Christine Sir Cleette: I'm Christine Sir Cleette.

Kyra Blackwell: I'm Kyra Blackwell.

Rosie Garin: I'm Rosie Garin.

Christine Sir Cleette: And you're listening to the Wire Cutter Show.

Rosie Garin: Hey, it's Rosie. So, last spring we released this really helpful bonus episode about allergies and how to keep them in check. Spoiler alert, it's pollen season again, so we thought we'd reair it. Good luck out there, people.

Kyra Blackwell: Welcome to the show. Today, we're doing a quick bonus episode on something many people are currently struggling with, seasonal allergies. Because of climate change, allergy seasons are becoming longer, and they really are becoming more intense. One in four adults in the US suffer from allergies. I've been struggling with seasonal allergies for most of my life since I was a very very young kid. There's this odd juxtaposition that you know you're excited for spring and you're really looking forward to the the energy the longer days the blooms of the flowers but it's tough not to feel well.

Rosie Garin: That's right. If you believe that you have to pay for things like maybe you're having to pay for the beauty outside karmically paying for it. Kyra and I are going to speak with one of our colleagues from the New York Times who's been reporting about what to do if you have seasonal allergies. Nina Agrial, a health reporter at the Times, is joining us to talk about how to determine if you're suffering from allergies or something else because sometimes it really can be confusing and what you should know about different medications and some of the other strategies you can use to combat seasonal allergies. Yeah, we'll also talk about what Wire Cutter recommends for helping reduce the pollen in your own home. And even if you can't control the pollen swarming around outside, you can do some things to improve your indoor air quality. So, we're going to take a quick break and then we'll be here with Nina. Be right back.

Kyra Blackwell: Nina, welcome to the show.

Nina Agrial: Hi, thanks for having me.

Kyra Blackwell: It's great to have you. So, a lot of people are struggling right now. It's allergy season. We've been in allergy season for a little while now. This can really span from spring to the end of summer at this point. And it does seem like allergy season is just getting worse year after year. Is that just my imagination or is that true?

Nina Agrial: No, there is actually data to show that the allergy seasons are getting longer and the pollen counts are increasing and they have been over time. So, global warming has caused the season to start about 20 days earlier than it used to.

Kyra Blackwell: Yikes.

Nina Agrial: And pollen concentrations have risen about 20% nationwide since 1990. Texas and the Midwest have seen the greatest increases.

Kyra Blackwell: But why is that? I think that with global warming, it means that the plants are able to flourish earlier in the season and flourish later in the year as well. And also they are able to grow bigger and produce more pollen per plant.

Nina Agrial: So that's that's almost a month longer more of allergy season that's happening.

Rosie Garin: Yeah. And so when I spoke to physicians about this, you know, some have been treating allergies for a long time. And they said that one of the physicians I spoke to who has been treating patients for 40 years said that when he started there were kind of these three discrete allergy seasons. 8 weeks in the spring, 8 weeks in the summer, and 8 weeks in the fall, and you would get a break in between, but now it's kind of one long running season. I mean, I really do feel that like sometimes it's just hard these days to tell if maybe you have allergies, maybe you have a cold, maybe you have CO. So, how can somebody tell if they're suffering from allergies or it's something else? So, some of the symptoms are definitely overlapping. But the key thing with allergies often is itchiness. It can make the eyes, nose, throat, mouth, ears even itchy. Allergies can also cause congestion, post-nasal drip, coughing, wheezing, and shortness of breath. But if you have a viral infection, you might have muscle aches or joint aches or a fever that you wouldn't have with allergies. And if you typically see symptoms around the same time every year and if you have a family history or a history yourself of asthma or eczema, those could also be clues that you're having allergies. I always feel like I forget that I have allergies and then it comes up again and it takes me a few days to remember, oh, this isn't maybe a cold, it's actually maybe allergies. At which point I usually think, should I take a Claritin? Should taking a medication be the first step if you think you're having allergies?

Nina Agrial: Um, I think it depends on how severe your symptoms are, but most of the experts I spoke with said first try to manage your environment. You can just try to limit the exposure to pollen. On really high pollen count days, you know, there are trackers you can use to see how high the pollen levels are. So, limit your exposure. Also, try to limit your exposure inside, keeping your windows closed. If you go outside on those high pollen days, wearing a well-fitting mask. As soon as you get home, shower and change. Keep pets out of your bedroom or when they come into the home, wash them. And if you use a saline spray or a netty pot, that can also help a lot of people. So listeners can also go back and listen to our second episode of the show about how to keep your indoor air quality clean. In that episode, we talk a lot about using an air purifier to reduce particulate matter and using a high quality vacuum and other cleaning tools to just reduce dust, which can help reduce pollen in your home. So, we will link to that episode in the show notes. Nina, I know you did not come here today to give us medical advice, but um I would like to talk a little bit about medication for allergies because you've done a lot of reporting on this. I kind of get confused by all of the different allergy medications. In one of your pieces, you break down the differences between nasal sprays, antihistamines, and decongestants. So, I'm wondering if you could start with nasal sprays. What should people know about these when they're dealing with allergies?

