Sunday Pick: What are allergies — and how to get rid of them with Dr. Zachary Rubin | from TED Health

Summary

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Podcast Summary: TED Talks Daily

Episode: Sunday Pick: What are allergies — and how to get rid of them with Dr. Zachary Rubin | from TED Health
Host: Dr. Shoshana Ungerleiter (TED Health)
Guest: Dr. Zachary Rubin (Immunologist, Pediatrician, Author)
Date: May 17, 2026

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Episode Overview

This episode dives deep into the science, impact, and treatment of allergies with immunologist Dr. Zachary Rubin. The conversation explores what allergies truly are, why they happen, how they can be managed (and sometimes "unlearned"), and how misinformation about allergy health proliferates online. Dr. Rubin brings insight both as a clinician and a prominent science communicator, offering practical strategies and myth-busting advice for sufferers and their families.

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Key Discussion Points & Insights

1. What Are Allergies?

[08:39]

• Allergies result from a “miscommunication” in the immune system, which mistakenly treats harmless substances (like pollen or peanuts) as threats.
• The body creates IgE antibodies against these substances (a process called sensitization).
  • Early phase: Histamine is released causing sneezing, itching, runny nose.
  • Late phase: Inflammation sets in (congestion, post-nasal drip, cough).
• Food allergies can cause anaphylaxis; environmental allergens usually cause respiratory or skin symptoms.
  “Your immune system looks at something like pollen and thinks it's basically a parasite and starts making these proteins called antibodies, specifically known as IgE.” (Dr. Zachary Rubin, [08:53])

2. Impact and Severity of Allergies

[10:10]

• Allergies are not just a minor inconvenience; they can seriously affect sleep, school/work performance, risk of infections, and overall quality of life.
• In Japan, allergies are such a crisis that some companies pay employees to relocate during pollen season to maintain productivity. "It's not just something to sneeze at. This is something that we really do need to take seriously to make sure that people are as healthy as." (Dr. Zachary Rubin, [11:59])

3. Immune System as a "Learning System"

[12:49]

• Allergies aren't flaws; the immune system is simply "overprotective."
• Even elite athletes, including up to 15% of Olympic athletes, experience asthma/allergies—proving these conditions are not a sign of weakness.
• Efforts to “boost the immune system” can backfire, increasing the risk of autoimmune disease and allergies.

4. Can You Get Rid of Allergies? Desensitization & Immunotherapy

[14:44]

• Environmental allergies can be “retrained” through immunotherapy (“allergy shots” or “drops”), gradually exposing the immune system to the allergen.
• This desensitization isn't a cure, but it can significantly reduce allergic responses if continued. "It's essentially like taking your immune system to school and showing it the same thing over and over...boring it to death." (Dr. Zachary Rubin, [15:14])

5. At-Home Allergy Tests: Pros & Cons

[15:58]

• At-home tests offer accessibility (in areas with few specialists) but are often inaccurate and yield many false positives.
• Clinical history is more important than test results: eating a food without reaction outweighs a positive test. “People may order a test...and are told you should avoid 20 foods, when in reality if you're eating them and not reacting, you're not allergic.” (Dr. Zachary Rubin, [16:56])

6. Health Misinformation & Common Allergy Myths

[18:04], [19:29]

• Dr. Rubin stresses skepticism toward “natural” remedies and bold social media claims—ask if they've been tested and validated.
• Top myths needing debunking:
  • Local honey doesn’t cure allergies (“the pollen in local honey is not what you're actually allergic to.” [19:54])
  • Misconceptions about meat allergy (Alpha Gal syndrome) and pseudoscientific treatments like acupuncture “cures”
• “You can't Benadryl your way out of anaphylaxis. That's not an appropriate treatment. It's always EPI first and EPI fast.” (Dr. Rubin, [29:16])

7. Alpha-Gal Syndrome (Meat Allergy)

[21:25]

• Caused by tick bites; symptoms can be confusing and delayed four to six hours after eating mammalian meat.
• Under-recognized, even among medical professionals.

