← That Can't Be True with Chelsea Clinton
That Can't Be True with Chelsea Clinton
Hep. B for Babies, Winter Colds, and Why Allergies are Rising with Dr. Zachary Rubin
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- [00:02]
A
Lemonade.
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B
Welcome to that Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton. Let's kick off this conversation with the latest on the hepatitis B vaccine. In a shocking and yet unsurprising move, the Advisory committee on Immunization Practices, a panel that this administration has politicized with its unqualified appointments, voted last week to end universal hepatitis B vaccine recommendations for newborns. Our guest today called it a dark day for our babies and our public health. I certainly agree. Dr. Zachary Rubin is a double board certified pediatrician and allergist who practices in Chicago. He's also a medical educator who shares his opinions on allergies, asthma, and, yes, vaccines. With over 4 million followers under the handle RubenAllergy, we're going to discuss what the recent as well as how to try to avoid getting sick this holiday season, whether allergies are on the rise. And yes, of course, we're going to talk to Dr. Rubin about his absolutely fantastic bow ties. Hi.
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A
Hi there. Thank you so much for having me on your show.
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B
Oh, my gosh. Thank you so much for doing this. I'm so pleased that you're wearing a bow tie. I was worried I might have an off bow tie day, so thank you. And it also looks like a festive one.
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A
Yes.
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B
That's also fun to see since we're chatting here in December and we love the holidays in our family. And I was thinking about kind of whether or not you might be wearing a bow tie this morning as we were trying to sort through whether or not we have kind of ugly holiday sweaters that we can wear to a holiday party this weekend. And I'm wondering, like, do you have the equivalent bow tie?
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A
Oh, my gosh. You know, I have several that are prints with like elephants, penguins, all sorts of animals. I have three German shepherds myself. So I have a German shepherd bow, but not the classic like ugly Christmas or Hanukkah type sweater. Although a couple of my followers did make this wonderful bow tie. That's a print of my great grandmother's painting that used to be behind me with every video for a few years.
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B
Oh, that's really lovely. Before we move on to more serious news, I also, while preparing for this conversation, learned that you're a very impressive hula Hooper. I'm so curious how you discovered that you have that skill. I do not have that skill.
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A
So what happened was as you, as you know, there's bar bat mitzvah parties where they'd have a hula hoop contest. And when I was a kid, I wanted to win those prizes so badly.
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B
Oh, my gosh.
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A
And I was terrible. So one day I told my mom, take me to a store, buy me a couple hula hoops, I'm going to teach myself. And I lock myself in the basement for a few hours, taught myself, and I've been pretty good ever since. And I decided with my content creation, to break down barriers between doctors and patients. I had hula hoop.
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B
That's fantastic. What's your longest hula hoop record? Do you know?
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A
Yeah, it's about two and a half hours. I did that to help raise money for the American Lung Association.
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B
Two and a half hours?
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A
Yeah. Yeah. Oh, my God. So I did that while livestreaming on TikTok, and we raised about $5,000 doing that.
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B
That's insanely impressive.
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A
Wow.
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B
That's very cool. Well, thank you for sharing that. And now I feel like next time I'm in Chicago, I want to come also see you hula hoop live. So I hope we could make that happen. Yeah. There's been just so much news recently and areas that I know we each care a lot about, especially as it relates to vaccines. And last week, there was a critical vote to end universal hepatitis B vaccine recommendations for all newborns.
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A
The DFO has transcribed eight votes yes and three votes no. The motion passes.
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B
I find this deeply challenging, and here's some I think especially absurd that can't be true. Tape from President Trump.
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A
Hepatitis B is sexually transmitted. There's no reason to give a baby that's almost just born hepatitis B.
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B
So, Dr. Rubin, can you please set the record straight and explain the many ways that hepatitis B can be spread?
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A
Yeah. So prior to 1991, when we look at how many babies were getting hepatitis B in the United States, it was roughly 20,000 babies. And the way that that's transmitted is not just from mom to baby. So if mom's infected, it could pass. We call it vertical transmission. It could also pass horizontally, meaning they're born and they've got casual contacts, either in the hospital, home, or in daycares, where it's a bloodborne pathogen. So if somebody has a cut, scrape, or open sore, what ends up happening is even microscopic amounts could lay on a surface and be infectious for up to seven days.
