Common Allergy Myths BUSTED

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I love how in the last video the thumbnail was what I see in the corner of my bedroom during sleep paralysis, and this one you're just super hyped about peanuts. You're seriously the most precious human being on this earth omg

👍︎︎ 1 👤︎︎ u/whereyoureyesdogo 📅︎︎ Feb 27 2020 🗫︎ replies

My doctors thought I had oral allergy syndrom but changing the way the food is prepared doesnt help and they never figured it out

👍︎︎ 1 👤︎︎ u/pnk1995 📅︎︎ Mar 02 2020 🗫︎ replies
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- Hey guys (upbeat music) I was so excited to see that you enjoyed the first video interview with Dr. Dave Stukus, the world renowned pediatric allergist and immunologist. Well here's part two, where we answer some of the most common questions people have about allergies. Boosting your immune system through supplements, hypoallergenic pets, growing out of allergies. There's so many great tidbits that are gonna be answered in this video, I hope you enjoy. If you have any residual comments, always feel free to leave them down below. And are you ready? Peewoop! Something common I have, a patient comes in a says, "I have dog allergies, "but I'm about to get my first pet, "and it's gonna be one that I have researched, "and it's a hypoallergenic pet." What say you? - I say that there is no such thing as a hypoallergenic cat or dog. - There is no such thing as a hypoallergenic cat or dog. Sorry Bear. - All dogs and cats release dander. And the dander comes from saliva, their skin cells, and their urine. They all produce dander, and for the person who has allergies, if you're exposed to that dander, you can have symptoms. Now, when it comes to, say, dog allergy, absolutely, there are a lot of people out there that are allergic to some breeds but not others. We just can't figure that out unless you're actually exposed to it. My advice for families when somebody had a dog allergy and they want to bring a dog into the home, go find the breed you want, spend time with it, rub your face on it. (Mike laughing) If nothing happens your probably gonna be okay. Even if symptoms occur, we have some avoidance measures we can do once the pet's inside the home. But if you do that and you're a mess, because your eyes are swollen shut and you're coughing and wheezing, maybe let's find a different type of pet. - There is something you can do if you are allergic to dogs, and you'd like not to be, and that sort of brings us into our next point, which is what treatments are available for those who do have allergies and want to get rid of them? - Yeah, so if we talk about environmental allergies, things that would cause itchy, watery eyes, sneezing, runny nose, it's important first and foremost to know, are you truly allergic? I'm not one for over testing, but when it comes to allergy testing, it's really helpful to establish the right diagnosis, 'cause we want to talk about avoidance measures as well. And there's a lot of symptoms, a lot of causes, that that kind of mimic allergies. So you can have just recurrent viral infections, weather-related issues that cause rhinitis, things like that. So if there's any question about it, or if you're trying some treatment options and it's not working, that's the way to go. But we have great treatment options. So antihistamines are the old standby. Now, we used to use things like diphenhydramine, which is the trade name Benadryl, and these first-generation antihistamines for decades, 'cause that's all we had. We don't have to use those any more. We have very well established, long-lasting, non-sedating, second-generation antihistamines, that will treat itching, sneezing, runny nose, but they don't work very well for treating nasal congestion. By far the number one treatment for all symptoms affecting the nose, would be a daily nasal steroid spray. So you use it every day, over time it helps decrease the inflammation, the swelling, and your symptoms improve. So those are the mainstays. Of course we have immunotherapy, or allergy shots, which have been around for over 100 years. So when you're doing all the right things, and trying to avoid what you're allergic to, taking medications, you've gone up the treatment ladder, and you're still suffering and miserable, we can help you. And we can actually take what you're allergic to and dilute it down, and inject it back into the body through shots, build it up over time 'til we reach a maintenance dose, keep you on that for several years, and desensitize you to your allergies. Some people were even cured. And there are some people that use sublingual drops, you put them on the tongue, which works sort of the same way. - All of these options are really interesting. You talk about the sedating properties of Benadryl, right? And actually, people use Benadryl for its sedating properties. Like, you have the ZzzQuil, or ZzzQuil, I don't even know the proper term for that. You also have it in Advil PMs and all those, they basically have a form of Benadryl in them to help you get sleepy. But now if you don't have to use Benadryl, you really shouldn't, because of a very specific study you talked about on Twitter, which I loved this study. The study actually talks about the level of impairment you experienced with Benadryl, versus things like alcohol while driving. Talk to me about that. - Oh, my favorite study as well. So there's the Iowa Driving Simulator. So