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