JENNIFER GOLBECKHi, everyone welcome to The Kojo Nnamdi Show. I'm Jenn Golbeck sitting in for Kojo. Later in the hour we dig into indoor air quality and the hidden air pollution lurking in our homes. But first, for those afflicted with asthma and allergies spring time in Washington can be misery. The cherry blossoms may be beautiful, but the rising pollen counts mean an abundance of coughs, sniffles, sneezes, water eyes, and headaches.

JENNIFER GOLBECKSo what are the most effective remedies for a bad case of allergies and what role is climate change playing in prolonging the sneezing season? Joining us to discuss are Dr. Dean Metcalf, the Chief of the Laboratory of Allergic Diseases at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. Dean, it's good to have you here.

DR. DEAN METCALFPleasure to be here.

GOLBECKJoining us by phone is Susan Kosisky, Director of the U.S. Army Centralized Allergen Extract Lab in Silver Spring, Maryland. Susan, thanks for joining us.

SUSAN KOSISKYThank you.

GOLBECKSusan, the lab that you work at is basically in my backyard and so I think maybe you are responsible for my spring allergies.

KOSISKYIt could be sure. And this is the month for them. I can tell you.

GOLBECKIndeed. Dr. Dean Metcalf, I want to start with you. What's in the air right now and what exactly is happening in our bodies that make those of us allergy sufferers feel frankly terrible?

METCALFYeah. So this is a time for tree pollen. And those people who suffer from it are suffering a lot. The basis for that is really people, who develop responses to allergens and in this case tree pollen. And when they inhale that tree pollen or breathe it in then they have sinusitis or asthma or whatever.

GOLBECKSusan Kosisky, how severe is this spring allergy season in the Washington region compared to past years?

KOSISKYThis year it's interesting, because we've been somewhat delayed with our tree pollen season. I guess with the cooler temps and we had maybe a little bit more precipitation than usual. We usually get a peek of like cedar, cypress, juniper pollen family members and elm and maple in February. And this year we had nothing, but a little blip, probably well below half what we would expect for February and likewise March.

KOSISKYThe second week of March we had the some temps in the 70 to 75 degree range for a couple of days. Things started to pop a little and it spiked somewhat. But even March seems to be a bit below average compared to at least the last two years where we had some of the warmest Februarys on record.

GOLBECKHow does weather in general affect the pollen count?

KOSISKYThis certainly for our tree pollen especially, the spring temperatures and fluctuations in spring temperatures will definitely tell us when the season is going to start or whether the tress are going to hold on to that pollen a little longer. The best evidence of this was in 2012. We had in February and March, I believe we had temps in the 70s and 80s for a pretty decent amount of time. And our tree pollen season actually shifted to four weeks earlier than what could be expected, you know, looking at daily averages.

GOLBECKSo for those of us who feel like allergy season is getting longer, are we crazy? Is it getting worse as well as longer?

KOSISKYThe studies like the World Health Organization corroborating with National Allergy Bureau pollen canning stations across the nation I think have definitely alluded to the fact that climate change is showing longer seasons, higher peak levels, and more annual total pollen production. We just hit over 20 years of data with the Washington D.C. region looking at our tree pollen, our weeds and grasses. And the tree pollen production over the last 20 years definitely seems to be trending higher for annual production levels. Grasses and weeds seem to be a little bit more stable oddly enough. Trees just seem to be affected a little bit more by whatever is going on with climate change out there in the region.

GOLBECKDean, we need to talk about remedies. What are the most effective treatments for seasonal allergies?

METCALFWell, we're talking about pollen so let's just talk about that first. I think we all appreciate that avoidance is the mainstay of therapy. For pollens it's not so easy. You know, you can stay inside your house with your windows closed, your air conditioning on. You can ride in your car in air conditioning, but that doesn't allow you to enjoy outside very much. And once you get outside there's not a lot you can do. If you are allergic to grass for example, you can wear a mask, but that doesn't work for trees. But if you get into treatment itself the mainstay of therapy for what we're talking about, I think for most people, which is hay fever or allergic rhinitis is a combination of antihistamines and nasal steroids.

GOLBECKAnd so what point do you just go to CVS and pick up some over the counter stuff versus like going to an allergist?

