The Crunchy Allergist 0:03
Sick of the fatigue and fog? Fed up with the unpredictable flares? Hangry from the super restrictive diets?
The Crunchy Allergist 0:12
Hello, and welcome to the Crunchy Allergists podcast. A podcast empowering those who like me appreciate both a naturally minded and scientifically grounded approach to health and healing.
The Crunchy Allergist 0:24
Hi, I'm your host Dr. Kara Wada. Quadrupel board certified pediatric and adult allergy immunology and lifestyle medicine physician sjogrens patient and life coach. My recipe for success combined the anti-inflammatory lifestyle, trusting therapeutic relationships, modern medicine and mindset to harness our body's ability to heal.
The Crunchy Allergist 0:46
Now although I might be a physician, I'm not your physician and this podcast is for educational purposes only.
The Crunchy Allergist 0:54
Welcome, everyone. Today's episode is another special edition from the first Annual Virtual Sjogren's Summit that took place April 1st and 2nd 2022. Spring allergy season can be really problematic for those of us with misbehaving immune systems of all varieties. So without further ado, let's dig in and see what we can do about it.
The Crunchy Allergist 1:17
Hi, everyone. My name is Dr. Kara Wada. I'm a pediatric and adult allergist immunologist and I practice at The Ohio State University Wexner Medical Center in Columbus, Ohio. I also happen to be a sjogren's patient and have dealt with nose and sinus symptoms. We'll talk a little bit about lung symptoms as well, both personally and professionally. So that's what I'm going to talk with you about today.
The Crunchy Allergist 1:45
The Sogren's specifically. Allergic disorders have been described in general in a variety of connective tissue disorders. But the association between allergy and primary sjogrens has not been terribly well documented. There have been a few studies that do suggest that about 65% of patients with Sjogren's have some sort of allergy type symptoms or manifestations. This is significantly higher than patients who just have rheumatoid arthritis, or who just suffer from dryness like symptoms. Allergic reactions can, you know have symptoms across the gamut. We're going to focus a little bit more on nose and eye symptoms. But allergies certainly can cause difficulties with foods and also with medications as well. And Sjogren's patients also do appear to have a little bit higher risk of allergies to medications and also skin contact allergy like what you may have with nickel, or fragrance or some other types of allergic rashes. So let's dive in to kind of the bread and butter of what I see in clinical practice, which are nose and sinus symptoms of all the patients that walk into my office dealing with runny nose, stuffy nose, itchy, watery eyes, any of those types of symptoms.
The Crunchy Allergist 3:16
We have something we call the rule of thirds or one thirds, about 1/3 of patients who walk in the door with the symptoms will have their symptoms triggered primarily by allergy type inflammation. About 1/3 of patients who come in will have a condition called non allergic rhinitis, this is something that then sjogrens would potentially fall into as well. And then 1/3 of patients have both situations going on. So let's dig into a little bit more about what I mean by inflammation. So inflammation as you very well may know is a response that our body has to infection, injury or insult. I consider allergy in the insult frame of reference. But essentially what happens is our tissues are trying to protect ourselves trying to repair and what happens when the nose tissues and sinus tissues get inflamed is they create mucus. They also can become swollen, red and irritated. When that happens, as a result of allergy, what's happening is the body's immune system has created allergic proteins. These proteins are called IgE they look like the one letter Y and these little proteins act like the lock to a door.
The Crunchy Allergist 4:46
If you're exposed to a particular allergen, like if you're allergic to kitty cats or oak trees, if you inhale that Oak Street pollen or kitty cat allergen, those keys the allergen come in contact with the lock of the protein, and they unlock the allergy cells to release all these different substances that create the symptoms that we experience. The itching, the watering, the runny noses, sneezing, all of those symptoms. That's just one way though, that inflammation can be triggered in this part of our body. There are other ways that those cells can get turned on. And so if we are opening the door with a lock in the key, we also could bust down that door. And that's what I use to explain the potential other mechanisms of non allergic rhinitis. But in reality, there are a lot of different ways that that can get turned on.