they took research subjects, and they put them in four different groups. They got baseline measurements to see how they're driving, are you hitting the cones, are you impaired, things like that. And then one group took 50 milligrams of diphenhydramine, or Benadryl. Another group drank alcohol 'til they were legally drunk-- - Sounds like a good study (laughing). - Another group took a non-sedating antihistamine, fexofenadine, trade name Allegra. And then we had the placebo group. And then they took all the baseline measurements. And then after they were exposed to these different types of interventions, they had them drive again. They found that the group that took Benadryl were more impaired than those who were legally drunk, but they weren't sleepy. So that you can't use sedation to know if you're impaired. And that's a really important concept. There's a reason why pilots are not allowed to take Benadryl for 30 hours before they get in a cockpit, because it can cause impairments. If you are taking these old, first generation antihistamines, you should not be driving cars. - Or operating heavy machinery. - No. - Or working, maybe even as a doctor, in some cases, right? - Right. - You can make some bad decisions as a surgeon in an operating room. - Absolutely. - These are all things that we need to consider. So it's really a great piece of advice, that if you can go for a second-generation antihistamine, the Allergras, the Zyrtecs, the Claritins of the world, those are all options for you. - And they're all over the counter. - The thing that I notice when I recommend this to a patient, they'll say, "It's over the counter, "great, I'll use it." They expect results from day one or two because they're used to using things like afrin, which is a nasal constricting spray, which is not great longterm because it caused rebound congestion and all those other problems. You use it, you feel great. Three days later you stop, (fingers snapping) and all of a sudden it comes back even worse. So now they're used to this instant relief from one of these nasal sprays, they use Flonase, they don't see it, they think it failed. But in reality, what's happening? - Yeah, so it just takes time. So when we talk about using steroids of any type, they're not immediate, fast-acting. So for a nasal steroid spray, you really have to do it every day, consistently. And then most people start to feel some benefit within a week or two, and we want them to keep using it, 'cause that's the way they're designed to be used. - Let's talk about something I hear quite often in my practice is, that milk causes, or the consumption of milk causes increase in mucous production. What say you? - It's a myth. - Okay. (both laughing) - There's actually a great review article in the "British Medical Journal" that really goes through the lack of evidence to support that. We hear it all the time, right? - [Mike] Sure, yeah. - People are told, professional singers are told to never eat dairy, or things like that. People with asthma are told to go dairy-free. So milk does not increase mucous production. There's a lot of people that already naturally produce a lot of mucous, and get the phlegm and the post-nasal drip. If you're drinking a lot of milk it can maybe make that a little thicker, and the sensation a little thicker. But more often than not it's just a placebo, or a no-cebo of, it's just something that you're doing and you're already sick in the first place. But there's really no evidence to support it. - Yeah, if you wanna get rid of the mucous, some nasal-saline, staying well hydrated, 'cause when you're dehydrated everything kinda clamps up in there, makes it difficult to breathe. But milk, not the culprit here. - Yeah, you know, like pancake syrup, a lot thicker than milk. Nobody's out there saying, (Mike laughing) "Don't eat pancake syrup when you have a cold." - It's a good time to bring up food journals. I like, or symptom journals, with my patients, when we're unsure if something's causing an allergy, or they're unsure about they're symptoms. 'Cause, to be fair, I don't remember what I ate last week, it's hard. But when you actually put it down on paper, that becomes an objective measurement, and takes away the subjectivity of it somewhat. - Yeah, I agree, I think journals are great. Because like you said, we're all fallible and we forget things. We know this from studies looking at juries and testimonies and crazy stuff like that, our minds are very interesting places. But a journal's nice for a couple reasons. One is that more accurately you can record things, and share with your personal doctor and go over things. But it also puts the timing in perspective, 'cause we know just by certain mechanisms, like with a food allergy, it's gonna happen pretty fast after eating a snack or a meal. So if your symptoms occurred three days later, we don't even need to worry about what you ate, in that period of time. - Yeah, very well said. Let's talk about a condition that I run into fairly often in my practice. At least fairly often in an undiagnosed fashion, that they don't even know that they had an allergy. The typical history is a patient comes in and says, "Look, I don't have any allergies. "Occasionally I get a stuffy nose, "or a runny nose during the springtime. "But then when I eat specific fruits, some vegetables, "I get an itchy mouth." Talk to me about what could be going on. - Yeah, oral allergy syndrome. I guarantee somebody