Dealing with Spring and Summer Allergies with Mark Aronica, MD

Podcast Transcript

Speaker 1: There's so much health advice out there. Lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough, intimate health question so you get the answers you need. This is the Health Essentials podcast, brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput: Hi, and thank you for joining us for this episode of the Health Essentials podcast. My name is Kate Kaput, and I'll be your host. Today we're talking to allergist, Mark Aronica, about coping with spring and summer allergies. It's that time of year when eyes start watering and noses start running, but what's really happening? What are we actually allergic to? And most importantly, how can we get a handle on our allergies and just enjoy the season?

Kate Kaput: Dr. Aronica is here to talk us through everything we need to know about those dreaded spring and summer allergies. Dr. Aronica, thanks for joining us today.

Dr. Mark Aronica: Thanks for having me. I appreciate it.

Kate Kaput: I like to ask people to start by telling us a little bit about the work they do. Tell us about the work that you do and what kind of patients you typically see.

Dr. Mark Aronica: Sure. Well, I've been at the Cleveland Clinic for over 20 years now. When I started there, I did a lot of research. Some basic research in asthma. Started doing some clinical work, clinical research in asthma as well. Currently... I won't go through my whole history, but currently I'm about 50% clinical. So I see patients 50% of the time. The other half of my time is spent doing clinical research. We're involved in several multicenter trials, looking at various aspects of asthma and allergic asthma. And then I do some administrative and teaching work as well.

Kate Kaput: All right, let's dive right into seasonal allergies. And I want us to start with the basics. What are seasonal allergies? What's happening in our body when we're allergic to something in the environment around us?

Dr. Mark Aronica: Yeah. Allergies are something that many people are predisposed to. So not everybody will develop allergies, but if you have a predisposition, your body recognizes these pollens, these proteins that we inhale as foreign and they mount an immune response against them. It's not something that happens all the time and it takes a little time to develop. So typically during the first few pollen seasons, most people won't have any symptoms. Although if you're a child, you probably won't remember anyway, but over the course of time, your body starts making IgE, which is the antibody that causes allergy against these particular proteins. And then the next time you are exposed that will lead to the development of symptoms. So IgE circulates in our body, it binds to these cells called mass cells that sit in our mucus membranes and in our airways and in our skin. And when the IgE recognizes that protein, again, it degranulates these mass cells and leads to the symptoms that cause seasonal allergies.

Kate Kaput: And so does that mean that allergies can get worse as you get older? Do they level out at some point? Or how does that work?

Dr. Mark Aronica: Yeah. No, good question. It's tough to say everybody's different. Certainly there's a variety of factors that go into how somebody responds during allergy season. And some allergy seasons may be worse than others. The duration of the allergy season also plays a role on how bad someone symptoms are. As allergists, we usually tell our patients that sensitivities can certainly change with time. It's not a rapid change, but people can be allergic to some things one year and develop new sensitivities depending on where they are and what they're exposed to. So it can change with time. Some people get worse, some people get better. Some people stay about the same, it's quite variable.

Kate Kaput: Let's talk a little bit about some of those allergens. What are some of the most common causes of spring allergies and then also summer allergies?

Dr. Mark Aronica: Right? In the spring, the first thing to pollinate in spring time in Northeast Ohio are the trees. So tree season did start a little bit later this year than in some years in the past. So we're into tree season now. This goes on for a couple months and tree pollens start to decline. And then we pick up with grass season. So grasses are the next seasonal spring pollen to accumulate in the environment. And then that subsides a bit. And actually in the summertime, mid-summer we usually get a little break where there's not a lot of pollens around and then fall kicks in and then the weeds start pollinating. And then we can talk about fall pollen allergies some later date, perhaps.

Kate Kaput: A little bit of break in between, but basically things keep blooming. And so we keep being allergic to them.

Dr. Mark Aronica: Correct.

Kate Kaput: And what are the things... You've mentioned, tree pollen in the spring. What kinds of trees are people allergic to? Are there kinds of trees that are less allergic than others? What are the things that people are allergic to?

