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--:-- Host: I've had allergies my whole life. When trees grow, they produce pollen. Allergies suck. Hey, I'm John Glenn Hill, and you're listening to Explain It To Me, the podcast where we answer the questions that matter most to you. A couple weeks ago, we asked to hear about your allergy struggles, and we found out a lot of you have them.
--:-- Host: Hi, my name is Melanie Pazdell. I'm from Chicago, Illinois. Growing up, I didn't really suffer from seasonal allergies, but I feel like in the past couple of years, particularly since the pandemic, my seasonal allergies have gotten really bad.
--:-- Host: Hi, my name is Dorian. I happen to know JQ, the host. Allergies have been the bane of my existence since I was a little girl, and the spring is my least favorite season because of them. Thank you.
--:-- Host: Hi, my name is Trey, and I've had allergies my whole life. Allergies suck. I'm plagued by them myself. As the weather gets warmer, there's this fine gold dust that settles on everything, and that's when the sneezing really begins. And it makes sense. One in five kids are allergic to pollen, and about a quarter of all adults are too.
--:-- Host: We're going to talk about how to make them better, but before we can work that out, We need to understand where they come from. So I reached out to Nilu Tumala. She's an ear, nose, and throat surgeon at NYU Langone Health.
--:-- Nilu Tumala: So right now, the most predominant pollen that we're dealing with is tree pollen. And so when trees grow, they produce pollen. And a lot of times these pollen, the pollen is dispersed, especially early in the mornings. And when certain individuals, not everyone, but unfortunately, when certain individuals breathe in this pollen, it triggers an immune response inside their bodies.
--:-- Nilu Tumala: And so with this immune response, you get this cascade of inflammatory reactions. And so basically certain cells inside the body are activated, and then they release all of these inflammatory markers, including histamine. And then this causes a whole bunch of different symptoms. And from a nasal standpoint, the main symptoms that this causes is nasal congestion. So it's harder to breathe through your nose. It causes sneezing and it causes a ton of like nasal drainage and mucus production.
--:-- Nilu Tumala: Is allergy season now different from how it has been in the past? The allergy season has changed over the years. And there's a couple of reasons for that. And one of the reasons that I think is really important is climate change. So over the past 30 to 50 years, as the environment has gotten warmer, as precipitation patterns have changed, the data also shows that the pollen allergy season has changed as well.
--:-- Nilu Tumala: But basically over the past like 30 to 50 years or so the pollen season is about three weeks longer and this there's slight variation depending on what region you're looking at in the U.S. and there's about 20 percent more pollen in the air. So with warmer temperatures starting earlier in the year the ground thaws and trees are able to grow earlier in the year.
--:-- Nilu Tumala: In the fall because it doesn't get as cold as fast and the ground doesn't freeze as quickly ragweed pollen sticks around longer than it used to. And so that's why on average, we're seeing this lengthening both because there's an earlier start to the pollen allergy season and the pollen allergy season is lasting longer into the fall.
--:-- Nilu Tumala: Okay. So this makes something in my life make sense because it'll be fall and I'm like, oh, is this a cold? Is it flu? And then I test negative for that, but I take allergy medication and I feel better. And I'm like, oh, that explains that.
--:-- Nilu Tumala: Should we expect seasonal allergies to just continue to get worse as climate change keeps going? So there have been studies that have tried to look at future projections of how the pollen allergy season will continue to vary and continue to change if global warming continues unmitigated.
--:-- Nilu Tumala: And the data does show that there is concern that the pollen allergy season will continue to lengthen and that there will continue to be more pollen in the atmosphere as carbon dioxide levels, one of the main greenhouse gases contributing to climate change, increases.
--:-- Nilu Tumala: Yeah, I want to get into impact now. What are the most common complaints you hear from your patients when it comes to seasonal allergies? Whenever the trees start blooming like now, the bugs start coming out. I am just stuffed up like crazy.
--:-- Nilu Tumala: It's really heartbreaking to now be an adult with seasonal allergies because I never had them growing up. And I feel like I can't go through the summer now without like having Zyrtex or Benadryl by my side because I'm so stuffed up all the time.
