Transcript
Two Docs Talk Allergies and Asthma Part 1
Recorded April 14, 2023
[Intro] Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence-proven facts powered by ENCORE Research Group and hosted by cardiologists and top medical researcher Dr Michael Koren.
[Dr. Koren] Hello, my name is Dr Michael Koren, and I'm the host of this edition of the MedEvidence Podcast. MedEvidence is our program where we find out the Truth Behind the Data. I have the great pleasure of having a wonderful guest today, Dr Sunil Joshi, who I've known for many years. He's actually my next-door neighbor in clinical practice and we bump into each other periodically. He’s a very impressive fellow who is an allergy immunologist. He is also very involved in organized medicine as a past president of the Duval County Medical Association and Foundation. Dr Joshi is also interested in clinical research and so am I. So here we are together.
[Dr. Joshi] Thank you for having me.
[Dr. Koren] Absolutely! We're going to have a pleasant chat this morning about clinical research, about allergy and immunology, about organized medicine, and most importantly how do we help patients with all this and how do people figure out this crazy confusion of medical information that they have to deal with every day.
[Dr. Joshi] Right! I'm excited to help get people to understand that.
[Dr. Koren] Beautiful. We're going to start the discussion today with a common problem that a lot of us deal with: pollen. So, start us off: what is pollen and why is it something we have to deal with? Give us a little background.
[Joshi yeah so pollen of course is produced by plants. This is the way that plants (in particular the ones outdoors) propagate their lifespan. During the winter months in particular in other parts of the country where things freeze and everything dies the trees are pretty much dormant during those months. As the weather warms up they start to grow again, but as they're growing they release pollen which is basically like the sperm of the trees.
[Dr. Koren] Spreading their seeds, we all like to spread our seed.
[Dr. Joshi] They're spreading their seeds so that you can have more beautiful trees and grasses and weeds out there but also it allows for life forms that continue to propagate as well. But that pollen has a lot of protein in it. It's very very small and so that pollen gets into our airways into our eyes, our nose into our lungs as well. Our immune system, not in everybody, but in a certain percentage of the population looks at that as being foreign and something that they should attack. As they [the immune cells] attack it they attack it through an allergy cascade; as opposed to a cascade that might attack a bacteria or a virus. That's how we get all of our symptoms.
[Dr. Koren] Interesting, interesting. So help people understand a little bit more. That the green stuff that's on my car here in Florida, is that what we're talking about?
[Dr. Joshi] It's like that. The yellow green stuff that you have on your car and on your patio here in Florida, especially from late January until about mid-March, is pine tree pollen. But typically, pollen is not big enough for you to see with the naked eye. That is the one pollen that you can see. People see pine pollen and they associate that with their symptoms, but believe it or not the most common tree pollinator here in Northeast Florida is the oak tree! We have oak trees everywhere and the oak trees pollinate at a much higher level than pine trees do, you just don't see them! You don't relate your symptoms to Oak tree pollen, you're relating your symptoms to pine tree pollen when in fact there are other trees that are most likely causing your allergy symptoms.
[Dr. Koren] Interesting. There's a lot of discussion about this seasonality of pollen and so can you get into that a little bit more? I know you said pine season is January through March here in Florida, it's probably different in other parts of the country.
[Dr. Joshi] Yes
[Dr. Koren] There's other plants that create pollen havoc at other times but there's also this notion that maybe we're having a bigger problem with pollen because of climate change issues. Maybe you can comment on some of those things.
[Dr. Joshi] No doubt about it. For the most part, for vegetation to go through its life cycle you have to have a period of dormancy. That dormancy typically occurs with freezes. What we have noticed over the last 25 years is the time in the fall to the first freeze, not just here in Northeast Florida but throughout the country, is becoming later and the length of the freeze season is becoming shorter. What's happening is the dormant period is much shorter too, so the pollen season tends to last longer. Here in Florida for instance, this past year we only had three major freezes this past winter. They were all right around the holiday days and then after that we had relatively cool weather but not freezing temperatures. This is why the pollen came out so early and why we tend to see pollen around here in January as opposed to up in the Midwest or the Northeast where they started seeing pollen maybe about two or three weeks ago. There are much longer and intense pollen seasons as climate change continues to occur.
[Dr. Koren] Interesting. How much of your practice is focused on these types of allergy issues specifically related to pollen. Just give a general estimation.
[Dr. Joshi] Interestingly enough, almost everyone who comes to our office thinks they have allergies, right? They're coming to see an allergist and they assume they have allergies but the vast majority of people we test actually come back negative on their tests. So somewhere between 25 to 40 percent of our population have their disease process pushed through because of pollen. There are of course other allergens: dogs and cats and dust mites and things like that. Pollen allergy is in that 25 to 40 percent range. A lot of our patients are non-allergic but still have symptoms of allergic diseases that we end up treating.
[Dr. Koren] Okay. I'm going to give you a little case scenario here and then I’d be super curious to see your perspective on it.
[Dr. Joshi] Okay
[Dr. Koren] So we have a 26-year-old white male, maybe he looks kind of like me.
[Dr. Joshi] Yeah? Maybe many years ago…?
[Dr. Koren] it's possible! This fellow grew up with a bunch of his friends and they all complained about having seasonal allergies up in the Northeast and this teenager had no idea what they were talking about. He actually thought they were faking it because they would be complaining about the air or the trees blooming or this/that/the other thing. I was in the same environment - I mean the person was in the same environment!
[Dr. Joshi] (Laughter)
[Dr. Koren] And I couldn't understand why that would be. Then things changed when this person went to medical school and graduated and was a resident. He went to his brother's graduation as it turns out. All of a sudden out of nowhere in May up in Massachusetts his eyes were watering, his face was swollen, and he’ sniffling. He didn't feel systemically sick, and he wasn't sure what was going on! I’d love your perspective on that.
[Dr. Joshi] That's actually not an unusual story. First of all, to the beginning of your story, people who don't suffer with allergies really don't get people who do. They don't understand why the watery eyes bother them, why they have to sneeze so much, why they’re blowing their nose all the time. You just look at them as being sick all the time, when in fact they're not. They're otherwise very healthy people. The story you're telling is of a person who is otherwise very healthy and didn't really suffer with allergies until they (very likely) got put into a situation where they had high levels of pollen. You're talking about May in Massachusetts. If they had a rough winter at that time their spring pollen / tree pollen would be at its peak in late April and early May! This is around the time you would have been out at an outdoor graduation. So, it makes perfect sense that that person was developing his first episode of allergic rhinitis out there at his brother's graduation.
[Dr. Koren] Interesting. I kind of alluded to the fact that this is actually my story and my history.
[Dr. Joshi] (Laughter)
[Dr. Koren] I'm going to be really really interested in more of your perspective, but we're going to go into that in the next segment
[Dr. Joshi] Great
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