Podcast: Do I Have Allergies or a Cold?

Dr. Aaron Pearlman:  When you’re really, really stuffy, you may want to take a decongestant. The problem with taking decongestants is you can get the potential for what we call rebound rhinitis or rebound congestion. You actually can get more stuffy because you take the decongestant then had you not taken it.

Courtney:  Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

The temperatures are getting warmer and the trees are in bloom. Spring is here… and so is allergy season. If you’re congested, your eyes are itching and your nose is running. What can you do to ease these annoying symptoms? And how can you tell if it’s indeed allergies or actually something else, like a cold?

To answer these questions and more, we talked with Dr. Aaron Pearlman, an otolaryngologist with NewYork-Presbyterian and Weill Cornell Medicine. He walked us through the most common questions about allergies, discussed which medications are effective, and offered lifestyle tips that can help ease symptoms.

Courtney: Dr. Pearlman, thank you so much for being with us here today.

Dr. Aaron Pearlman: Thank you so much. It’s my pleasure to be here.

Courtney:  It’s allergy season. People are sneezing, stuffy noses, itchy eyes. How common are allergies?

Dr. Aaron Pearlman: Allergies are very common. It’s a very common problem. We all know people who have allergies. Probably about 25% of the population is allergic. An allergy is when your immune system mistakes something that’s normally not harmful to your body as something harmful and it creates an immune response and releases a bunch of different chemicals into the body that ultimately result in symptoms.

So a really common molecule I think that everybody’s familiar with is histamine, because one of the major treatments for allergies are antihistamines, right? They are drugs that are designed to fight this molecule, histamine, and block its effect on, which we think causes the symptoms, things like sneezing, itchy eyes, runny nose, swelling.

But allergy can be as serious as something as causing shortness of breath, swelling to the point of, could become fatal in very rare instances.

Courtney: And so what are the biggest culprits? I feel like we hear a lot about pollen, like what’s in the air that’s aggravating all this?

Dr. Aaron Pearlman: The biggest culprits are varied. Year round allergens like dust, mold, cat, dog. And then you also have things that are, like, chemical allergies, like drugs. People are allergic to anti, certain antibiotics. People can be allergic to food. People can be allergic to synthetic materials like latex.

Courtney: Right.

Dr. Aaron Pearlman: Allergies are seasonal for some people because they are allergic to certain things that bloom in that season, right? Like pollens, tree pollen, grass pollen, weed pollen.

So it’s springtime here in New York, and so it’s tree season and the tree blossoms are blooming, and if you’re allergic to the trees that we have in the Northeast, then this is your season to feel symptomatic.

Courtney: I remember one year going to see the cherry blossoms and then I had to go home and shower and change my clothes ’cause I could not stop sneezing.

Dr. Aaron Pearlman: Yes, that’s exactly right. So that pollen layers on your skin, on your clothes, and you bring that pollen inside with you. And now you sort of contaminated your home environment. So you did exactly the right thing, which is to bathe as quickly as possible, get the clothes off that have the pollen on them. You know, try to reduce the amount of allergen that you’re bringing into your environment.

Lifestyle modification is one of the most important things you can do to manage your allergies. You know, if it’s a particularly high pollen day and you’re a really bad allergic, it may not be the best day for you to go to the park.

Courtney: How do you know if it’s allergies or how do you know if you have a cold?

Dr. Aaron Pearlman: Number one thing I always say to somebody is, if you get this way every time during this season, it’s probably an allergy, right? So, if like, every spring you’re sneezing and stuffy and mucus-y and itchy, then you know this is most likely allergies.

But, if it’s not seasonal for you, then you very likely have a cold. And also colds have different symptoms than allergy. They also have body aches, chills, you can have fever with a cold. You’re not typically gonna get a fever with an allergic response.

Courtney: I wonder if you could just break down a little bit more, medications you can take.

Dr. Aaron Pearlman: Yeah, so you have antihistamines, you have nasal steroid sprays. Sometimes if it’s very severe, you can use a decongestant just so you feel better.