--:-- Nilu Tumala: I woke up one morning with a really bad headache. It almost felt like the flu. Like my head was really heavy. My eyes were itchy. My ears were itchy. But also I felt it in my body. Then I went to the doctor and they're like, yeah, that's cedar fever. You have seasonal allergies. And ever since then, I've been dealing with seasonal allergies for over 10 years.
--:-- Nilu Tumala: So there's a couple of symptoms I hear very commonly from patients. And the big one is I can't breathe through my nose. And I always feel like my nose is dripping or I always have to blow my nose. And of course, there's just the constant feeling that you have to sneeze or constantly actually sneezing.
--:-- Nilu Tumala: And so what I hear a lot from my patients is the specific symptoms that are secondary to allergic rhinitis, which is the nasal allergy symptoms. And so the three main symptoms there are nasal congestion, difficulty breathing through the nose, increased mucus production. So it's like post-nasal drip or constantly having to blow your nose and then sneezing.
--:-- Nilu Tumala: But then a secondary concern that I hear a lot from my patients is I can't sleep well at night, right? The fact I'm not breathing well through my nose, it's impacting my sleep quality. And then also I don't feel like I'm paying attention as well during the day, right? And this is actually a huge concern in children as well.
--:-- Nilu Tumala: Studies have shown that kids who have allergies whether it to pollen mold dust animal dander they also are not doing as well in school in certain studies because they impacted by their allergy symptoms And so that impacts their ability to pay attention during the school day.
--:-- Nilu Tumala: Are there more serious side effects to allergies? So basically, when you're introduced to these allergens, and we're talking about pollen here specifically, and it creates this immune reaction in the body that then causes this cascade of the inflammatory reaction, that can increase your risk of having an asthma attack, which is a huge respiratory concern and definitely is a major driver of people having to go to the emergency department to be able to protect their breathing.
--:-- Nilu Tumala: Is there anything you want our listeners to know before we let you go, anything we haven't touched on? There's a lot of different ways that climate change is impacting allergies beyond just pollen allergies. One of the other things that we're seeing is the increased risk of mold exposure with worsening natural disasters in the face of climate change.
--:-- Nilu Tumala: And so we're seeing intensified hurricanes and flooding events, and all of this water is increasing the risk of mold exposure and mold growth in the homes. And so that's another really common allergen that we really need to be conscientious of and we're definitely concerned about from a healthcare perspective of how people's allergies are getting worse in the face of climate change.
--:-- Host: Okay, that's outdoor allergies. So maybe you've thought of a solution. Why don't I stay inside all spring to avoid the pollen? I don't have to touch grass, but what if it's coming for you inside too? That's after the break.
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--:-- Host: Support for Today Explained comes from Built Rewards. These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars. But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head. Not anymore, says Built Rewards.
--:-- Built Rewards: Built Rewards says it lets you earn points on your rent. By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more.
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--:-- Built Rewards: When you're ready to travel, they say BILT points can be converted to miles or hotel points all around the world. You can earn points on rent and around your neighborhood wherever you call home by joining BILT.com slash explained.
--:-- Host: That's J-O-I-N-B-I-L-T dot com slash explained.
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--:-- Host: Explain It To Me is back. And unfortunately, so are your allergies. And the worst of it is, you can't escape them inside. Enter Joseph Allen. He's the director of Harvard's Healthy Buildings program.
--:-- Joseph Allen: The majority of outdoor air pollution you breathe happens indoors. I think most people think that's wild and maybe inaccurate, but it's not. And the reason is this. We spend 90% of our time indoors. Outdoor air pollution, like pollen and other allergens, comes inside. And you're breathing most of your breaths each day indoors.
--:-- Joseph Allen: The first thing we have to think about is outdoor air pollution coming inside. And then we have indoor sources of air pollution. When you cook, that releases particles in the air. When you use surface cleaners, that's releasing chemicals into the air. And indoor air pollution can be 5, 10, or even 100 times higher than outdoor air.
--:-- Joseph Allen: So there's a whole bunch we have to be worried about when we're thinking about indoor air. Yeah. Can you describe what those indoor allergens are? What's causing this? Well, you have a bunch. So you have everything from outdoors that can trigger allergies, including things like outdoor air pollution or allergens that come inside.