8. Allergy Communication and Advocacy Online

[25:29]

• Dr. Rubin’s journey into social media began during the pandemic, as a way to combat misinformation and make evidence-based allergy science accessible. “I was starting to see the effects of the misinformation...whether it was the COVID 19 or allergic diseases.” (Dr. Rubin [25:57])

9. Life-Saving Tools: EpiPens & Emergency Preparedness

[27:51]

• Myths cause dangerous hesitation in using epinephrine for allergic reactions.
• Epinephrine is the only treatment for anaphylaxis; guidelines now promote shared decision-making about when to seek emergency care. "It's not that, it's the fact that we're treating a severe allergic reaction...You can't Benadryl your way out of anaphylaxis." (Dr. Rubin, [29:16])

10. Oral Immunotherapy for Food Allergies

[29:44]

• Gradual exposure to allergenic foods can desensitize patients and lower the risk of life-threatening reactions, but it's not for everyone.
• Requires daily commitment, benefits and risks should be discussed with a specialist.

11. Are Allergies Getting Worse? Why?

[31:07]

• Allergy prevalence is rising globally, for reasons not fully understood—could relate to environment, urbanization, and climate change.
• Pollen seasons are lengthening and worsening due to increased CO₂; smoke from wildfires and poor indoor air (e.g., gas stoves) can exacerbate allergies/asthma.

12. Changing the Conversation: Empathy and Future Directions

[34:00]

• Allergies are “highly complex” and impact both quality and quantity of life.
• Encourages societal shift from dismissing to understanding allergies. “If you have a really better appreciation [for] the immune system and how it works and how it abnormally responds to our world, you'll gain more empathy and understanding for those who live with these issues.” (Dr. Rubin, [34:25])

13. Looking Ahead: Hopes for Allergy Therapy

[35:28]

• Dr. Rubin is optimistic about future disease-modifying treatments and a deeper understanding of allergy mechanisms.
• Hopeful that in 10 years, allergy prevention and management will be more precise and effective, with less stigma and more empathy.

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Notable Quotes & Memorable Moments

• “Your immune system looks at something like pollen and thinks it's basically a parasite.”
  – Dr. Zachary Rubin ([08:53])
• “It's not just something to sneeze at...allergies need to be taken seriously.”
  – Dr. Zachary Rubin ([11:59])
• “You can't Benadryl your way out of anaphylaxis. That's not an appropriate treatment. It's always EPI first and EPI fast.”
  – Dr. Zachary Rubin ([29:16])
• “Local honey...it's great to support local businesses...but it's false advertising to say that it's going to treat allergies.”
  – Dr. Zachary Rubin ([19:54])
• “These allergic diseases are highly complex...I want to change the way that we talk about allergic diseases because they're often not taken seriously or the butt of jokes.”
  – Dr. Zachary Rubin ([34:05])

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Timestamps for Important Segments

• [08:39] – What is happening in the body during an allergic reaction?
• [10:10] – Real-world impact and severity of allergies
• [12:49] – Immune systems as learning systems and reframing allergy misconceptions
• [14:44] – Can allergies be “unlearned”? Desensitization therapy explained
• [15:58] – At-home allergy tests: what works and what doesn’t
• [18:04] – Evaluating allergy information and debunking myths
• [21:25] – What is Alpha Gal syndrome?
• [25:29] – Dr. Rubin’s entry into public health advocacy online
• [27:51] – Myths about EpiPens and managing emergencies
• [29:44] – Oral immunotherapy: promise and challenges for food allergies
• [31:07] – Are allergies actually increasing? The role of climate and urban environment
• [32:04] – Climate change and environmental impact on allergies
• [34:00] – Changing attitudes: Empathy, understanding, and future hope in allergy care

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Takeaways

• Allergies are complex, chronic diseases arising from an “overprotective” immune system.
• Sufferers deserve empathy, evidence-based care, and serious attention—not dismissal.
• Misinformation is rampant; skepticism and expert guidance are crucial.
• Treatments exist to reduce the severity and impact of allergies—avoid unproven cures.
• Allergies are on the rise, likely due to environmental changes.
• The future of allergy medicine holds promise for better prevention, treatment, and understanding.

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Dr. Zachary Rubin’s practical explanations, advocacy for debunking allergy myths, and commitment to human-centered science communication make this an essential listen for anyone living with—or caring for someone with—allergies.

Transcript

[Elise Hu]

Happy Sunday y'.

[Dr. Zachary Rubin]

All.

