speaker 4 (19:32):
And it's interesting.
Speaker 2 (19:33):
So I knew that people used to use a lot
of benadrill in shift work settings to go to sleep
because of that drowsy thing, and so it just it's
kind of scary when you think about operating vehicles. Now
somebody's listening to this and they've learned a lot and
to thinking this could be me. I think I need
to seek some help or somebody they know could use
some advice. How can they reach out to you, guys?
Speaker 3 (19:52):
So in order for us to accept a patient, they
need to be referred to us. So we can accept
referrals from different types of health practic.
Speaker 5 (20:00):
And that's kind of a moving target these days, but
generally speaking, any physician, medical doctor could refer to us,
Nurse practitioners can refer to us, and sometimes dentists refer
to us as well.
Speaker 2 (20:11):
And there are there any resources that are out there
or associations or websites people could go to to get
some information for themselves if they don't have an opportunity
to get into see you guys.
Speaker 5 (20:21):
Yeah, with respect to food allergies, Food Allergy Canada is
a good resource, so folks could just google that if
someone is looking for an allergist in their area, that
they would like to speak with their primary care provider
about being referred to. The Canadian Society for Allergy and
Clinical Immunology or CSACI dot CA has a tool there
(20:43):
called find an Allergist, so you can look up in
your own locality and that's available all throughout Canada and
they can help direct you to a board certified allergist
who can hopefully help with your problem.
Speaker 2 (20:56):
Well, doctor Keith, thank you so much for joining me today.
I really appreciate it. I'm sure everybody listening got a
lot out of our conversation.
Speaker 4 (21:02):
Thanks.
Speaker 5 (21:03):
It was wonderful to be here and I hope everyone
can manage their allergies well throughout this grass pollen season.
Speaker 2 (21:10):
Today we're learning all about allergens and how we can
navigate the summer as best we can, even when the
air is full of grass and pollen. We'll be right
back after the break. Welcome back. Today we're learning all
about allergies and how we can navigate the summer as
best we can even when the air is full of
(21:31):
grass and pollen. Let's get back to the show. Hi,
doctor you welcome to the show.
Speaker 4 (21:37):
Hi, nice to be here.
Speaker 2 (21:39):
That's great to have you here. It's an important topic
because we have already talked to your colleague, doctor O'Keefe
and we were looking at the how and the what
of allergies. But now we're going to look a little
bit more at probably what people come into your office
to talk about on a day to day basis. That's
allergies here in New flann Laboratory. Can you give our
audience a bit of a background on yourself.
Speaker 4 (21:58):
Yeah, So originally born in Ontario.
Speaker 6 (22:01):
Then I met my lovely wife in school and once
we had kids, we moved back to the Rock, which
is where she's from, to be close to family. Other
than that, most of my training in Ontario, so like
my undergrad masters at Western in London, that's school and
Queens and Pediatrics in London, and then allergy immunology training
(22:25):
in Hamil Pandemic Master and then left Ontario live on
the Rock and the rest is history.
Speaker 2 (22:32):
Well that's a good move. Actually go there and get
that training and then bring it back here because you're
one of what only five allergists in the province.
Speaker 6 (22:39):
Right, Yeah, Yeah, there's like three of us here on
the east and then one in central one west.
Speaker 2 (22:45):
Yeah, well that's great. I'm glad we could get two
of you guys in one episode as well, because it's
really helpful information. Doctor keep is saying that allergy is
cand affect up to thirty percent of people when it's
talking about the environmental allergies, and we want to talk
a little bit about the ones that are out yours
this season in our region Newfland, Labordor. We have a
challenging environment and the best of times, but it can
(23:06):
also get challenging for people with allergies. What are the
primary allergic reactions or allergens you're having people come into
your clinic to talk about.
Speaker 6 (23:15):
Yeah, so like this time of the year definitely, Like
pollen season is kind of the big thing, right, So
come like March April, sometimes a bit later here, and
that's kind of one of the things, like pollen season
typically starts a little bit later here compared to the
rest of Canada. But you get the whole gamut of
eye symptoms, no symptoms, so itchyis running, no sneezing, running,
(23:37):
post nasal drip, snoring, all of that, and then stemming
from a lot of like the pollen symptoms, you can
also get some of like the cross reactive symptoms with
life fruits and vegetables and such like that. So kind
of that whole home mix of things.
