Allergology (ALLERGIES) with Zachary Rubin

Dander enemies. Gluten intolerances. Runny noses. Shellfish bummers. Skin prick tests. Epipen pockets. Allergies? WE GOT ‘EM, folks. And we’ve got double board-certified allergist, immunologist, and author of the New York Times Bestseller “All About Allergies” Dr. Zachary Rubin. The Doc takes a quick break from his many demanding jobs to let me pepper him with questions about sneezing, allergy shots, Benadryl naps, home testing vs. office visits, oral challenges, unfriendly fruits, street tree sexism, and so much more. We’ve been itching to do this one for a while, so get it in your system ASAP.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Alie Ward?

  Oh, hey. It's that mole you should get checked out. Ally Ward. This episode, nothing to sneeze at. It's allergies. It's allergies. What kind of allergies, you ask me? Maybe you're blowing your nose. Maybe you're sitting on the toilet forever, sick with allergies. We're going to talk about all of them. This ologist is the author of a new book all about allergies and hosts an exceptionally popular series of videos on TikTok and Instagram and YouTube. They answer all of our questions about what's wrong with us. So many questions. I had a lot of you suggest via Patreon that we reach out to this person. And it was a delight to connect. One evening after their very long workday, they put their kids to bed. They showed up with a kind smile and a curly

• 0:43Alie Ward?

  mop of hair, a still crisp business shirt and a bow tie. We chatted after hours, asking the questions that you submitted via patreon.com/ologies, where you can join for as little as a dollar a month and support the show. Thank you for that. Also, thank you to everyone wearing Ologies merch via ologiesmerch.com. And thank you to the folks who keep us up in the charts by leaving some fresh reviews, such as this one from the lovely Mackenzie KW, who wrote, no need to play it cool. In a world where all the kids want to be nonchalant, this podcast is so fantastically chalant. Mackenzie KW, couldn't be cool if I tried. And I do every day. Thanks ever so much for that. And if you have left me a review, I have read it and I have cherished it unless it was mean. And thank you to sponsors of the show who make it possible for us to donate to a cause of the ologist choosing

• 1:28Alie Ward?

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• 2:05Speaker 01

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• 3:05Alie Ward?

  Also, heads up if you have kids or you need kids-safe versions of ologies. We have smologies, S-M-O-L-O-G-I-E-S. There are shorter, kid-friendly episodes available in their own feed wherever you get your podcasts. It's also linked to the show notes. Okay, so this ologist is a double-board certified allergist, immunologist, and a pediatrician who has a private practice outside of Chicago. They attended Case Western Reserve University, did a residency in pediatrics at the University of Illinois in Chicago, and a fellowship in pediatric and adult allergy and immunology at Washington University, which honestly, it's frankly going overboard with achievement already. There's so many boards that they're certified through. But they have 2.2 million TikTok followers, over a million on Instagram. And that is because they know their stuff. They're fun to listen to.

• 3:50Alie Ward?

  And it's no wonder that on the evening that we spoke a few weeks ago and recorded this, the news had just come out that their book, All About Allergies, had landed a top spot on the New York Times Bestseller list. So allergology, it sounds goofy as hell. I can't do anything about that. But it's very much a real branch of medicine. And the word allergy, that was just coined in 1906 from the Greek word allos, for other or strange. So let's meet them and we'll talk about allergy shots, skin pricks, pollen, shrimp trying to kill you, gluten, Benadryl naps, intolerance versus allergies, home testing versus office visits, oral challenges, unfriendly fruits, street tree sexism, and so much more with immunologist, author, science communicator, and allergologist Dr. Zachary Rubin.

• 4:54Speaker 04

  Zachary Rubin, R-U-B-I-N, he/him/his.

• 4:59Alie Ward?

  We can call you Doc.

• 5:00Speaker 04

  Yeah.

• 5:01Alie Ward?

  You know, I had an allergist, his name was Dr. Itches. Can you believe it?

• 5:05Speaker 04

  That sounds hard to believe.

• 5:06Alie Ward?

  I know.

• 5:07Speaker 04

  Was that out in California?

• 5:08Alie Ward?

  It was out in California. I think it was pronounced I-chiez technically, but it was written like Itches for the most part. We've been talking about nominative determinism too much recently, but stay tuned for an episode with a guy about journaling, whose last name starts with Penn. Anyway, enough of my internal monologue. What is an allergy?

• 5:28Speaker 04

  Allergy is the study of abnormal immune system responses to foreign substances. It's a whole field that's been evolving rapidly over the last 100 to 200 years.

• 5:39Alie Ward?

  And what's the difference between an allergy and an autoimmune disorder? Are they the same thing? Are they one and the same or no?

• 5:47Speaker 04

  They're not. There's some similarities.

• 5:49Alie Ward?

  Okay.

• 5:49Speaker 04

  Now, the immune system is made to protect you from infections. It's made to look for cancer cells, right? You're looking at your own cells and making sure, okay, this one's good, check. This one's good, check. Duck, duck, goose. You know, oh my gosh, this looks like it's abnormal. We're gonna kill that.

• 6:04Alie Ward?

  All the time, your body is finding wonky cells and killing them, including little tiny baby cancer cells that you gobble up, just like, no way, man, not here.

• 6:14Speaker 04

  And then you have checks and balances to make sure, hey, food's okay, right? How you know that that's not a germ? So it's got so many different ways to figure this stuff out, that an allergy is abnormal response to foreign substances. Autoimmune disease is an abnormal response to your healthy tissue. And a lot of this is due to these proteins called antibodies. They're like little tags that mark things for destruction, or make sure that they are just not able to function. And so depending on the types of tags that are made, it's either to remember a germ so that you can fight off that infection before getting sick, or it could cause an allergic reaction, or it can cause an autoimmune reaction.

• 6:55Alie Ward?

  So remember how when we learned that a coronavirus had all those spike proteins, right? The proteins on the end of a cell give our immune system signals on whether or not it is friend or foe. And then the immune cells kind of spread the word of what's on their shit list. Sometimes it's a harmful virus, or a bacteria, or it's a cancer cell, and they destroy it, which is a great immune response. I have no notes on that. Sometimes, though, they go after your own healthy body, like an autoimmune disease. And I do have notes on that, which is, please stop that. And with allergies, harmless substances can make your body freak out for some reason because they think, I gotta take care of this.

• 7:36Alie Ward?

  And then these proteins, these antibodies, I have heard of I G E and different things like that, immunoglobulins. Can you break down a little bit of what an allergist looks for?

• 7:48Speaker 04

  So there are several different types of antibodies or immunoglobulins. I G G is typically the one that your body makes in response to an infection to remember it. I G A is an antibody that tags things in your gut, mostly. I G M, as in Mary, that one is going to protect you against the infections initially. Then I G E normally helps protect against parasites, but is like the allergy protein.

• 8:16Alie Ward?

  I G E, come on, man. Get it together.

• 8:20Speaker 04

  Because when you make antibodies in that class to, let's say, cat dander, or pollen, or food, it thinks, oh, my gosh, this foreign substance is a parasite. We've got to mark it for destruction and create this whole cascade of events. The B cells in your adaptive immune system make those specific proteins that are like a lock and key, and then they latch on to another cell called a mast cell, which have these little granules that contain a lot of chemicals like histamine, which most people are familiar with because you take Benadryl or Zyrtec as an antihistamine to block those effects. And so you make those antibodies, they coat those cells, and then subsequent exposure to pollen, mold, cat dander, peanut butter, et cetera.

• 9:05Speaker 04

  If it latches onto that, it activates those cells and creates all the symptoms that people experience. It could be itching, sneezing, runny nose, watery eyes, coughing, wheezing. It could be more severe, like vomiting, problems breathing, or even in life-threatening situations, we call it anaphylactic shock, where the blood pressure drops. And then that means your blood's pooling out of vital organs, and that could increase the risk of heart attack, stroke, or even death in rare situations.

• 9:32Alie Ward?

  An amassed cell, just a side note, is a white blood cell that can live in connective tissues, like all over the damn place, in your intestines, your nerves, under the skin, lungs. And they have chemicals like histamine and other things that trigger inflammation in response to threats. And what do these histamines, what do these reactions do in a healthy body? Do they help fight off and swell things up to purge bacteria and stuff? What are they doing on a normal day?

• 9:59Speaker 04

  Right. So histamine has a ton of different functions, depending on where it's released in the body. So you may not realize this, but histamine is involved in stomach acid regulation. And so when you take Pepsid, that's actually an antihistamine. It helps decrease stomach acid production. Histamine is also produced in your brain for multiple reasons, to suppress appetite and part of your sleep-wake cycle. So if you were to take Benadryl, it gets into your brain, it blocks histamine ability there, you get tired.

• 10:29Alie Ward?

  Oh, that's why that happens.

• 10:32Speaker 04

  If it's in your skin, let's say you get a mosquito bite or an insect bite. Histamine is released to make the little surface blood vessels leak a little bit, so that immune cells come in and then gobble up whatever foreign substance is there to protect you from further damage. So you get a mosquito bite, which is really a hive, usually. So that chemical is crucial for your body to function, and there are even more reasons for it to work in different ways. So when people are joking and saying, oh, just get rid of all the histamine in my body, well, you won't be able to function.

