Dr. Zachary Rubin on What Every Parent Should Understand About Allergies

Debbie:
Hey, Dr. Rubin and welcome to the podcast.

Dr. Zachary Rubin:
Thank you so much for having me.

Debbie:
Well, I’m thrilled to be bringing this topic to the show when I heard about your book as the parent of a neurodivergent kiddo who has struggled massively with allergies. And it’s just one of these really just complicated things in our life. And hearing from so many parents, I know this impacts a lot of listeners and their families. So we’re going to be talking about your new book, all about allergies, everything you need to know about asthma, food allergies, hay fever. and more and congratulations on being a New York Times bestselling author.

Dr. Zachary Rubin:
Thank you so much. I’m just so excited that we’re able to talk about allergic diseases more for the general public and change the way that we think about it because allergies are not just something that you would sneeze at. It’s really a persuasive issue that affects millions of people.

Debbie:
Yeah, yes, absolutely. And we’ll get into your book, but I just also want to say that I so appreciate, well, I just love someone who’s so all into their area of interest and just kind of has the gift of sharing it with the rest of the world in a way that we can understand it. And you did that so well in the book. I thought it was so readable. And I’m not a techie person, and medical jargon can be tough for me, but it was very accessible. So well done with that.

Dr. Zachary Rubin:
Thank you. I really appreciate that. It’s very challenging to take any medical topic, something that physicians and other healthcare workers spend years learning how to do it, and then to be able to try to get that distilled down to a level that’s not completely watered down, but enough for you to be able to really dive in and take better charge of your health by having a better understanding of not only what we know, but also what we don’t know and what we’re looking forward to.

Debbie:
Yeah, absolutely. Well, you nailed it there. And before we get into it, I’d love it if you could just spend a moment talking about your kind of personal interest in this. Like, why is this the area that you’ve chosen to focus your career and life on?

Dr. Zachary Rubin:
Absolutely. So I grew up with a pediatrician in the household. My dad was a general pediatrician. He’s still practicing, kind of near the tail end of his career now. But I saw what medicine was like growing up. And it was very different than what it is now because the primary care physician literally took care of you whether you were in the clinic. or in the hospital. So I remember waking up in the middle of the night, my dad would just be going to the emergency room, doing a spinal tap on a really sick child and having them admitted to the hospital. He would round out his patients in the hospital, go to clinic, round on them after clinic. And it was really a way of life. And I saw that I met a lot of his patients and their families and it really drew me to medicine early on. And I thought I was going be just like my dad. I’m going to go into pediatrics. And I ended up specializing in as a pediatrician initially. But then I did rotations and subspecialties, including allergy immunology. And I fell in love with it pretty much immediately because of the versatility, the breadth and the depth of the field, the fact that it’s constantly growing. And there’s just not enough people helping them out with these severe allergic diseases. And not only do you take care of the children, but when they grow up, you don’t lose them because in allergy, you actually train to take care of all ages. So I’m able to take care of entire families and build these wonderful relationships with people to improve their quality of life and help keep them out of the hospital and as healthy as possible.

Debbie:
Yeah, and you just said it there quality of life because, know, I’ll just say as someone who I don’t have that I know of any allergies other than I really dislike cilantro. I don’t know if that’s an allergy, but it’s definitely a thing. It totally tastes like soap, yes.

Dr. Zachary Rubin:
Does it taste like soap? Yeah, that’s a genetic issue. It’s not really an allergy. It’s just how your taste buds perceive cilantro. Not everybody has it, but yeah, it can be really nasty for some people.

Debbie:
Yeah, okay. All right. So that’s as close as I get to something being, you but, you know, my child developed allergies around the age of 10 after we moved from the US to the Netherlands and, and it’s just been a part of our life now for the past 10 years. And so I didn’t really understand what allergies even were. And then looking at your book, you know, there’s so many things that were included in there that I didn’t know would fall under the umbrella of allergies. So would you kind of set the stage for us if you will and just kind of define what is an allergy what really gets included in that definition.