Nina Agrial: So, nasal sprays, like Flonace is one you might have heard of, um, contain a type of steroid. They're called corticosteroids. And these help reduce inflammation in the eyes, in the nose, in the throat. But for them to work, you have to start taking them, you know, a few days to a week or two before your symptoms hit. And, you know, so they can really kick in. So, a lot of times people who are regular seasonal allergy sufferers, physicians recommend that they get their prescription and or go get their over-the-counter drugs and start using them a week or two ahead of when they typically begin to experience symptoms. And just a note that even though they're steroids, they're not absorbed systemically like an oral steroid would be. So they're considered low risk.

Kyra Blackwell: Okay. So you can still do the Olympics and do do

Nina Agrial: I don't know what the Olympic policy is, but I think so. Yes.

Kyra Blackwell: Okay.

Kyra Blackwell: So what about that second one, the antihistamines? I think this is what a lot of people use during allergy season. What should people know about these?

Nina Agrial: For people who have moderate to severe allergies, doctors often recommend the nasal sprays. They tend to work really well. But if you're somebody who has is using a nasal spray and have a breakout symptoms where it's a really particularly bad day or you just occasionally have allergies, sometimes the antihistamines can be enough and they help manage the itchy symptoms. So that itchiness and inflammation is caused by histamine, a chemical that your immune system releases when triggered by an allergen. And these antihistamines can work kind of immediately or, you know, pretty quickly.

Kyra Blackwell: So you wouldn't recommend that somebody take them on a daily basis? Um, I think you would have to talk to your doctor about what is the best. I know a lot of allergy sufferers do take them frequently,

Nina Agrial: but sometimes you can manage it better if you have the steroid like the nasal steroid and then sometimes use the antihistamine as a like a backup.

Rosie Garin: Yeah. Sometimes doctors say if you try one of these second generation antihistamines and it's not working for you, try another.

Kyra Blackwell: And there are different sort of generations of antihistamines, right? Like I think I read in one of your pieces that the second generation are things like Claritin, Zerek, Algra, but then there's this first generation of antihistamines which is benadryil and you're not necessarily that there's some problems with benadryil, right?

Nina Agrial: Yeah. I mean, obviously, it's still available and I think widely used, but a lot of doctors, this was one of the surprising things I heard in my reporting, many doctors I spoke with really said they steer clear of benadryil, especially in older patients, because it can cause confusion um and drowsiness. You know, there's been some research linking prolonged long-term use of benadryil to an increased risk of dementia, but those studies weren't causational. And we do know though that the use of benadryil can be associated with increased confusion and the second generation antihistamines don't do that as much.

Kyra Blackwell: Okay. Great. Well, what should people know about decongestions that third category?

Nina Agrial: Yeah. So, some antihistamines like Claritin D and Algra D that um come combined with pseudoedran pseudaped and doctors say these shouldn't be used in kids at all. Adults, if they do use them, should only use them for a few days at a time because they can increase heart rate and blood pressure.

Kyra Blackwell: Okay. So, let's say someone has tried these various medications. They're just not getting relief. They've still got the runny nose and the itchy eyes and they're just miserable. What is another thing that they could do? So ultimately, you know, if you've tried limiting exposure in your environment and limiting your outdoor exposure and tried these various kind of shorter term medications, you might be referred to an allergist and you would might have a talk about starting allergy shots. These are shots that allergists administer, you know, starting with a very small dose and then going progressively higher to sort of increase the amount that you're able to tolerate. But they're not something that's going to like give you relief tomorrow or this season. They take a number of years to work. Um, but they can have effects that last years as well.

Rosie Garin: Wow. So, it's like a long-term investment in your uh allergy relief.

Nina Agrial: Yeah.

Rosie Garin: Okay.

Rosie Garin: Nina Agaral, health reporter at the Times, thank you so much for joining us today. Thanks for having me.

Kyra Blackwell: Thanks, Nina.

Rosie Garin: Okay, Kyra, we covered a lot in this episode. So, I just want to briefly recap for listeners who are, you know, struggling with allergies right now and they just kind of want an easy step by step how to approach this problem. So, first line of defense, reduce your pollen exposure. So, that could be, you know, wearing a mask outside and then really thinking about your indoor air quality. When the pollen count is high, close your windows, take off your shoes and clothes when you come inside the house. probably wash your clothes, take a shower, and keep your home clean. You can use an air purifier to reduce particulate matter. Use a good vacuum cleaner and other tools to, you know, get the pollen off your furniture, off the floors, all of that good stuff.

Kyra Blackwell: The next step is to understand the differences between the different allergy medications. You're of course going to want to talk to your doctor if you're having really bad symptoms. We are not giving medical advice here, so you should consult your doctor. The main categories of medications are nasal sprays, the kind with corticosteroids in them. Antihistamines, and those you'll want to use second generation antihistamines like Zerek, Claritin, and Algra. Probably best to usually stay away from benadryil. Use the decongestants like Claritin D, and Algrad D sparingly. You don't want to use those every day. Um, and if you can't get relief, that is the time to talk to an allergist. you may want to explore having amunotherapy like allergy shots.

Rosie Garin: If you want to find out more about Wire Cutter's coverage or if you want to check out the products that we recommended today, go to ny times.com/wirecutter or find a link in the show notes. That's it for us. Till next week, thank you so much for listening. Bye bye.