Speaker 2 (23:52):
Yeah, it's funny because it's not just the environmental ollogens outside,
but there's also year long allergens inside that we're facing
in our own living environment, right.
Speaker 6 (24:03):
Yeah, definitely right, And those are particularly important too when
we're in heat waves and some of us are trying
to enjoy the sun, but at the same time we're
spending a good time indoors because you know, went.
Speaker 4 (24:11):
Overheat as well.
Speaker 6 (24:12):
So in terms of dust might, especially here in Newfoundland,
the dust mights are a very prominent allergy. And then
like pet danders as well, and those definitely play a
role all year round.
Speaker 2 (24:24):
If I was thinking about the ones outside, you see
commercials and you don't know if the commercials are actually
relevant to hear you, like it's rag weed season or
dandelions or whatever. What are some of the specific things
that people would be really triggered by and they kind
of change shout the season. I'm guessing as they grow
and shed their pollen whatever exactly. Yeah, so there's like
a typical.
Speaker 6 (24:44):
Like progression in terms of pollen, and this is kind
of like throughout Canada, but just like I said, the
timing's a little bit different. So typically treat pollen picks
up in the springtime, then grasp allen over the summer,
and then we pallen towards the end of the summer.
And then there's the mold spores, which are typically like
kind of early spring, but most prominently kind of like
end of summer in the fall, when everything's kind of
(25:06):
damp and wet, that sort of humidity aspect of things.
Speaker 2 (25:10):
It's funny talking to some people, I think that, you know,
I don't know if it was exceptionally bad this year
with all the rain, but a lot of people were
suffering with a lot of like it seems like allergic
symptoms because it was just so wet. You'd think that
is that actually causing mold and things like that's it
that can bother a restoic system.
Speaker 6 (25:26):
Yeah, so definitely, like the outdoor molds can kind of
fluctuate and typically like the damp, cooler kind of temperature.
So that's like when the freeze fall in the spring
and then in the fall when like the leaves and
that sort of thing, probably what a lot of people
suffering from. And this is kind of anecdotal, but historically
it seemed like Newfoundland had milder and shorter seasons, like
(25:47):
you know, it was kind of like the cooler climate
kind of thing. But you know, you've probably noticed in
the last few years the summers have definitely been hotter
and they're only getting hotter, right so, at least like
in the clinic in the last probably two three years,
definitely seen a lot more patients for more severe kind
of fallen symptoms as compared to the previous years. You know.
Speaker 2 (26:06):
And I think about it too, like you think about
the spring and even the following starts getting colder in
the summertime. If you're an outdoors person, you are in it,
Like you know, I hike these colost trail every opportunity
I get. Does it work like that, like if you're
actually closer to the potential allergen or is it just
so saturated in the air around us that it doesn't
really matter if we're like in it or not.
Speaker 4 (26:28):
Yeah, it's a good question.
Speaker 6 (26:30):
I think what you're maybe getting at is like if
I expose myself a lot to it, will I get
used to it, will kind of lessen my allergies kind
of thing. And I think there's kind of a couple
of parts to that. So one part is yes in
the sense that you can be sensitize yourself and like
kind of change your allergies. But that's usually when we
(26:51):
talk about allergy shots or ammuno therapy because you usually
use much higher doses to actually be sensitize yourself. So
like from a like objective allergy perspective, like you need
mega doses. What being outdoors is not enough, Like in
order to kind of insensitize, you retrain your immune system
aspect of things. And that's like allergy shots you continue
(27:12):
for three to five years to kind of like sa
retrain your immune system in terms of getting used to things. Definitely,
like as human beings, we definitely habituate to different symptoms, right,
So like lots of people with like cats and cat
allergies or us mites and like thus mites are all
year round or like you know, like it's bad at
the beginning of the pol season, but by the end
(27:34):
of it, you're kind of acclimatized to it, so you
get used to, like, I'm a little bit stuffy, a
little bit itchy, but that's kind of my baseline, and
you kind of get used to it and it's not
too bothersome, So there is truth to that, and like
kind of like the classic kind of story is oftentimes,
especially with like pet allergies, that you know, someone grown
up with a cat or dog, their entire lives, no problems.
(27:57):
They go off like on trip or school or work
or like on for a couple of weeks and then
come back and then all of a sudden they're like,
what's going on? Why do I suddenly like start reacting
to patents? Partly because like you know, when you're living
with the animal, say your your allergies are hovering at
say fifty percent all the time and like fluctuating forty
to sixty, you don't really notice it. You're a little
(28:18):
bit stuffy. But if you go away for a period
of time and you go from zero sixty, you definitely
notice that kind of change, right, So I think that's
the aspect in that regard.