[Elise Hu]

Elise Hu here Today we are bringing you a Sunday pick where we share an episode of another podcast from ted, Handpicked by us for you. For many of us around the world, it's that time of year for allergies. This raises some interesting questions like does eating local honey help reduce allergies through micro exposure to pollen? How effective are at home allergy tests? And why do so many Olympic athletes have asthma? In today's episode of TED Health, host Shoshana Ungerlider sits down with immunologist Dr. Zachary Rubin to dig into these questions and more. From cat dander to pollen to peanuts, Dr. Rubin discusses how minor to severe allergies can affect your health and what you can do to manage them. Listen to Ted Health wherever you get your podcasts. Learn all about Ted's podcasts at podcasts.ted.com.

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[Dr. Shoshana Ungerleiter]

This is Ted Health, a podcast from Ted and I'm your host, Dr. Shoshana Ungerleiter. I have to make a confession to you. I was not the biggest fan of the subject of immunology in medical school. Immunology is what it sounds like, the study of the immune system. But when I was in school, it felt like trying to memorize a language that I didn't speak. Antibodies, IgE mast cells, histamine. I learned to recite the terms, but honestly, it all felt pretty abstract. Allergies especially were taught as these isolated moments. A kid sneezing in the spring, someone breaking out in hives after eating shrimp. It felt like an allergic reaction only had a beginning, a middle, and an end. No root cause, no underlying meaning. Why does the body suddenly decide that grass is the enemy? How can something as small as a peanut in a Snickers bar become a life or death threat? Back then, we didn't spend much time on these deeper questions. But over the last decade or so, the whole field has shifted. We now understand allergies as part of a much bigger story about how the immune system learns, adapts, and sometimes gets a little too good at protecting us. The thinking has moved from just avoid the thing that you're allergic to toward treatments that help the immune system slowly unlearn those reactions. When the pandemic happened, these conversations went into overdrive. Suddenly, everyone was talking about immunity, what it actually means, how vaccines work, why some people respond differently than others. The immune system was no longer a niche topic in medicine. It became a dinner table conversation. And yet, for many of us, including doctors, it can still be hard to keep up. The science moves quickly. The noise online moves even faster. So I find myself paying attention to the people who can cut through that confusion. The ones who can explain complicated science in a way that still feels human. And one of those people is Dr. Zachary Rubin. He's a double board certified pediatrician and allergist immunologist practicing in Chicago. He's also a nationally recognized public health advocate a trusted media voice and the author of a New York Times best selling book called All About Allergies. With more than 3 million followers on social media, Dr. Rubin has become one of the most accessible translators of complex immunology into practical and everyday guidance. I am a generalist physician. I don't treat allergies all day, every day, but I get questions about them all the time from my patients, from friends, from my own family, and more often than not, I catch myself thinking, I wonder what Dr. Rubin would say. So yes, I'm professionally interested in this conversation, but I'm also genuinely excited about it. So stick around for this interview after a quick break to hear from our sponsors.

[Elise Hu]

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[Dr. Shoshana Ungerleiter]

Doctor Zachary Rubin, welcome To Ted Health.

[Dr. Zachary Rubin]

Thank you so much for having me. It's really great to finally talk virtually face to face.

[Dr. Shoshana Ungerleiter]

Yeah, likewise. So I want to start simple here. When someone says, I have bad allergies, which is actually me right now, what does that actually mean? Like, what's happening in the body when someone reacts to pollen or food or a bee sting?

[Dr. Zachary Rubin]

Right. So there is an immune system response that's quite complicated, and I'm going to distill it down to the basics. So at some point, your immune system looks at something like pollen and thinks it's basically a parasite and starts making these proteins called antibodies, specifically known as ige. If you ever get a blood test, that's what they're measuring, and that's a process called sensitization. So you make those antibodies, they sit around you, your body, and eventually you get exposed to that substance again. And that's when your immune system becomes active. And there's two phases. There's an early phase where histamine and some other chemicals are released that can create some relatively minor symptoms for some people, more severe for others. It could be sneezing, itching, or runny nose. But then you start having this late phase reaction where cells called eosinophils and some other chemical messengers come in and create inflammation. And that's where you start getting more congestion post nasal drip, potentially a lot more coughing involved. And that's a little bit harder to reverse that process once that starts to set in. And so if it's for environmental allergens like cat dander pollen, it's gonna create some of those upper respiratory symptoms, maybe a rash, like hives. And then for food, it could actually be potentially life threatening. We call that anaphylaxis.