Some people have allergies that are so significant, they can cause something called anaphylaxis. And anaphylaxis is, like, a life-threatening condition where you get your bronchospasm, your throat can close, and if your allergy is that severe, you should be carrying an epinephrine pen with you at all times.

And ultimately you have allergy shots. Patients receive an injection once a week of what they’re allergic to, trying to build up their own natural immunity through the progression of the shots. And as you get further and further along in the therapy, you start spacing out those shots to every two weeks, once a month. We call that maintenance therapy. For those perennial allergens, that’s a pretty good thing for people to try if they’re really quite symptomatic, because this is the thing that may give you the longest lasting control with the least use of medications.

Courtney: And I’m wondering for seasonal allergies, is the advice similar?

Dr. Aaron Pearlman: Seasonal allergies is a little trickier because you can treat somebody through their season with oral medication or topical nasal medication. It now is, sometimes you may not get great control with medication, and so you might want to think about moving on to immunotherapy. Or sometimes they have such significant seasonal and perennial allergens, it also makes sense to include their seasonal allergens in their immunotherapy because you’re already doing shots for the perennial allergens like dust and mold.

Courtney: Is there any benefit to taking, like, over the counter medications for allergies, you know, a few weeks before the season begins, or even year round? Or is it something just kind of when the season starts?

Dr. Aaron Pearlman: It depends which over the counter allergy medicine we’re talking about.  Over the counter drugs like Zyrtec, Allegras, Claritin. These are antihistamines. Antihistamines work within 30 minutes of taking them. There, it’s an immediate acting medication. But something like a nasal corticosteroid, like a nasal spray, such as Flonase, you know, Rhinocort. These medications help decrease inflammation by using them over time. So in those cases, I do tell patients, let’s say you’re a grass allergic. So grass season is, you know, May, June, July, hat have you. So, April, you start using Flonase in preparation that when your season comes, hopefully you don’t have such a robust allergic response.

I’ll mention decongestants, they decongest you so you feel more open in your nose. And when you’re really, really stuffy, you may want to take a decongestant. The problem with taking decongestants for greater than a short period of time, and that could be as short as maybe three days, is you can get the potential for what we call rebound rhinitis or rebound congestion. You actually can get more stuffy because you take the decongestant then had you not taken it .

So you know, though I understand the impetus to want to take them, I would recommend strongly to try to avoid it. A lot of patients come on medications that are antihistamines that have a decongestant in them. I almost always try to have the patient not buy that product, to buy an antihistamine and buy a decongestant, and so that way they don’t take that decongestion every day. They only take it when they most need it.

Courtney: What about nasal rinses or saline sprays? Do those help?

Dr. Aaron Pearlman: Absolutely. I’m a big fan of saline rinsing for multiple types of inflammatory problems that can occur in your nose. It does a couple different things. Number one, it helps you mechanically remove the mucus and allergens that are sort of layering in your nose. When you breathe in these molecules, they’re sticky, these pollens, and they stick to the mucosa, and so they perpetuate the inflammatory response that’s occurring. And so by rinsing, you are mechanically removing them. And hopefully over time, if you do this day and day after day, you lower that inflammatory responsiveness that occurs in the nose.

And then when your nose is living in a chronically inflamed state, we know that the lining of the nose doesn’t work properly. And when you’re chronically inflamed, whether it’s from allergic inflammation or chronic sinus inflammation, your mucus is kind of stuck and static. Saline rinsing helps you move that mucus and has been shown to reestablish normal function over time.

Courtney: Are there some changes people could make to their habits that would help to manage allergy symptoms?

Dr. Aaron Pearlman: Well, number one, keep your environment clean, right? So if you have dust or mold allergy, wear a mask when you clean at home and clean frequently. Try to get rid of as many carpets as you can. You want to have dust covers on your pillows and on your mattress.

If it’s for seasonal allergies, it’s not a good time to leave your window open, right? Even though it feels great, the weather’s great and you want to have that fresh air, for you it may not be right. You may also benefit from air conditioning because air conditioning is gonna filter the air and take a lot of the pollutants outta the air. You might want to consider getting a air purifier. If you have a pretty significant amount of dust molecules flying around, try to get as much of that out of the air as you can.