Dr. Zachary Rubin:
Yeah, so the field of allergy is the study of how the immune system abnormally responds to foreign substances. So there’s a wide range of how that could happen by the immune system. So classically, most people are familiar with in the springtime, you have a sneezy, runny, stuffy nose and you’re itching a bunch. And that’s one particular abnormal immune response. And I’m not going to get too much into the weeds of it. The book really goes more into detail about that. But then there’s other ways that the body can abnormally respond. So as an example, you could be allergic to the cold temperatures. Essentially, the cold temperature activates a part of your immune system that releases histamine and that causes hives. And so you could also get swelling with that. That’s another aspect. You could have all sorts of adverse reactions to medications. And there’s different ways that that can happen. It could be mild or potentially life-threatening or potentially disabling. It depends on the situation. And so this really goes into a lot of different issues that often overlap with different specialties in ways that people don’t necessarily think about. But again, this affects millions of people around the world in different ways that oftentimes we don’t even fully understand. And it can be difficult to be able to pinpoint exactly why certain situations are happening, given the limited amount of knowledge that we have. And sometimes we have to sit with that uncertainty. which can be very unsettling, but if we can find ways to at least manage the symptoms better, we’re gonna be in a much better place going forward.

Debbie:
Well, I was interested to read that you write in the book that pollen counts have been steadily increasing over the years. And you also said that food allergies are increasing. And you give some explanations, but it seems like there’s still a lot of uncertainty out there about why exactly this is happening. How do you answer that question?

Dr. Zachary Rubin:
Yeah, so like a lot of chronic diseases, it’s not generally one issue that is leading to it. Unless you have a specific genetic mutation that leads to a genetic disorder, a lot of the time it’s, yes, you are born with certain risk factors through what you inherit from your parents, but then there’s also environmental triggers and it’s not always necessarily one issue. And so when we see these rising food allergy rates throughout the world and in many countries, it’s not just one thing. And so a lot of researchers are trying to figure out why is this the case and we found many associations meaning people who have these different risk factors tend to have food allergies more often but it doesn’t mean it’s the one causative. So a couple examples as I talk about in the book is that c-sections that when babies aren’t born through the birth canal they don’t necessarily get the healthy bacteria from mom exposed into their gut and those bacteria can help process the food proteins in ways that may interact with the immune system in a healthier way and create a more balanced approach, but through C-sections you don’t get that bacterial exposure, therefore the immune system may not be trained as well to recognize these different food particles as something to tolerate rather than say, my gosh, this looks like a parasite, we should do something about this. That’s an example. Another is We know children who have eczema are higher risk of developing food allergies and eczema rates are steadily rising for many reasons. Eczema is kind of the gatekeeper to other allergic diseases, not just food allergies, but asthma and seasonal allergies. As your skin starts to create these proteins called antibodies, specifically the IgE subtype that can create allergic reactions later on, they don’t just sit in the skin, they can travel throughout the body and create those other diseases. Vitamin D, Low rates may be associated with this. So it’s a lot of different issues that come together to create this problem. And if we’re demonizing one particular issue, then we’re going to be caught flat-footed and not really think about the whole picture of what we can do to help not only treat these things, but prevent them from happening in the first place.

Debbie:
Yeah, yeah, that makes sense. And as you’re answering that, I’m thinking about, you know, the the co occurrence of allergies with neurodivergence, there’s a MD, Dr. Malhouser, we’ve had on the show a few times, and she’s really pushing to make medical care, more neurodivergent affirming. And she talks about this kind of constellation of symptoms that there are all kinds of kind of chronic challenges that lot of neurodivergent folks face and I know that allergies are part of that. So what is the science, the research say about the co-occurrence of allergies with neurodivergence?