[Dr. Shoshana Ungerleiter]

Okay, Okay. I love starting here because I think it gives us sort of a shared language. And once we understand what's happening inside, everything else about allergy starts to make a lot more sense. And so building on that, allergies are often treated like maybe minor annoyances for some, but for some people, of course, they're life altering. So can you share a story, maybe from your clinic or your training that shows what's really at stake here?

[Dr. Zachary Rubin]

Yeah, absolutely. And so I'm going to paint a general picture of what I see rather than one particular story, because I see this almost every day. So oftentimes, whether it's a child or an adult who have severe allergies, they end up having a little bit of a harder time at work or at school because they're not able to sleep as well, because once you have that significant congestion, you're mouth breathing a lot. So that could dry out your mouth. You're not getting the same air quality coming in through your mouth as your nose. You may be waking up in the middle of the night. Cause you're itching and sneezing and having a hard time breathing. So you're just not sleeping as well. We know sleep is one of the most important aspects of your health. If you have poor sleep quality, you're at higher risk of developing obesity, high blood pressure, even diabetes. And in the short term, it's functioning at work and at school. And it's so bad that in Japan, it's considered a national public health crisis. To the point that many companies will pay their employees to move away during their spring pollen season and temporary live in other parts of the country. Or they even go to places like Hawaii or Guam to work temporarily to get away from their pollen season. Because they lose up to about a billion dollars a day in productivity. Because allergies are so bad there. And it's taken very seriously as a national health issue, which we don't see that as much in the United States treated it the same way. It's often the butt of jokes or not taken as seriously. But many people have a hard time with their quality of life, or they end up having higher risk of ear infections or sinus infections and needing antibiotics. So it's not just something to sneeze at. This is something that we really do need to take seriously to make sure that people are as healthy as.

[Dr. Shoshana Ungerleiter]

Oh, my goodness. Absolutely. And I would just like to say I'd love to go to Hawaii for the next couple of months to get away from my allergies.

[Dr. Zachary Rubin]

Take a sabbatical. Yeah, yeah.

[Dr. Shoshana Ungerleiter]

So I think hearing those real world stakes really brings it home. And it also makes me think about how people emotionally process that experience. And so I think you've said our immune systems are learning systems, and I love that framing. So how do you help patients understand that allergies are not a flaw, but more like a miscommunication in the immune system?

[Dr. Zachary Rubin]

Right. So a lot of times you see in the media and pop culture, you know, SNL is an example where people living with allergies are seen as weak or that they're a loser, a geek. It's this stereotype that needs to go away because even the most elite athletes can have asthma and allergies. In fact, it's roughly about 10 to 15% of Olympic athletes have asthma, as an example. And so it's not that they're weak, clearly they're the best athletes in the world. It's that their immune system is abnormally responding to foreign substances and thinks that these substances are a lot more dangerous than they actually are. As an example, when we talk about asthma, your airway has to determine if whatever's coming inside your lungs is safe to be around or not. And you can have an exaggerated immune response where you get more inflammation, more mucus plugging up the airways. Anybody who breathes in Wildfire smoke is going to cough, because that's a lot of material at once. But little bits here and there generally don't cause the same types of severe symptoms if you don't have asthma compared to if you do. And so it's that exaggerated response where the immune system is almost too hyperactive for its own good. And so when you hear people say, hey, take the supplement to boost your immune system, in reality, that term doesn't make sense, because if you're boosting the immune system, you're actually increasing the risk of developing not only allergies, but autoimmune disease as well, because that's a similar type of reactant not to the foreign substances, but to your own healthy tissue, like you see with lupus or thyroid disease as an example.

[Dr. Shoshana Ungerleiter]

Yeah. That framing, to me, actually feels incredibly hopeful. Meaning that this isn't a broken system, it's just a confused one, maybe. Which I hopefully naturally leads me to the next question that people always wonder. Is it ever possible to actually get rid of allergies? To correct that miscommunication in the immune

