Podcast: Why Allergies Happen and How to Find Relief

Dr. Gudis: The pollen isn't causing your nasal congestion. Your immune system's attack on that pollen is causing the nasal congestion, and the sneezing, and the itching, and the sleep disturbance, and the brain fog, and the difficulty concentrating. It's the immune system's overreaction that really is the problem. 

Courtney: Welcome to Health Matters, your bi-weekly dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison. This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at the letter H for hay fever or allergic rhinitis. If you're like me, you may have spent the last few weeks sneezing. To help, we spoke with Dr. David Gudis, otolaryngologist and chief of the division of rhinology and anterior skull base surgery at NewYork-Presbyterian and Columbia. He explains what causes allergies, their surprising effects, and how to manage our allergies this season and beyond. Dr. Gudis, thank you so much for joining us today. 

Dr. Gudis: Thank you for having me. 

Courtney: As someone who sneezes year-round, I'm very excited to dive into a conversation about allergy season. 

Dr. Gudis: You're not alone. 

Courtney: It doesn't seem like I am. So to start, what is hay fever, which I think is one of the more common allergies. Is that right? 

Dr. Gudis: Hay fever is sort of an antiquated term for what we would now call allergic rhinitis, or more commonly allergies. I presume because people used to think it was sort of like a fever or a cold related to plants or hay, which really is what allergic rhinitis is. And allergic rhinitis is basically an allergic reaction to something in the environment, and it's causing them symptoms that are similar to what people can experience if they're having a cold or an upper respiratory infection. 

Courtney: So sneezing, runny nose, itchy eyes, things like that? 

Dr. Gudis: Sneezing, nasal congestion, runny nose, itchy eyes, fatigue, sleep disturbance, even relationship to mental health. It's really a systemic inflammatory process, so even though most of the symptoms are localized to somebody's nose or their eyes or throat, the symptoms can really impact and affect numerous organ systems and somebody's overall wellbeing and quality of life. 

Courtney: That's fascinating that allergies can even affect mental health. I definitely wanna come back to that later in the conversation. Can you tell us what causes a person to have an allergic reaction? 

Dr. Gudis: The way to think about it is that allergies are an overreaction of the immune system, and the immune system is your body's way of fighting off things that are trying to attack you, like viruses or fungi or bacteria. Allergies are the immune system essentially misfiring and overreacting, and the most common example of that is hay fever. And, and essentially what happens is in the spring when plants and trees are blooming, there's lots of pollen in the air, the immune system sees that pollen as an attack, and it thinks that pollen is an external microbe, like some kind of germ that's trying to infect the body, and it responds with an extremely robust and vigorous inflammatory reaction to prevent or treat that infection, even though it's not an infection. Pollen is not hurting us. 

Courtney: It seems like a big overreaction to a flower. 

Dr. Gudis: Correct. Pollen or ragweed or pet dander or cockroach, whatever it is that someone's allergic to, the immune system sees that as a threat, and it fights hard, and it's the inflammatory response that causes our symptoms. The pollen isn't causing your nasal congestion. Your immune system's attack on that pollen is causing the nasal congestion, and the sneezing, and the itching, and the sleep disturbance, and the brain fog, and the difficulty concentrating. It's the immune system's overreaction that really is the problem. 

Courtney: So you mentioned pet dander, pollen, I think roaches. What are the most common types of allergens? 

Dr. Gudis: In this part of the world, spring allergies to tree pollen is definitely very common. Up to 20% of the population has some kind of environmental allergy in that regard. Pet dander, whether it's dog, cat, or any other pet, for example, those are common allergens. Cockroach fecal matter actually is a very common antigen, as is dust in urban environments. 

Courtney: I did not know that cockroach fecal matter was a common type of allergen. Thank you for that. So we hear people say that they feel like their allergies are getting worse. Can that be true? Can your own allergies get worse as you age? 

Dr. Gudis: Not only do allergies get worse as people get older, at least until young adulthood, but it's becoming more and more common among the population more broadly. Part of the reason that it gets worse as people get older is that in terms of allergies, the first exposure might trigger a little bit of a runny nose or a little bit of congestion that somebody might not even notice or think twice about, but after repeated exposure over the first, second, and then third allergy season, things tend to progressively worsen. The immune system becomes more and more effective at identifying and attacking this misinterpreted threat. 