--:-- Joseph Allen: Indoors, you can have allergens like from pets. So cat allergen, dog allergen. You can also have it from unwanted pests like cockroach allergen, mice allergen, rat allergen. And then you have other things that can trigger allergic reactions or sensitivities in people. Things like some of these volatile organic chemicals or what we call VOCs.
--:-- Joseph Allen: Or even I mentioned when you cook indoors, you're releasing particles in the air And that can have a triggering effect for some people too. Some are really quite toxic. Some are more benign. But many of them can be irritants. In other words, they can, in low levels, may be okay. But in higher levels, they can make your eyes itchy and things like that. Or cause respiratory issues, particularly in kids.
--:-- Joseph Allen: Do we know how prevalent indoor-related allergies are? There are studies showing high rates of asthma, attacks and exacerbations and other allergy related issues related to all of this in the indoor environment related to whether it be pests or pets or some of the chemicals we use indoors.
--:-- Joseph Allen: A lot of what we know about allergens and things like pollen, we spend a lot of time thinking about outdoor air pollution, not so much thinking about what's going on inside of our homes that can trigger some of this. And people often attribute an allergic reaction to something that they think is happening outside, where it actually could be something indoors that's causing it.
--:-- Joseph Allen: I would love to go back in time and kind of talk about the history of this building quality situation. Let's start back in the mid-1800s and take us on through. What's it looking like? What do we know? All right. I love it. the history of air quality told through the lens of public health.
--:-- Joseph Allen: So yeah, about 150 years ago, we had Florence Nightingale telling us, the only defense a true nurse either asks or needs is cleanliness and fresh air from open windows. She's talking about fresh air from open windows. At about that time, we started to set these health-based standards in the late 1800s, early 1900s, because of the prevalence of things like tuberculosis and other respiratory pathogens.
--:-- Joseph Allen: So this was the basis for building codes and standards for like 100 years. Then come the 1970s, what happens? Well, in response to the global energy crisis, we start to choke off the air supply in our buildings. So we turned our homes and offices and schools into these little hot boxes of all this garbage indoors, and we stopped letting them breathe.
--:-- Joseph Allen: And we started using filters that are worse that don capture a lot of the airborne particles And then that started really the era we in now which is the sick building era But coming through COVID people start to realize oh, okay, we need better ventilation, more air coming in, better filters to capture those particles that carried the virus.
--:-- Joseph Allen: And so I'm hopeful now that we're kind of seeing the folly of the past 40 years. We go back to Florence Nightingale, back to our roots and say, you know what? It doesn't take that much to have a healthy building. It's a little more fresh air, some better filters. A couple other things, of course. I'm simplifying it a bit, but it doesn't take all that much really to have a healthy school, a healthy home, a healthy office, a healthy hospital.
--:-- Joseph Allen: It's impossible to talk about health without talking about disparities. I'm curious how those disparities show up when it comes to indoor air quality. We talked about impacts on mental health, brain health. When we think about kids in schools, we also know better air quality is associated with better math scores. Better tests of reading comprehension.
--:-- Joseph Allen: So it's not just this amorphous thing. Oh, it's a little worse air quality. No, no, no, no. This is having a major impact on kids' ability to function in the classroom. We see this in college kids. We see this in adults that air quality is influencing our brain health. And then we see these disparities across society when it comes to our buildings.
--:-- Joseph Allen: So in schools that are predominantly black and or predominantly have kids on free or reduced lunch, we see even lower ventilation rates. Okay, say someone hears this and they're like, let me get my indoor life together. Let me get my indoor air quality life together. What do you recommend that they do? Are there things they should be buying, things they should be doing?
--:-- Joseph Allen: Yeah, great question. I think there's a couple things I do and people should do. I would recommend in their house. The first is I think you want to maximize how much outdoor air you're bringing in. So that can be pop an open window.
--:-- Joseph Allen: Second thing is you want to increase the level of filtration. If you're in a building with a central system, that's a Merv 13 filter, a higher grade filter. It doesn't cost much at all. Also, in my house, I use portable air cleaners with HEPA filters.
--:-- Joseph Allen: I mean, think about your bedroom. You spend a third of your life in one little box on this planet. You better be sure that air quality is good in there. So, you know, you wanted to know where you should put an air purifier. I'd put one in the bedroom. That's where I have it.