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B
For a whole week. A whole week?
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A
For a whole week. 30 to 50% of cases prior to 1991 were from some other reason outside of mom. And so once they implemented this recommendation where regardless of mom status, every baby was going to Get a dose at birth, it dropped the rates of hepatitis B infections by 99%. That is dramatic. It's a public health achievement because hepatitis B is a unique virus in babies where it affects adults differently. You could have many cases that are asymptomatic. You can't tell if an adult has it, and they could give it to a baby, which, if they're infected, nine in ten develop chronic infections. What that means is they will end up at a higher risk of cirrhosis, liver cancer, liver failure, and premature death. You will hear countless stories of people who have been affected by this in the 80s and early 90s, and you don't really hear that anymore. I'm a younger physician, and I have never seen a case of chronic hepatitis in a child ever. And now we are at risk of that happening again because of politics and ideology and using incomplete data, not looking at the totality of the evidence. That's really going to set us back, and we're going to see cases rising again.
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B
You know, I was also struck listening to President Trump, how frequently viruses that can be transmitted in multiple ways are often framed as only being sexually transmitted. Why do you think that continues to happen?
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A
Well, it's part of stigmatizing different diseases for whatever nefarious purposes there might be. By saying that it's sexually transmitted or that it's only through dirty needles, it changes people's perception on the real risk of the disease. Certainly if you choose to refuse it, that's okay. But then you have to understand the risks of doing that. By taking that recommendation away, it sows doubt and confusion as to why we were doing it in the first place, which is what I was talking about earlier, that this really does save lives. It's really a cancer vaccine. When you really think about it deeply. It's the first cancer vaccine that we get, and it's been extremely effective and also safe. They presented no new data that the hepatitis B vaccine at birth caused significant harm, that the harms outweigh the benefits. That didn't happen recently.
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B
And so now that the recommendation has changed, what's gonna happen at the hospital level? Like, what can, you know, expectant and new parents expect?
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A
So not right away. We won't see vaccine access go away immediately. But there is a big question about whether health insurance companies will be covering this vaccine because it's not universally recommended at this point. And it's going to create some bureaucratic red tape in terms of how do we implement this program now instead of it being a specific guideline for everybody. Now there's multiple steps and that's gonna take multiple steps to get that done. I think there's gonna end up being more mistakes in terms of who's going to get it administered. There's gonna be more parental refusal because of the language itself. So there's a lot online and a lot on television where people are saying misleading statements or incomplete statements about this vaccine. And now they feel empowered because the federal government as a, quote, unquote, independent advisory community on immunization practices, which we all know is not really independent. RFK Jr. Fired all of the experts that were independent, that had little to no conflicts of interest with people who have known conflicts of interest in anti vaccine rhetoric. They literally had a lawyer who makes a living off of suing vaccine manufacturers or sending letters to schools or the fda. And Aaron Seri spent two hours speaking at this meeting, questioning vaccines and talking about a bunch of nonsense, really, and misleading people about the true safety and efficacy of vaccines.
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B
You know, Doctor, when back to kind of the dynamic that most insurance companies cover most vaccines in large part because of the ACIP recommendations, what will happen, do you think now? Will there be like out of cost, like sticker price on, say, the hep? Do we have any idea how much it will cost for families? What can parents expect as to whether or not they'll have to pay for it and how much it could cost?
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A
So it really depends on where you live. So as an example, I'm in Illinois and we are fortunate that Governor Pritzker just signed into law HB767, which now pushes the recommendations towards the state level. There's a new vaccine advisory committee that insurers in the state of Illinois have to follow those recommendations. So they're not going to change this. It's going to be covered in Illinois. I can't speak for other states. You know, they're in other places in terms of what's going on. But a lot of states are starting to do this in terms of not following the acip. They may end up legally compelling insurers in their states to do something like Illinois is doing. So we'll see how that plays out. I suspect initially, because we were already starting to see this with some health insurers, that they will initially cover these vaccines. I don't know if that's going to be happening in the long run, though. And depending on the vaccine, this could cost families who are lower income quite a bit of money. And they may end up foregoing it because they can't afford it. And on Top of that, a lot of folks don't realize this, but about 15% of moms aren't properly screened for hepatitis B surface antigen during pregnancy and at the right time. So whether it comes from vertical transmission on accident or the horizontal transmission, by removing it, we're going to have higher cases of hepatitis B. It's just a matter of time.