• 11:04Alie Ward?

  Yeah. Well, what about this thing I've been seeing on the internet about endometriosis and Pepsid and histamine response in people with mast cell activation? I've been hearing people with uteruses saying Pepsid has helped them with a lot of like period pain. Is that true?

• 11:24Speaker 04

  So here's the deal on that. And unfortunately, with a lot of women's health issues, it's not well studied. And so we have to kind of really get into some of the biochemical, physiological pathways to try to infer what's going on here, because we don't really have clinical trials for Pepsid. And what I'm hearing from women online mainly is for PMDD, where they are having very severe symptoms around their menstrual cycle. So cyclically, they're having some very severe symptoms all over. When you are going through your menstrual cycle, there are cyclical changes to your sex hormones, especially like estrogen. And we know estrogen acts on mast cells, just like we were talking about for allergic

• 12:05Speaker 04

  reactions. If you've got additional activation of those cells releasing histamine, that could be causing some of the uncomfortable symptoms. And so when women report they're taking Pepsid, which I mentioned earlier is an antihistamine, some women say it's changed their life. But we don't have the clinical studies to say, hey, let's take a thousand women, randomize them to either getting the medicine or a placebo. The study group doesn't know what they're getting. The people giving the medication doesn't know what they're getting. We call it a double blinded study to reduce bias and any potential, we call confounding factors, and then following them over time and seeing what happens. That is the kind of gold standard study to do, but costs a lot of money, resources. You have to have a lot of buy in to do that. And so a researcher's got to be able to have

• 12:49Speaker 04

  a lab to create that kind of clinical study and get all the patients. And that takes years to do. But that would be the best way to know. Right now, it's anecdotal evidence. I tend to believe women when they tell me this works for them. And since Pepsid is generally a well tolerated medication with not a lot of side effects to it, I don't see a lot of harm in doing it. Now, remember, folks, if you're listening to this podcast right now, this is not specific medical advice.

• 13:14Alie Ward?

  Yes.

• 13:15Speaker 04

  Talk with your doctor.

• 13:16Alie Ward?

  Not intended to diagnose, treat, or cure any diseases. Can you break down what is a respiratory allergy response versus what is something that is more systemic, like anaphylactic versus? Sneezeing and runny noses. My in-laws have allergies to shellfish, right?

• 13:35Speaker 04

  Right.

• 13:35Alie Ward?

  And my brother-in-law does not go anywhere without an EpiPen. And then my husband has cat allergies and so his does not need an EpiPen. So what's the breakdown of when something gets like serious?

• 13:48Speaker 04

  Right. So we either indirectly or directly measure for that Ig antibody that could specifically bind to a protein. So a skin test indirectly measures that if you have it, you get a little bump on your skin after exposing it to that particular substance. A blood test can directly measure and quantify it, but none of that can tell us severity of reactions. It really can't. There are people like myself where prior to treating my cat allergy, I would wheeze around cats and have trouble breathing.

• 14:16Alie Ward?

  So the allergist would ask you like, hey, what happens when you're exposed to that thing you're allergic to? How bad is it? How sudden does it come on? Because one really maddening thing I'm now learning about allergies is that they can be completely different for every person. And animal dander or dust or pollen may cause some folks to wheeze or have congestion or just general misery coming out of their face. While other triggers can cause anaphylaxis, which is a really sudden reaction that causes your blood vessels to open up, blood pressure to suddenly drop, the pulse rate shoots up and breathing becomes difficult due to muscle constriction. So an EpiPen or epinephrine pen delivers a shot of adrenaline into your muscle, which is really quickly taken up by your system.

• 14:59Alie Ward?

  And that adrenaline, that fight or flight chemical helps to open up airways, which then relaxes the muscles that are constricting your respiration. So an EpiPen can be used in those life-threatening circumstances. But also you should still see a doctor. If you've ever needed an EpiPen, still check in with a doctor afterward, they say.

• 15:17Speaker 04

  Food tends to, if you have that positive test and you get exposed to it, you are more likely to have more severe symptoms than if it's like pollen, mold or cat dander. And there's a lot of potential reasons why that's the case. It has to do with where is the exposure? So whether you're, you know, having it in your nasal passages, which is used to seeing a lot of these things, or is it in your gut like when you eat food, right? So the route of administration makes a difference in how those reactions occur. The potential way that the immune system responds to a food versus an environmental allergen can be different.

• 15:51Alie Ward?

  And you're talking about when you were a kid and your cat allergy. And I want to hear exactly how. You remediated that, how you treated it. But let's go back, back in time, childhood. Now, you are trained as a pediatrician and you're not the only doctor in the family. Right? Can you tell me a little bit about when you decided that you would follow in family footsteps and be a Dr. Rubin?

• 16:16Speaker 04

  Yeah, so my dad, Dr. Rubin, Senior, Ira Rubin, he has a private practice and has been in the same practice since I was two weeks old. So my dad was busy all the time, and this was when medicine was practiced very differently. So for folks who may not be aware, when we think about medicine over 20, 30 years ago, the pediatrician, the primary care physician, not only took care of you in the clinic, but in the hospital as well. So I remember it would be two in the morning and my bedroom was right by the garage and we had this rickety garage door opener that was like, and I wake up immediately. He would go to the emergency room when he was on call to do a spinal tap on a kid and admit them to the hospital. And then he would round on all of his patients on his service and then go to clinic, take

• 17:01Speaker 04

  calls about the hospital patients while he was in clinic, and then go back to the hospital before he was done, see the patients again, and then go home. So it was a very long day, but he built these beautiful relationships with his patients. To even this day, I practice in the same town, two days a week that he's in, and I get his patients. Even before coming here, one of his patients came to me for issues related to severe eczema. So I get all this feedback about how wonderful of a human being he is with his patients. When I was in eighth grade, there was a take your kid to school day. I had already been seeing what my dad does on a regular basis because I'd wait for him to finish work or whatever it was. But this was the first time that I really remember vividly patients' parents coming

• 17:45Speaker 04

  up to me and shaking my hand and saying, you know, I love what your dad does. It's such a noble profession. You should be proud of what he does. And at a young age, that was very impressionable. I was like, oh, my God, I want to do this. I think this is so cool. You're learning every day. You're doing so much for people and it's so rewarding. I saw that early on.

• 18:02Alie Ward?

  And Dr. Rubin, Senior, figured since his son had this spark of curiosity. And ambition in that direction, he would give him a taste of pre, pre, pre, pre-med, creating this 18-hour course called Dr. Rubin's Mini Medical School for high school students, tested on his son, who loved it.

• 18:20Speaker 04

  Because when you get that impression early on, you get that mentorship early on, you can make a decision that you won't waste your time later on. You could either love it or hate it. And I actually like it when you hate it ahead of time because then you're not putting all of that effort and resource into it and you find out, no, no, no, I want to do something totally different. I think it's valuable. And so all those experiences led me to go to Case Western Reserve University in Cleveland.

• 18:43Alie Ward?

  So meanwhile, Zachary was still mentoring high school students with these emerging medical aspirations, which as it turned out was kind of priming him for mass science communication.

• 18:54Speaker 04

  And so all of these teaching experiences that I've had at an early age drew me towards what I do now, which was, you know, I initially wanted to be like my dad and be a pediatrician. But when I started rotating in specialties, I did allergy. I was like, no, no, no, this is what I want to do. So cool. I get to take care of all ages. The field was exploding with new research and new treatments and new ways to think about the immune system at the time that I was getting into it, primarily outpatient-based preventive medicine in a sense, like keeping kids out of the hospital. I had some really terrible experiences with kids dying and being really sick and that just weighed on me. I'm a very, as much as I can be reserved or outgoing, I take my patients home with me and I still think about some of my earliest experiences.

• 19:39Speaker 04

  And so that's shaped my goal in life is to empower people of knowledge and make them as healthy as possible and avoid the hospital as much as possible. And so it has been such a journey the last several years between all of my training. I finish up right when the pandemic starts.

• 19:58Alie Ward?

  Oh, God.

• 19:58Speaker 04

  So just like everybody, I went to social media to can make connections. And I was like, holy crap, there's so much misinformation out there. And I saw it translated in my clinic. I had a family bringing a child who was giving them nasal iodine spray. They were spraying iodine up the kid's nose, thinking it would help them stay healthy and not have allergies. And they heard that from a pharmacist on TikTok.

• 20:20Alie Ward?

  Oof. And you should not do that, just to clarify.

• 20:23Speaker 04

  Do not do that. It could cause thyroid dysfunction potentially. There's not enough evidence that it's not only effective, but safe. And so I started on Twitter and then made my way to TikTok. And I first was very much against it. I thought it was a kid's app, and I thought it was silly. But now I know what the power is of it. You know, you really can give a lot of good information on platforms where you have your face talking to people. And I built a following over four million over the past six years, just educating.

• 20:52Alie Ward?

  Bonkers. What do your folks think about that?

• 20:56Speaker 04

  Oh, they're thrilled. They think it's so cool. I can't believe it. Last year, I'll be at the airport or out and about, and people recognize me. I never thought

• 21:04Alie Ward?

