Jan 14, 2015

Interview Transcript

Announcer: Medical news and research University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: When we say allergies most people think of springtime, flowers, trees, pollens, but winter allergies are also a problem. We're talking with Dr. Marty Trott, an Ear, Nose, & Throat Specialist at St. Johns Medical Center in Jackson Hole. Let's talk about winter allergies. I've never heard of such a thing, but it exists.

Dr.Trott: Yes. Allergies exist all year round. We think of things typically during summertime as you mentioned, tress, grasses, weeds, but there are things that happen all year round and some of those things happen during the summer and winter, like cats and dogs, and in Wyoming, horses.

Interviewer: Yeah, sure. Okay.

Dr. Trott: But in the fall and winter and spring, people talk about snow mold or other things that exist in the home.

Interviewer: Snow mold?

Dr. Trott: Well, basically when the snow is melting and there's a high humid condition, mold spores and fungi, which people can have allergies to, also exist.

Interviewer: Really? Can you see those on the snow?

Dr. Trott: You can see fungus in the snow, but what you see may not be the symptoms you're actually experiencing.

Interviewer: Okay. What are some of the other winter allergies?

Dr. Trott: I think those are the main ones. I mean, in places that are warm enough and wet enough, potentially like Salt Lake, you could have dust mites.

Interviewer: Okay.

Dr. Trott: Up here in Jackson Hole, where it's a little bit drier, the humidity is lower, dust mites are less of a problem.

Interviewer: Okay. So a lot of your allergies it sounds like, other than snow mold, probably happen inside.

Dr. Trott: Right.

Interviewer: Explain some of those things and maybe what I can do to avoid them.

Dr. Trott: Well, high humidity environments are probably the biggest problem creating where there's potential issues with allergies. And the other places that are a problem are barns and those people that have barns and there's many of them here. So people that are out there with horses kicking up dust, or there out feeding their cows or horses, they potentially are around high humidity environments and all kinds of bacteria and fungi grow better in high humidity environments than low humidity environments.

Interviewer: The same types of symptoms, I suppose.

Dr. Trott: Yeah. Itchy eyes, sneezing, runny nose, and patients who have asthma. One of the biggest challenges for us treating asthma are patients who are exposed to things in the home that trigger their asthma, like mold allergies or fungal spore allergies.

Interviewer: Can I get a shot for a snow mold or . . .

Dr. Trott: Yeah, I suppose one could. It's our last line of therapy. We typically, like everything else, try avoidance first where possible, and then use medical management, pills or nose sprays or inhalers, in those cases where they are necessary and then the absolute line of defense is to use desensitization which usually comes in the form of some kind of allergy shot.

Interviewer: All right. So I come in and I'm suffering some sort of allergies, and these sprays or pills, are they pretty decent? I remember as a kid I suffered allergies terribly and it didn't seem like the pills ever worked.

Dr. Trott: Well, a lot of the pills work but we have a trade-off between the side-effects of the pills and the benefits of the pills. So a lot of the pills that are highly effective also cause a lot of side- effects like fatigue. Some of the newer medications which are now available over-the-counter, like Claritin, which is always on the radio, those medications have a lot less in the way of side-effects, but they're also slightly less effective in terms of potency. But if it works for the patient, that's what matters. It's not a matter of what we call it or what the side-effects are from our standpoint, it's really important how it effects the patient.

Interviewer: Okay. So you do some pills, you do some sprays, and then what's the second level?

Dr. Trott: The second level, in patients who are not responsive to conservative therapy, we consider doing allergy testing. And I don't typically allergy test patients right off the bat because if they tell me that they're allergic in spring, it's typically trees.

Interviewer: Sure.

Dr. Trott: And if they're having problems when they're cutting the grass it's probably the grass.

Interviewer: Is this the scratch test?

Dr. Trott: It is a scratch test. There's also a blood test that can be done. I think the scratch tests are a little bit more cost effective, and from my perspective, trying to determine if we're going to treat a patient with any kind of an allergy shot, we want to know specifically what they're allergic to.

Interviewer: Sure. So the shots, now, is that a higher potency? What's in the shot?

Dr. Trott: Well, shots are made of things that you're allergic to. Essentially, if you're allergic to bees we can give you bee venom and desensitize you to the bees. So if you get stung by a bee in the future you won't have a life threatening reaction. And patients that have asthma that's triggered by grass pollen, we give them grass pollen injections that desensitize them to the grass pollen with high degrees of efficacy. Coming up in the near future, within the next six months, the FDA will be approving medications that you can use under your tongue that will also be effective for specific types of allergens and it looks like Timothy grass, a type of grass, will be one of the first of them.

Interviewer: And where is that going fit into the whole ladder of treatment options?

Dr. Trott: Well, I think it's going to be dependent on what the patient and the physician decide together is best for that particular patient. I try to steer patients to the easiest things to do, the most cost- effective things to do, that's going to resolve their symptoms.

Interviewer: What would you want one person to take away from this conversation, who's suffering from allergies, maybe, like me, disillusioned as a kid, the shots didn't work? Have things gotten better?

Dr. Trott: I think things have gotten better and I think allergies are also more of a problem. There are more people who are allergic now than there ever were before, and we have a little bit of an understanding of why that is.

Interviewer: Why do we have more allergies nowadays?

Dr. Trott: There's a lot of theories about that. Some are fairly complex, immune discussion theories. Allergies weren't even really described until the late 1800's and when they first were described they were with the wealthiest of people in England. There's a thought that there's a connection between hygiene, vaccinations, and allergy and the more we immunize ourselves against other things that would otherwise kills us, the more likely we are triggering our immune system to be responsive to things that less harmful but potentially harmful.

Interviewer: It's a trade-off really. You don't get diseases that kill you, but you might have a plugged up nose.

Dr. Trott: Right. And I would never advocate for someone not getting measles vaccinations, or chicken-pox vaccinations, but we are understanding somehow that the instances of allergy and asthma is far greater here in the developed world than it is, for instance, in Africa.

Interviewer: Interesting.

Dr. Trott: And it's not dietary necessarily, it's got to be something else that we're doing, and there's a lot of people looking at this.

Announcer: Medical news and research University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

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