Dr. Mark Aronica: Yeah. No, that varies quite a bit too. So not everybody is allergic to everything. The ones we test to most around this area include trees like birch tree, maple, oak, willow tree, probably a couple others I'm missing. But those are the general more common tree allergies because they populate Northeast Ohio quite a bit.

Kate Kaput: That was one of my other questions how do allergens vary by region? And are there parts of the country or parts of the world where seasonal allergies are more and less common?

Dr. Mark Aronica: Yeah. It varies depending on the flora in the different area. So the Pacific Northwest is a little different than Northeast Ohio, as far as the trees that cause allergies. Western red cedar is a common allergen in other parts of the country, but not so common here because we don't have it. So we used to say, we're... I trained in a university town and a lot of people came in from different parts of the country. The first year or two as a freshman or sophomore at college people would tell me that their allergies went away and they did because they're in now exposed to new things that aren't where they were. They're not allergic to them yet, but many times as they stayed longer in the area, they would then develop sensitivities to the new trees or grasses in the area they are now living and develop allergies, one, two, three years down the road.

Kate Kaput: So you think you're getting a break, but really it's just that your body hasn't decided yet that it's allergic to the things where you are?

Dr. Mark Aronica: Sad but true.

Kate Kaput: Got it. Talk to us about some of the symptoms of spring and summer allergies, and especially any lesser known symptoms or things that we might not realize are symptoms.

Dr. Mark Aronica: Sure. The most common symptoms would include the itchy watery eyes, as you had already mentioned. Nasal congestion, runny nose, dripping nose, what we call rhinorrhea. Itchiness is a very common symptom associated with allergies. A lot of people will have congestion, but one of the things I always ask my patients is, does your nose itch? Does your eyes itch? And if they do then that suggestive more of an allergic phenotype than not. Some lesser known symptoms, fatigue is actually a very common symptom associated with allergic rhinitis. Sometimes under reported by patients. But we know in studies of children, for example, in school, if you treat their allergies, they tend to perform better. And part of that is probably treating the congestion, but also is getting rid of some of that fatigue. And the fatigue is probably brought on by disrupted sleep patterns because of all the congestion and runny nose and sneezing and things like that.

Kate Kaput: That makes sense. When you feel better, you perform better in all parts of life.

Dr. Mark Aronica: Exactly.

Kate Kaput: Do we have any sense of how common seasonal allergies are?

Dr. Mark Aronica: Yeah. Numbers vary a bit the data that's out there suggests that about 7% to 8% of the U.S. population has been diagnosed with hay fever. Worldwide it's probably a little bit larger 10% to 30% are estimated numbers, but a fair portion of patients have allergic rhinitis.

Kate Kaput: That's interesting. That seems like a surprisingly low number given... Especially here in Northeast Ohio, it seems like everybody's allergic to something, things start blooming and everybody's sneezing.

Dr. Mark Aronica: I would say that seems similar to my take on it as well. Having said that I do see a fair number of patients that come in with symptoms of congestion. And when we test them, they don't test positive to any environmental pollens. So not all runny noses are allergic. There are things called non-allergic rhinitis. What we call chronic non-allergic rhinitis, irritants can be big drivers of those symptoms as well. Dust particulates pollution can drive non-allergic rhinitis as well. So all runny noses are not allergic, but it's certainly fairly common.

Kate Kaput: And don't forget that you can be allergic to the indoors too. Like you said, it's not just exactly the things in bloom outside. It's the cats in your house or the dust in your vents, or... Right.

Dr. Mark Aronica: Exactly. Exactly.

Kate Kaput: And how severe can allergies get? It seems like they kind of run the spectrum. There are some people who are just sneezing here and then some people for whom it can be really debilitating. Is that right?