The Crunchy Allergist 5:42
So one is irritation. If you walk into a smoky bar or a sawmill, all of that particulate in the air is going to be irritating to our sinuses, our sinus passageways, and our nasal passageways are trying to keep the air that we breathe, filtered out, humidified and clean before it reaches our lungs. And so as it's purifying that air and conditioning that air before it gets to our lungs, it may want to expel what's not supposed to be there.
The Crunchy Allergist 6:17
One other situation that we can see is in, for instance, Sjogren's. In Sjogren's disease, what's happening is our immune system is creating a response to our exocrine glands, those glands that produce saliva and other coatings of our mucosal membranes, or those tissues that line our sinuses, and our nasal passageways, our throat and into our lungs. And if that mucosal tissue is not as moisturized or as dry, the mucus is going to be a different consistency. The little cilia or hairs that line our breathing passageways, and our sinus tissues may not function as well to clear out that mucus. And we're going to have some differences in how our immune system responds when those areas encounter infection.
The Crunchy Allergist 7:15
So in the case of colds, or flu viruses. So, when we are thinking about how we can restore moisture, or restore balance to our sinuses, and our our nose, we want to in many cases, return moisture through the air that we breathe. So some things that we can consider using our cool mist humidifiers, there also are different devices you can install on your actual home heating appliances that will humidify your entire house. And it's also very beneficial to look into at least changing out your furnace filters on a regular basis to help kind of filter out any debris or dust or anything that may come up in in your internal environment. When our nasal passageways become irritated, or inflamed and swollen, they become more sensitive to the other things in our environment that may be more irritating and so it can be a bit of a snowball effect as inflammation tends to be when the nose and sinuses become chronically inflamed, as in the case of allergies or even these non allergy processes like primary or like sjogrens in itself. This can lead to enlargement of structures known as turbulence.
The Crunchy Allergist 8:52
So when we think about our nasal passageways in our sinuses, I'm going to talk a little bit about our anatomy. So we have our nose with our nostrils. In the middle of our nostrils, we have the septum. You may have had someone tell you or heard about someone having a deviated septum, it means the septum is off, or a little crooked. Most of us are I'm pretty deviated. And that can become problematic if you have chronic inflammation in your sinuses or if it's extremely deviated, because that septum may become closer in line to the turbulence turbine. It's our bony structures inside of our face behind her cheek sinuses that are on either side of the septum and they're covered in that mucosal tissue. Those structures can be calm enlarged over time, if these tissues remain inflamed and stay inflamed chronically, and over time or if you have a bad cold for instance, they can swell to the point where they're touching that septum. And that's when you're going to feel like you can't get any air in and out of your nose, you'll feel completely congested, congested, and or what I will call obstructed.
The Crunchy Allergist 10:15
There are other reasons you can become obstructed. Some people may develop non cancerous growths in their sinuses called polyps. This is not something that's terribly common with sjogrens, but can occur on its own in a different process with allergies or other underlying conditions. But there are other reasons one could have kind of complete stuffiness or obstruction, this is just one of them. Being able to control some of that inflammation is really important though, so that you can try to minimize the potential for needing antibiotics, which can increase the risk of yeast or yeast infections, and decreased kind of risk to injury to your gut flora as well. And it also can decrease the need over time for the potential for sinus surgery. What can happen essentially with chronic inflammation is that that swelling can close off the drainage pathways that drain our sinuses. So we have several different major sinus cavities in our face. Not quite sure why exactly we have sinuses, we think that it's probably to help lighten the weight of our head. But we have sinuses, behind our cheeks, in our foreheads. And then we also have them deep behind our nose and between our eyes, and then even deeper back in there. So there are some pretty significant structures in there in all of those structures are again kind of lined with mucosal tissue makes mucus, and that mucus needs to be able to be thin, and make its way out so we can swallow it down the back of our throat. If those tissues become swollen, these small little drainage pathways can become closed off.