  Of course.

• 21:06Speaker 04

  That that would happen. Never. No, like, but I was just heading the books for years and studying to plummet down. I didn't think that was even possible.

• 21:15Alie Ward?

  You're everyone's favorite allergist. Like, of course. You're everyone's probably primary allergist, given American health care.

• 21:24Speaker 04

  I mean, one allergist are 50,000 people these days in the United States.

• 21:28Alie Ward?

  That's actually the recommended ratio from the World Health Organization. But the numbers outside of Europe, this is a little more grim. So in the US, it's estimated that there is one allergist for every 75,000 people. I was like, really? There was a 2022 study, telehealth and allergy services in rural and regional locations that lack specialty services, came out in the Journal of Allergy and Clinical Immunology Practice. And it said that in all of Wyoming, serving 600,000 residents, there are like two allergists. Puzzlingly, Wyoming also gets two senators, which is the same number as California, which has 40 million residents. So clearly, we've got some ratios to work on in the United States.

• 22:12Alie Ward?

  Now, further south, and according to the 2021 paper, Current Situation of Allergy Education in Mexico and Other Parts of Latin America. That number leaps to one allergist to 175,000 people. So either way, we're feeling red in the face. I wanted to ask a little bit about kids and exposure because you are, you know, trained in peds, as I think they say on television shows. What does exposure do when we're young? I've seen some videos of people being like, I'm going to go to the hospital parking lot and feed my baby peanut butter and see if they're okay to kind of test that exposure. How has that changed from the time, say, your father was a pediatrician to now?

• 22:55Speaker 04

  Right, so there wasn't a ton of scientific research on this because, one, it's a newer field, okay? So there were a lot of inferences made about what are we trying to do to address these issues? Because starting in the early 90s, we started to see an uptick in the number of kids developing food allergies. When we were kids, did you know anybody with a food allergy?

• 23:17Alie Ward?

  Very few, yeah.

• 23:19Speaker 04

  I had a milk allergy that I outgrew before I could really remember it. And then I knew one girl with a peanut allergy, but that's about it. And so in the 90s, this was starting to increase. And pediatricians were saying, well, what are we going to do to address this? How can we make a difference? And initially, they thought, well, maybe if we take the kids we know that are at highest risk, which are those with eczema, as an example, we will recommend delaying the introduction of these foods. And that was the recommendation since 2000 initially. And then the rates kept going up. And they're like, oh crap, what do we do about this? Well, there were some researchers from multiple centers around the world who came together and said, well, we noticed an interesting trend that if you look at Jewish kids in Israel

• 24:02Speaker 04

  versus in England, the peanut allergy rates are very different. And they noticed the common denominator was the exposure, that kids in Israel were getting this Bamba peanut snack, which you probably see in the grocery store now. But they were giving it to babies in Israel, but not in England. So they inferred that the timing of introduction makes a difference. And so they were able to convince hundreds of parents to go into a clinical trial where they would randomize and say, hey, this baby's going to get peanut before one, this one's going to wait till they're five. Let's see what happens. What happened was, in the early introduction group, they were 80% less likely to get peanut allergies compared to delayed.

• 24:42Alie Ward?

  For more on this, you can see the 2008 paper, "Early Consumption of Peanuts in Infancy Is Associated With a Low Prevalence of Peanut Allergy." It's in the Journal of Allergy and Clinical Immunology, or the Wikipedia page for Bombas, which is probably like, "Hey, babies who eat Bombas have an 81% lower chance of getting a peanut allergy." And apparently, that is not just marketing. Part of it is just the recipe, because it's got popcorn and it's coated in peanut powder. It's kind of like a Cheeto, which is, "A less potent and safer substrate for peanut oral immunotherapy compared to raw and roasted peanuts." So yeah, I guess a baggie of peanut prevention is worth a pound of EpiPens later on. Sign me up if I were a baby.

• 25:24Speaker 04

  So not 100%, not foolproof, and we still are seeing a growing number of people with food allergies. But that did make a difference. We know that earlier exposure now to these highly allergenic foods could potentially push the immune system towards tolerance. And that's what we want. So having a varied diet earlier in life, obviously, under the direction of your pediatrician, to help with these issues can make a big difference. But it's not completely a done deal story, because we have changed that recommendation since about 2015, and it's been revised a few times. And we're just now starting to see a little bit of a decline in peanut allergy rates, to the point that now the most common food allergen in babies is egg, then peanut.

• 26:08Alie Ward?

  Oh.

• 26:09Speaker 04

  But like a lot of things in medicine, when you make a guideline change, it takes a long time for that to change, for a lot of reasons. Many physicians are just a little bit slower to adapt, because they were trained a certain way, and it's hard to kind of push that into a new direction.

• 26:24Alie Ward?

  And according to Johns Hopkins, 8% of kids have an allergy. And the most common ones are now eggs, milk, and peanuts. But peanuts, and tree nuts, and fish, and shellfish, those commonly cause the most severe reactions. But the good news is that folks tend to outgrow allergies to milk, and egg, and wheat, and soy. But the bad news is the nuts and the peanuts and the fish or shellfish are kind of usually with you for the long haul. So time, it's our most mortal enemy.

• 26:54Speaker 04

  And in our current system, if you're a primary care physician, you're lucky if you get 15 minutes with a patient. Because to keep the lights on, you have to see so many people when Medicare, Medicaid, private insurance, the reimbursement to the time that you spend with the patient is so low that it's challenging. And it's really a problem with our systems that makes it such that people are going to TikTok and Instagram and whatnot to get their health information.

• 27:22Alie Ward?

  Yeah.

• 27:22Speaker 04

  Oftentimes not in the best places from people who are, who really have no business giving that advice.

• 27:27Alie Ward?

  You can see the May 2025 article in the Journal of Mental Health titled, "Right to the Point: Gen Z is Turning to Social Media, Not Doctors, for Health Advice." And it gets its stats from a study that gathered data from 16,000 people in 16 countries. And among the 74 pages of dissociation-causing levels of just being cooked, a chart that was chillingly titled, "Spike in Belief That Average Person Can Know As Much As a Doctor, Especially Among Young People." Which is like, again, there's 74 pages of this study, so we'll link it in the show notes. But it explains that up to 45% of people aged 18 through 34 trust someone without

• 28:10Alie Ward?

  a medical degree as much as they trust a doctor. But the percentage of that same age group who has regretted a medical decision is like 58%. And all this information was gathered before this new wave of AI-generated content that hallucinates like up to 80% of the time. So I don't know, folks, things are getting weird. But when a trip to the ER is best made in an Uber to avoid the thousands of dollars in ambulance bills, even if you're insured, it's understandable that no one knows what to trust. But let's start with doctors. What is it about peanuts and maybe eggs? Is it that higher protein foods tend to set off alarm bells?

• 28:53Alie Ward?

  Or I always wondered, like, why are peanuts so agitating for some systems?

• 28:59Speaker 04

  It's not really well understood, but probably has to do with the nature of the protein structure itself and how it interacts with the immune system. And the fact of the matter is, is that if you cook peanuts, it doesn't break down the protein in appreciable amount for your immune system to be less reactive. So the good news about egg allergy is that most children who get an egg allergy, it resolves within the first few years of life. Because most of the time, people are allergic to proteins that when you bake it, you have a muffin or whatever, the immune system can tolerate that. And it's really more of the raw egg. And if you consume that regularly, you train your immune response to be less reactive to egg proteins over time. So that tends to resolve. Same thing with cow's milk,

• 29:41Speaker 04

  even wheat, kids outgrow that. But when it comes to peanut, tree nuts, seafood, especially adults, like if adults develop seafood allergy, unfortunately, it's usually lifelong for most. Yeah. But I will tell you an interesting story, actually, about the egg and milk allergy. So I had an elderly patient, I talk about this in my book, who came to me because they had a stem cell transplant to beat cancer. And they were in remission. Great. We were all really happy. But as a side effect, developed a severe milk and egg allergy. Why? Because the donor had a milk and egg allergy. And you can actually transfer allergies that way. And so it became engrafted in his immune system that I looked at his blood tests and his skin tests, and they were just through the roof. Wow.

• 30:25Speaker 04

  He survived, and he's doing well, but now he can't eat those foods.

• 30:29Alie Ward?

  So plasma is the 50% of blood that makes it a liquid. And it carries around everything from proteins to immune cells. And those immune cells, like the IgE antibodies, which evolved to flag parasites, they now took up the hobby of freaking out about other stuff. Are they just bored? I've also been curious about the hygiene hypothesis of if you completely sequester a child from a lot of different bugs and germs, that their immune system has a more reactive time. I know it's a hypothesis. Has it become a theory at all?

• 31:04Speaker 04

  So it still is a hypothesis, and I think it's becoming weaker over time, actually.

• 31:08Alie Ward?

  Okay.