Dr. Mark Aronica: Right. The allergic rhinitis symptoms are somewhat subjective, but certainly some people suffer more than others. And again, why that is probably not as well understood. The testing we do doesn't tell us anything about severity. All it tells us is that you have the potential to react to those pollens, but the severity really depends on what you're exposed to and how much you're exposed to and what other factors might be contributing to your symptoms. But some people get so congested and have so many symptoms that it is very debilitating, hard to focus, hard to work, hard to get to sleep sometimes at night. So yes, it does play a big role on those.

Kate Kaput: I've been there. It can really feel like being sick. Sometimes when it gets really bad, it's like having a bad cold.

Dr. Mark Aronica: Exactly.

Kate Kaput: You mentioned testing. So tell us a little bit about how you can determine what you're most allergic to and what the process is of getting tested for allergies.

Dr. Mark Aronica: Allergy testing is relatively simple from my perspective. What we're looking for is whether or not you have IgE against that particular protein, the protein with which can cause allergies. So when we test, we essentially want people to be off antihistamines, because antihistamines are one of the few things that can interfere with our test. And then we just put the drops of antigen on your skin. We scratch through them, we wait about 15 minutes and then we look for a hive, a wheal and flare response on the skin. And that tells us if you have a sensitivity to that particular protein or antigen. Protein antigen means the same thing in this instance.

Kate Kaput: And so when you say you put it the antigen on your skin and you scratch through it, that's the tests where you get the pin prick that's... You're actually putting the thing that you might be allergic to on the skin. Correct?

Dr. Mark Aronica: Exactly.

Kate Kaput: And it's a fairly painless... I mean, I've done it before myself. It's a fairly painless process. Correct?

Dr. Mark Aronica: Right. It's relatively painless. If you are allergic to a lot of things though, you can have a kind of itchy skin for a while, so that can be problematic, but it only lasts a few hours in general. And usually we put a little medicine cream on there to help suppress the itchiness.

Kate Kaput: Got it. Yeah. I've heard people who are nervous about the pricking and it doesn't really hurt. Totally fine. And then it's like you said, you take a little bit of medication to make that allergic reaction go down and you're good to go. What do those tests typically test for? Or is it just seasonal allergies? Are there other things that you test for as well?

Dr. Mark Aronica: Yep. We test for year round allergens or what we call perennial allergens. And those include things like cats and dogs and dust mites, some of the molds, and then the seasonal allergies would be the grass, trees, weeds, and the pollens.

Kate Kaput: A little bit of everything. I know that you said you have a background also in asthma. What can you tell us about allergy induced asthma? What is that? What does it mean?

Dr. Mark Aronica: About 90% of children with asthma will have allergies. About 65% of adults with asthma will have allergies. Allergic asthma can get worse in when people are exposed to the allergens that make the... That trigger their asthma. So similar to what's happening in the nose, the same thing is happening in the airways in patients with allergic asthma. So you're inhaling the pollens, the proteins that cause allergy, the same thing that happens in the nose is happening in the lungs or airways. It can trigger an asthmatic attack or an asthma response. Interestingly, not everybody who has... Even in patients with multiple allergies, not all allergens will be necessarily a trigger for the asthma. As an example, I have a patient who worked at the clinic in the research side and was exposed to rodents, mice and was sensitive to mice. Also, had a cat and dog at home also was positive to grasses, trees and weeds.

Dr. Mark Aronica: When I saw her the first time her asthma was bad and we had to manage it and treat that pretty aggressively with medication. As an allergist, I usually don't anymore, but this was quite a while ago. And I said, "Well, maybe you should think about getting rid of your cat or dog." But obviously nobody wants to get rid of their pets. I don't do that anymore, anyway. Because I know nobody's going to get rid of their pets. But interestingly, when she left the research side of things and stopped working with mice, her asthma got much better. Her allergic rhinitis was still there. She still had allergy symptoms, but her asthma seemed to be driven more by the rodent exposure than it was to anything else that she was sensitive to. So sometimes even if people are poly sensitized, there may be one or two things that are actually triggering other aspects of their symptoms.