Speaker 2 (28:27):
It sounds like being in a rock concert and not
realizing how loud is so you walk out the music's off. Yeah, exactly.
Speaker 4 (28:32):
That's a great analogy.
Speaker 2 (28:33):
Yeah, okay, cool, that's good. Okay, So somebody has allergies,
you don't say, oh your lyrics to grass, go cut
the lawn, it's going to make you better. It's probably
gonna make them worse. Okay. So I'm thinking if that's
the case, and somebody can't unless they've got special medical
treatment to be able to like again desensitize them to this,
is there is there conditions that can exacerbate it them.
So like you know, being and being mowing the lawn
(28:56):
or you know, being outdoors in the woods, does that
make it actually worse for people?
Speaker 6 (29:01):
There's not a like a one answer to that, I think,
like so as you probably can imagine, like there's a
whole range of severity from patient to patient, And when
you talk severity, it depends on objective symptoms as well
as perception of symptoms. Right, So someone might have a
running nose and it's the worst running nose in the world.
Speaker 4 (29:18):
Other people like running.
Speaker 6 (29:19):
Nose, But like I love my cotter dog and that's
totally fine. I love my hike in I'm just going
to do it and that's fine, right, So so that
part of it, and then I guess when we talk
about pollens, at the end of the day, there's no
avoiding these things, right, So whether it's dust mites, pets, pallen,
you're never going to one hundred percent avoid them, right, So,
like you can't avoid the outdoors. Dust mites are everywhere.
(29:43):
Even if you don't have pets. Half the people who
you can let have pets. So any public place you're
going to be exposed to some dandard. Right, So I'll
just say you don't need to live in fear and
worry that it's going to necessarily working you because to
some degree the allerges themselves are unavoidable. So it's kind
of you know, our goal I think at least Michael
and I suspect this a like doctor O'Keefe as well
(30:04):
or Andy, is that you know, we're going to try
to improve your quality for right, Like oftentimes you're going
to have some symptoms, but we ideally want you to
be able to carry on with the things that you
want to do, whether that's hyping, having pets, doing whatever
you need to do.
Speaker 4 (30:19):
Kind of.
Speaker 2 (30:21):
Today we're learning all about allergens and how we can
navigate the summer as best we can even when the
air is full of grass and pollen. We'll be right
back after the break.
Speaker 1 (30:32):
You're listening to what we broadcast of the Wellness and
Healthy Lifestyle Show with Doctor Mike Wall. Listen live Thursday
nights at seven pm and Sunday's at four pm.
Speaker 2 (30:43):
Welcome back today, we're learning all about allergies and how
we can navigate the summer as best we can even
when the air is full of grass and pollen. Let's
get back to the show. So if you were to
give and I know you can't. Obviously, everybody's unique, Every
symptom is unique, every case is unique. But there's some
general advice to people listening. What would you tell the
average person on managing alleviating allergies.
Speaker 4 (31:04):
This time of year.
Speaker 6 (31:06):
Yeah, So typically when I chat with patients about environmental allergies,
I talk about it.
Speaker 4 (31:11):
It's like a threefold approach.
Speaker 6 (31:13):
So there's kind of avoidance, there's medication, and then there's
you know, therapy. So generally avoidance wise, like I said,
is minimizing your closure knowing that you can't one hundred
percent avoidant, right so from a Pallen its outdoors kind
of thing. So the main kind of avoidance thing you
can do is typically try to sleep with your windows
closed during pollen season, so whenever you're symptomatic, so that's
six eight hours when you're sleeping is kind of like
(31:35):
a time when you get a break. When you're awake,
you're going to be outdoors, and like I said, you're
not going to be able to avoid all that, all
the different explosion.
Speaker 4 (31:42):
We don't want you.
Speaker 6 (31:43):
We want you to be active, want you to do
all those different things. Depending on the severity pollen wise,
sometimes people are more sensitive if you have other skin
disorders like zeema and different things like that clothing if
you dry it outdoors, you can imagine see the pollen
on your car, you can see the pollen on your clothes,
and that'll make you itchy. Bully doesn't bother as much.