• 31:09Speaker 04

  There's a different hypothesis that I think makes a little bit more sense. It's a slight nuance to this whole discussion. A lot of people are saying, huh, you gotta build their immune system. You gotta have them get sick and they'll be stronger because of it, right? They treat the immune system like a muscle when the immune system is really more like a library that you grab volumes over time of different books. You learn about the germs and then you go back and say, huh, looks like that again. I guess we're gonna have to act on that, right? That's really what the immune system is more like. And so the hygiene hypothesis has been misconstrued with that. The idea that if you're hyper cleansed and you're not getting sick is a problem. There is an issue with the cleanliness factor, yes. Like, we should encourage kids to go play in the dirt and be outside.

• 31:52Speaker 04

  And if you have pets, it could potentially have a protective effect, but not forever. A case in point, I had a dog growing up. When the dog passed away and I got exposed to dogs later, that's when I became allergic. Do you know what I'm saying? So that's a classic example. I see that in my patients all the time. But there's something called the old friends hypothesis, which makes more sense to me. It's not a matter of getting sick. It's the type of exposure matters. There are a lot of healthy microbes in our environment. They're on our skin, they're in our gut. You may hear that buzzword, the gut microbiome.

• 32:24Alie Ward?

  Yeah.

• 32:25Speaker 04

  It's like this big thing right now where all these companies have sprouted up with like AI-generated this and probiotics and prebiotics. And the problem is, is we don't have a lot of good clinical evidence right now that intervening with probiotics makes a difference because we know there's changes in the microbiome when you get sick. One of my co-fellows who mentored me a year ahead of me, he published a study where kids with RSV, if they had that infection or they didn't, they compared stool samples and found completely different gut microbiomes, if you were infected or not.

• 32:57Alie Ward?

  You can see the 2020 study, Altered Gut Microbiota in Infants is Associated with RSV Disease Severity. Or there's also a 2025 paper in the journal Microbiology Spectrum titled, RSV Infection Disrupts Gut Microbiota and Metabolomeostasis in Mice, Regulating Pulmonary Inflammation Via the SPHK/S1P Pathway, which notes that using a mouse model, the researchers investigated the interplay between pulmonary inflammation.

• 33:25Alie Ward?

  Lung issues and gut microbiota and found that dietary changes, notably a low-fat diet, ameliorated lung inflammation and essentially white blood cells in lung fluid. So that highlighted the role of diet intervention in managing RSV infection. And this is brand-new research done in mouse models, but fascinating nonetheless when it comes to diet and inflammation and the strength of our immune systems pre and post-infection. What about blood tests for allergies where you send your blood away and they tell you stay away from pineapple or corn or things that you kind of had no idea? Are those also wallet lighteners or do they have merit?

• 34:08Speaker 04

  It's a lot worse than just lightening the wall, and I'll tell you why. So there's one type of test called food sensitivity testing. They'll say, send some blood in, we'll give you a packet of 90 pages that'll say you are sensitive to 30 foods. And every time I see this in my clinic, it's almost always an adult patient and it always says it's positive to coffee.

• 34:28Alie Ward?

  Oh.

• 34:28Speaker 04

  And I'll say, do you drink coffee? And every time they say yes. Why? Because what that test is measuring is for a different antibody called IgG, which we mentioned earlier. That is a tolerance antibody. It's part of how your immune system knows that food is safe. It tells the immune system to just decrease that response. So anything you've been exposed to or similar foods, it'll show up as positive on the test. And they will say, hey, all right, these are the positive things, avoid them, and then add it back in. And so you could do that without getting the test. You could do an elimination diet, single food at a time, and do that yourself, rather than spending $100 to $300, getting confusing results that makes it seem like you can't eat anything except for grass.

• 35:13Speaker 04

  You potentially lose weight in an unhealthy way. You start having this very unusual relationship with food that creates anxiety, potentially nutritional problems. So

• 35:23Speaker 04

  That's one test that really should not be done at all. And I post this online all the time because it is potentially very damaging for people and not helpful. And when people say, oh, no, it did help me, you could have done the same thing without the test and gotten the same results. Because we do have situations where you eat something and it may have a sensitivity where it may cause some type of symptom, but we don't have the molecular pathway to understand how X food causes Y symptoms. How can you develop a test if you don't know the underlying problem? I believe people, when they say, I eat gluten and it causes problems, I believe them, but we don't have a test to always prove that.

• 36:00Alie Ward?

  Yeah.

• 36:00Speaker 04

  So I want to make that very clear for the audience, that just because a test exists, and I say this all the time, doesn't mean it's helpful. And I'm very judicious about it. There's another test called allergy testing, IgE testing. That's what I do in my clinic, but they'll do at-home testing and they don't have an expert interpreting those results. So people will come to me with a packet saying, it says I'm allergic to all of these different foods. And then I'll ask them, do you eat them on a regular basis? Yeah, yeah. Do you have hives when you eat it? No. Do you have swelling? No. Probably no. You're not allergic. You can have a positive test for IgE antibodies and it doesn't mean anything really clinically. But when you avoid that food unnecessarily, especially for children, and then try to reintroduce it, you could induce an allergic

• 36:43Speaker 04

  reaction. Because again, the timing of exposure matters so much. And this is highly nuanced and can be very confusing. But panel testing for food can be very damaging for people because of the high false positive rate, meaning it says you're allergic, but you're not, in the setting of having really either no symptoms or it's nonspecific and we're not sure what's going on. So I really try to only test people when I think it's going to actually change things for a positive way. My goal is to help people understand their bodies better and leave my office with less problems or better clarity, not give them more problems that could be potentially lifelong.

• 37:21Alie Ward?

  So yeah, the at-home kits typically look for antibodies called immunoglobulin G, which can tell you what the body has been exposed to. And those results can be hard to interpret, which leads people to eliminate a bunch of things which could actually make allergies worse down the line. So what you need is an IgE test. And doctors say, don't bother with the hair testing kits because IgE isn't even hanging out in your hair. So best bet is to see a doctor for a skin or a blood test to see what IgE antibodies you're packing in there. Well, is it a difference in your body's reaction between a sensitivity, an intolerance, and an allergy?

• 38:01Speaker 04

  So intolerance is problem digesting the food.

• 38:03Alie Ward?

  Okay.

• 38:03Speaker 04

  So that leads to lactose intolerance is very common. It's where you don't have enough of an enzyme called lactase that breaks down the sugar molecule, lactose, which leads to increased gas production that causes bloating, abdominal pain, maybe nausea, but diarrhea, upset stomach, you know, all the Pepto Bismol commercials.

• 38:20Alie Ward?

  Yeah, I was gonna say, that sounds familiar.

• 38:23Speaker 04

  Exactly. And so it's not life threatening. It's not an immunological problem. You could theoretically do something called a hydrogen breath test where they consume dairy, wait a while, and then breathe into a tube because if you have lactose intolerance, bacteria create hydrogen gas and you can measure that, which is really cool. Like we're nerding out here.

• 38:41Alie Ward?

  Yeah.

• 38:41Speaker 04

  But not something that's pleasant to do. So I never order it because I, again, a lot of things I listen to my patient, I say, you're telling me this is causing a problem. I believe you, right? I don't need a test for everything because the gold standard in a lot of what I do is you witness somebody doing that and seeing if they have a problem. So we often call that an oral food challenge. That term, I don't know who came up with it, but it sounds like it's a game show, you know, where

• 39:09Alie Ward?

  Yeah.

• 39:09Speaker 04

  I'm at the office and they're eating small incremental amounts. Okay, is Johnny gonna eat enough to be allergic or not? And the other thing, for those who are in the food allergy community, they're gonna laugh at this because a lot of times you'll hear people say, oh, they passed their food challenge or they failed their food challenge. Oh no, you know, they had a reaction. And I'm like, it's a test. It's either positive or negative. You don't get a pregnancy test, you pass or fail a test.

• 39:33Alie Ward?

  Yeah, that's fucked.

• 39:37Alie Ward?

  That's so awful.

• 39:39Speaker 04

  But, you know, eight to 10% of the population is food allergy. So a lot of people get that.

• 39:44Alie Ward?

  Well, what happens if it seems almost?

• 39:48Alie Ward?

  In the zeitgeist, where I feel like before the sourdough epidemic of 2020, no one wanted to eat gluten. I mean, I live in LA, but you know, gluten was blamed for a host of bloating and downdrift and all kinds of stuff. But I feel like I see fewer gluten-free items in bakeries in LA now. So is that just, people need to disambiguate, like, what is too many carbs and your blood sugar stinking, or what is eggs, or what is butter, or what is the nuts on the croissant?

• 40:21Speaker 04

  Right. I mean, it's so important for people to use the terminology correctly, because it's created a lot of problems for different groups of people.

• 40:28Alie Ward?

  So an allergy is distinct from an intolerance. And in his book, once again, all about allergies, he writes, "The term food allergy should not be a blanket term. There are many ways the bodies can react to food. When you think about someone who reacts quickly to a food and needs epinephrine, that usually refers to IgE-mediated food allergies. This means that the immune system," he writes, "has created IgE antibodies that can latch on to a particular food, which can be potentially life-threatening. And symptoms, which can come from a bunch of different organs, may consist of hives, swelling, vomiting, difficulty breathing, or wheezing, or passing out due to a drop in blood pressure, or a combination of all those things. And there are many other types of reactions to foods that don't look like this,

• 41:12Alie Ward?

  nor are they caused by IgE. So for the sake of decreasing confusion," he writes, "whenever I refer to a food allergy, he means an IgE-mediated food allergy." So intolerances are typically far less immediate and life-threatening. They happen once the food has reached the gut and symptoms are bloating and gas and pain, maybe cramping, changes in bowel reactions, and maybe barfing. Still worth paying attention to and advocating for yourself, for sure. But yeah, they're different biological reactions that often get confused with those suffering, especially the IgE-mediated food allergies, paying the price socially.