out there watching this has oral allergy syndrome. - Is probably like, "Yes!" - All right, so you're not losing your minds, this is a real thing. This goes to the similarity in proteins. If somebody has outdoor pollen allergies, things like trees in the springtime, grasses, weeds in the summer, ragweed in the fall, fruits and vegetables often contain similar looking proteins to the pollen that causes your itchy, watery eyes, sneezy, runny nose. Most of the time these proteins are on the skin, or on the outside part, and you can very easily sort of degrade them, break them down, and get rid of them. Part of the reason that you only have symptoms in your mouth, which we'll talk about in a second, is because our saliva actually helps break them down. So oral allergy syndrome can occur when people have outdoor pollen allergies, and you eat a fruit or vegetable, typically when it's fresh, that is similar to the pollen that you're allergic to, causes itching, tinging inside your mouth and throat. Very rarely it can progress to a more severe allergic reaction, but most of the time it's just discomfort in the side of the mouth. Now the cool thing about oral allergy syndrome is, oftentimes you can still eat the same fruit or vegetable if you cook it, if you peel it, if you can it, or if you prepare it in some way. An the classic example is, I'm allergic to tree pollen in the spring, if I eat a fresh apple my mouth goes crazy, but I can eat apple pie all day and I'm fine. - For those patients, do you just give them the guidance of changing the preparation of their food? Or do you put them on a medication? Do you have them have an EpiPen? What's your strategy for that? - Yeah, we also wanna be real careful, make sure we're not missing a true food allergy, which can progress, obviously. But oftentimes it's just education, they can work around it. Sometimes it's seasonal, and they're fine with apples in the wintertime, but then they have issues in the spring when their allergies are already kinda flared. Sometimes an antihistamine can hep prevent some of those symptoms. And then some patients who actually end up getting immunotherapy, or allergy shots, all the symptoms go away as their allergies get treated. - Being a pediatric allergist, you not only deal with the patient, you deal with the patient's family: parents, guardians. That's gotta be a challenge, especially with all this anxiety. - It is, but I love it. Because you're right, I have to try to figure out, can this child, and if they're young, they can't verbalize, what's actually going on with them? So what's the real likely diagnosis? Perceived diagnosis from parents? And then I have to help educate the caregivers. You're the ones that have to go home and live with this every single day. I see you in the office a few times a year, 20-30 minutes at a time. But how can I give you the skills and the empowerment to go home and live with this and navigate the world, where you don't have to watch your child sleep every second of every night, worried that something bad's gonna happen. It's a fun part of the job. I continue to try different approaches to it. The whole social media online world has really given me a lot of great insight into the fears and concerns, and I address that with families now, and I talk to them about these anxieties. And oftentimes they'll tell me I'm the first physician or medical professional that's really asked them about it, and then they open up, and you can just see the weight go off their shoulders, so that's great. - For sure. Do you ever guide them to resources online, that maybe something that you've published. Do patients appreciate that? - Yeah, absolutely. I acknowledge it. I say, "Listen, I know you're gonna go online "to look for medical information. "I do it as well, "it's the world we live in right now. "Be very careful, "'cause there's a lot of misinformation out there. "Here are some vetted resources "pertaining to your condition." And lastly, I tell every single family, "If you come across something that raises concerns, "write it down and call me. "I'll talk to you about it. "I'd rather talk to you for 10 minutes "than have you lose sleep for a week "thinking that something is a real risk when it's not." - That's awesome. I see a lot of newborns in my practice, or at least infants. Very often, I get presented with patients coming in and saying, "Oh, my child has X milk allergy. "Cow's milk, goat's milk." You know, there's all sorts of things being presented to me. Do you order allergy testing on all these patients, especially with them being so young? What's the normal route that you like to take with those patients? - Yeah, so that's a great example of the important distinction between a true allergy, and even if it is an allergy, what type of allergy. So the allergy tests that we do only evaluate for this IgE immediate allergy response. If an infant or child is experiencing rapid onset hives, or swelling, or wheezing, or vomiting after eating dairy products, and it happens every time, that raises suspicion for the IgE allergy-- - Which is the the true allergy. - Right, the immediate hypersensitivity. They can have a delayed allergy. So in young infants, they present with, they're on a milk-based formula, or sometimes mothers are ingesting cows milk while they're breastfeeding, and they get the painless, bright red blood in their diapers. So that is also considered an allergy, but not immediate onset IgE, we