Kate Kaput: Let's talk a little bit about how you manage allergies. And I want to start by talking about nasal sprays. I'm told that nasal sprays are one of the best / only ways to actually try to prevent your seasonal allergies if you start using them early enough. So what can you tell us about nasal sprays, how they work, what they do?

Dr. Mark Aronica: Sure. Nasal sprays really are the best medical therapy. We have these ways to manage allergic rhinitis. There are two classes of medications right now: the nasal steroid sprays, many of which are over the counter. So fluticasone, which is Flonase®. Betamethasone, which I believe is Nasacort®. And then the antihistamine nose sprays, which are still prescription. And those include Azelastine and Patanase™, which is Olopatadine, which sometimes I have a tough time saying, but both are very effective. The benefit of the nasal steroid sprays is they are generally once a day in most instances, but they do take a little time to kick in and have benefits. So usually I tell my patients, at least two to three weeks before allergy season starts, you want to start up with your nose spray because of that time lag and efficacy. Also, technique is very important with the nose sprays. And so sometimes I see patients who come in and say, "Well, I tried this nose spray, but didn't work." And then we review technique, and a lot of times if we improve their technique, that will help.

Dr. Mark Aronica: The antihistamine nose sprays, the advantage of those is they do work a little bit quicker than the nasal steroid sprays, but generally they're twice a day medications. They should be used twice a day to get the maximum benefit. Having said all that, I always tell my patients, if you're getting benefit, there's nothing wrong with dropping the dose to find the lowest dose that keeps you under control. The lowest dose is always the best dose in managing symptoms.

Kate Kaput: And what is the difference between them or between what they do for you?

Dr. Mark Aronica: Even though you would think an antihistamine spray is only blocking histamine, really the studies on those nose sprays show that they do have anti-inflammatory properties as well. That is generally how the steroid sprays work. They're anti-inflammatory they block multiple pathways in the allergic phenotype. The responses that your body is making to cause those symptoms are blocked very effectively by the nasal steroid sprays. The antihistamine nasal sprays, not only block the histamine, but they're also anti-inflammatory to some degree and allergy at its root cause is an inflammatory disease of the upper respiratory tract.

Kate Kaput: Got it. So you mentioned that form in using them is pretty important. What can you tell us about how you are and are not supposed to use your nasal sprays?

Dr. Mark Aronica: Right. I think the biggest mistake people make is doing a big sniff when they use a spray. They stick it in the nose and they score it in. They're inhaling very hard. Really, if you suck the medicine to the back of your throat and it's swallowed, it's not doing anything for the nose or sinus. So you want as much of the medicine to stay in the nose as possible, and you don't want to squirt it into the midline of your nose either. So I always tell my patients [steer] away from the midline when you squirt it in, usually the pump action on the spray is enough to drive the spray into the nose and sinus. After you use it, you can take a gentle sniff, but you don't want taste it in the back of your throat. You don't want it dripping down the back of your throat. You don't want it dripping down the front of your nose. You want as much of that medicine to stay in the nose and sinus as possible.

Kate Kaput: So what can you tell us about other medication options? Let's start with over the counter and then if there are any prescription medications, we can go into those as well.

Dr. Mark Aronica: Sure. Antihistamines have always been moved over the counter quite a while ago. We tend to recommend the long-acting non-sedating antihistamine. So cetirizine, which is Zyrtec®. Loradine, which is Claritin® and fexofenadine, which is Allegra®. Benadryl, we shy away from because it is very short acting and it is very sedating. So it's not going to give you the same benefit as a long-acting, non-sedating antihistamine. And they're generally very safe to use even long term. I know the box says once a day. Occasionally I will tell my patients they can use them twice a day if they're having a lot of trouble or if they find them to be very beneficial. Not everybody will have a significant benefit with them, but sometimes they do add a little bit to symptom control in some patients.

Kate Kaput: Now some versions of these medications have like a - D at the end, right? Zyrtec-D®, Claritin-D®, what does that mean? And how do you know the difference between which one you need?