• 41:50Speaker 04

  And then that causes some people to get irritated, because they had to put in a lot of work to that. And then people don't take it as seriously, and it becomes the butt of a lot of jokes. Celiac disease is a very serious disease and it's actually an autoimmune disease. It's not technically an allergy because the immune response is your antibodies are made to attack your healthy intestines and other potential tissues. So people can get really sick with that and they treat it like a food allergy. It's managed a little bit differently, but it has to be treated like a food allergy where even a small amount could cause severe symptoms, severe abdominal pain and all these problems versus an intolerance. Yes, you're going to be uncomfortable, but you can tolerate a much higher dose than

• 42:34Speaker 04

  someone who has a food allergy or celiac disease as an example. And so I try to educate as many people as possible about these different issues because once people have a better understanding of it, then they can have a little bit more empathy when somebody says, hey, look, my child has a severe peanut allergy. Can you accommodate our needs and work through those conversations? And many places are great, but when pop culture and the media talks about these things as if it's funny, ha ha, you know, like in the movie Hitch where Will Smith's face just is swollen like a balloon.

• 43:05Speaker 05

  No, I think you have food allergies.

• 43:09Speaker 04

  And he's chucking down Benadryl and it's like, no, like that would be epi and all this kind of stuff. It makes people not understand the severity of it. It can be very difficult because a lot of parents and kids are bullied over this issue because it's not just a problem with you as the individual living with it. It affects families and communities and many people who don't have food allergies are affected by it because kids, they'll go to school and snack time. It's like no peanuts or tree nuts. And people are like, this is a bummer. And we need people to understand why this is important, why it needs to be taken seriously. But at the same time, we need to find the right balance to accommodate everybody.

• 43:46Alie Ward?

  Right. And, you know, I wanted to ask some questions from listeners too. Speaking about things to eat, obviously, that might help you early on especially. Rachel wanted to know they're in Lepine, Oregon. They say they're a lifelong allergy sufferer.

• 44:02Speaker 06

  I have lived on both coasts. I am still allergic to everything. And I've had so many people tell me that I should just eat local honey and it'll make everything magically better. And I've tried it and it has never worked for me. So what I want to know is Does it work? Or maybe I'm eating the wrong local honey? Or maybe there's a severity of allergies that honey can't touch? What's the deal here?

• 44:26Alie Ward?

  And we will get to that answer in a moment. But first, let's donate to a charity of his choosing. And Dr. Rubin had a really, really sweet and heartbreaking choice.

• 44:34Speaker 04

  I have an idea for the charity.

• 44:36Alie Ward?

  Okay.

• 44:36Speaker 04

  Okay. There is a small not-for-profit called Red Sneakers for Oakley. I met the parents of this child named Oakley Debs, who he tragically died from food allergies. He was on a trip with his family and he had a nut allergy and ate a coffee cake that they didn't realize had a walnut extract in it. And it's like cold Thanksgiving weekend. He had a little lip swelling. They gave him some Benadryl. He was fine. Then he went out and played for a few hours, came back in, started vomiting everywhere. And he said, call 911, I don't want to die. And he, he ended up having anaphylaxis. They didn't get epinephrine to him in time. He decompensated quickly. He was on a ventilator. He passed away.

• 45:19Alie Ward?

  Oh, my God.

• 45:20Speaker 04

  And his family felt like they just didn't know enough about food allergies. So they were able to create this holiday in May called International Red Sneakers for Oakley Day, where people will wear red sneakers, take pictures to remind people of their son, who just loved life and loved red sneakers. And I got to meet them. They're just lovely people. And they're just trying to make a difference of educating and advocating for people with food allergies. So, yeah, that, that's who I think would be deserving of something like this.

• 45:47Alie Ward?

  So International Red Sneakers Day is on May 20th, and Food Allergy Awareness Week is the second week of May. And Red Sneakers for Oakley helps spread food allergy awareness among schools and workplaces and other communities, teaching what a food allergy is and why food allergies are dangerous and should be taken seriously. They also help people recognize a mild to severe allergic reaction, what anaphylaxis is and what to do in case of anaphylaxis. So on May 20th, bust out some red sneakers and spread the word in honor of Oakley. And you can find out more at redsneakers.org. And thank you, Dr. Rubin. We will donate in your honor. And thanks to sponsors of Ologies. This podcast is brought to you by Squarespace.

• 46:32Alie Ward?

  If you haven't heard me gushing about Squarespace for years, it's an all-in-one website platform. Whether you're trying to grow a business you have, or if you're just a baby business getting started, it has everything you need. That's where I secured my domain name. It helped me build a professional site. I can update it so easily. I've been using Squarespace since before Ologies existed. After procrastinating for years, I literally built my website in one evening. They have templates, they have flexible editing tools. Squarespace also makes it easy to share your work. You can book clients, you can get paid. They have built-in tools for scheduling and invoicing and email, all in one place. Whenever someone I know needs a website, whether they're a scientist that needs to put their work up, or someone who's just starting a business,

• 47:17Alie Ward?

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• 48:02Alie Ward?

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• 50:02Alie Ward?

  OK, back to patron Rachel and Yara, Eddie Capello, Erin Grassi, Anthony Richards, Lauren M., Nancy C., Bob Riggs, Nikki Lawrence, and first-time question askers Meredith Deirdre, Ben Resnick, and Sarah Fenton, who all wanted to know, honey, honey, honey, honey, honey, what's the deal?

• 50:19Speaker 04

  The deal is, is that I support local businesses, right?

• 50:23Alie Ward?

  OK.

• 50:23Speaker 04

  It's a tasty treat. If you are above 12 months old, it's safe to have to treat a sore throat and a cough naturally. However, for allergy purposes, there's a big myth that the pollen that you consume in those products will desensitize and dampen the immune response like allergy shots, right? Because you have regular exposure. They're like, oh, yeah, I have a teaspoon every day. Which, yeah, so a lot of sugar.

• 50:45Alie Ward?

  Yeah.

• 50:46Speaker 04

  The reality is, when you consume that honey, it's not the pollen you're allergic to. So when you look at roses and you sneeze, it's not the pollen that makes you sneeze. It's the fragrance.

• 50:57Alie Ward?

  What?

• 50:57Speaker 04

  The fragrance is what's doing it.

• 51:00Alie Ward?

  No.

• 51:00Speaker 04

  Versus, you see those ugly plants that just like blow a lot of pollen in yellow? Like, you see those videos every year where like a tree goes down and it's like a plume of yellow smoke?

• 51:10Alie Ward?

  Yeah.

• 51:11Speaker 04

  That's what you're allergic to. It's the pollen, like from birch trees, Bermuda grass, ragweed, all these relatively uglier plants that just blow millions of pollen grains for miles, that you're breathing in and you don't always see it, but you're breathing it in constantly. That's not in honey. So there's no plausible mechanism for it to actually do that unless it's a placebo effect.

• 51:33Alie Ward?

  Wow, okay. So someone who calls themselves So Many Questions asked-

• 51:38Speaker 07

  More recently, I started getting comments from non-medical professionals that, props, I'm not actually allergic to the fruits I'm allergic to. It's the pollen, which is so embedded in the fruit and impossible to remove, that I cannot consume any part without interacting with the pollen. Or something, something about oral allergy syndrome? Or is it anything different than what I've been living my whole life?

• 51:58Alie Ward?

  Tommy McElrath also asked-

• 52:00Speaker 08

  Hi, this is Tommy McElrath from Chattanooga, Tennessee. I'm wondering why our bodies hate tree sperm so much.

• 52:06Alie Ward?

  But is it even the tree sperm? Or is it the fruit sperm? Sometimes if you have a fruit allergy, can that be the pollen? Or is that some protein in the fruit? And other potential frutaphobe patrons asked about this as well. Karen Malinas pleaded, "Tell me I'm not crazy that bananas and cantaloupe make my ragweed allergies worse?" While Rayleigh Grim wrote, "Why do some fruits make my mouth itchy? Looking at you, peaches." Kirat Singh, AJGC, The Quins, Sid Alamad, Eric Periandri, Elizabeth, Anthro Curator, Eliza Hammer Gage, and Lilly would like to know precisely- What the fuck, they say, is oral allergy syndrome? And why do kiwi and celery and conquered grapes make my mouth so mad?

• 52:45Speaker 04

  So this is a really interesting phenomenon. It's the most common form of food allergies. Every time I talk about this, and I guarantee you, if people are gonna write in the comments section in this, they're gonna be like, oh, my God, I didn't know this.

• 52:56Alie Ward?

  Yeah.