Dr. Zachary Rubin:
Yeah, so it’s an emerging issue that I believe needs more research, especially because as you know, it’s a spectrum of various issues. So it can impact people in different ways. One of the challenges that I see in my clinic is the ability to communicate those symptoms properly. And so sometimes we have to look at these symptoms and understand, okay, is this related to the different behavioral issues that folks have or is there an abnormal immune response happening? Is it both? And so we also have challenges with identifying what are the specific triggers for that. Because if we don’t have a patient who can communicate with us specifically that these animals as an example are triggering it or this is the particular time of the year or how it flares up. A lot of that becomes a little bit more challenging to be able to do the best that we can to figure out, this is what’s actually going on. How do we find those triggers? How do we avoid those triggers? And the more we have research into this, I believe we’ll be able to provide better care.

Debbie:
Yeah okay super interesting. Let’s spend a few minutes talking about food allergies. Again, this is for me, I experienced this as a parent when we had guests come visit us and their kiddo who was the same age as my child had life threatening food allergies. And I got to for that weekend, see firsthand just how challenging it was from getting takeout to like everything and this kind of hypervigilance that these families are living with. So I’m wondering if you could talk a little bit about food allergies and how you kind of advise parents who are navigating this. think there’s probably a lot of myths out there about how to prevent them and what to do. So yeah, I just love to hear some thoughts on food allergies.

Dr. Zachary Rubin:
Right, so when a family comes to me and they’re concerned that their baby or young child might have a food allergy, I get a detailed history about what actually happened with the event because sometimes it’s not actually a food allergy and I worry that some families fall into the cracks of getting a little bit overdiagnosed. So we have to make sure that we understand what a food allergy is that is the type where you do have to be vigilant, very much so. So an example would be a baby who has peanut butter for the second or third time and they develop welts all over their body or their hives and it’s very quick and they’ve had this happen multiple times. We would then get a skin test in the office where we take a little bit of peanut extract, scratch their skin with it and see does a welt form from that. That helps approximate the diagnosis and I say approximate because the gold standard is actually having them eat it in my office, which I wouldn’t do if the history is highly suggestive. So I try to do it in a safer way with a skin test to be as confirmatory as possible outside of them actually eating it in front of me. And then what we do is we sit down for quite a bit of time and we go over several aspects about food allergies before they walk out the door. And there’s a lot that we have to talk about and we don’t have the ability to go over everything and sometimes families have to navigate these issues on their own. But I typically start off by telling families, just like we said earlier in the episode, We don’t fully understand why this is happening. There’s a lot of families that are dealing with this. I’m diagnosing food allergies almost every day in my clinic. There’s nothing that the parent has done that has caused this. It’s not their fault. I say that immediately because a lot of times parents come in with lot of anxiety and guilt saying, well, why did this happen? Did I do something where I didn’t feed them the right food or I had to take this medicine or I didn’t eat enough during pregnancy? And I try to first allay those fears because I want to have them start off on the right foot of understanding how to navigate the world because this can be a potentially lifelong change in how they navigate the world and it can be a big deal because as much as food allergies aren’t really visible to people, they can be life-threatening and have to be taken seriously. So I set the stage up that way. Then I have a written action plan that’s that is going over what happens if an accident happens because we’re human. What do we do in situations where we suspect there’s an allergic reaction because of accidental ingestion or maybe a new food allergy develops? That has a list of symptoms of mild or potentially life-threatening symptoms called anaphylaxis and what to do for each scenario. If you’ve got mild symptoms like itching or hives after eating something that may contain the allergen, We recommend an antihistamine, I typically recommend one of the newer ones like Zyrtec to take. If it’s something more concerning, like they have problems breathing with tongue swelling, wheezing, or a combination of symptoms from multiple body parts like hives and throwing up, then we would advise them to use epinephrine. And there’s different options that we go over to discuss that. And then I talk about how do we navigate certain situations? What are the approaches? for families now that they have a child with food allergies. Well, the first is learning how to read labels properly and making sure that you check all labels, even if you know something is normally safe, you have to still read it because it could change. And so anything that says contains said food allergen, that’s something that needs to be avoided. If it says may contains or process in a facility, then we start to get a little bit in the weeds of the nuance of whether or not that’s something we have to worry about because There’s newer research to suggest that it’s more of a legal cover your butt term and it’s unclear who’s going to react to that. So we have a nuanced discussion with that. I don’t want to get too much into those details because it’s very specific. You always talk with your doctor if have concerns. It’s just a podcast to raise awareness, right? So I want to make sure that people understand that. And then we talk about some communication tips to help with navigating these situations. So now that we have to avoid these foods strictly, we’re going to be at parties, we’re going to be at school, we’re going to be at family gatherings, and also maybe there’s other siblings at home. How do we navigate all those situations? And so it’s important to make sure that you communicate with people that your child has a food allergy that has to be taken seriously and nothing they eat could contain this. And we talk about cross-contact issues where if a food protein is on a surface like a plate or a knife, some utensil, you have to make sure that you’re washing that with soap and water and clean those surfaces. And also, when you travel, like on a plane, you’ve got to wipe things down with wet wipes to make sure that there’s no possibility that your hand touches something and then touches your mouth. So those are some of the examples of what I talk about. And it’s a lot of information. And there’s even more to discuss, which I always tell families to take their time, that there’s a lot of resources that are good out there to look at, and be careful what you looked at online because there’s a lot of myths out there.