Dr. Mark Aronica: Right? The D essentially stands for decongestant. So there's the antihistamine plus an added decongestant. The decongestant generally pseudoephedrine, which is regulated to some degree. Most of the time you have to show your license to get them in Ohio. Decongestants can be very helpful in some patients because they're decongesting, right? They're constricting the blood vessels and the nose. They open up the airway a little bit more for some patients, but they do come with a higher degree of side effects. So they have a caffeine like effect. In many patients, they will increase the heart rate. They can elevate blood pressure in some patients. They should not be used on a very regular basis, unlike antihistamines, which can be used daily. Decongestants would probably be used more on an as-needed basis to cover tougher days, but certainly no longer than 10 to 14 days at a time.

Kate Kaput: They're really different medications. You shouldn't be on the decongestant every day. And is that going to be like a swap? Say you're having a really hard day or you're going somewhere where you're allergic to everything. Is it like you don't take your regular antihistamine that day and instead you take the decongestant or do you take both?

Dr. Mark Aronica: You can take both. And usually what I tell my patient from a cost effectiveness standpoint, if you buy Sudafed® by itself over the counter, you can still keep your antihistamine. The antihistamine decongestants tend to be pricey. So you have your antihistamine, if you feel like it offers benefit, and you want to take that daily, that's fine. If there are days when you're having a little bit more trouble and you need a decongestant, you can add that to your antihistamine on an as needed basis.

Kate Kaput: Got it. So you kind of mentioned this, but will any of these medications make you sleepy or keep you awake? Is there a best time of day to take them maybe especially the everyday ones, anything people should know there?

Dr. Mark Aronica: So Sudafed definitely in some patients has, as I mentioned, a caffeine-like effect. The reason they called long-acting non-sedating antihistamines is because generally they're non-sedating. Having said that of the three medications I mentioned Zyrtec, which is cetirizine, tends to have a little bit higher risk of sedation than the other two, followed by Claratin (loratadine). Allegra (fexofenadine) is the only long acting, non-sedating antihistamine that's actually approved for airline pilots because it is the least sedating of all three of those.

Kate Kaput: Interesting. Now, is there a way to determine which of the three is best for you? Do you just try them out, see whatever works or is there any way to tell where you should be starting?

Dr. Mark Aronica: Right. From my perspective, an antihistamine and is an antihistamine, right? They're all do the same job. They all block the same receptor. Having said that some patients come into my office and say, "Well, I tried X, but X doesn't work anymore. And Y works better for me." I'm not going to argue. I think that's fine. If it works better, then that's the medicine I'm going to tell you to use. So some people do notice differences sometimes with the antihistamine and if one works better for you than another, then I would stick with the one that works best.

Kate Kaput: Especially if you're an airline pilot with allergies.

Dr. Mark Aronica: Exactly.

Kate Kaput: All right. Let's see, you mentioned that you can take the regular... the antihistamines daily and that the decongestants shouldn't be taken in the long term. Are the antihistamines OK to take in the long term? I mean, if you have year round allergies, can that be part of your daily medication repertoire? Or do you need to take a break now and then?

Dr. Mark Aronica: Right. In general, again, I recommend the nasal sprays as a more regular use, sometimes adding an antihistamine on top of that. Having said that if you felt benefit from the oral antihistamines, then there really is nothing wrong with taking them on a daily, regular basis.

Kate Kaput: OK.

Dr. Mark Aronica: Long term studies on these medications have shown the safety and efficacy even for years of use. So they are generally safe, hence the move towards moving many of these to the over the counter realm.

Kate Kaput: Got it. Now, talk to us a little bit about home remedies for dealing with allergies. Is there anything that works? Is there anything that especially doesn't work? What should we be on the lookout for? What can you tell us?