• 52:57Speaker 04

  It happens to so many people. It's called oral allergy syndrome, and this is what happens. So when you develop a pollen allergy, the tree sperm, as you were saying in that question, those grains have so many different parts where your immune system could bind to it and be like, I like this, and create those antibodies. And you're exposed to millions of them all the time during those seasons. And it's getting worse over time. As temperature rises, more pollen grains are being released with higher CO2 levels from greenhouse gas burning. You know, I know people don't like hearing the term climate change, but sorry, data's there.

• 53:30Alie Ward?

  You understand.

• 53:31Speaker 04

  They've spent years in, I think it was either South Korea or Japan, where they actually had specific tanks with trees that they were growing with different amounts of carbon dioxide that they were exposing to. And the higher the levels, the, what do you know, the more pollen that's being released. Okay, so besides the point, but you develop the pollen allergy and you look at the structure molecularly of the pollen grain, there's a lot of similar features to certain fruits, vegetables, and even nuts. So we call that cross-reactivity in immunology, where the immune system looks at two separate things and gets confused and says, oh, it's the same thing, and reacts to it. So people will get itching in their mouth, mild swelling, irritation in their throat, and rarely it can progress to a severe allergic reaction. And that's the raw form of those foods.

• 54:16Speaker 04

  But if you cook, can, freeze, process, or even microwave it, depending on the individual, it'll break down the protein enough so it's safe to eat. So many people are like, yeah, apples make me itchy, but they can eat apple pie? It's for that reason. They have a birch tree allergy.

• 54:31Alie Ward?

  So yeah, congratulations. You may have seasonal oral allergy syndrome, or OAS, or it's also called pollen food allergy syndrome, which sucks if you like fruits or if you own a mouth. Like you can have birch tree allergy symptoms by eating apricots and cherry and kiwi and mango, or pear, or nectarine, or even vegetables like carrot and celery and potato. Let's throw some nuts and legumes in there, almonds, hazelnuts and peanuts and soy. Your birch tree allergy is like, hey, what's up? It's me again, even with herbs. You got ragweed allergies? You might have to avoid banana and cantaloupe and watermelon and cucumber and stuff, and romaine lettuce and sunflower seeds. If you're a grass allergy girly, certain times of the year, you say goodbye to melon

• 55:14Alie Ward?

  and orange and peach, and plum and tomato and green peas. So yeah, maybe if you're feeling self-loathing, you can make a salad out of all that stuff. But maybe this is helping you understand yourself better than therapy or a tarot card reading. So you're welcome. Maybe you're like, who knew? Not me. Holy smokes, I never knew that. Duh, that's gonna change lives. If it's okay, I'm gonna ask you a few more Patreon questions. If my eyes dart over here, it's just because I'm looking at a document of 79 pages of questions. We got so many. Oh, some people were asking if it's true that cities planted more male trees and that's why people's allergies are getting worse. Have you heard that?

• 55:55Alie Ward?

  Because Kay Francie Pants, Laser Intraligator, Genetosaurus, Sadie Vipond, Annalise DeYoung, Nancy C, and Kelsey Simon heard that and they would like a flim-flam check.

• 56:04Speaker 04

  Let's get into that. So this is called Botanical Sexism.

• 56:08Alie Ward?

  Oh.

• 56:09Speaker 04

  It sounds really catchy. And every spring, I guarantee you, I could put $5 down, somebody's gonna make this post. They're gonna say, "A horticulturalist claims that city planners in the 1940s purposely planted only male trees because they didn't want to deal with the female plants making fruit and didn't want to give, you know, fruit to the masses." And it's all this corporate blah, blah, blah, right? And look, on the surface, that kind of sounds like it makes sense, and there's a lot of issues related to sexism, which are real, but it's being misapplied to this situation. Because the reality is that most trees in cities are essentially hermaphrodites. You have both male and female parts. So you're producing pollen, and you're also having trees catching them and making fruit

• 56:54Speaker 04

  anyways. But the issue was, is that there was Dutch Elm's disease. Earlier in the 20th century, that wiped a bunch of elm trees that were part of cities. And so when they replanted them, in the text, it said, "We're not going to put cottonwoods up because the cottony seeds would just, you know, really make things dirty." You've probably seen what cottonwood seeds look like.

• 57:15Alie Ward?

  Yeah.

• 57:16Speaker 04

  Catch on fire, they can, you know, clog up drain pipes and sewage and all that. So they didn't want to put that in cities, and so they chose other plants. They're not necessarily just male plants, as an example. And so they're trying to use this idea of botanical sexism as the reason why allergies are getting worse every year.

• 57:33Alie Ward?

  So the origin of this was a Scientific American blog post from 2015, but the long and short of it is, they cited a passage from 1949 that was really just about cottonwood trees, but in reality, only about 5% of street trees are solely male. And if you're like, "Tell me everything about street trees," you can see our Caribology episode about carib trees with the wonderful Megan Lynch, which also tells you how to eat stuff from street trees. So systemic sexism, it's pretty much everywhere, except for the trees on your block giving you allergies.

• 58:05Speaker 04

  As I mentioned earlier in the episode, the real reason is the fact that we've had rising temperatures as greenhouse gas emissions have been making the planet warmer. It means the pollen season is starting earlier and ending later, and we've tracked this. It's happening. The amount of pollen grains are more, we have more air pollution in many places. So you combine all that together, you're getting a lot more exposure than you did 20 years ago, so more people are going to complain of this as you're just getting bombarded with pollen. If you've ever been to Texas in December,

• 58:36Alie Ward?

  Mm-mm.

• 58:37Speaker 04

  It's called cedar fever.

• 58:39Alie Ward?

  Oh, dear.

• 58:39Speaker 04

  It's like yellow dust is on all the cars, and it's not even that those pollen grains are highly allergenic per pollen grain, it's just there's so much, it overwhelms the immune system that people are just so debilitated by this. And if you've got an audience in Texas, they're probably like, "Mm-hmm, yep, know what he's talking about."

• 58:58Alie Ward?

  I remember seeing that in the Bay Area when I was like in high school. My mom was, there was a puddle and it had yellow all over the top of it. And my mom went, this pollution is so shameful. And I was like, Mom, I think that's pollution. She'd never seen it in that volume. She's like, what? But you know, a lot of people wanted to know, are they screwing themselves over by taking like Claritin and Zertec daily if they have a cat or half the year if there are longer allergies? Are there repercussions? Asking for a friend. We're asking for a list of friends, including patrons Ashley Adair, Aaron Sorensen, Kylie Lime, Caterpillar Sam T, Christine Hurley, Carol, and first time question asker Leanne Sales.

• 59:37Speaker 04

  So long-term side effects of antihistamines that are of the second generation, meaning like Zertac, Claritin, Zyzol, Allegra, not Benadryl. So that's a different story. But these newer ones, as we talked about very briefly earlier on, the role of histamine is to suppress appetite. So if you take antihistamines long enough, it could increase your appetite and indirectly cause weight gain in some situations.

• 59:59Alie Ward?

  Oh, wow.

• 1:00:00Speaker 04

  Yeah. We don't know how common it is and how much of a dose effect it is, but we know that's a possibility. The other, which the FDA finally admitted, which I have known since I've been an allergist, is that if you were to stop abruptly Zertac after taking it for three or more months, you may notice like, wow, I feel like my body is crawling with ants. I'm really itchy. It's withdrawal. You can have withdrawal from it.

• 1:00:25Alie Ward?

  Oh, no.

• 1:00:25Speaker 04

  And so people have to titrate down very slowly sometimes. It doesn't mean that everybody who takes it daily for three months or more will have this, but it's something you gotta know so that you know what to do and talk with your doctor about.

• 1:00:37Alie Ward?

  And for more on this, you can see the May 2025 announcement. FDA requires a warning about rare but severe itching after stopping long-term use of oral allergy medicines, including Zertac, Zyzol, and other generic and trade names. So yeah, some people may experience rare but severe widespread itching, with some patients requiring medical intervention by stopping taking allergy meds. So I hope that there's at least one of you screaming at this revelation if this is making sense for you. Do GLP-1s affect histamine at all or allergies?

• 1:01:11Speaker 04

  This is a really interesting question that anecdotally in my clinic, I've had patients on GLP-1s who'd say, you know, I've noticed my allergies got better or my asthma got better. And it's unclear exactly why that's the case, but I call them off-target effects that oftentimes are beneficial, but we just don't have the data yet to really understand what exactly is going on. But this is something I was learning about in medical school, the pathway of GLP-1. And at that point, I was so excited because I said, this is going to be something that's going to change how we practice medicine, and it's doing it now.

• 1:01:45Alie Ward?

  So yes, we do need a GLP-1 episode, and I'll get on it. I'll get on the episode, not the medication. But meanwhile. You mentioned cottonwoods, and that brings me to bedding. Scott LaForce, Tim Shell, Fiona Glenn, Eve Holden a Goose, Moody Blobfish wanted to know, Holden a Goose asked, do anti-allergy beddings like Allerman actually work for dust mite allergies? Is there anything you can do if dust mites give you the hebes?