Debbie:
Yeah. Yeah. I mean, you mentioned the airplane I just flew last week and they made an announcement that there was someone on the plane with a severe nut allergy and they asked everyone to have anything that had peanuts in it. And I was just thinking about that kind of a weight that these families carry, being, you know, especially, and I’m thinking of kids. who are neurodivergent families are often already feeling like, okay, we’re that parent or we’re that family at school. And then you add in a food allergy which could impact an entire classroom. How do you talk with families about that? Or do you see changes in how kind of society at large is being understanding of the realities of severe food allergies?

Dr. Zachary Rubin:
Yeah, it’s a it’s a big challenge because food allergies is not just one particular food like you were on a plane like you said They’ll announce a peanut allergy, but people have all sorts of food allergies It’s not just peanuts and so it becomes very difficult to find the balance that’s needed to accommodate as many people as possible while also not creating a major inconvenience for people because Unfortunately, when a family has a child with food allergies, they’re at a much higher risk of being bullied by other families or other kids. And a lot of that comes down to poor understanding of what food allergies are about, but also because a lot of families feel inconvenienced by this, especially because they don’t understand it. So we have to find a way to balance it. I do think that we’re doing a much better job now than even 10, 15 years ago with this. But there’s still a long way to go in terms of having a better understanding of food allergies for the general public. And also, as I mentioned before, issues related to cross-contact in food manufacturers and those precautionary labels that really don’t have a lot of scientific basis to it. I know there’s an international community trying to figure out what is like the minimum eliciting dose that’s going to cause an allergic reaction for the majority of people. It’s a difficult issue because Testing as we know it doesn’t really answer that question that well because there’s other secondary factors that can lead to a severe reaction like you eat the food you’re allergic to and then you go exercise and that elevated body temperature and exercise can lead to a more severe reaction or if you have uncontrolled asthma There’s a lot of different situations that you can’t really identify just from testing alone that could influence whether a reaction becomes severe

Debbie:
Before we go to break, I just want to touch upon asthma because that was something that I was as I was reading your book and I flipped I’m like, asthma, I wasn’t expecting to see that in a book about allergies. Could you explain why you include that and why that is considered an allergic reaction?