can't test for it. It's a clinical diagnosis, as you know. And you take milk out of the diet and that magically resolves as the gut heals, and then you can just introduce it again when they're older and more mature. So that's a different example, but we don't need to do an IgE test for those babies. So it really gets down to what's actually the likely diagnosis by the history, but it also points to, infants will have symptoms. So reflux is not a medical condition, it's a condition of being a baby. - That's where I was going next, 'cause that's the number one question. - Absolutely. So babies spit up, and we get in this formula roulette. Like, we started on this formula, they were spitting up, so we switched to this formula, and you're on these expensive, disgusting, hypoallergenic formulas, which may not be necessary in the first place. So it's getting comfortable as the physician seeing enough babies and saying, "Okay, I think this is likely "just a normal part of the spectrum. "They'll grow out of it as they get older, "let's not make any drastic changes." But also providing that reassurance to parents, of course, but also being able to recognize, "Okay, I think this is crossing over "into a different realm here." - Sure. I like to use the growth chart as the biggest reassurance for patients. Because you have to explain to parents, your child will not grow if there's something wrong. If they're constantly being sick, or if they're truly having some sort of immune deficiency, they can't grow. And if you see a child is gaining weight well, is thriving, is playing, the fact that they have reflux every now and then is not a dangerous condition for your child. So that's a line of reassurance I really like to take with parents. - I agree. Reflux is a laundry problem, not a medical problem. - That's well said. A big topic in the media right now surrounds food allergies, peanut allergies, we see the rates going up. We actually had a scare in the '90s, that we told parents to stay away from allergy-possible foods, and that's actually fueled a bigger problem for us, where now we've sort of seen the research point in the other direction, that we should be doing single-food introduction wen we do solid foods at four-to-six months, and do peanuts. And the great study that came out, I believe it was with peanut paste, or some kind of peanut snack in Israel-- - Yeah, Bamba. - Bamba, that's a delicious snack right there. And we've seen that early introduction to these foods actually decreases incidence of allergies. Can you speak on that? - Yeah, absolutely. You're right. We used to think avoidance would prevent allergy from developing, and it turns out that's not the right way to go. You do the best you can with the information available at the time, and we didn't have great studies that said, "What happens if we avoid versus introduce?" Well now we do. So the Bamba, where infants in Israel had much lower rates of peanut allergy compared to infants in the United Kingdom who weren't exposed to peanut until after a year of life, really leapfrogged into new intervention studies. The big LEAP trial, this was a rockstar moment when this was published in "The New England Journal of Medicine" in 2015, changed everything. 'Cause they took two groups, infants where they said, "Let's avoid peanut," infants where they said, "Let's keep peanut in your diet "from an early age, before 12 months of age, "at least three times a week until you're five-years-old." And then they challenged all of them to see which ones actually had peanut allergy. Well, those infants that kept it in their diet on a consistent basis, had a dramatic reduction in peanut allergy at five years of age, compared to those that avoided it. So that's led to new guidelines in the United States, and Europe, and Australia, where we now actively recommend: let's introduce peanut and other allergenic foods into the infant's diet around four-to-six-months of age, once they've already demonstrated the interest and ability to tolerate solid foods. So start with the rice cereals and the purees, and things like that. We never want to use whole or partial peanuts, so there's age-appropriate forms, such as thinned peanut butter, or these Bamba snacks, or peanut flour. But now we want babies to eat, and keep it in the diet. So it's not one little introduction and then, "Have a nice life." It's keep it in the diet, make it a part of the diet. And we're hopeful that by introducing this on a population level, allergenic foods, diverse diets early in life, that we can actually see a shift in the rates of peanut allergy and other food allergies over time. But that's only part of the puzzle. So we don't fully understand why kids develop food allergy in the first place, or what's led to the rise in food allergies. It's likely the way we introduce allergenic foods is part of it. There's something called the Hygiene Hypothesis, that shows it's been documented throughout the world, as societies have moved from farming environments, where babies are exposed to farm animals and more specifically, the poop from farm animals, early in life, to more clean environments in urban settings, that there's a shift in the immune response. There's a misconception that babies have delicate immune systems. They don't, their immune systems are robust! And they wanna go to the gym and practice. And what happens when you don't expose them to germs and bacteria that they can fight off? Their