METCALFThat's a good question. Well, I think -- there are a couple of things that you can get over the counter. One of them are non-sedating antihistamines, for example, which people often reach for and you can actually get nasal steroids. I think you go to an allergist if you have a history in these seasons of having major problems where you have to go beyond traditional therapy or if you are taking some of these medicines and they're not doing the trick, then you need to see an allergist.

GOLBECKAnd how do you know when to medicate? Does it make sense to just medicate yourself all year long?

METCALFRight. Well, there are people that have allergies all year round. But if we're talking about the tree pollen season, you know, you want to start medicating yourself at the earliest sign that you're having a reaction. If you wait too far in the reaction, it's harder to get maximum effect from the antihistamines, for example, that you use. So you should start them fairly early in the season and see if they work. And then if they don't, they're not adequate, you can go to nasal steroids or you could go to your allergist to try to get some further therapy.

GOLBECKSo I had really terrible allergies when I was kid. And my mom in addition to having us try over the counter medicines would have us do all kinds of other stuff. So I'm going to ask you if some of it worked.

METCALFOkay.

GOLBECKSo if the pollen is really bad and you have bad allergies, does it help to take a shower to like wash the pollen off?

METCALFWell, I could see the rational for doing that. I don't think it helps a lot. On the same vein you can wash your dog or your cat and get pollen off of your animal that you have in your rooms too. But, you know, it probably helps a little bit. But it's not going to make a big difference. I don't think.

GOLBECKSo, Susan, the parallel like nature equivalent if it rains does that help wash the pollen out of the air and make my allergies better?

KOSISKYYes. It most certainly -- as a matter of fact, I think we've had sort of -- I know last year was one of the wettest on record. And likewise I think probably February into March we had quite a bit of precipitation, which always seems to hold down the pollen counts. We were looking this morning because yesterday our pollen count was starting to climb again with the nice weather. And this morning was sort of damp, a little bit misty and cloudy and the pollen count was much reduced. Most of came out yesterday morning. It's a 24 hour count. So most certainly the dampness, high humidity also, and wetness due to rain or showers in the atmosphere sort of keeps the pollen levels down.

GOLBECKIt's interesting that you say that yesterday was some of the first time we saw some of these counts go up, because we got a tweet from Sabrina who says, "I woke up with allergies for the first time today. And then I turned this on to listen to Jenn Golbeck and this topic and it's perfect and I laughed." So there you go, Sabrina. That's why.

KOSISKYThat's why.

GOLBECKWe also got a tweet from Jenn who says, "I did immunotherapy allergy shots when I was in my 20s in New England and conquered my allergies until I moved to D.C." So we are going to talk about the D.C. specific allergy issue. But, Dean, I would love to hear your thoughts on immunotherapy both the allergy shots like Jen has talked about in this tweet, but also immunotherapy tablets as an alternative. So tell us what this is and how well it works.

METCALFWell, let's talk about tablets first, because we're in the tree season and there aren't any tablets FDA approved for trees. So that's not going to help us this time. There are tablets for grasses, rag weed, and house dust mite and those are taken before and during the seasons or if it's perennial you take them all year round. There are some allergists that will compound sublingual drops. Those are off label and there's not a lot of evidence that they work very well. Traditional immunotherapy like this individual is referring to, which most of us call allergy shots can be very effective in some people if the allergy shots are designed to attack if you will the allergies that the person has.

GOLBECKInteresting. So I never had allergy shots as a kid. My brother got them. He still has allergies though. So I never really understand like how well they actually work in the long term.

METCALFYeah. So generally the recommendation if -- when you start allergy shots to something specific such as certain trees, you'll take those allergy shots for a couple of years and hopefully you can stop them and you'll have some prolonged unresponsiveness. And other people, they have to continue to take allergy shots. And in some people, it will not work effectively.

GOLBECKAnd so the idea with the shots is that you kind of get them for a certain amount of time like maybe a year or two and then you're better. But do the tablets work in the same way?

METCALFWell, the tablets work -- the whole idea is to give small amounts of something you're sensitive to so you're body develops a response that prevents more severe reactions. So the principle of both of them is the same. Others I think general people reserve tablets for less severe allergies. And probably allergy shots for more severe allergies. But the other difference is that an allergist can compound multiple allergens in one allergy shot. But these tablets are really for one thing. So you take a tablet for ragweed or you take a tablet for house dust mite. But say you're allergic to both, then an allergy shot can be compounded to have both those things in it.