So if that's while there's something like you know, I
(32:03):
don't hand your clothes outside on high pollen days and such.
And it's not a perfect thing, but why I talked
a lot of patients about looking up like the Paullen counts,
so you can go like Paul on count out set
John's Toronto, wherever you are, and the weather network is
usually that first link and you can kind of get
a rough age of what's in the air and if
it's low, moderate, or high and kind of gauge your
(32:24):
activity there. So maybe I won't go for my twenty
k run that day. You know, if the holling caounts
are high, it's kind of.
Speaker 2 (32:31):
Like a UV rating, or even look at humidity or
anything like that wind chill in the winter, okay, after you. So,
one of the things is I think sometimes people may
confuse allergies with other symptoms. It could be a congestion,
or it could be a skin rash or something along
those lines. Can you walk me through some of the
signs and symptoms that somebody may actually have an allergy
not something else.
Speaker 4 (32:52):
Yeah, for sure.
Speaker 6 (32:54):
Kind of a couple of the symptoms that we look at.
We kind of categoricalize the different allergic diseases that we see.
So if you have a lot of the itchyis runinose, sneezing,
post nasal drip, you know, we definitely kind of think
about environmental allergies or allergic rhinitis. So kind of like
the upper air waste sort of things, sometimes during pollen
(33:14):
season and otherwise if you start to have like coughing, wheezing,
shortness of breath, exacerbations with viral infections or exercise, you
start to think about asthma and that aspect different rashes.
So typically there's kind of the two main rashes that
we see oftentimes are hives and then also exemo type rashes.
(33:35):
So I've typically they're smooth, very itchy, blotchy, it can
be a little bit raised sometimes kind of like welts,
whereas the exemo type rashes are typically rough, bumpy. Sometimes
there can be a little bit of oozing in secretions.
And then we think about exema in terms of the
exemo type rashes, and that can be kind of the
way your skin is, like called atopic dermatitis, or it
(33:57):
could be like contact triggers, so like sometimes people.
Speaker 4 (34:00):
React to like metals, creams, sun.
Speaker 6 (34:02):
Blocks, hair dyes, different things like that. And then in
terms of hives, there's a whole variety of different reasons
to get hives, which is one of the things that
we see a lot of. So one is probably the
most common that we see is something that was often
called idiopathic or like acute verticarias, so hives that we
don't really have a good reason, and a lot of
people might have experienced this, Like you know, you're stressed,
(34:22):
you have a deadline, you break down a couple of hives,
or or you have an infection, you break out in
a few hives. Sometimes you just have an itchy spot
and you look and there's a few hives, or like
something swollen and there's no clear cauds. And that's probably
the most frustrating but also one of the most common
things that we see from the HIGHS perspective. A small
proportion of hives are usually directly allergy related, right, so
(34:45):
typically they come in one of two flavors. So if
you're thinking antiphlactic galleries and everybody oftentimes thinks about antiflact
galleries when you think about hives, the typical triggers for
those are foods, medications, seeing insects. Typically, for those reac
actions to work, the allergen's got to get into your blood. Right,
So if you think about a food, a medication, a
stinging insect, food or medication, you're ingesting stinging, it's like
(35:09):
you're stinging gets into the bloodstream.
Speaker 4 (35:11):
Circulates.
Speaker 6 (35:12):
Once it circulates, moves around, and that's when you get
those systemic reactions, right, So reactions in multiple places what
you see in the movies kind of thing. Right, So, stomach,
you're vomiting, diarrhea, lungs, trouble breathing, heart and blood vessels, skin, hives,
and swelling reactions.
Speaker 4 (35:28):
Those ones are typically very fast, very reproduced.
Speaker 6 (35:31):
So and you think like peanut allergy, you know, reaction,
you know reaction, you know, reaction, very fast, very reproducible.
Speaker 4 (35:38):
Kind of thing.
Speaker 6 (35:38):
So oftentimes the all tail of that is that one,
like you can imagine there's a they're clearly patterned and
oftentimes like you know, I just ate that cookie that
had been out and like I had a reaction, it's
not as subtle and hidden kind of thing. So that's
one subset of hives that would be allergy pause. And
then the other one typically is when you're in contact
(35:59):
within it environmental allergen. So classic thing being like you know,
say someone cat allergic, a pedicat r rash, Touch your eye,
your eye.
Speaker 4 (36:08):
Swells up, Rub your lip, your lip swells up.