You hinted to this earlier, which is like changing your clothes, taking a shower when you come home, trying to avoid touching your face until you wash your hands.

Courtney: Are there some things people experience that they might not realize are allergy symptoms?

Dr. Aaron Pearlman: Sometimes people don’t realize they have allergies at all. Some people come and they say they feel stuffy all the time, but so why would that be an allergy? Because I think a lot of people discount perennial allergens like dust and mold, right? Also, I’ll have patients come and see me and say, oh, well, I don’t think it’s allergy. I only have a dust allergy. And I try to explain to them that dust allergy is a really important allergen actually, because it’s with you all the time. You know, if you just touched your desktop and brushed the desktop, you’re gonna release dust into the air and you’re allergic to the mite that’s on that dust.

Mold too is also quite ubiquitous. It’s pretty much on every surface that we touch. And if you have a strong mold allergy, you’re gonna, you can be very reactive to that. So people who have perennial allergens really need to, most typically will initiate some sort of daily maintenance therapy to sort of control that allergic response.

Courtney: And so what are the kinds of allergy tests and what do they tell you if someone’s trying to figure out what they’re allergic to?

Dr. Aaron Pearlman: Right. So there’s two sort of workhorse tests for allergy. There’s blood testing, which we call in vitro testing. And then there’s in vivo testing, which means skin testing. Skin testing is probably a little bit more accurate than blood testing, but blood testing is still pretty good. And basically you’re looking at a panel of allergens that are common in the area where you live. But some allergens like dust and mold, those things are conserved over all environments. So those would be the same for all people.

Testing is important because you don’t wanna just throw a bunch of different medicines at somebody who doesn’t actually have that problem. Patients come in with years and years of antihistamine use and they may not test positive for any allergen, and they may not even feel much different when they don’t take an antihistamine. And so they’re putting themselves at risk of secondary side effects from those medications over time for something that they’re not actually treating appropriately.

Courtney: Is it possible to grow out of allergies? Like you had them when you were young and then you’re an adult and it doesn’t bother you anymore?

Dr. Aaron Pearlman: Well, it’s not impossible to grow out of allergies, but it might not be that likely, though It can happen. Your allergy profile can change every seven-ish years. It’s probably more likely, I guess, that you might develop new allergies.

Courtney: Okay.

Dr. Aaron Pearlman: One way of growing out of an allergy, maybe, with having had immunotherapy. So the whole purpose of immunotherapy is to make you less reactive to whatever you were allergic to. Maybe we could consider that growing out of an allergy.

The other thing I would say is sometimes people say, oh, I used to be very allergic, but now I’m not. But they moved from California to New York, right? So their exposure is different or vice versa. They never had allergies in California and here in New York they’re, like, miserable. You can develop allergy based on environment. You absolutely can develop allergies as an adult.

Courtney: So it sounds like if you have allergies, the best thing to do is maybe talk to your doctor to describe them, to try to figure out the best course of treatment for yourself.

Dr. Aaron Pearlman: Absolutely. It’s hard to figure this out on your own. And some of these medications are prescription only and like any medication, they all have a risk profile and a side effect profile, and you need to discuss that with your doctor and of course, understand what medications you’re already on. Over the counter medication has risks. Long-term use of antihistamines can predispose you to cardiac arrhythmia, which means abnormal heartbeat, so you have to think about these things when you’re taking them on a daily basis for months and months or years and years on end.

Courtney:  Dr. Pearlman, thank you so much for being with us here today and talking us through allergy season. This has been great guidance and it’s been so great having you.

Dr. Aaron Pearlman: Great. It was my pleasure to be here.  

 Courtney:  Our many thanks to Dr. Aaron Pearlman. I’m Courtney Allison.  

Health Matters is a production of NewYork-Presbyterian.  

The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Pearlman’s work with patients, check out the show notes!

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