[Dr. Zachary Rubin]

system when it comes to environmental allergies, there is a way to what we call desensitize the immune system, and it is kind of training it to be less reactive over time. So we do that in the form of shots or drops. Shots are a little bit more effective where we take what you're allergic to in small quantities and slowly increase the amount that you're exposed to through injection to introduce that foreign substance closer to your lymph nodes of your immune system, rather than inhaling it. Or it's on your skin, which your immune system's not the same throughout your body. So when we do it in that controlled way, it's essentially like taking your immune system to school and showing it the same thing over and over again and boring it to death. That, okay, fine, I've seen this for a hundred times. It's not that big of a deal. I'm not going to send out all these chemical messengers like I did before. And it's not technically a cure because if you stop it, it theoretically can revert back to what it was before. That's why the term is desensitization. But it is the only disease modifying treatment that we have where we're actually really fixing the root cause of it, rather than saying, okay, avoid exposure, take medications for the chemicals that are being released, those are more like band aids. But immunotherapy, the shots or drops is a way to really get at that root issue.

[Dr. Shoshana Ungerleiter]

There are now dozens of at home allergy tests that you can order online, a cheek swab, mail and kit, and then suddenly maybe you're told you're allergic to 50 foods. For someone who's curious about their triggers, what's useful about these tests and where do they fall short?

[Dr. Zachary Rubin]

The usefulness comes into play when there's little access to seeing a specialist. So in some places, depending on where you live, it could take six to 12 months to see somebody, if at all. In other places, like where I live in the western suburbs of Chicago, there's a lot of allergists, so it's a little, it's a lot easier to get in. And so that can be a limited resource where an at home test may make sense, but for the vast majority of situations it actually falls quite short. And the reason being is one, you could have a test where they claim they're going to help you and it really doesn't. As an example, food sensitivity testing, it's not measuring for anything that's going to change management versus a food allergy test where we're measuring the IGE antibodies that I mentioned earlier. There's a high false positive rate, meaning it'll say you're allergic because it's positive, but in reality you're not. So people may order a test that's several hundreds of dollars and told you should avoid 20 foods, when in reality if you're eating them and not reacting, you're not allergic. The clinical history is much more important than any testing when it comes to these issues. So we have to combine the clinical history of what's going on and determine will these tests help us confirm that diagnosis, to then act upon it rather than just trying to look for a needle in a haystack. Because if you do it that way, you're likely gonna poke yourself and hurt yourself along the way.

[Dr. Shoshana Ungerleiter]

And I think because it's so easy to get overwhelmed or even misled when you're just trying to feel better, that really ties into the bigger issue of how we Evaluate health information in general. And of course, you spend a lot of addressing health misinformation online. And when you see a viral claim about natural antihistamines, immune boosting supplements, what questions do you wish people might ask before deciding whether there's any truth to it?

[Dr. Zachary Rubin]

Right, So I always encourage people to have a healthy dose of skepticism when they hear bold claims online, especially if they're giving a confident, simplified explanation to a complex problem. So when people see a viral claim online, especially when it comes to supplements or various treatments, you got to ask, okay, has it been tested? How has it been tested? What is the actual outcome that they're measuring? And has it been reproduced in populations that apply to me? You can make a viral claim about something and it only applies to a very small subset of a population. But is that generalizable to the entire country or to all adults or all kids, generally speaking, most of the time it's not, unless you look at the evidence based guidelines that are put out by various medical societies. Most of the time, these claims only apply to a small group, if at all.

[Dr. Shoshana Ungerleiter]

It feels like we're all trying to navigate this flood of advice all the time. And sometimes even for doctors, it's hard to know what's harmless versus what's actually unhelpful or even risky. And you've got a huge footprint online, so you know that social media is full of allergy advice. You know, it's cut out dairy, it's cut out gluten, eat local honey, take massive doses of vitamins. What are some of the most common allergy myths that you hear and which ones do you wish would just disappear?

[Dr. Zachary Rubin]