• 1:02:11Speaker 04

  Yeah, there are types of beddings that can help decrease the amount of dust mites by essentially kind of like suffocating them, essentially. So dust mites are critters that live wherever your human skin cells are. And if there's enough humidity, so humidity above 50% starts to have them multiply, you know, that moisture, because they're about roughly 80% water. They create a lot of allergens, though, and it's the year-round one that can also irritate people's skin. So if you have eczema, you got to decrease the amount of dust exposure. That's a hidden allergen to some people. So it's stuffies, the bedding, carpets, anything that's upholstered. So it's a lot of work. And this is true of any chronic disease. You got to work at changing your lifestyle to help reduce some of the

• 1:02:56Speaker 04

  effects of these ailments, including if you have a dust mite allergy or asthma, any of these things will impact day to day.

• 1:03:04Alie Ward?

  That is something that you can't even hide from, it feels like. And I guess keeping your home dusted helps. Maybe?

• 1:03:13Speaker 04

  Yeah, so any kind of what I call environmental reduction strategy, you have to do multiple interventions. It's not, okay, I vacuum my carpets once a week and that's all I do. It's never going to be enough. You have to make sure that you're changing your bedding. You've got to have an air purifier. All these different things together is more likely to be successful. But that in conjunction with medications and then we could also offer immunotherapy, where we give allergy injections and train the immune response to be less reactive over time.

• 1:03:41Alie Ward?

  What about, you've mentioned eczema a few times and Daniel Zonis, Tommy McElrath, Sunflower Star and Travis Howerton wanted to know, Travis asked, when I was in elementary school, doctors told me I had eczema. Whatever it is, it comes and goes, mostly on my hands, very dry, bleeding cracks. They use steroid creams. Tommy wanted to know, can you explain the links between allergens like eggs, dairy, corn and eczema? Like what's their link? Why are they such good friends?

• 1:04:07Speaker 04

  So actually, the science on this has changed a lot in the last 10 to 20 years. So we used to do a lot of food testing for kids with eczema and say, all right, let's avoid these foods and it could fix it. And when you actually collate all the data together, you've got a very small chance to significantly improve the skin through just eliminating certain foods, whether you do testing or not. And the problem, as I mentioned many times before, delaying the introduction or stopping foods that you test positive for when you were fine with them to begin with, could cause a food allergy that's potentially lifelong and life threatening. And the issue with eczema, there's a few things. One is skin barrier dysfunction.

• 1:04:49Speaker 04

  So the skin is supposed to protect you from the outside world and regulate temperature. But if it's defective, then there's things, dust, food, whatever, can get into your skin and create inflammation of a specific type called TH2. That makes more of those IgE antibodies. And that can then travel around and create asthma, food allergies, hay fever, et cetera. And so you also have a situation where bacteria on your skin are different. When you have eczema, you're higher risk of having Staph aureus, which newer research suggests they're releasing specific proteins called proteases that break down other proteins or activate sensory neurons to cause itch. So these bacteria that sit on your skin, they're causing you to itch. So you scratch. What happens?

• 1:05:33Speaker 04

  You just grab bacteria on your fingertips and you seed it to another place.

• 1:05:40Speaker 04

  So that from an evolutionary survival perspective, it's like, hi, getting a free ride.

• 1:05:44Alie Ward?

  Yeah.

• 1:05:44Speaker 04

  And that can cause a higher risk of infections, too. So a lot of different problems for a complex chronic skin disease that lives in different parts of the body, depending on how old you are and for other factors. Hands are a very common area, especially for older kids and adults, especially when it's dry out. And so we wear jewelry on our hands all the time. If you have hand dermatitis or hand eczema, you really should reduce the amount of jewelry you have because that can make it worse, right? You have a foreign substance sitting on irritated skin. You think that immune system is going to be happy saying, the heck is this metal doing here?

• 1:06:22Speaker 01

  Stop touching me.

• 1:06:23Speaker 04

  There's another common thing that people ask, and it's probably in your questions in the 75 pages.

• 1:06:27Alie Ward?

  Yeah.

• 1:06:28Speaker 04

  Gel nails, be careful of gel nails, okay? Because if you do them yourself and you're not good at it and you've got like a crack in your skin, you could create what's called an acrylate allergy. The substance that makes the gel nail, acrylates, you need to cure them, right? You've got to put them under a light of some sort to take the monomer and convert it into a hardened polymer. And if that monomer gets into your blood, then your immune system is like, what the heck is this? And it creates a reaction called a delayed hypersensitivity reaction that's kind of like a poison ivy rash. And it may show up on your fingertips or on your eyes because when you touch, you seed some of that acrylate and it leads to inflammation around that very sensitive area.

• 1:07:12Alie Ward?

  Okay, zero people asked about that because what? So yeah, the Journal of Allergy and Clinical Immunology, it's one step ahead of you. They have a 2025 paper titled Allergy to Hypoallergenic Gel Nail Polish. First off, very cunty use of the air quotes around hypoallergenic. But it continues that it's important to consider this allergy, even if a gel nail polish product is advertised as hypoallergenic. And it says, in addition, in patients presenting with a facial rash who use gel nail polish that may be from contact dermatitis. So if you are a gel nail polish person and you have wanted to sue your salon for a rash or an infection, perhaps your IGE response is to blame.

• 1:07:57Alie Ward?

  Sorry. So thank lead author, Dr. Zarina Hadzik, an internal medicine physician out of Pittsburgh, for her contribution to the science. But as long as we are blaming things, what is more villainous than poison ivy or poison oak? Those with those plants on their minds, and perhaps their skins, our listeners, Ranger France, Really Grim, James Thomas, and Brain Shenanigans, who shared that their partner had an uncle who had a poison ivy allergy. And one summer, they had a bonfire, and they burned wood that had poison ivy on it. And the uncle ended up in the hospital from inhaling the burned poison ivy. It sounds like literal hell on earth in your lungs. And patron Anjali Hamali asked, "I'm so curious about poison ivy. I developed an allergy to it after being exposed to it multiple times. Why do some people have it, others don't,

• 1:08:42Alie Ward?

  and others get it?" Why are some people so allergic? And other people are like, "Oh, you get a spot and it goes away." My sister is absolutely later if she gets near it.

• 1:08:52Speaker 04

  Right, so one of the cells that creates this reaction is T cells, which is another part of your adaptive immune system. And so I think the best way to put it is that somebody's T cells are a little bit more killer. They're a little bit angrier. You know? Everybody's immune system responds differently.

• 1:09:09Alie Ward?

  This is the last Patreon question, last listener question, that it was so common, and I wanted to save it to the end. Angelo O. wanted to know, allergy shots, they're given to build up tolerance to the things you're allergic to. Is being exposed to that allergen similar to shot therapy? You mentioned that you had some shots as well. You had some therapy for your cat allergy. So allergy shots, what's the deal? So this was asked by over 40 of you, including first time question askers, Susan and Sydney Gasebeak.

• 1:09:40Speaker 04

  So theoretically, for some people, if you're around cats enough, it could cause a similar effect. We call it desensitization. The immune system is turned down a bit, to be less reactive. Not necessarily a cure, though. So a cure means you're tolerant that you could be exposed anytime you want, no big deal. With desensitization, you have to have constant exposure for that to really work. That's why, again, I was fine with dogs and cats until I lost them and lost that exposure. And then when the re-exposure happened, it's a problem. And so your immune system acts differently depending on what part of the body it is. And so when we do a slow, controlled exposure through either drops or injections,

• 1:10:25Speaker 04

  injections are usually a little bit more effective, and you increase that over time, you're presenting that allergen, that protein that they think is foreign, closer to part of the immune response that causes these things to happen, the lymph nodes. There are people right now studying something called intra-lymphatic immunotherapy, where instead of doing a subQ injection just under the skin of the fat layer, like on your arm, they go ultrasound guidance to your groin, to the lymph nodes there, and introduce the proteins there. Wow. And it induces the same thing much more quickly because you're getting closer to the source. Why the crotch? Honestly, I don't know. Maybe there's more of them down there. I think it's an easier area to access, most likely.

• 1:11:08Alie Ward?

  I looked this up, and these are called ILIT injections. It's I-L-I-T. It stands for intra-lymphatic immunotherapy. And these shots are given to your groin nodes because those ones are just under the skin, so they're the easiest and they're the least painful poke.

• 1:11:25Speaker 04

  But anyways, the analogy I like to use for people is this is like taking your immune system to school, showing it the same thing over and over again, a little bit more, a little bit more, a little bit more, until you get bored to death, right? Or like, you know, most kids are afraid of scary movies. And then over time, they are like, eh, not a big deal, because they got exposed to it enough. But not every kid will be okay with it. Same thing with immunotherapy. It's not 100% effective for a lot of reasons, but for many, it works well. It worked well for me. It's the only disease-modifying treatment we have for severe allergies, where we actually fix the underlying problem or get close to it. Everything else we talked about is avoidance, reducing exposure, or taking medicines like Band-Aids.

• 1:12:07Alie Ward?

  Okay, I lied. One last question from listeners. Adam Luptak, Greg Wallach, Tiffany Overby, Full Metal Knee, Emmett Wald, David, and first time question askers Dark Arts Hobbit and Sean Leach. And I guess, speaking of needles, I should have asked this too. If you think you have an allergy, I guess not an intolerance, but a sensitivity, like skin prick tests, still kind of the best way to go?