immune systems get bored, and they start reacting to things like peanut. You know, peanut is a harmless protein. But that's part of the reason why we're seeing more of these allergies. So it's a complicated issue that we don't have complete answers to. - Of course. I, again, my mind goes back to that challenge aspect, that the same way we don't challenge our mental state, that if we don't put challenges for ourselves, it gets really boring at times. And what happens? You start building up anxiety. Right now, I think one of the big problems we have in our society, I like to call it, or I'm pretty sure I've read this somewhere, Problems of Progress. We've become so safe in our mental space, in the fact that no one's physically attacking us, there's no lions, crime has gone down, that now anxiety's prevailing and is becoming a bigger problem. Much how we've become so safe with antibiotics, proper hygiene, boiling our water for our kids, which is crazy. But because of that, we are actually creating a world that's too clean, and therefore not challenging us enough, and it's creating new problems like allergies. - Oh yeah, I think that's part of the puzzle, absolutely. And it's kind of interesting, the IgE allergy antibody, initially our bodies developed this to fight off parasites. Yeah, we don't have to worry about that a whole lot anymore. - Which is a test we do then, if we're considering parasites. - Yeah, absolutely. So now that that's gone away, this IgE was kind of saying, "Yo, hey, "I wonder what's gonna happen here "if somebody eats this food," or whatever. So it's a fascinating-- - Yeah, it's crazy how the body adapts in positive ways, but also in ways that can actually be harmful to us. For those of us that had childhood asthma. They're 30-years-old, they don't have asthma anymore. What changed? - That's another great question. So asthma is a chronic condition that affects the lower airways, as you know. It's hallmarked by two things: Inflammation, for some people that inflammation is a really big part of their asthma, for others there's not too much inflammation, but everybody has some form of it. And the second part is recurrent and reversible episodes of bronchiospasms. So the muscles around the airways will squeeze and tighten. Asthma can be very severe and can cause life-threatening and fatal exacerbations. Unfortunately it's 2020, and we have five people dying from asthma exacerbations every day in the United States. It's tragic, and it's preventable. Or it can be more subtle, and you only have symptoms every once in a while. So part of it goes by what's your history of asthma, and then asthma can change over time, like a lot of chronic conditions including allergies and things like that. So there's a lot of people out there that had asthma symptoms when they were a child or teenager, and as they become an adult their symptoms just improve over time. It can also happen the other way as well. So a lot of adults can develop asthma or have worsening symptoms, even though they had mild symptoms as a child. - So this is the perfect time to jump in and say this is a question we don't yet have an answer to. What's gonna happen in this scenario. You're gonna have, undoubtedly, some expert come in, I like to call them IKA experts, I Know All experts, and say, "Yes, the medical community doesn't have the answer, "but I have the supplement "that will fix that problem for you." Have you seen that? What's your experience with that. - Yeah, I've come across that every once in a while. So there's a great quote along the lines of, "Extraordinary claims require extraordinary evidence." So, what's the evidence? There's a lot of frustration from people with chronic conditions, where we don't have cures. Sometimes we don't even have a great way to diagnose certain conditions, or treat them necessarily, and they really suffer. And that leads to "What if? "What if I choose this alternative therapy, "or this supplement?" And you get caught in this dangerous web of pseudoscientific claims, and these buzzwords. And then a lot of it has to do with marketing. So a couple of rules of thumb. One, if the person that's giving you the medical information is also selling you a product or a service, that's a red flag; that's a conflict of interest. So check up with it, talk to your doctor. Always go back to your personal doctor. "I read this online, what are your thoughts on this? "Is there any evidence or research to back it up?" And then the second thing is, really, what's the evidence? Anecdotal experiences are really powerful. There's a lot of people using social media, who live with chronic conditions. And they tell the world about it, "This is what it's like for me to live with this, "and here are some of the things I found to be helpful, "not helpful," things like that. I think that's amazing, because the support systems are lacking, and it's really important for people to have somewhere to go to find the support. But, your experience does not make you an expert on the disease. It makes you an expert on what it's like for you to live with that experience. There are too many individual nuances that affect our health, that make your experience almost impossible to translate to mine. There may be some overlap, but it's really hard to tease that out. - I think a statement I made in one of my past videos was that I do believe patients are experts in their own disease, but they're not experts in the disease. When