GOLBECKInteresting. So, Susan, how long will this allergy season last? Have we reached the peak?

KOSISKYWell, we're a little bit delayed this year. I know the maples and the elms and some of the early flowering allergenic trees in our region definitely were two to three weeks delayed. So it might just be if the weather warms up and stays pretty dry and we get some of those persistent spring breezes, being delayed in onset, it might be a little later with respect to ending this year. Duration it's interesting. Usually stays about the same from year to year. If you just look at some of the grass, it's the most fluctuations that we see seem to be onset and just sort of when the season finally wraps up for the trees.

GOLBECKSo you don't have good news for our listeners, who are sniffling today. They have to wait a little bit longer.

KOSISKYYeah. Not if it's sunny and windy and dry. The pollen levels will stay up.

GOLBECKWe're going to take a quick break. We'll be back in just a moment. Stay tuned.

GOLBECKWelcome back to The Kojo Nnamdi Show. I'm Jenn Golbeck sitting in for Kojo. I'm talking with Dr. Dean Metcalf and Susan Kosisky about seasonal allergies in Washington D.C. Susan, I wanted to follow up with you. So we talked about this year's allergy season, but what role is climate change playing on allergies? Is it making allergy season worse? Is it making it longer?

KOSISKYI think with respect to longevity, it's, you know, the season. And it seems to be -- there's been some studies done in the northern latitudes where they feel that climate change is definitely causing pollen seasons to be a little bit longer peak levels of pollen concentrations to be a little bit higher, and total annual production being a little bit higher. In our region, I was talking to a meteorologist the other day. They said 30 years is probably a good time element for consideration for climate change.

KOSISKYAnd just looking at our preliminary data that we have with respect to weather variables and whatnot in our region it looks like our tree pollen production most certainly with the warming that seems to be trending in our area, for annual pollen production yield is indeed trending higher. Grasses and weeds, again, looks to be a little bit more stable not so much that our annual pollen production is getting higher.

KOSISKYAnd that the tree season seems to possibly be a little delayed in its start, but maybe not lasting as long in our area, so some interesting changes. I was thinking the other day. Maybe there's more to it than the microscopic eye has to add to some of the findings that we've seen so far with respect to some of the research that's out there.

GOLBECKSo I want to take a minute and brag a little bit. I grew up in northern Illinois. As I mentioned I had really terrible seasonal allergies my whole life up through adulthood. I moved from Illinois to Washington when I was 24 and my allergies disappeared. And it's not just me. We got a tweet from Richard who says, "I lived in Chicago for most of my adult life, terrible seasonal allergies. Moved to D.C. and now they've gone. Go figure."

GOLBECKAll right. So me and Richard are team no allergy here, but what we also have a lot of stuff about is people, who didn't really have bad allergies and then they moved to D.C. and then developed terrible allergies as adults. So why do people develop allergies at a certain point in their life or sometimes grow out of them? Dean, go ahead.

METCALFSo most people develop allergies, you know, by the time they're 30. And as they get older develop few and some people get better like you have and other people you report. Some people do get better with time. Sometimes they move to an area where they're not allergic to the endogenous pollens. But the problem is, of course, for every person that gets better there are a number that gets worse. And usually it occurs in the second or third season in a new area. And then they start problems they didn't have before. So it's very individualistic. It's influenced by age, gender, other medical conditions, how physically fit you are, are you eating a good diet and a lot of things.

GOLBECKSo it's interesting you say it develops in like the second or third season that you're in a space. Why would that happen that you wouldn't -- like I could imagine showing up and being like, oh, I had no idea I was allergic to this tree that lives here and not where I was. Why does it take a few seasons?

METCALFWell, you have to go through a process of sensitization.

GOLBECKInteresting.

METCALFThat process in some people, who are really prone to develop an allergy to something specific like a certain tree pollen. That might happen very rapidly. It could actually happen in the first season. More often people have to go through several seasons so that their intolerance builds up and builds up to the point where they become symptomatic.

GOLBECKSo it's interesting. You've revealed a think a fundamental misunderstanding in the way I have thought about allergies, because I think -- and I'm a scientist. This is not my area obviously. I think I always presumed that you just sort of had the stuff you were allergic to. Sort of like you're born with like a peanut allergy or something and that's there. And then it's just if you're exposed to that thing. But you're saying that at least for seasonal allergies this is something you build up a kind of lack of tolerance to over time.