The Crunchy Allergist 12:13
And because we are living breathing organisms in the world, these tissues are not sterile. So we have bacteria that naturally live in and on us. Not only in our guts, we think of our gut bugs and on our skin, our skin flora. But we also have bacteria, viruses, fungi that live in our sinuses and our nasal passageways. And so if these drainage pathways become closed off, that then becomes an area that is much more prone to developing a sinus infection that may need then antibiotics to help treat it. So this is a really interesting area that both allergist and ear, nose and throat physicians are increasingly interested in discovering more about our microbiome of our nose and our sinus cavities. Because it is thought that this microbiome plays an important role in chronic inflammation, especially in those individuals who maybe have completely negative allergy testing. The amounts and types of the bacteria can vary greatly based on many different factors including antibiotics, recent viral infections and underlying health conditions such as something like Sjogren's.
The Crunchy Allergist 13:30
So let me touch a little bit. I mentioned kind of two different types of physicians that care for this area of the body. There are those include ear, nose and throat surgeons. Those doctors are also known as otolaryngologist. Oto means ear, larynx means voicebox ologists studies them. They are surgery doctors, so they primarily trained to be surgeons, and they learn about surgical interventions and diseases that affect essentially all this part of our body so they can specialize. In addition, just being a general anti semi special specialize in hearing disorders. Some may specialize in sinus disease, the Rhine ologists Some may specialize in the voicebox laryngologist.
The Crunchy Allergist 14:24
If you are in an area that has a large medical community, you may then see that there are ear nose and throat doctors who have these additional kind of specializations. The other type of doctor that you may encounter to help care for your sinuses and your nasal passageways are allergist immunologist. So this is my training background. So how did I get here? I started off I did my four years of undergraduate education went to a really small liberal arts school in Northern Illinois. Go Rockford you Diversity. And then I did four years of medical school at the University of Illinois College of Medicine. And then I did residency. So residency is when you train to be, kind of do your specialty. And so that was my general training. So I did four years, which was a combination of internal medicine and pediatrics. To be an allergist, immunologist, you don't need to do both, you can do one or the other. I just happen to really like caring for both kids and adults. And then I did an additional two years of training then to specialize in allergic and immune immune system conditions of the body.
The Crunchy Allergist 15:40
My training and the immune system tended towards learning about overactive immune systems relating to making allergic responses, drug allergies, food allergies, all of the sinus allergies and asthma that we're talking about, but also under active immune systems, and in particular immune deficiencies. Interestingly, not all of this is very cut and dry. So there are some autoimmune conditions that we also take care of, in particular, chronic hives and swelling conditions as well.
The Crunchy Allergist 16:16
So that's kind of the background. So I would not be a person who would ever do your sinus surgery. I've never done one, you don't want me doing one. But I have kind of this training in evaluating the immune system, and also knowing how to treat allergic and immunologic conditions that I've studied.
The Crunchy Allergist 16:37
So let's jump into some practical tips. We've kind of talked a little bit about the nitty gritty about what's going on, but let's talk about some practical tips that may be really helpful to deal with your sinus and nasal symptoms.
The Crunchy Allergist 16:54
In particular, one thing that I think is really helpful, especially if you're dealing with dryness, is nasal saline. So saltwater can be really helpful to loosen the mucus in the night nasal and sinus patches, passageways, and rinse away pollen, and other debris. It has been proven to increase mucus clearance by about 30% from just our baseline ability to clear mucus. Now there are some caveats there are many different ways that you can administer nasal saline. One are the little tea pot like devices, also known as neti pot. Those are have been used for centuries if not millennia, in traditional Indian medicine and can be very useful. But for some people, especially those who have chronic ear problems, those may not be the best option. So with any of these different products or things that you've tried out, if you're feeling like you're getting water trapped in your ears or your ears are popping, that probably is not a good device for your anatomy. So there is some trial and error with these different products.