Courtney: Can you develop allergies as an adult even if you've never had them before? 

Dr. Gudis: Absolutely, yeah, especially if there's a change in environment. I was an undergrad at Columbia, and I think it was my sophomore year living in a dorm in New York City. In one spring, I just got, like, a cold that would not go away, and it took me, like, a month to realize that it wasn't a cold, that I had actually developed allergies, which I had never had before, and that's a very common experience for people who move. When the environment changes over time, if there's something in the en- that environment that represents a trigger, then that can definitely result in allergies later in life. If someone makes it to age 30, 40, 50, and never had an allergic reaction before, they're not likely to develop environmental allergies. 

Courtney: So research has shown that on average, the pollen season is approximately three weeks longer now in the US than compared to 50 years ago. Can you talk about how allergy season is getting longer? 

Dr. Gudis: There's actually been a ton of evidence to show that allergy season is getting longer and getting worse, that allergy season is increasing in duration, meaning it lasts more weeks, two or three weeks longer than it used to, and that pollen concentrations are greater than they used to be. So for people who suffer from allergies, it's not their imagination that it seems to be worse this year than last year, or worse last year than the year before. These things really are happening. 

Courtney: And what are the other implications of allergies becoming more prominent and the season lasting longer? 

Dr. Gudis: Believe it or not, it's, it's the most common reason for reduced productivity in the workplace. It's an extraordinarily expensive problem for the US healthcare system to treat. About 20% of people, more or less, suffer from allergies. There's a lot of missed work and missed productivity as a result of allergies, and it tends to impact more severely patients of lower socioeconomic status, which can often be as a result of differences in environmental factors, and it impacts not only someone's individual physical symptoms, but their overall wellbeing and quality of life. 

Courtney: Is it possible that allergies are getting more common now because of how we're living today versus the past? 

Dr. Gudis: Our immune system is not well-engineered for the environment of 2026. Our bodies are just not well-equipped to deal with triple-washed and wrapped-in-plastic diets. And as a result, our immune system is not being exposed to the normal antigen, dirt, and germs that it needs in order to learn the difference between what's a threat and what's not a threat. The last 300 years of industrialization have dramatically shifted how we actually live. It's impossible for evolution to keep up with the rate of change in our environment.

Courtney: Yeah, that's interesting. And so you mentioned that allergies can impact our mental health. Can you describe some of those impacts? 

Dr. Gudis: When people have allergies, not only do they sleep worse, meaning their sleep architecture is disrupted, they don't get the same restful sleep for every hour of sleep that someone without allergies does. They're not able to sleep with the same duration because they're frequently waking up congested or stuffy or uncomfortable. And we know that sleep dysfunction has a strong association with mental health, specifically depression and anxiety. Sleep impacts your sense of smell because if your nose is stuffy, your sense of smell doesn't function as well, and your sense of smell is actually really important for your mental health. When people have a poor sense of smell, they report increased feelings of loneliness. And between sleep, olfaction, the fact that people have reduced memory and concentration, increasing symptoms of what people will refer to as brain fog or feeling out of it, all of these things significantly impact rates and incidence of anxiety and depression. 

Courtney: So what are the paths to relief for people? 

Dr. Gudis: First few very basic measures that I would definitely advise for anyone who suffers from allergies are, number one, avoidance. And this one's really hard because after a winter, especially like this year, as soon as it's nice out, everybody's gonna wanna be outside. Unfortunately, that's when pollen counts start to rise. You should probably do your best to keep your windows closed and an air conditioner on rather than the windows open in your home, especially your bedroom, where you spend many, many hours. When you come home from being out, shower and change because you're covered in pollen. It's in your hair, it's on your skin, it's on your clothes. And if you come home and get right into bed and roll around in your sheets all night, then you're just rolling around in your allergen all night. 

Courtney: Right. 

Dr. Gudis: Vacuuming often, a hardwood floor instead of a rug is definitely favorable. Air purifiers, those are really important. 

Courtney: And how about over-the-counter treatments? 