Dr. Mark Aronica: Right. No, it's not always easy, but the simplest and the very first step for any asthma or allergy management program is avoidance, right? Avoid the triggers if you can. Obviously it's difficult to avoid some things and some are easier than others, but avoidance is always the first step in managing any allergy. After that, it's a little bit more difficult. So some of my patients respond and do very well with nasal lavages. Just saline lavage into the sinus clearing out the palms that accumulate during the day. Clearing out the sinuses that provides a non-medical treatment for further symptoms. Other than that, I think it's somewhat hit and miss. Some patients tell me some things work better for them than others. Again, I'm not critical if they find some non-medical therapy that helps them as long as it's safe and they're doing it appropriately.

Kate Kaput: So when might allergy shots be the right move and what does that entail?

Dr. Mark Aronica: Right? Allergy shots are generally our third step in managing patients. First step avoidance, second step medical management. Third step would be the consideration for allergy shots or allergy immunotherapy sometimes called SCIT, S-C-I-T subcutaneous immunotherapy. Allergy shots are a personal preference. Some patients come in and say I don't want to take a lot of medications and I'd rather go on allergy shots. And obviously that's an option too. Some people aren't responding well to medical management. And then we would consider the use of allergy immunotherapy to manage their symptoms. It's not a quick fix for allergies, and it's not a cure for allergies. Unfortunately, we don't have any cures for allergies. When we start shots, we are giving you something you're allergic to, right? So there is a risk of having a systemic whole body anaphylactic reaction. So we start at a very low dose and gradually increase.

Dr. Mark Aronica: Sometimes patient symptoms will get worse early on in allergy immunotherapy until their body gets used to the shots. But generally I tell my patients about six months before they will notice some benefit with immunotherapy. The duration of therapy is we... Guidelines recommend about three to five years of therapy with allergy shots. So early on, we ask our patients to come in once a week. They have to wait for 30 minutes after the injection because of that risk of a systemic reaction. So it's a fair time commitment. Once they get to a maintenance dose, then they generally come in every four weeks. So about once a month.

Dr. Mark Aronica: And then as I said for about three to five years, we do know that if you derive benefit from allergy shots, and if you can stay on it for three to five years, many patients anywhere from in the neighborhood of 60% to 80% of patients, when they come off shots will have sustained benefit, meaning the benefit they obtained while they were on immunotherapy, whether it be reduction in medications, reduction in symptoms during pollen season and reduction in symptoms during an exposure will often be maintained for several years or longer after they come off shots. 

Dr. Mark Aronica: So it can have a long lasting benefit for patients as well, which is one of the advantages.

Kate Kaput: So it can't cure them, but it can mitigate them for quite a while.

Dr. Mark Aronica: Exactly.

Kate Kaput: And then do you ever hear from people who need to do them again? They come back many years later and they say, "I used to do allergy shots. They worked great time to try it another time."

Dr. Mark Aronica: Definitely. In those cases we would retest because sensitivities do change with time, but also we know that people who are on allergy shots may lose some sensitivity to some other allergens. And so we retest so that we are making sure that when we put them back on shots, we're putting them back on something they are still sensitive to, or perhaps have developed a new sensitivity to.

Kate Kaput: Got it. I know that we said there's no real way to prevent allergies, except that you can start using the nasal spray while in advance to give yourself a little bit of build up. Are there any other things that can do to mitigate allergies impact on you during the spring and summer?

Dr. Mark Aronica: Right. Getting back to the avoidance side of things, typically spring, what I tell my patients for the spring is I know, especially in Northeast Ohio, it's nice to open windows and then things when the weather breaks, but people with allergies probably do better if they keep their windows and doors closed during the spring pollen season running the air conditioner heat is much, much better than, than letting the pollens inside the house. If you're out for an extended period of time, when you do come in, just washing off, rinsing your face washing, if you can change your clothes. Obviously, not everybody's going to change their clothes three or four times a day, but if you're out hiking or something like that, and out in the outdoors for a long time come in and change your clothes that gets rid of the pollens to accumulate on your body clothing, face hair, things like that while you're outdoors.