The Crunchy Allergist 18:12
Another option is getting a can of pre-made nasal spray mist, this can be incredibly helpful especially with little ones I use these products all the time on my kids get their daycare colds super helpful because it's a lower volume or less amount of the saltwater solution and it's a nice fine mist so it doesn't necessarily feel like you are drowning in in the saltwater or feel like you got you know hit with a wave at the ocean.
The Crunchy Allergist 18:47
Another option is something that's a little bit of a combination between like the neti pot and the mist in that there are different squeeze bottles. One brand in particular is NeilMed, which I don't have any affiliation with other than they send a bunch of samples to our office. But these are increased volume so it's a greater volume similar to the neti pot, but you can use them kind of seated upright or standing in the shower. What I typically recommend with those is making sure your head is turned down so that the water or saltwater solution is going up and then out the other side with any mucus or debris that's coming out.
The Crunchy Allergist 19:32
The other really important tip with nasal saline if you're using a product where you need to mix your own saltwater solution, make sure to follow the instructions on the product you're using. Most of them will recommend using distilled water or water that you've boiled and then let cool down. It will also say just from trial and error. I find it to be much more comfortable if I'm using the larger vault Unlike the squeeze bottle or the teapot, if I warm up that water a little bit so that it is closer to body temperature, rather than room temperature, it's much more comfortable especially if the sinuses and nasal tissues are inflamed or irritated in any way.
The Crunchy Allergist 20:18
There also are some other products that you can mix in with with those saline solutions. Sometimes, ENT doctors or allergy doctors will consider prescribing anti inflammatory type medicines like a nasal steroid, which helps decrease swelling in the sinus passageways decreases inflammation there. Sometimes, some doctors will have you mix that into your saltwater solution to do as a medicated rinse. And occasionally, if someone's dealing with chronic sinus infections, they may have you actually incorporate antibiotics and that solution as well.
The Crunchy Allergist 21:02
There's also one other product again, I have no affiliation with this company. I've had some patients like this and I have a sample from the office, which is essential oil based. The thing I would just caution you with is to try a small amount first because this is like a mentholated product. And so you could imagine that if your sinus passageways are pretty irritated that something that has kind of that that minty kind of mist to it, mistiness, I don't know if that's a word or not, but maybe irritating. So I would start with a small amount and kind of do a little trial before you kind of jump headfirst into using those products. The advantage to this is it is supposed to help break up the mucus. So maybe helpful for people who have really thick mucus that is not coming out very easily.
The Crunchy Allergist 22:03
The other thing that can help in that situation is actually using a little more concentrated saltwater solution as well. But you're gonna want to try to troubleshoot this with your your nose and throat or allergy doctor to find out what might be the best strategy for you. Little sidenote, the reason why either boiled water or distilled water is recommended and not water just directly from the faucet is because there have been some cases of severe and infection including meningitis or brain infection that have occurred with using these devices.
The Crunchy Allergist 22:44
Generally they are very safe. Talk to your physician if you have any questions, make sure that you're cleaning out your rinse bottle. And again, just using water that is either boiled and cooled down or distilled.
The Crunchy Allergist 23:00
Alright, so number two thing that I like to recommend is cleaning up your air quality. One of the main functions, as I mentioned of our nasal passageways is to warm up humidify and clean the air that we breathe before it hits our lungs. So our nasal mucosa is the main interface between our bodies and our outside environment. And it's the first tissues to see all of this particulate matter in the air, which includes allergens, but also irritants like air pollution, and dust and debris. And that is going to vary in what that looks like. Depending on what part of the globe each of us is in. If we're living in a more urban environment, with a lot of exhaust, if we live near highways, then maybe it's more of the pollutants. If you're out in the west coast or the southwest of the United States, it might be more dust in the air because it is a dry, more arid environment. But cleaning up our air quality can be quite helpful.