we see, let's say, heart attacks. Now, a patient can be an expert in exactly what they're feeling, what happened, what medicine works for them, what treatments didn't work for them. But now, seeing that on a population level as a physician is really valuable, because now I know, well, if a patient's taking this medication, I know that just 'cause it worked for Person A, it might not work for Person B. And I think that's really important for patients to consider, that there's a reason why we're doing a lot of these things. Please ask your doctor what that reason is, but don't automatically assume that they're just guessing, or that they don't know, because there's a lot of times we're making decisions, where there's a really good reason as to why. What's the biggest mistake you've seen family medicine doctors or general practitioners make when referring to you patients, meaning that maybe they've done some testing, or haven't done some testing in the first place, what are your thoughts? - Yeah, number one across the board, and it's not just family medicine doctors, it's primary care physicians and medical professionals, it's the overuse of food allergy IgE tests. There are these panels that are commercially available, they're heavily marketed as: Wouldn't it be convenient to do a simple blood test on your patient and find everything they're allergic to? The tests don't work that way. We can only interpret the test results in the context of a detailed clinical history. So, they're not screening tests, they're not pregnancy tests, it's not positive or negative. It only helps indicate the likelihood that an allergy may be present. So when we see patients that have already had all these tests done, and foods that they're eating on a regular basis and you shouldn't even be testing for, it can be really confusing and hard to sort out. So that's-- - That's such an important point. So if you're eating tomatoes, and you get one of these IgE blood tests, which is the allergy test we're discussing here, and it comes up positive for tomatoes, that does not mean on its own, that you have a tomato allergy. Because if you're eating the tomatoes, we know from the history that you're not having an allergic reaction, so this test is giving us a false-positive, which happens, what's the percentage of false-positives with these tests? - Oh, some would say up to 50%. Yeah, and you get a range. And you know, if you have environmental allergies there's cross-reactivities. So if you have a dust mite allergy which causes chronic nasal symptoms from your exposure inside the home, you can have a falsely elevated shellfish on testing. You're not allergic to shellfish necessarily, but it just shows up on the test. - So what do you do in that scenario if, let's say that cross-reactivity exists, or you suspect that it's a cross-reactivity, and the patient hasn't had shellfish in ages. Do you do a challenge, or-- - Yeah, if it's been a while since they've had it, or, it depends on the level too. A lot of them are real low level, wishy washy, so on a scale of zero to 100, if it's barely detectable, we often will just say, "Let's go ahead and eat it," if they're comfortable with that. But that's always, you're welcome to come to my office and hang out and eat food. - Yeah exactly. - It's fun, it's a great part of the job. - As an allergist, you study the immune system, right? An allergy, as we said earlier, is an overreaction of the immune system. What do you say to patients who say that they want to take, or are actively taking supplements that are immune-boosting. - Oh yeah, the old immune boosters, you know. When you boost the immune system, bad things can happen, and that's autoimmune conditions, right? So when you have lupus, your immune system is overactive against your own body tissues-- - We should rename autoimmune disorders immune boosting-- - Yeah, yeah. (Mike laughing) And this goes back to these false claims. There's supplements, there's specific foods that you say, "If you eat blueberries, it'll boost your immune system." There's rarely any evidence at all to support that. If there is evidence, it's cherry-picked data from a mouse in a lab, where they look at one measure of their blood. But how does that translate to an actual human being, and how much do you need to eat, or take, or things like that? So if you wanna boost your immune system, vaccines. That's what they do, it's fantastic! So a lot of people have concerns about vaccines. Sometimes 'cause they don't understand how they work. Vaccines are a way to take a small piece of a bacteria or virus, most often not a live virus that can cause infection, and you introduce it to the immune system, typically through a shot. And then your immune system says, "Aha, you're a foreign protein." And you build an antibody response. The first antibody's called IgM, Immunoglobulin M, IgM is the abbreviation. IgM then says, "Hey, guess what? "IgG," IgG is the protective antibody, that's the soldier coming to the fight. "Guess what we have a new foreign invader here. "I want you to remember this guy. "If you ever see him in real life, "you can mount a fast response and fight it off." So you give a small piece of the protein. Your body takes it up without getting sick. You remember it. And then if you encounter it later in life, your body can mount a very effective boosted immune response against that pathogen. - Would you say, I mean, the way you said it was awesome, making