Dr. Zachary Rubin:
Yeah, so asthma is a chronic lung disease that is really an abnormal immune response to the outside world that you have this hypersensitivity, you know, as an example, let’s say we are all in a room and there’s a bunch of fresh cut flowers. And some people it kind of triggers some nasal symptoms. But for those with asthma, that strong fragrance can cause them to cough a lot or even wheeze. And that’s because the immune system was exposed to the substance, a volatile organic compound, and it creates an exaggerated response that could lead to the smooth muscles around the airways to tighten up, increase mucus production, and airway narrowing, it bronchospasm, so it’s hard to get air out of the lungs. It’s an obstructive process. So you could have coughing, wheezing, shortness of breath, chest tightening, and or difficulty breathing that unfortunately can be fatal, and we see about a dozen or so deaths regularly from from asthma could also be if it’s not well controlled can can lead to long term, you know, scarring of the lungs essentially if it’s not well controlled over time. And then there’s also exposure to steroids, which decreases that immune response, but also can have a lot of long term side effects. So asthma is really an allergic lung disease in many cases, but it’s also to make it even more confusing. Asthma is not just one disease. There’s many subtypes to it, which I go over in my book.

Debbie:
Wow. Okay. Thank you. Okay, so I wanna pivot and spend the last chunk talking about what I’m personally dealing with is trying to help my kid who has such incredibly challenging allergies. And living here again in the Netherlands, I would say like once a month, it’s a news story. What are the pollen counts today? And every time I see these stories, I’m just struck by. What a quality of life issue it is to go through months at a time feeling like you can’t smell things and you’re just constantly uncomfortable. You talk about how it impacts sleep. Let’s dive into that a little bit. What exactly is going on with people who have hay fever or these kind of big spring allergies as we’re recording this?

Dr. Zachary Rubin:
Right, so hay fever is the old term to describe allergic rhinitis. Rhinitis is inflammation of the nasal passages. Allergic means that the abnormal immune response is specifically rated to that antibody called IgE. So if you do a skin test, you would get positive reactions to things like pollen from trees, grasses, weeds, mold, cat, dog, dust mite. etc. And so what ends up happening, especially if we’re talking seasonally, spring is one of the more common times that people experience this, is that tree pollen grains deposit in the nasal passages or in the eyes, or even on the skin. And the immune system responds to that by releasing histamine and other chemicals that can cause itching, sneezing, and runny nose. And as that immediate reaction is going, then more cells of the immune system are recruited in this inflammatory response where other cells like eosinophils come in and create congestion and post nasal drip where there’s just a lot of mucus production that makes it hard to breathe. And so we are naturally breathing through our nose when we go to sleep, but when you are very congested, you don’t get quite as good sleep quality. It may be harder to fall asleep, to stay asleep. You may be very itchy and it can be very unpleasant to the point that your sleep quality is affected. And we know sleep is one of those important aspects of your health. Also with that chronic inflammation, it can increase the risk of ear infections and sinus infections and your ability to concentrate at school or work. And interestingly, I like to talk about this fact that I learned the past couple of years. Japan, of all places, has one of the worst tree pollen seasons in the world. It’s so bad that they actually have a national public health emergency announced a few years ago. And many companies, because they lose so much in economic productivity, that they will pay their employees to temporarily move them to different parts of the country or to other areas like Guam or Hawaii for a month or two, just so that they can get out of that area that’s causing them such distress and then they can work more efficiently. It’s costing them that much in productivity and time that they’re willing to do that in many parts of the country.

Debbie:
That’s fascinating. And talk for a moment about you said, you talked about the sleep quality and you we just did an episode on sleep challenges in neurodivergent kids and we know ADHD kids are much more at risk of having apnea and you start looking at how all this could be compounding what’s already a challenging situation. But the concentration is that because of the poor sleep or is that actually just part of brain fog that is part of the allergic reaction?

Dr. Zachary Rubin:
It’s all the above. So if you’re not sleeping well because you’re not breathing well, you’re not gonna concentrate but also during the day if you’re itching and Sneezing and having a runny nose and you’re having this constant feeling like a lot of people’s neurodiversity They are very attuned to their bodies And so if there is an itch it could be very very distracting and I see this a lot too with my patients with eczema when it’s very severe and they’re neurodivergent they really have a tough time being able to pay attention because they’re constantly scratching their skin or thinking about I gotta scratch this because it is a feeling if you’ve never itched before and I have because I had eczema as a child I know what that feels like it is like there’s something in the back of your head just kind of gnawing at you constantly on top of everything else it really compounds upon itself so when you can get that itch under control it can really help you focus better

Debbie:
Yeah, it makes so much sense. so talking about hay fever, allergic rhinitis, you know, as far as I know, there’s Zyrtec, Claritin, I’ve heard about injections, you talk in your book about, you know, keeping the staying indoors on high pollen days and things but What’s kind of the, is there a best practice or is it kind of like trial and error and seeing what works best for you if this is something you’re struggling with?