The Crunchy Allergist 24:05
So ways that we can do that are on the inside of our house actually opening up the windows. Now this is a little bit of a double edged sword because when we think about allergies, we want to keep the pollen out of our house. But indoor air quality actually is sometimes or has been estimated to be about five times worse than outdoor air quality. So in general opening up our windows allowing some fresh air into the house, or apartment, and living space can be really beneficial. If you are very allergic, you may want to talk with your doctors about kind of what strategy might work best. I tend to tell my patients you know just keep your bedroom window shut so that you're keeping pollen out of your bedroom. But you may want to think about opening up windows and other parts of your house or opening them during kind of low pollen, times of the day or or the week.
The Crunchy Allergist 25:03
Using indoor air purifiers can also be helpful. The main thing I recommend to patients is to when you're evaluating, okay, which which unit should I get, you know, kind of look at the size of your room look at the capacity of the product, but also look at the cost of replacing the filters. Or if you're able to clean off the filter, that's where a big part of the expense is going to be with your air filters, and filtering units. And then running the vacuum, once a week can be really helpful if you're low on energy and need to consider ways to get creative with using the vacuum, looking into some of the robotic vacuums are great consideration and have come down considerably in costs. So that's another strategy you may think about. Especially if you're looking to replace a vacuum, or and wanting to find some creative ways to use less spoons kind of throughout your day.
The Crunchy Allergist 26:10
A couple other things we can do to help our immune system out is to try to do our best to get good sleep, sleep is our body's time to repair. And on average, as you know, kind of the average person needs seven to eight hours to function best. Given you know, a lot of us with Sjogrens deal with considerable fatigue, we may be on the higher end of needing more than that eight hours. But sleep really is important when it comes to kind of our sinus health as well. Which is ironic, because so much can come about trouble with sleep can come about from dealing with difficulty breathing.
The Crunchy Allergist 26:58
So again, it can be kind of the chicken or the egg. Getting symptoms checked out if you're having issues with snoring, or congestion that are affecting your sleep is also really important. Because we want to help you get the rest that you need to help your whole body rest and repair is best able. I also love the idea.
The Crunchy Allergist 27:22
So moving on to kind of next topic of food is medicine. The data is increasingly clear. And there's more data to show this is the case in in asthma in particular. But a plant forward diet feeds those good gut bugs and creates an anti inflammatory chemical signals kind of throughout the body. That said, we know that there's no one size fits all diet that works for everyone. So kind of working with your registered dietician or some one to kind of help you through that can be really helpful. But I think it is important just to know that there is some emerging data, looking at the role of food in kind of our sinus and and respiratory health in general.
The Crunchy Allergist 28:11
That said, medicine is medicine too. And as at least in the northern hemispheres, we are getting into our spring allergy season. And one misperception I hear all the time that I want to at least kind of help you out with today is there's a thought that using allergy medication early makes it less effective, which is actually not the case. What you're going to see though is over time, if allergies are worsening, then some of those medications just may not be as helpful or as useful. When we think of allergy medications.
The Crunchy Allergist 28:48
I think was sjogrens in particular, it is really important to find out do you make allergy protein or not? In part because some of the medications that are going to be run in the mill for the average allergy patient, something like a Claritin, or Zyrtec or even Benadryl are very drying. So if you are already struggling with dryness in your mucous membranes, and you don't have allergy inflammation, adding to that situation, I actually would want you not to be on those medicines, because they're not helpful. If allergy testing is negative. I would say they're largely not helpful if allergy testing is negative. And they're actually going to have the potential to be more harmful in adding to the dryness you're experiencing.
The Crunchy Allergist 29:35
If the other thing I would mention, or have you consider especially if you know more conservative management techniques like the saltwater rinses and so forth are not as helpful is thinking about using a nasal spray type medicine in again, as we've kind of talked about through these different sessions this whole weekend, a lot of what we see in medicine and in Sjogren's is trial and error.