METCALFYeah. You break your tolerance. It's quite variable, but people's sensitivities depend upon a number of things. A familial predisposition to get allergies, for example, is very important, and generally you have to react to whatever your allergen is a pollen or peanut or whatever or be exposed to it to develop this protein called IGE, which fixes on mass cells and when it sees the allergen, you know, it pops out histamine and things like that. So generally there is a process of sensitization or breaking of tolerance if you will.

GOLBECKThat's really interesting. Thank you for clarifying that for me. All right. We're going to dive into people's remedies that have worked for them or questions that they have about remedies. Let's start with Brenda in La Plata, Maryland. Brenda, you're on the air. Go ahead.

BRENDAHello. And it is pronounced La Plata.

GOLBECKOh, thank you.

BRENDAI just recently bought some Manuka honey and it's a factor 16. It's raw and it's from New Zealand. And besides being very medicinal, I mean, you open the jar and it almost smells like medicine. It's delicious too.

GOLBECKThat always helps.

BRENDAAnd the way I take it is with some Havarti cheese on a whole wheat cracker.

GOLBECKThis just sounds like a snack, Brenda.

BRENDAOh, it's so good with the cheese, the milk and honey. But anyway, so Manuka honey. It's powerful. It's raw.

GOLBECKBut let me get our guests' thoughts on these, because I want both of your thoughts on honey as well as bee pollen, which is also sometimes suggested as a way you can eat bee pollen from the place that you're going to help with your allergies, either of you have thoughts?

METCALFWell --

GOLBECKGo ahead, Dean.

METCALFMy first thought is if something works for you even though it may not work for somebody else, go for it. You know, everybody's individual. Everybody's sensitivities are individual and their expectations are individual. The idea of honey having medicinal purposes has been around for a long time and there's some people that find it helpful and other people that don't. Certainly sounds like a benign therapy for most of us. So if it works it's terrific. I think in most people they're not going to have the kind of effect they want from eating honey and are going to have to go to more targeted therapy. But, again, if something works that's not a medicine per say and that works for you, then sure. Absolutely.

GOLBECKWell, Brenda, I am going to come join you for some cheese and crackers and honey whether or not it helps my allergies. Thanks for calling. We got a tweet from Beth who says, My friend's aunt came to her graduation in Williamsburg, Virginia in May and loved that her allergies didn't bother her there, whatever. So I guess a lot of this just depends where you are. On that topic let's take a call from Rachel in Silver Spring. Rachel, you're on the air. Go ahead.

RACHELHi. Thanks for taking my call. I grew up in the D.C. Maryland area and I was never allergic to anything. And then in my mid-20s in the spring I started having these like -- I would suddenly tired related to absolutely nothing. And, I mean, weird tired like, you know, in the middle of a meeting. And I mentioned it to somebody who said, Oh, you know, you should try Benadryl. Benadryl, that makes you tired?

GOLBECKI was going to say that's a good way to get to sleep, yeah.

RACHELYeah. And they said, no, no, no. This is a form of allergies. This could really -- that's what it could be. And there was no sneezing or anything, no eye watering, just this tiredness, but I tried it and in fact it made all the difference in the world. After that I plunged into, you know, learning about what am I actually allergic to and how to treat it, because you really can't take Benadryl all the time. But it's an allergic reaction that most people don't seem to be aware of because it doesn't seem like an allergy.

GOLBECKWell, thanks, Rachel. Let me get Dean's thoughts on this. So this raises an issue to kind of talk about what are the symptoms that people might want to look for and I think we, of course, know sneezing and coughing and itchy eyes. But are there other symptoms like Rachel mentions here fatigue, other things that may not be as obvious?

METCALFYeah, sure. Absolutely. Fatigue is a problem with a lot of people with severe allergies not only just due to the medicines they take, but because intrinsically fatigue is part of it in many people. Trouble concentrating sometimes and other things go along with that. In terms of using something like an antihistamine to treat fatigue, I think most people would want to expect some degree of evidence that there's some kind of allergies going on. I wouldn't want people to think that you take Benadryl for fatigue, but if it works for fatigue, why not?

GOLBECKOh my gosh. If I take Benadryl, like I'm --

METCALFYeah. It puts me to sleep.