Right. The number one is often local honey. Treating allergies because it may seem harmless on the surface, but. But the reality is, is that when people are struggling to treat their allergies, it's better to get that specialist advice and care rather than trying to go for treatments that are not proven to work. Because the longer you wait to get that treatment, the more likely you're gonna have adverse outcomes like infections or not sleeping well, not concentrating well. And local honey. It's great to support local businesses. It can be a tasty treat. It's known to help with a sore throat and a cough. But it's false advertising to say that it's going to treat allergies by acting like allergy shots. Because the pollen that's in local honey is not what you're actually allergic to. You're allergic to pollen from wind pollinated plants and honey and the pollen that's there is not ones that you're exposed to regularly. So that really needs to go away. Other myths that I see online include there's a type of meat allergy called Alpha Gal syndrome, which is now probably the 10th most common food allergen in the United States, because when people are bitten by certain ticks in their saliva, there's a sugar molecule called Alpha Gal that when they're bitten, you then become sensitized to the sugar molecule that's found in all mammals except for humans and certain primates. So if you eat beef, pork, venison, dairy products, certain medications, it has that sugar molecule and it can create a potentially life threatening allergic reaction. And so there is a treatment called S.A.T. where they take take needles and acupuncture and put it in your ear for several days or if not weeks. And they claim it cures Alpha Gal syndrome. And that is something that can cost a lot of money, that is not shown to be helpful. And if it was helpful, this would be a cure for food allergy in general because it's the same type of immune response. So it really doesn't make any sense. But it gets advertised quite a lot lately on social media.

[Dr. Shoshana Ungerleiter]

So I have never heard of Alpha Gal syndrome. How does one know if they have it?

[Dr. Zachary Rubin]

Let me just give you a brief history about this. So especially in the east coast where this first kind of originated, there were many people who would complain of having hives or problems breathing at night for no reason. And it looked like anaphylaxis. It looked like a severe allergic reaction. And doctors were just puzzled by this. They'd call it idiopathic anaphylaxis because they didn't know what the underlying cause was. And then they really thought hard about what was happening with these patients who were waking up in the middle of the night with these symptoms. And they did a lot of history taking and a lot of studies to figure out that, oh man, these people who were waking up in the middle of the night were also having these antibodies to the same sugar molecule. And oh, these ticks called the Lone Star tick, were endemic to those regions. These people were getting tick bites and becoming sensitized to this sugar molecule found in meat. It almost looks like food poisoning after having steak. And it doesn't always happen. It's an inconsistent allergic reaction that sometimes it'll happen and sometimes it won't. And it's often delayed by four to six hours after ingestion, which is not like a classic food allergy that's more immediate. So you really have to have a high index of suspicion to know if this exists. And so I've made content over the years trying to raise awareness to this because many people in healthcare don't even know that this exists.

[Dr. Shoshana Ungerleiter]

Okay, fascinating. Well, thank you for educating me because I am a doctor and have never heard of this. More of my conversation with Dr. Zachary Rubin after this quick break.

[Elise Hu]

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[Dr. Shoshana Ungerleiter]

It makes me curious hearing all of this to know a little bit about your own journey into this world of social media. You've you've built a huge following explaining all sorts of things about science, including allergies on social media. Did you ever imagine yourself doing that? And what made you realize that there was such a big need for clear explanations about allergies and immunity For a

[Dr. Zachary Rubin]

lot of people who got into this space, this happened because of the pandemic. So I had finished my fellowship at Washu and St. Louis right as the pandemic was starting, and I had moved to the Chicagoland area to join a small private practice as everything was shut down. So it was very hard for me to connect with people when there were no social events. And as a specialist, you need to connect with primary care to get referrals. And so I went on social media just to connect with people. I really wasn't on it before, and I was on Twitter, and I quickly realized, oh, my God, there's so much bad information on the Internet, and this is what people are actively seeing. I, even early on in my career, saw somebody who brought their kid in and said they were using a nasal spray with iodine in it because they heard about it on TikTok. And that's not something we generally recommend. It could be potentially harmful. And so I was starting to see the effects of the misinformation, whether it was the COVID 19 or allergic diseases. And so spring of 2021, medical student from Canada asked me to go on TikTok to make videos. And at that time, I thought, why would I go on a children's dancing app? I didn't really understand the power of it at the time. Obviously, you know, hindsight's 20 20, but I said, okay, I'll give it a try. And slowly but surely, I started making a ton of connections, building a following. I joined Team Halo 5DS from the world Health Organization. And I know you and I connected through that and met a lot of wonderful people. And it just morphed into what it is now over the years, to the point that I have over 4 million people following me on multiple platforms. I had a book come out recently called All About Allergies that made the New York Times bestseller list talking about allergic diseases.

[Dr. Shoshana Ungerleiter]

Congratulations, by the way.

[Dr. Zachary Rubin]

Thank you. Thank you. It's provided so much more that I love what I do in the clinic, and I also love what I do online because they intersect so much that I'm helping bridge the gap between doctors and patients and building trust back by giving that nuance and clarity that is so desperately needed online.