• 1:12:30Speaker 04

  Yeah. So if you come into an allergist's office, we offer that because it's quick. And in the context of a good history, it's accurate. And so you get a good sense right away, rather than waiting on a blood test. And sometimes it's harder to interpret. The skin test is generally a little bit easier to interpret. But in the setting of food, I will get a skin test to prove that, yeah, I'm pretty sure you're allergic. And then the blood test, I track over time to have a better sense of, yeah, this went away, maybe, I don't know. Let's have you eat it or a food challenge. Or no, it's not likely going to go away.

• 1:13:00Alie Ward?

  I had one once. It was so fascinating. But yeah, those are fun. They're scary. They don't hurt very much, though, right?

• 1:13:06Speaker 04

  They're itchy.

• 1:13:07Alie Ward?

  They're itchy.

• 1:13:08Speaker 04

  They're very itchy. And sometimes you get a little bit of a burning sensation. I've had it done on me many times, you know, through my training, like we would practice on each other to do the technique. And one time, oh, my gosh, one of my fellows, one of the types of testing, the scratch test is where you take plastic and scratch the skin. But you can also take a needle and go slightly deeper. And instead of doing an intradermal where you're like going very shallow to the skin and make a bubble, you basically stabbed me and gave me dust mites deeper into my arm. And I had this big knot, like, right there for weeks.

• 1:13:42Alie Ward?

  And that's dust mite poo, right?

• 1:13:44Speaker 04

  It's poo, yeah.

• 1:13:45Alie Ward?

  Yeah.

• 1:13:46Speaker 04

  Hey, you said it first, okay? I wasn't going to freak out our fans, but the allergen to dust mites is their fecal matter. Yes.

• 1:13:53Alie Ward?

  Yeah. You might as well know who you're dealing with.

• 1:13:54Speaker 04

  That's true.

• 1:13:55Alie Ward?

  When you're dealing with a dust mite allergy. All the better motivation to clean up the environment, of course. But what I imagine is going to be so hard to chase diagnoses when symptoms can vary and the environment can vary so much. But what is the hardest part about your job?

• 1:14:12Speaker 04

  Living in the gray zone, as you're kind of referring to, which is trying to help reassure people that sometimes we don't always have the answers and sometimes testing doesn't even help. And really getting into the mindset of we're going to try to take symptoms that are doing this, like you're riding this tidal wave and make it a gentler experience. That's what I try to do a lot, especially for like patients with mast cell activation syndrome where they've got multi systemic severe recurrent symptoms that like these patients often don't feel like they're taken seriously. And I try to do my best to help them through these issues. That uncertainty, doctors hate uncertainty in general. When we are certain of a diagnosis and a treatment plan, awesome, we fit into a box.

• 1:14:54Speaker 04

  But a lot of allergy and immunology is trying to figure out the world in the context of an immune system that we still don't know nearly enough about and have testing. So I always come into my clinical practice with humility that my patients know a lot more than I do, that I try to be a guide and a voice of risks and benefits of doing this or that and how to have better balance in their life. And certainly I will have, you know, recommendations where I'm like, hey, you got your asthma inhalers, you got to take this all the time. This is what I think you should do and blah, blah, blah. But a lot of times answering the why is so difficult. And also for my patients, I know that pain of uncertainty, like why is it that when

• 1:15:34Speaker 04

  I do these things in my life, this happens or this happens and I have no idea why it's happening is such an excruciatingly anxiety provoking experience for people. That we all are creatures of certainty and it's a survival instinct. But if we can kind of figure out ways to live with that gray zone, I think we'll be in a much better place.

• 1:15:57Alie Ward?

  It's also so frustrating that it's your own frickin body. You're like, come on, man. But also it's so fascinating, too, that you're married to an immunologist. Like, oh, you guys must, you guys must text each other. So many articles and papers and research. That's gotta be great to have someone to talk about that at any hour of the day. You know, you do so much communication and it's gotta be so rewarding. Your book, All About Allergies, is out. You have a very, very prolific and well-attended social media presence. But what is your favorite part about your work? Favorite part about your job?

• 1:16:30Speaker 04

  Well, ever since I've done all of these things at once, I've found this common link with the education and relationship building piece to it, that a lot of people know who I am now. And I may not know them directly, but the fact that I will have somebody stop me on the street and say, you know, you've made such a difference in my life, or helped reassure me that I'm not alone. And I've never actually laid eyes on them before is such a rewarding experience. And then on top of that, now having patients bringing in my book to sign. It's a cool experience. I love it because I worked my butt off on this book. I spent every night writing it, every single night. Once I knew that I had the green light to do it,

• 1:17:13Speaker 04

  because my grandmother's in her 90s and I wanted to make sure she could read it. And she read it. And it just, it made my world when she could read it. My grandfather's not with us anymore and he would have just, he was like my best friend. And I love my grandmother, too, but it's like they're extensions of each other. They were such an important part of my life of helping people. Like, they started a soup kitchen over 20 years ago in Chicago called The Uptown Cafe. They helped out with other people to do this. And they would take me every Monday for a long time. That would help serve people. And it helped me at an early age, understand that it doesn't matter who you are. You could be a brilliant person and hit rock bottom. It does not matter. And that gave me this sense that if we can give people skills to help themselves, it can make a huge difference in this world.

• 1:17:57Speaker 04

  And that's driven me with a lot of the stuff I do on my platform, which is that a lot of the information, if you can get a better context to it, like I do with my book, you can really have a better sense of how to live day to day, even in the areas of uncertainty.

• 1:18:12Alie Ward?

  That's so beautiful. That's wonderful. How did you write a book and have a social media channel and have a practice? What the hell, man?

• 1:18:20Speaker 04

  I don't sleep.

• 1:18:23Alie Ward?

  Is that why you have an Oura ring? Is that an Oura ring?

• 1:18:25Speaker 04

  It's trying to tell me to sleep, yeah.

• 1:18:27Alie Ward?

  Yeah, I'm the same.

• 1:18:28Speaker 04

  I don't care about you. I'm just pretending I do. No, it's one of these things where I'm a doctor and I make recommendations. I don't follow my recommendations all the time.

• 1:18:36Alie Ward?

  No.

• 1:18:39Alie Ward?

  Well, thank you so much for all the work you're doing. You literally have saved lives. Like every day, just go to bed, if you go to bed, which you don't, and say, maybe just casually saved a life today. Which is awesome.

• 1:18:54Speaker 04

  Thank you.

• 1:18:56Alie Ward?

  So ask incredible people itchy questions and find Dr. Zachary Rubin at Rubin underscore allergy on YouTube and TikTok and Instagram. And again, his brand new New York Times bestselling book, all about allergies. Everything you need to know about asthma, food allergies, hay fever, and more, is available wherever you get books. We will link all of that in the show notes. We are at Ologies on Blue Sky on Instagram and I'm at Ali Ward with one L on both. We have more links to studies up at aliward.com/ology/allergyology. Allergyology, easier to spell than it is to say. We also have shorter, kid-friendly versions of Ologies. Episodes are called Smologies. They are available for free wherever you get podcasts. Just look for S M O L O G I E S. That's how you spell it.

• 1:19:41Alie Ward?

  Ologies merch is available at ologiesmerch.com. And if you'd like to submit questions before we record, you can join our Patreon at patreon.com/ologies for as little as a dollar a month. Happy, happy birthday to my sister, Janelle, and thank you to Erin Talbert, who admins the Ologies Podcast Facebook group. Avliyan Malik makes our professional transcripts. Kelly Ardwire does the website. Noelle Dilworth, scheduling, producing, is nothing to sneeze at. Managing Director Susan Hale keeps our show running faster than our noses. And cutting things out better than an elimination diet are Chig Chafee and Lead Editor Mercedes Maitland of Maitland Audio. Nick Thorburn injected the show with lovely theme music. And if you stick around to the very end of the show, I may tell you a secret. This week, my secret is that I have, I'm still at South by Southwest. I get on a plane and fly back late tonight.

• 1:20:27Alie Ward?

  And I'm so tired. I feel so bad for Jake and Mercedes. There's so much editing to do in the asides that I just recorded. Just long pauses and then sighing and then trying it over again. My brain is blurry. But last night, we're the iHeart Music Podcast Awards. We won last year. We did not this year. And that's okay. We lost a hidden brain, which is respectable. I'll lose to them. They're so good. But on the red carpet, for some reason, avocados were sponsoring part of the awards show. And someone standing in front of me was like, you've got to get some of this hand mixed guacamole. And for some reason, I like, I didn't want to tell them that I don't really like guacamole or avocados. And I felt like, well, I didn't,

• 1:21:11Alie Ward?

  I didn't want to like diss their decision to do so. And so I just, I waited in line and then I got to the front and I was like, oh, can I just like have an avocado? And they gave me an avocado instead of guacamole. So there's an avocado in my purse. I'm going home with an avocado and not an award. And so when I land in LA, I've got an avocado for Jared. See, this secret isn't even that good. I'm so tired. Zach, I'm so sorry that the secret at the end of this one sucks. I'm gonna sleep so hard when I get home. Okay, I love you guys. Bye bye.

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