GOLBECKLike 20 minutes and I get a four hour nap from that.

METCALFRight.

GOLBECKSo here's a flip of that question from Louise in Warrington, Virginia. Louise, you're on the air. Go ahead.

LOUISEHello.

GOLBECKYeah. Go ahead, Louise.

LOUISEOkay. Sorry. I am just wondering, I do take allergy shots, but there are days when I just feel this time of the year, just feel absolutely exhausted. And so I'm wondering and I think maybe that's already been answered. But the issue of fatigue and if there's anything one can do about that. Thank you.

GOLBECKYeah. So, Louise, I think I misinterpreted your original question, but let me pitch this to Dean as well. Are there things in our lifestyle that can make us more susceptible to having worse allergic reactions? So if I am fatigued, say I'm working a lot. I'm not eating all that well. Like all of these kind of unhealthy habits, could that potentially make my allergies worse?

METCALFYeah, I think in general people recommend if you have allergies to keep yourself in physical condition and to watch what you eat and it makes it easier to combat whatever reactions you have. I would just say just a caveat about fatigue. You know, if you're having isolated fatigue in the absence of anything you can clearly identify to cause it, don't forget that if that's persistent you really need to see somebody. See a physician about that, because there are a lot of things that can cause fatigue and tiredness outside of allergic diseases.

GOLBECKOkay. Let's take one more call from Jerry in Arlington, Virginia. Jerry, you're on the air. Go ahead.

JERRYHi. I was a teen overseas in the tropics and I developed a severe allergy to Cogon grass. I came back to college at AU and all of a sudden all my nose and eye problems got worse and from April till October. And I suffered until I was almost 40, when I was told to take pressed alfalfa in large doses and vitamin C. And within 10 days, I was not Mr. Hay Fever anymore. I have no science for it, but it cured me. And since then, I'm now 73, since then I've had maybe two attacks and I popped alfalfa and vitamin C and literally within minutes, the attack went away. I'd love to know if it's real, but for me I stopped being Mr. Hay Fever.

GOLBECKWell, Jerry, it's real for you. And I think that's all that matters. I would love to be able to take a vitamin C and a pill and have my allergies just instantly go away. Dean, this pretty much falls into --

METCALFYeah, I mean, I think -- look, we've talked about it before. But if something works for you, you do it, especially if it's safe. For the vast majority of people, I don't think that kind of approach would work. And we have to go more traditional approaches. I mean, if traditional approaches are there, because they work over decades and people know that it helps them. Some of these other approaches work for some people. But they're highly variable.

GOLBECKSo, Susan, I'm going to throw the last question to you. I've had Dean answering all of these questions and comments from people about their own symptoms. But a lot of what we've looked at at the end here is looking at location and the pollens that are in particular locations. And I'd just like your thoughts on that as someone who looks at allergens about, you know, what is the role of these different allergens and how to they vary on location and affect people?

KOSISKYWell, I know with our region and, you know, from some of the comments we're hearing, they say if you come to the Washington D.C. area without an allergy, you're probably going to leave with one. I know, though, nationwide and it depends on the location with respect to the different types of trees and weeds and likewise grasses, although, grasses tend to share so many proteins. They're highly cross reactive. But different locations most certainly have different flora.

KOSISKYAnd so folks may be -- as a matter fact, we had a call from a doc. A patient moved from the Midwest and, actually, I believe it might have been even farther west in California and was highly allergic to olive tree. And they came to D.C. and thought, "Oh, good. There's no olive trees out here." Well, we have ash. We have the white ash, which is in the same family. And she developed allergies here or actually was reacting to the ash, which was sort of cross reactive to the proteins in the olive tree out west. But from region to region of the country, most certainly there's different tress and weeds that affect folks a little bit differently from area to area.

GOLBECKWell, that's all the time we have to talk about seasonal allergies. I'd like to thank both of our guests for a very enlightening conversation. Dr. Dean Metcalf is Chief of the Laboratory of Allergic Diseases at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. Thank you, Dean. Susan Kosisky is Director of the U.S. Army Centralized Allergen Extract Lab in Silver Spring, Maryland. Thanks for joining us, Susan.

KOSISKYThank you.

GOLBECKWe're going to take a quick break. We'll be back in just a minute to talk about indoor pollution. So you can't stay safe from those pollens even if you stay inside.