Dr. Mark Aronica: So those are some of the smaller, easier things to do to limit your exposure during pollen season. And I will say that given what's happened in the last couple years with COVID and I was a little reluctant to bring up COVID in an allergic rhinitis interview, but people wore masks. And a lot of my allergy patients did feel some symptomatic improvement from wearing their mask. Obviously, if you're not inhaling the pollens, then you're not going to be asymptomatic. Some of my patients feel that wearing the mask has helped them and will continue to do so for again, out hiking, extended period of time mowing the lawn, things like that certainly can be of some benefit for those patients as well.

Kate Kaput: So your mask can really do double duty keeping everything out.

Dr. Mark Aronica: Exactly. Exactly.

Kate Kaput: And what about bathing pets? I've also heard... Can pets, can dogs bring allergens into your house?

Dr. Mark Aronica: Certainly possible. I mean, dogs and cats obviously can cause their own allergies just from the dander that they release, but also if they're out for extended period of time, they can bring in outdoor pollens to the inside as well. So that's harder because not all pets like to be bathed frequently. So it does become a little bit more difficult. If you have a pet that loves being bathed then great. There is an interesting study many years back, I forget the exact date now, but where they looked at bathing cats and they found it did help because the cat actually ran away from home. If it was bathed too frequently, at least in this particular study. But not all studies showed the same thing.

Kate Kaput: As someone who's tried to give my cat a bath. I don't know that I recommend that.

Dr. Mark Aronica: Exactly.

Kate Kaput: What about humidifiers, air filters in your home? Can anything like that help?

Dr. Mark Aronica: Again, for indoor allergens, dust mites in particular, frequent vacuuming and dusting can be helpful. Washing sheets frequently in hot water, using a vacuum. Most vacuums nowadays are canister vacs. They don't have the old bag like my grandmother did where you turn on the vacuum and a big puff of dust came out of it. But frequent vacuuming can help both from an indoor allergy standpoint, but also for the pollens that might accumulate indoors during that time. Changing your furnace filters frequently, or as recommended is always appropriate. I don't usually recommend humidifiers for my patients largely because things like dust mites and mold thrive and higher humidity. So if you're raising the humidity level indoors that might increase some of those allergens as well. And so we have to be a little bit more cautious about that.

Kate Kaput: OK.

Dr. Mark Aronica: Again, if my patient tells me, "I have a humidifier and it works for me,” again, I'm fine with that. And I just make sure they clean it appropriately and regularly and prevent any other problems from developing because of it as well.

Kate Kaput: Got it. Especially if you have indoor allergies and outdoor allergies and you're keeping your windows closed to deal with the outdoor allergies, then you got to do some things to make sure you're taking care of your indoor allergies as well. So that makes sense. Dr. Aronica, is there anything that we haven't discussed today that's important for people to know or to understand about seasonal allergies?

Dr. Mark Aronica: No, I think we covered it pretty thoroughly from my perspective I'm happy with the discussion we had. I guess I would just reiterate not all runny nose is allergy. If I could predict who has allergies that would... I would love to do that. I like to think I'm better than 50/50 at predicting allergies in my patients, but I'm probably close to 50/50, but that's why we have the testing to evaluate that. There are very good treatments for non-allergic rhinitis as well. So whether it's allergic or non-allergic, we have management strategies available for both. So that's the good thing.

Kate Kaput: So at the end of the day, if you're having some of these symptoms, go get checked out, see what it is and so that you know how to deal with it.

Dr. Mark Aronica: Right. I think the advantage of testing is just finding out what you're... knowing what you're allergic to. Right. If you have an idea of what you're sensitive to, then it's a little bit easier to avoid those things.

Kate Kaput: Yeah, absolutely. As someone with all kinds of allergies myself, it's helpful just to know so that you can try to avoid it or at least see it coming. And you're not blindsided by random allergies at times that you didn't expect them. All right, Dr. Aronica, thank you so much for being here with us today. And for speaking with us on this really helpful topic, to learn more about springtime allergies, please visit www.clevelandclinic.org/respiratory. Thanks for being here with us today.

Speaker 1: Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's to make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. You can also follow us on Facebook, Twitter, and Instagram for the latest health tips, news and information.