Speaker 6 (36:11):
Or save grass pollen allergy fresh cut grass. You sit
on it wherever you're in contact, you get like high swelling.
So one once again, allergy wise, if it's allergies driven,
hives typically very fast and very predictable. So you know,
you just bet the cat, you know, you just sound
on grass, and it's typically more than just the hives. Right, Yeah,
(36:31):
So you're close to a cat or pollen, you're sneezing,
your eyes are water, all that sort of thing. And then,
like I said, the anaflat galergies, you also get the
other symptoms like breathing, fainting, bombing in addition to the
hives kind of thing. Right, So, the the hive like aspect,
like I said, is a whole can of worms. And
then there's a lot of different rashes that are not
(36:51):
allergy at all that look like the hives but behave
differently and it's one of the things that we see
a lot of, and there's a big differential in terms
of considerations.
Speaker 2 (37:03):
That's the point though, That's why you're on the show,
is that we need to have experts. It's never ever
that simple, and I think that's one of the appreciations
we try to give to our listeners is that there
is obviously a tremendous amount of training that goes into
your specialty. But that's why we have experts like you
on here. So one of the things is you chose
this field for a reason. You're a physician. You get
to help people every single day. What's the most rewarding
(37:23):
part of your job as somebody who deals with this
area of medicine.
Speaker 4 (37:29):
Oh, that's a tough one. I think there's multiple parts.
I guess that I really love about my job.
Speaker 6 (37:38):
So I think from a personal level, I love diving
into the underlying mechanisms and understanding the path of physiology
of the different diseases and with the newer medications where
the different treatments are targeting, you know, and those pathways
are always expanding, and I find that very intellectually stimulating.
Speaker 4 (37:58):
From a clinical perspective, probably the.
Speaker 6 (38:01):
Most satisfying parts are with food allergies patients that are
able to outgrow or if it's uncertain and then we
do food challenges and are able to clear allergies. Changing
that quality of life for patients is very rewarding, right, So,
you know, they start off with typical you know, you
avoid it, it's life threatening, you could die. There's lots
of anxiety around it. And then seeing that transition if
(38:24):
you're able to, like in that minority, be able to
clear the allergy or roule it out, is like a
very satisfying part. And then I think the environmental allergies
I get a lot of joy from too, right, because
it's a very testable, treatable, satisfying kind of approach to things.
Like I said, from medications, fortunately, they're very safe. We
(38:45):
have a number of options, and if that doesn't do it,
then we have therapy, which is a little bit more
of a commitment. But also you see the difference in
those patients that start the allergy shots and it's night
and day. Obviously it doesn't work for everybody, but I
find that very rewarding and kind of that variety right
like kind of as we've touched upon, the good thing
about the specialty is there's a whole.
Speaker 4 (39:05):
Gamut of things.
Speaker 6 (39:07):
Then this is just the allergy part, there's also the
immunology part, right, so like your immune system and all
that aspect.
Speaker 4 (39:12):
I thinks, too that's great.
Speaker 2 (39:14):
Now there seems to you a very clear pass reaching
yourself and at doctor O'Keefe as well, and I really
appreciate you guys taking the time to get with your
busy clinic and spend some time helping all of us
understand something I didn't know much about it. Be honest, you,
I learned a lot during this episode and I always
love that. So thank you so much for joining us today.
Speaker 4 (39:32):
Yeah, no, it was great darting with you.
Speaker 2 (39:37):
Thank you to doctor O'Keefe and doctor you for joining
me today. We hope you found today's episode on allergies
helpful as we try to make the most out of
our summer. Understand the environmental allergens that affect us in
New Fland of Laborador is crucial for managing our symptoms
and enjoying the outdoors to the fullest. Remember, allergies can
be diverse and can impact each individual differently, So if
you suspect you might be dealing with allergies, don't hesitate
(39:59):
to speak to your medical team. Seeking out professional advice
can help you identify ologens, explort treatment options, and improve
your quality of life. We're really fortunate to have such
knowledgeable experts who share their insights with us on the show.
Their expertise allows us to navigate and gain valuable knowledge
that's important on different subjects. So if you have a
topic you want to learn more about. You can find
(40:19):
us on social media or email us at Wallshow at
vocm dot com and let us know what you want
to hear about. Well, thanks for tuning in today. I'm
your host, Doctor Mike Wall. We'll be back next week
with another episode of The Wall Show on your VOCM
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