[Dr. Shoshana Ungerleiter]

Yeah. And clearly that clarity is filling a gap, and it's literally saving lives in some Cases, especially when we talk about emergency situations. And so. So I wanna talk about epinephrine. Okay. It saves lives, but many people don't carry it if they need it or hesitate to use it. What are the biggest myths you hear about EpiPens?

[Dr. Zachary Rubin]

A lot of folks are very scared of using it, thinking that if I use this, that means I'm gonna die. The connotation associated with it can be quite scary for people. Or I have to go to the emergency room if I use it. And so I wanna tell folks that the recent evidence based guidelines from our American Academy of Allergy, Asthma and Immunology say you need to talk with your doctor about how to treat anaphylaxis and whether or not based on the symptoms, it's appropriate to go to the emergency room or not based on individual situations. So this is something that we're starting to move in a different direction of shared clinical decision making instead of just blindly going to the emergency room every time you use it. Many people think that you go to the emergency room because of the epinephrine itself. It's not that, it's the fact that, that we're treating a severe allergic reaction. And sometimes you need multiple doses or you may need other medications or you may even have a secondary reaction several hours later. We call that biphasic anaphylaxis. So understanding why you go there or if you need to go there is an important discussion to have with your doctor and have a written action plan to know, okay, based on these symptoms. This is when I use an antihistamine versus this is when I use epinephrine. And epinephrine is the only treatment for severe allergic reaction? It is the only one, really. Everything else that's given is secondary to relatively minor symptoms. So you can't Benadryl your way out of anaphylaxis. That's not an appropriate treatment. It's always EPI first and EPI fast.

[Dr. Shoshana Ungerleiter]

That hesitation can be so consequential. And it highlights. Right. How much fear and misunderstanding exists even around life saving tools, I think, which connects to one of the most hopeful areas in your field, at least from my perspective. And that's oral immunotherapy for food allergies. For a parent maybe, whose child can't even touch peanuts, what does that treatment actually involve?

[Dr. Zachary Rubin]

Right. Essentially what we do is we have you consume a small amount of that allergen, like peanut as an example, and slowly increasing it over several months to desensitize the immune system to an extent. Kind of like the allergy shots for environmental allergens. But we, with food, we're trying to trick the immune system so that if you accidentally ingest it in the field or in the real world, your likelihood of having a severe allergic reaction is diminished. It's not necessarily a cure, but it's a way to help manage it for people, especially if they're very sensitive. And so there's a lot of promise in using this as a tool to help managing food allergies more actively, rather than passively surveilling and making sure that we don't have a reaction in treating it. So. So for a lot of families, it's very helpful. On the flip side, it also can have side effects and change your lifestyle because you have to take this every day. You have to do certain things to make sure it's safe to do, and that can take a toll on some people. So it's something that I spend a lot of time talking with my patients about to determine, is this the right course of therapy for them? Because for some families, it's amazing, others may not be. It just really depends on the situation.

[Dr. Shoshana Ungerleiter]

Zach, a lot of people feel like allergies are getting worse. I hear this all the time. Longer pollen season, maybe more food allergies, more kids carrying EpiPens. Is that real or are we just noticing it more?

[Dr. Zachary Rubin]

It's definitely real. The question is, why is this happening? And that's not fully understood. If we knew the why, we'd have a much better time being able to prevent these things or managing them better. Because in, in medicine, when we understand the pathophysiology or the mechanisms of disease, we can then target therapies towards it. We now have a lot more asthma therapies. Because asthma is not one disease. There are multiple molecular mechanisms we call endotyping to figure out, is this due to eosinophils or IgE antibodies as an example? We have medications that can fine tune target some of those things. And so there's a lot that we can do with this.

[Dr. Shoshana Ungerleiter]

Yeah. And to me, it raises bigger questions about the world we're living in. You touched on this earlier, but how our environment is shaping our bodies and climate change is increasingly part of the allergy conversation. What does that actually look like in your clinic when it comes to pollen exposure and respiratory allergies?