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B
So painful. You mentioned the current advisory committee on immunization practices members that indeed are rife with conflicts, rife with a lack of pertinent expertise. And now we have the government itself changing recommendations, as you mentioned, without any new evidence, and also changing the CDC website to say that studies have not ruled out the possibility that infant vaccines cause autism. Although actually many studies indeed have ruled out that any vaccines have any connection to autism. Like, how are you seeing this in your practice? Like, are parents asking questions where they're kind of reciting, you know, incomplete or completely wrong information? Like, how are you seeing this in your day to day practice?
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A
So my dad is a general pediatrician and we both practice in the same community. We're hearing the same thing, which is there's a little bit of increased hesitancy amongst a small group of individuals. And the line that I hear most commonly is, well, I don't want to vaccinate my child to whatever it is because it's not been properly safety tested that there hasn't been a placebo controlled trial. That's the number one sticking point that I'm hearing in terms of misinformation, which is really off base. Vaccines are the most scrutinized medical intervention that we have, where we have surveillance going on for decades on these vaccines. If there's adverse effects, it gets reported. And the idea that there's no placebo controlled trials is just not true. The initial iterations of vaccines had very robust clinical trials, including placebo controlled trials. The issue is that when you get a newer version of the vaccine, when you do a clinical trial, you can't then go back and do a placebo controlled trial because it's highly unethical. That's telling a family you're going to consent to a trial where you're either going to get a vaccine or a placebo and you don't know which one you're going to get. And we're withholding a known treatment that's effective that we know works. That's essentially what was happening with the Tuskegee experiments where they were withholding treatment for syphilis for many individuals. And that was unethical. And we are trying to make up for that mistake that happened a long time ago by looking at clinical trials this way. So what they are trying to propose right now that RFK Jr wants to see happen is to keep questioning and sowing doubt into the safety of vaccines. Now, for those who don't know, I'm an allergist, immunologist. Part of what I do is actually evaluating adverse reactions to vaccines. It's something that I see from time to time. And I evaluated, especially in the beginning of the pandemic when the vaccines were being rolled out. I saw a number of patients who were concerned about safety issues and adverse reactions. And that was something that I evaluated in real time. I had two patients who had severe allergic reactions to the COVID vaccine. And we learned over time what that actually meant and how we could address those issues. People may remember they had to wait 15 to 30 minutes after they got their first vaccines. And that was all born out of properly evaluating the safety of it and the science evolved. So it's not to say that adverse reactions don't happen. It's just that most of the time they're very rare and most of the time they are mild. Every so often you could have a severe reaction, and I acknowledge that. But when you look at the benefits and the risks from a population standpoint, we've been able to stamp out so many diseases that used to devastate people. You know, our parents and grandparents saw these things in real time. You and I really haven't seen these things. Part of the failure is its own success.
- [15:14]
B
At all times, and especially right now. Rights and dignity need champions. Across the world, people are losing access to essential healthcare. We see growing attacks across the board, but especially on contraception, abortion and gender affirming care. It can feel like fear is winning, but we know that fear only wins when we stay silent. That's why the International Planned Parenthood Federation is calling on all of us to come together to help protect essential healthcare access. When you donate, you can help local providers deliver life saving services in more than 150 countries. You can help fuel the fight for policy change and empower organizers to stand up for all healthcare. But especially right now for reproductive choice and freedom. If you give today, your gift will be matched. Visit ippf.org true to make your match donation right now. That's ippf.org true. I want to turn now to the fact that, you know, we're entering winter, although here in New York city it's like 20 some odd degrees today. So it very much feels like it's already arrived. And there's been so much in the news recently about where our cold and flu kind of levels are. I know there's a lot of concern that this could be a very bad flu season, given what's happening in the UK and elsewhere. Wonder what's in your crystal ball. Kind of what you think any of us should know about this upcoming kind of winter season of viruses and particularly as it relates to the flu.