--:-- Joseph Allen: The third thing you can do is you can get one of these lower cost air quality monitors that are now available to the public. You can measure the particle levels. You can measure CO2, carbon dioxide, which is a proxy for ventilation. You can measure those VOCs we talked about, the volatile organic chemicals.
--:-- Joseph Allen: You can measure things like radon, which is the second leading cause of lung cancer, big problem in homes. But these sensors, they used to be several thousands of dollars. Only scientists had access. Now maybe it's 100, 200, maybe 300. So not cheap, cheap, cheap. but definitely more available to the masses.
--:-- Joseph Allen: So if you do a couple things, you want to bring in more outdoor air, upgrade your filtration, and measure the air. All right, Joe. Thank you so much for explaining this to us. Well, thanks for having me. It's nice to be back on.
--:-- Host: Coming up, what if I told you there's a potential cure-all on the horizon? Would you try it? That's after the break.
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--:-- Host: Support for the show today comes from LifeKit, the podcast from NPR. What's in your life kit? I'm asking. They didn't ask that. Every day you have to make choices that might shape the direction of your life, but you can't flip to the back of the book to find an answer key. Instead, you can listen to the Life Kit podcast from NPR.
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--:-- Host: It's Explain It to Me and we're back, this time with my colleague Dylan Scott, who covers health for Vox.
--:-- Dylan Scott: Okay, so we've spoken about seasonal allergies and related issues with indoor air quality. How effective are the allergy medications that are available over the counter? You know, it feels like there are so many options. You've got your pills, your sprays, all these different things. What is the landscape like?
--:-- Dylan Scott: Yeah, right. There's a whole aisle at the pharmacy where you can shop for these over-the-counter medications for allergies. And yeah, you've got Claritin, you've got Benatril, you've got Xarelto, this long list of medications.
--:-- Dylan Scott: But, you know, antihistamines, you know, they can help, but they don't probably work as well as any of us would like to see. You know, these allergies hit us when it's springtime, when the weather's getting nice. All we want to do is get outside. So, you know, antihistamines, they're better than what we had before, which was basically nothing.
--:-- Dylan Scott: But they aren't cutting it these days. And so, you know, nasal sprays, they're annoying. I don't know about you, but I hate spraying stuff up my nose. I think a lot of people have been looking around for a while and thinking like, how can this be the best that we can do? This drug that maybe works like half the time or this sort of disgusting liquid that I have to shoot up my nostril.
--:-- Dylan Scott: Like, we've got to be able to do better than that. Right. And we're actually finally getting to the point where maybe we can. so your reporting shows that you know we might be on the cusp of another medication revolution for allergies almost like the one allergy cure to rule them all but it's not a new medication per se there's some history there sure so there is an existing drug it's called i'm gonna butcher the scientific name but i'll get the brand name right it's called omelizumab uh but it's sold It's sold by the brand name Zolaire, which is a lot easier to handle.
--:-- Dylan Scott: So this was a drug. It was approved 20 years ago, and it was approved for the treatment of asthma. Now, as you can imagine, like asthma, you know, asthma reactions and allergic reactions tend to share a lot in common. And obviously, people who have asthma tend to suffer more from seasonal allergies than people that don't have it.
--:-- Dylan Scott: And obviously, people immediately think, we're going to develop some new drug, we're going to start from scratch and come up with some kind of novel treatment. But a lot of times in medical science the first step is to look at what you got on your pharmacy shelf and think all right is there any way that this could actually be effective for treating something that it not been used to treat before
--:-- Dylan Scott: And so some preliminary clinical trials were held and they showed really promising results People who took Zolaire, who got injections shortly before the allergy season started, they reported having fewer symptoms, fewer days where they had to take a daily antihistamine or some other allergy medication. they just in general reported having a better quality of life during the allergy season.
--:-- Dylan Scott: And so you've started to see some doctors here in the United States prescribe patients Zolaire for their seasonal allergies. It hasn't been approved for that purpose by the FDA yet. Again, this was a medication originally developed for asthma. But this kind of off-label use where we have an existing drug and figure out it works for something else, that is something that happens all the time.
--:-- Dylan Scott: And part of the reason doctors feel comfortable doing this is Zolaire is a drug that's been on the market for 20 years. And so it's early stages. I don't think its use is widespread yet, but I've talked with doctors who are starting to prescribe this for their patients, specifically for seasonal allergies.