[Dr. Zachary Rubin]

Right. So over time, we are seeing pollen counts increasing as temperatures and burning fossil fuels is increasing. So our pollen season starts earlier, ending later. And we have really good studies to show that as you increase CO2, that's like plant food for photosynthesis. It's going to produce more pollen. And so every year I hear, why are my allergies worse than ever before? So there's that positive correlation that we see there with the increase in pollen counts. What I see now in my area in the Midwest every summer. Now, the past few summers, we've had wildfire smoke coming from Canada, where it's blowing south, and it's blanketed many parts of the country. And the air quality index is so high that a lot of people are getting sick. And this is going to become more and more of a problem as our environment is changing in ways that are not healthy for our lungs. We're also learning about our indoor environments as well, that even just gas burning stoves are associated with developing asthma. Because when you're cooking and you have that fire going, there's, there's pro inflammatory volatile organic compounds like nitrogen dioxide that's being released, and if you don't have good ventilation, you're breathing that in. That's not healthy for your lungs. We have a shift from tobacco smoking to vaping, which vaping is not necessarily a healthier alternative. It can be just as bad and we still don't even know the full ramifications. But we are seeing a lot of younger individuals coming with severe respiratory distress and developing these types of pneumonias that we haven't been seeing before. So there's a lot of shifting problems that is happening as our environment is changing and what we're doing with it.

[Dr. Shoshana Ungerleiter]

Zach, you just mentioned earlier your new book, All About Allergies, which is a New York Times bestseller. It's written for everyone from new parents to adults who suddenly develop allergies later in life like me. What's the one thing or one idea you hope readers walk away with?

[Dr. Zachary Rubin]

The idea I really want people to understand is that these allergic diseases are highly complex. There's a lot that we know, but a lot more that we still have to know about them. And they need to be taken seriously because they are major quality of life issues, but also even quantity of life. And so I want to change the way that we talk about allergic diseases because they're often not taken seriously or the butt of jokes. And if you have a really better appreciation understanding of the immune system and how it works and how it abnormally responds to our world, you'll gain more empathy and understanding for those who live with these issues. I hope for people, you know, after listening to this, get a better understanding and appreciation for the fact that Life is a lot about balance. We talk about medical school, homeostasis, and that's very true for the immune system, that you don't want to boost it, you don't want it to be lacking. You want to have balance in life. And I think that's a good way to live life too, is that we lead by balance. And you know you're going to have stress in life, but how can we balance that out? How can we think about the work life balance? And so that's all interconnected.

[Dr. Shoshana Ungerleiter]

I think ultimately what you're doing is empowering people and giving them a way to make sense of something that can feel really overwhelming for some of us. And so looking ahead, if we Fast forward maybe 10 years and imagine a family sitting in an allergist's office like yours, what do you hope will be different about how we prevent, treat and then talk about allergies disease?

[Dr. Zachary Rubin]

I'm hoping in the future that we'll have a better understanding of the why. Why is this happening? How do we prevent these things from happening? And hopefully in the next 10 years or so we have more disease modifying treatments which are slowly starting to make their way. In the end of my book, I give some hope about future directions. What's the type of research that we're doing for these different diseases? And as an example with food allergies, they're starting to take medications that are already FDA approved and finding novel approaches to hopefully stopping food allergies in their track. So I'm really excited with where we're going with this field. It's a big reason why I wanted to become an allergist is seeing the tremendous amount of growth that's been going on over the years and seeing that it's a lot more than just a runny nose. We do a lot of different things that help people feel better.

[Dr. Shoshana Ungerleiter]

Yeah, it is an exciting time for sure. And I just want to say thank you so much. This has been been such an eye opening conversation and honestly a really grounding one for me. So again, I'm grateful to you for sharing your time and your stories and your clarity with us and thanks to everybody for listening.

[Dr. Zachary Rubin]

Thanks for having me.

[Dr. Shoshana Ungerleiter]

And that's our show for today. Thanks again to Dr. Rubin for joining us. I highly recommend following him on social media. Ruben, that's R U B I N Allergy or check out his new book, all about allergies. Thank you so much for listening. TedHealth is a podcast from Ted and I'd love to hear your thoughts about this episode. Send me a message on Instagram hoshanamd this episode was produced by me, Shoshana Ungerleiter and Jess Shane, edited by Alejandra Salazar and fact checked by Vanessa Garcia Woodworth. Special thanks to Maria Lajas, Farrah de Grange, Daniela Balarazo, Constanza Gallardo, Tansika Sang Marniwang and Roxanne hi Lash.

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