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A
Right. So the typical milieu since the COVID 19 pandemic is still there in terms of RSV. COVID 19, the issue is influenza. The vaccines that we have currently may not have been the best match for this virus. And while it's still important to get vaccinated, there are still gonna be a lot of people getting sick from influenza. What the vaccine does is it decreases the risk of severe disease. That's still going to hold true, most likely. And so a lot of experts are concerned that because of declining vaccination rates, we're gonna see more hospitalizations this winter, and it's gonna be quite busy in the hospital. So that is a bit confusing. So I do want to urge people, if you have not gotten your flu vaccine yet, if you've not gotten your updated COVID 19 boosters, it's not too late to vaccinate, Please make sure that everyone's covered, especially if you've got family members who are immune compromised, have chronic diseases, elderly, or you've got a baby at home, you want to have that kind of ring vaccination so that you have that level of community immunity to protect those who can't protect themselves.
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B
We all got our vaccines. We all got our flu and Covid vaccines a couple of months ago. I'm curious, Dr. Ruhman, you know, for your patients, what questions do kids have, not only their parents, but do kids have around, kind of why they need to get the flu shot every year. And what do you. What do you tell them?
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A
I often will tell kids that these vaccines, like influenza, is like getting a study guide for a test. Does that mean you're going to ace the test every time or get 100%? No. But are you going to get a higher score than if you didn't get the study guide better? Leg up.
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B
Love that framing.
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A
So I always put it in that context because it's easy to have this analogy when thinking about school. And who wouldn't want to leg up when they're in school to do well on a test? Right?
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B
That's great. You know, you mentioned rsv, and I want to ask you about kind of the recent reporting that an RSV infection in early infancy may substantially raise the risk of childhood asthma, particularly for kids with at least one parent who has asthma. Can you share a little bit more about the study and kind of what you think it really tells us?
- [19:23]
A
So there's actually multiple studies that have looked into this in different angles just to make that clear. This is not a new finding, actually. And it's not just rsv, it's rhinovirus as well. And it's more about this concept that when someone gets a viral infection, RSV being one of the more common ones, it can cause your immune system to be a little bit dysfunctional or dysregulated, where it gets a little bit confused and may end up creating this situation we call sensitization in allergy. That's where you generate these proteins called antibodies, specifically of the class called immunoglobulin E, or ige for short. And in addition, some of my colleagues, when I was in training, did research on the gut microbiome in these viral infections. And it can significantly alter the bacterial milieu of your gut, which is responsible for how we process food and how we go about the world. We really do rely on these healthy microbes in our body to know what is safe and what is not safe. So RSV has different ways that it could impact the body, especially if it's early on. And so it is true that if a baby's infected with rsv, they do have a higher chance of developing and asthma and allergic diseases in general. It also is the most common reason why babies are hospitalized these days as rsv. It's a very infectious virus. And fortunately, now we have an antibody that we can give babies when they're born called nirsevimab, that can decrease the risk of getting not only infected, but severely infected. And now there's vaccines for pregnant mothers as well as elderly, which has been a huge boost for our public health.
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B
I know you've been very vocal in a way that I particularly appreciate, because I have as well about the hypocrisy of the Trump administration, rolling back clean air rules, possibly also rolling back clean water rules, while claiming to support the Maha movement. Curious what you want kind of people listening to know about why you've been so vocal, kind of why you're so worried about kind of these rollbacks, as, you know, really affect affecting our lungs and our susceptibility to probably all sorts of things.