The Crunchy Allergist 30:12
So we think about the nose sprays that are in the family of Flonase, Nasonex, Rhinocort, there's a whole bunch of them. They each have little nuances about them, some have alcohol in them, some don't some have other additives or our fragrance that may or may not be helpful or harmful, irritating to particular people. So this is really some of the nuances of what I can be frustrating to work through with patients but can be really gratifying and rewarding if we can find that right fit. So I would say you know, even if you've tried some of them or had trouble tolerating some of those different nose spray medications, that may be something to revisit or think about as well. Especially if you're dealing with a lot of stuffiness or trouble getting air in and air out of your nose, those medications are going to be overall the most effective things you need to watch out for those certainly, they can sometimes contribute to more dryness so again, kind of have to try to thread that that thin either needle and find a good fit.
The Crunchy Allergist 31:26
The other thing to know is they can take two to four weeks to see their full effect. So they are kind of a low and slow buildup type medicine. That is not going to feel like it's immediately effective right off the bat. While we're talking about nose sprays, I'm gonna grab my little fake one. It's not fake, but old one. A little mock up. When you use nose sprays. You want to point your nose down towards your toes. Point the nozzle out towards your ear and the same side. This nozzle does not need to go in very far just a tiny little bit and then do your best not to sniff or snort the medication when you spray it. This is an old one we'll see if it works and see where it sends the medication up. In a nice mist that's going to propel the medication plenty to get it where it needs to go inside of your nasal passageways, so you don't need to go and then swallow it. It tastes gross. You don't want any extra of that. So grab a Kleenex or a towel and just dab the excess that may drip out. And that is a much typically more tolerable way to use those nasal sprays than how most of us kind of have learned to use them before.
The Crunchy Allergist 32:48
And last but not least, if you are allergic and you make those allergy proteins, there are ways to help shift your immune system back into better balance with something called immunotherapy. So crazy enough immunotherapy is actually one of the oldest treatments we have for allergies. And it's one of the most natural ones too. It's actually been practiced for well over 100 years. And this treatment essentially uses a combination or formulation based on what you test positive for the allergist mixes up a recipe kind of based on those results. And then you are administered that mixture or that personalized serum in small gradually increasing amounts up to kind of a target dose. Generally speaking, it is administered either through shots that's the most common at least in the US or under the tongue. And then there also is a kind of much newer way of administering which is directly into the lymph node. Unfortunately that is not done all that often. Though, if anyone is in Ohio, I have a very good friend who is doing that and can help connect you. But those are using then kind of purified pollen or the other allergens you're allergic to and gradually over time as your immune system sees those pollens and other allergens. It shifts that response from fighting it off to ignoring it. And what's really cool about it is that over time, your immune system actually learns the lesson. And once you stop treatment after about a three to five year course of treatment, you continue to have benefit typically for some years after which is awesome. Since most of what I have to offer aside from diet and exercise and you know dealing with stress tend to be more band aids. So this is a nice kind of more lasting root cause way to approach illness.
The Crunchy Allergist 34:04
So this is the rundown on sinus and allergy care. One thing I forgot to mention when we were talking about moisturizing products, we talked all about saline. But there are some other products that are really great that are directed towards sjogrens and other dry nose patients that are in the forms of gels and other sprays. There's an ingredient called Xylitol that many of us are familiar with from a lot of the oral preparations, but those can be also very helpful for sinus which arising as well. And one other last note before I forget if you were CPAP or BiPAP for your sleep apnea, talking with your care team to see and make sure that you've had your settings kind of optimized to humidify and warm up the air can be really helpful to help restore some moisture to those tissues as well.
The Crunchy Allergist 36:01
So that was a whole lot. I look forward to talking more during question and answer session. And doing my best to steer you in the right direction. I hope everyone is learning so much from everyone today from all of our speakers and I look forward to talking with you all very soon.
The Crunchy Allergist 36:22
Thank you so much for joining me today for this special edition of the crunchy allergist podcast. If you missed the first Annual Virtual Sjogren's Summit, but want access to all of the amazing talks like this one, head over to www.crunchyallergist.com for more details. I would also love it if you would consider sharing this episode with five of your friends or family members that may be struggling with seasonal sinus and or allergy symptoms so we can share the awesome information and education that we bring to you here on the Crunchy Allergist Podcast. Thank you so much and look forward to talking with you next week.