Dr. Gudis: There are extremely effective over-the-counter treatments, and the most effective thing somebody can do on their own is to use nasal sprays. The nasal steroid sprays are corticosteroids, and steroids are suppressive of the immune system. So if someone had allergies and they took lots of oral steroids at high doses, their allergies would completely disappear, but that's a very dangerous treatment. Nasal steroids, however, are very, very safe. It's extremely rare for people to have negative side effects beyond it tastes bad, or it made my nose feel kind of dry. And nasal antihistamine sprays are also extremely effective. I prescribe these medications all the time. When that's not enough, then using oral antihistamines on top of that is definitely worth doing. And if someone has allergies, they should start their treatment before allergy season gets bad. Once it gets bad, it's harder to treat, no question. 

Courtney: What if someone's tried all this and these measures really aren't helping? 

Dr. Gudis: When none of that stuff is enough, usually the next step is allergy testing and allergy treatment. And what that means is what's called immunotherapy or what people call allergy shots. The basic concept is that if someone is allergic to, say, dog dander, then their allergy shot, their immunotherapy, introduces them to increasing concentrations of what they're allergic to. And what this does is train a different part of your immune system, not the allergic part of the immune system, but a different part of your immune system, a different immunoglobulin, to start attacking that antigen. So now when I'm exposed to that dog, a different part of my immune system is attacking those things as it reaches my body before my allergic system can mount a defense. 

Courtney: I'd love to talk about the benefit of neti pots. I have found relief in a neti pot before. 

Dr. Gudis: Neti pots and sinus rinse bottles are fantastic. Neti pots actually go back thousands of years. The basic idea is to flush salt water in one nostril and out the other. It's rinsing out the nose of any allergens, dust, and debris that could be triggering an inflammatory response. It's actually a very, very common treatment for chronic rhinitis and chronic sinusitis and nasal polyps and allergic rhinitis, or it can even help people get over a regular viral cold, a regular common cold. 

Courtney: What are some other issues that patients come to you with? Are there other common problems or diagnoses that might overlap with allergies? 

Dr. Gudis: The first thing that can be a challenge, I think, for some patients is to understand whether they are having an allergic reaction or a cold or a sinus infection. All of those things can cause nasal congestion, increased nasal discharge, facial pain or pressure, fatigue, impact your sleep, impact your memory and attention, concentration. But there are a few key differences. If someone's having a regular viral upper respiratory infection, a regular cold, then by day three or four, they should be starting to improve, and by day seven or eight, they should be nearly back to normal. With allergies, especially if it's an environmental allergy because of something like pollen, you're not gonna be better by day three or four. That's gonna continue for a few weeks. When it's impacting the skin, the skin is a critical part of our immune system. That's what results in eczema or atopic dermatitis, allergic dermatitis, essentially. All of those things go hand-in-hand with the allergic reaction. Number two, fevers are often associated with a viral upper respiratory infection, fevers and body aches. Those are not common symptoms of environmental allergies. And then if someone's having s- like, a bacterial sinus infection, those symptoms tend not to manifest until after five to seven days of those initial symptoms of congestion, and that's when things would generally turn into facial pain and pressure and the nasal discharge changing from clear and watery stuff to very thick mucus coming out of the nose or a postnasal drip. 

Courtney: Dr. Gudis, you've really helped us understand our seasonal allergies and given us so many great tips about how to manage them. What are some final thoughts you have for people who are suffering from allergies? 

Dr. Gudis: It's real. You're not alone. You're not imagining that it's impacting your mood or your sleep or your overall wellbeing or your ability to concentrate or focus at school or at work. It affects lots of people, and it can impact your health and wellbeing in myriad of ways, but there are very effective treatments, and if the over-the-counter stuff doesn't work, then definitely see a doctor. There are lots of things we can do to help. We can make it better. 

Courtney: Dr. Gudis, thank you so much for joining us today and breaking down allergies. I learned so much from talking with you. 

Dr. Gudis: Thank you for having me. 

Courtney: Our many thanks to Dr. David Gudis. 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. Gudis's work with patients, check out the show notes. 

NewYork-Presbyterian is here to help you stay amazing at every stage of your life. Join us next time when we discuss inflammation and how it impacts the body. That's in two weeks right here on Health Matters. So you don't miss it, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.