it very realistic and understandable. Would you say getting a vaccine is almost like practicing for a competition? - Yes. - So the illness is the competition. Do you say, "Oh, why practice "when you can just get more experience through competition?" Well yeah, you can get measles and get immune protection that way, but then you're getting all sorts of risks that way, because measles has complication rates, pneumonia, encephalopathy. So why do that, when you could practice by getting the vaccine, which doesn't come with all the risks that comes with the true illness, and make yourself prepared if measles does come around? - That's exactly right. And the booster vaccines, a lot of people have concern, "Why so many vaccines?" Well the reason is because, just like going to the gym. If you go to the gym and get all buff like Dr. Mike here, but then you don't go to the gym for a couple of years, all those muscles will kinda go away, and you forget how to fight it off. So you give the booster so that you get more long-lasting memory. - Perfect. I have patients that come in, they say, "I have an egg allergy "so I can't get the flu shot." And they're trying to skirt the flu shot by doing that. I very kindly inform them that that's not a thing, we can actually give the flu shot with an egg allergy. I say that we will have you stay, maybe for a longer period of time, we'll watch you in the office. And now something has come out where they specifically make sure that there is no egg component in certain flu shots. - Oh yeah. - So I believe it's called Flublok? And it's given some reassurance to patients. But in reality, you can get any flu shot, is that correct? - Yes, yeah. So we used to recommend avoiding, because when you make the influenza vaccine, oftentimes it's using hen's, chick embryos. So the theory was that you could introduce small amounts of egg protein in the vaccine. And we used to avoid, or we would do these torturous desensitizations to kids, five steps, things like that. And then in 2009, the H1N1 influenza pandemic hit, and we said people were very sick. And we needed to find a way to vaccinate people with egg allergy. And since then, there's been over 45 clinical trials that have all shown the exact same thing. People with egg allergy, even if they have a history of severe anaphylaxis, can safely receive the influenza vaccine. It turns out there's either not egg in it, or not enough egg to cause a reaction. - And we do this, and I'm sure you've given flu shots in your office with this. I've given it in my office. No one's, I even watch them for a period of time, and no one's ever had a reaction. It was something that was more theoretical, and then in practice it didn't turn out to be that way, which happens in medicine. That's why we look for good quality evidence. There's a lot of times there's expert opinions out there, without randomized controlled studies, turns out to be false. That's why we use expert opinion, solely expert opinion, as the lowest form of evidence, and the randomized controlled studies as the ones that are gold standard. - Yeah, and actually you bring up a good point. This is something I've adopted recently with patients in the office, is I'd admit, and I'd say, "Listen, this is the way we used to do things. "The evidence has evolved. "This is what the evidence now shows. "We didn't have evidence before, now we do." Or, "The evidence has changed our mind on things." And this is where people get frustrated, as you know. "Oh, well we used to say this thing, "and now you're saying this thing, "and how are we supposed to believe any of it? "Maybe I'll just ignore it all." Well, that's what science does, it's progress. - There's actually a great book on the subject called "The Half-Life of Facts." And it really shows that we need to have a level of humility in science, because we'll say, "Oh, this species is extinct." And then we'll go to another depth of the ocean, and we're like, "Oh wait no, it's actually not extinct." - When I was a kid, Pluto was a planet. - Yeah, that's true (laughing). To me it still is, 'cause I feel like that's my level of solar system education, but apparently it's just what? A rock, a moon, an asteroid? - I honestly have no idea at this point (laughing). - I'm sure you guys know, let us know in the comments, educate us on the solar system. One of the most common allergies my patients tell me about, especially because I'm a family practice doctor, I see patients with bacterial infections, is penicillin. Which basically means that they're allergic to both penicillin, amoxicillin, the entire class. New research has come out to show that the majority, the huge majority, aren't actually penicillin allergic. Tell us about that. - My favorite statistic in all of medicine. - Okay (laughing). - 10% of the general population reports having a penicillin allergy. - Okay, so 1/10 people will say they're allergic. - But more than 90% of those same people are not actually allergic. - That's a huge percentage. - Yeah, and it's a big problem, 'cause it stays with you your whole life. - Now from my understanding of that research is, they had an allergy, or allergic reaction, when they were children, or perhaps had some sort of reaction, that may not have been a true allergy, and then they carry that on into adulthood. Whereas if you look at over the age of 10, then a lot of these self-resolve, or actually were not allergies to begin with. - Yeah, so the majority