Dr. Zachary Rubin:
Right. Right. So before seeing a doctor, there’s a few things that I tell everybody they should consider, which is one, saline rinses. You get distilled water, use a neti pot or some other type of device, and just clean your nose every night. Just like you brush your teeth every night, you should clean your nose. Nasal hygiene is often not talked about enough. So you get rid of the mucus, the allergens, and the irritants. That way, if you’re using nasal sprays, it’s more effective, but also you’re not breathing in at night all of those things that are causing the inflammation. So that’s a baseline. I also like having air purifiers in the bedroom, laundering your sheets regularly, having dustproof covers, keeping your windows and doors closed as much as possible, and bathing at night is helpful. And then the medications, they treat different aspects of the symptoms. So the antihistamines typically are good at itching, sneezing, and runny nose. But if you want more comprehensive care, you do need nasal sprays that either contain a steroid or antihistamine in it. Those are more effective for post-nasal drip and congestion. And then there are decongestants that you can get, but you don’t want to use them for more than a few days because they can raise your blood pressure and you can become dependent on them. So you got to be careful with those types of sprays. And if the over-the-counter medicines aren’t working, you should see an allergist because then they can test you to figure out how to reduce exposure if potentially prescription medications are needed. And then the immunotherapy or allergy shots or drops to train your immune system to be less reactive is the only disease modifying treatment we have for seasonal allergies or allergic rhinitis. to actually get at the root problem, which as we said in this podcast episode, it’s an abnormal immune system response. So we’re going to re-educate it by having a controlled exposure to those allergens.

Debbie:
Fascinating. Okay. Let me ask kind of one more question then we will wrap up. I’m just thinking of parents who are dealing with multiple things. There’s food allergies, maybe eczema, maybe hay fever, all of these things. Is there kind of a holistic way to approach, you know, if you’ve got multiple things going on, what’s the way forward?

Dr. Zachary Rubin:
Well, the way forward is being vigilant about understanding what are the triggers so that you can find ways to reduce exposure. So that is the bedrock of any aspect of allergy care. Again, because the immune system is responding to the outside world, you got to know what part of the outside world is triggering those responses. So if you know that and you can reduce exposure, you may be able to be less reliant on medications. Unfortunately, with climate change and the fact that pollen counts are rising, there’s more air pollution, some of this is unavoidable. So we have to try to find ways to mitigate and reduce some of that risk and then also potentially use medications. Again, an allergist can really quarterback and understand all these different issues and connect the dots and come up with a comprehensive plan for this.

Debbie:
Great. Okay, so we’re gonna wrap up, but I just wanna mention your book again. It’s great cover, by the way. It’s a very nice looking book. It’s called All About Allergies, Everything You Need to Know About Asthma, Food Allergies, Hay Fever, and More. It’s just out as of a few months ago. And you also have quite a presence on social media. So where can listeners connect with you and learn more about your work?

Dr. Zachary Rubin:
Yeah, so I’m on pretty much every major social media platform. Most of the time the handle is @rubin_allergy My last name is spelled R U B I N. So I’m on TikTok, YouTube, Facebook, Instagram threads. I have a sub stack as well where I talk about some of these issues and also issues related to public health. So you can feel free to follow me on any of those platforms and you can get my book wherever you get your books.

Debbie:
Awesome. Thank you. Thank you so much for making the time to talk with us today. Congratulations again on your best selling book. And yeah, and just thanks for doing this work in the world. It’s so needed.

Dr. Zachary Rubin:
It’s my pleasure and thank you again for having me.