--:-- Dylan Scott: How do patients take this medication? Yes. So this is actually an injection. It's not a daily pill. Oh, okay. Yes. So this is a type of treatment. It's called monoclonal antibodies. Basically, what monoclonal antibodies are, are these specially designed proteins that can go into your body and stop certain biological reactions from happening. For example, your allergic reactions.
--:-- Dylan Scott: And so the way that we develop these proteins is through a shot. And so like, for example, with this 2022 study of Zolaire, patients received a 300 milligram injection a couple of weeks before the pollen and grass allergy season was supposed to begin. So they weren't taking a pill every day. They got one injection and over the following months had much better luck with their allergy symptoms than the people who were relying on, you know, an antihistamine or a nasal spray.
--:-- Dylan Scott: So, you know, we've talked about Zolaire in the context of seasonal allergies, but are there other allergies that this medication could help with? Yeah. So what is really exciting about Zolaire? It can actually go in and stop your immune system from overreacting in the first place. It can stop the allergic reaction from even beginning by blocking certain receptors in your body.
--:-- Dylan Scott: And so this shouldn't just stop allergic reactions from pollen or from grass or for some other seasonal allergy, but it could also stop reactions to food allergies like peanut allergies or insect allergies or mold allergies. Like because of the way that they function, this is stopping all allergic reactions. It's not just targeting the histamine release after the reaction has already started in the way that Claritin or Benadryl do.
--:-- Dylan Scott: And so it seems at least plausible at this point that you could get this injection. And at least for a certain period of time, it would stop any allergic reaction. Not only pollen, but food allergies, insect allergies, mold allergies. And so that makes them almost like an all-in-one genuine allergy wonder drug, the likes of which we have never had before.
--:-- Dylan Scott: That honestly is amazing. I'm sure there are plenty of people who will be able to say, oh my gosh, I can have shellfish or peanut butter or these things that I have not been able to have. What is the cost of Zolaire looking like? you know, pharmaceuticals are notoriously expensive. Is this expensive? It is expensive. The list price especially is high.
--:-- Dylan Scott: And that's why I do think going forward, health insurance coverage will be really important. So the list priced on Zolaire is $1,500 a pop. Now, obviously, like the people who get prescribed this medication for their asthma do not necessarily have to pay that price. But this is sort of the problem with off-label use. You know, doctors feel comfortable using Zolaire for allergies because, you know, they've seen these studies that show it can be really effective.
--:-- Dylan Scott: But from the health insurer's point of view, they're like, well, wait a minute, you're just prescribing this drug that hasn't been approved by the FDA for this use? Like, that was an asthma drug. Like, why would we cover that for seasonal allergies? But we don't know. We're still kind of in this transition period.
--:-- Dylan Scott: Earlier, we heard from an ear, nose and throat doctor about how climate change is making allergy seasons longer and more intense. Do you feel like American science is ready to face these challenges, you know, with so many attacks from the Trump administration on federal funding for scientific research?
--:-- Dylan Scott: I think it's worth thinking about like the the chain of research that leads to a new drug getting developed. and almost every drug that has ever been developed in the United States started, like its foundation was based on science that was funded by the federal government.
--:-- Dylan Scott: In a lot of cases for a clinical trial like that, it's the pharmaceutical company that's footing the bill because they want to get a drug approved so they could eventually sell it. But if we take the longer view, like we so desperately need this kind of government funded research to give us new ideas about how we could better treat all kinds of things, including allergies.
--:-- Dylan Scott: And my fear would be that maybe not tomorrow, maybe not a year, even five years from now, but 10 years from now, suddenly the pipeline for allergy treatments is drying up because that kind of basic research that leads to new ideas for new treatments was cut off in 2025.
--:-- Host: Dylan Scott, thank you so much for explaining this to us. Thank you for having me, JQ.
--:-- Host: spiritual journey? Give us a call at 1-800-618-8545. This episode was produced by Devin Schwartz. It was edited by Miranda Kennedy, fact-checked by Melissa Hirsch, and engineering by Matthew Billy.
--:-- Host: Special thanks to the folks at WABE in Atlanta for helping make this episode happen. I'm your host, John Glyn Hill. Thanks so much for listening. Bye! ACHOO!