weren't a real allergy. So a lot of people have side effects from antibiotics. So delayed rashes are very common, especially in kids. You can have stomach issues, diarrhea, cramping, and oftentimes it gets labeled as allergy, where it wasn't, it was just a side effect, or some weird symptom that occurred while you're sick. Even for those who have a true allergy to penicillin, if you're not exposed to it, that often goes away. And 10 years is kinda the magic. So if you're a kid, even if it was a legitimate penicillin allergy, but now you're an adult, it's probably gone. And we have very easy tests. We have either skin-prick testing we can do in the office, which is very reliable and easy to do. We have challenges. So we now know that with children especially, delayed onset rash, several days after starting amoxicillin, Augmentin, things like that, no other scary symptoms to worry about. Hang out in the office, we give you two doses. We give you a 10% of the typical dose, wait 20 minutes or so, make sure nothing bad happens, then we give you the rest of the dose, have you hang out for an hour. And that at least rules out the possibility of an immediate, anaphylactic reaction. And the studies show that 95-96% of those kids with that story, delayed onset rash, they get it again, they're fine. The other 4%, they may get a rash again, but it doesn't cross over to cause anaphylaxis. So bottom line is, this is becoming more and more talked about in the lay-press, in media, and among allergists and physicians. Talk to your doctor if you are one of those people walking around thinking you're allergic to penicillin; it's worth revisiting. We know that patients who have a penicillin allergy label, it stays with them for a long, long time, they don't do as well. So they get inferior antibiotics, they're more costly, they may have more side effects. Broad-spectrum antibiotics are a bad choice. Penicillin's a great antibiotic for a lot of common infections like strep throat, and ear infections, and sinus infections, things like that. And with the rise of antibiotic resistance, this is a big problem on a population level as well. - For sure. And interesting to note, I have actually, we just talked off-camera, have had, and currently have, a reaction to penicillin, specifically amoxicillin. When I was 13-years-old, I was incorrectly prescribed amoxicillin for what was to be a virus called mononucleosis. Now in certain cases, I believe 60% of the cases, you will develop something known as a morbilliform rash, which is a full body rash, pink papules, macules, that is essentially a drug eruption, from taking amoxicillin with mononucleosis. Now, after that, there was only other other instance in my life, a year later, that I took amoxicillin, same thing happened, I realized I was allergic, and now in my chart it says penicillin allergy. However, most recently, I had a really bad preseptal cellulitis, which is the infection of the skin surrounding the eye, and I was prescribed antibiotics. I forgot to mention, my mistake, 'cause doctors are really bad patients, that I had an allergy to amoxicillin. Took it, and what do you know, a few days after I finished my course, a delayed reaction. I don't know if you guys can see it, I have a full-body rash, this morbilliform rash, drug eruption. What do you think about that? - You're the rarity. (Mike laughing) - Yay! - So, despite you're asking, I'm not gonna do the full body exam, I take your word for it. But no, so it can happen. But it's also important, because you didn't have a severe anaphylactic reaction, right, you developed an annoying rash. - Yeah. - So you're the exception, not the rule, and it's most likely in your best interest to avoid penicillin. - Sad. Now I have to deal with a inferior antibiotics increasing... No, I'm just kidding. I mean, look, each individual case requires individual decision making, and shared decision making. So I'll live with this, I'll be okay, it's not the end of the world. But it's definitely not fun to be covered pretty much neck-to-toe in a rash. So if you do have this, I feel for you. We can have that bonding moment. - But most importantly, and as awful as this is for you, for every one of you, there's nine people out there with the same story when you were 13, that can get it again, they're fine. - Yeah, exactly. So that's why it's important to have the conversation either with your primary care doctor, or if they're unsure, get an allergist involved. We have one right here, and information's down below. We covered everything (upbeat music) there is to know about allergies. To learn more about Dr. Stukus, and everything that he's doing, links down below. Twitter, where he works, all that great information. And if you wanna check out some other cool playlist videos about medical cases, click here. As always, stay happy and healthy.
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Channel: Doctor Mike
Views: 1,084,150
Rating: 4.9563522 out of 5
Keywords: allergies, peanut allergies, food allergies, food allergy, food allergy treatment, peanut allergy treatment, preventing peanut allergy, peanut allergy, milk mucus, penicillin allergy, blood test allergies, oral allergy syndrome, immune boosting supplements, allergist doctor, doctor mike, dr. mike, dr mike, mike varshavski
Id: KOfJOccJH7E
Channel Id: undefined
Length: 34min 40sec (2080 seconds)
Published: Wed Feb 26 2020
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