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A
So my specialty as a pediatric allergist really focuses on preventing kids from getting Severely ill. And we know that there are a whole host of issues that can increase childhood disease. We know these things to be true. We know pollution severely affects everybody, but especially kids who have a developing immune system, that if you have a child living in an urban area with a lot of air pollution, they're at higher risk of developing asthma. Asthma is not something that really should be taken lightly. It is a severe chronic lung disease. What is happening right now, and seeing the current administration rolling back regulations related to clean air, as an example, in terms of what level of particulate matter that's less than 2.5 micrometers in diameter, PM2.5, they're allowing more of that into the air, yet they want to make America healthy again. Makes absolutely no sense, especially when we know these things to be true. We're just actively putting our heads in the sand to roll things back for political and financial gain. But in the long run, it's going to bankrupt society because we will continue to have more health problems. And we see this in the summertime now that we're getting wildfire smoke coming from up north, coming down. I see this in my clinic, people going to the hospital because of wildfire smoke. I never thought in Illinois I'd have to deal with that. It's something that would happen in California, but now it's happening in Illinois, it's happening in the East Coast. You probably remember that 2023, the summer.
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B
Oh, absolutely, I do. I picked my kids up from school and we went home immediately. Like, you're right, we can't play outside. We can't go outside. Yeah, yeah.
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A
The number of ER visits and hospitalizations strongly went up in New York and in other areas because of that. And we're only gonna see this continue to happen because temperatures are continually rising. We're putting more greenhouse gases in the air. And a lot of people don't like to say the phrase climate change. It's manufactured by humans. I mean, it is what it is. You can't just ignore that and pretend it doesn't exist. And I became really charged to do this type of work because when the Trump administration first came in, they put on this communication embargo on federal health agencies for about three weeks. And I have a lot of patients with food allergies who rely on the press releases from the FDA for recalls related to, oh, there's an accidental allergen in this particular food product, like they accidentally put in peanuts or whatever it is. And because that information wasn't able to actively go out, I went into the websites and did everything that I could to collate that information and start telling people this is what's going on. And that was frightening to have to do that. And to see our publications like Morbidity and Mortality Weekly Report, or mmwr, which was published every week for decades. Yes.
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B
Even published the week of September 11th.
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A
Exactly, exactly. That stopped. And that stopped multiple times. That's frightening that we're not able to get the information out to people, and instead we're getting blanketed with lies and mistruths and half truths and omitting the real evidence of what's going on. And so I urge anybody listening to this that you should not be afraid to speak out, to speak up. Use your expertise, tell your story. If you're affected by this in any way, tell your story. Put that out there. Write to your legislators, Tell them how dissatisfied you are with how things are going right now. Because if we don't speak up, it's just going to continue to keep getting worse.
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B
You've also been publicly critical about the Surgeon General nominee. Casey means what especially concerns you about her nomination?
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A
So you can argue about whether or not expertise matters these days. With the dawn of social media, it democratizes expertise. But when it comes to a position like Surgeon General, where you are essentially America's doctor, giving out medical education and advice to the general public outside of social media, you should have the right credentials and the expertise. So she never completed her residency. Her training is a surgeon, an ENT surgeon, and she dropped out. She does not have a medical license. And what she has done is created a career out of sowing doubt and distrust in our current healthcare system in nefarious ways and has some potential financial conflicts of interest. She started a company that sells continuous glucose monitors that have no evidence of benefits for people who are healthy. It's something that's meant for people who have diabetes. And so there's a lot of questions about whether she really has the right expertise. She's been on podcasts saying things that are just blatantly wrong scientifically and medically. And so it's really hard to take someone like that seriously when they're just out there spreading misinformation.
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B
You talked about how you diagnosed food allergies and kind of treat people with food allergies. Curious, kind of. What are some of the most common ones? And why do you think we've seen food allergies increase over the last few decades?
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A
So some of the most common food allergens for children specifically are going to be peanuts, egg, cow's Milk. Then you have like the top 10 in general with like wheat, soy, seafood of fish and shellfish, sesame. And now there's something called alpha gal, which you may not have heard of. That's a meat allergy.
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B
I haven't heard of that.
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A
I'll tell you a little bit about it, please. Yes, it's now considered the 10th most common food allergen in the United States because there's been a rise in tick bites from a particular tick called the Lone Star tick.
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B
That's a benign name for something that sounds quite dangerous.
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A
Yes, it's very dangerous. The Latin word is Amblyoma americanum. So that's kind of fun, rolls off the tongue. But this sugar molecule that's in their saliva is called alpha gal for short, or galactose, alpha 1, 3 galactose. And so they're typically on deer. And when they bite humans, they introduce the sugar molecule. Your immune system thinks it's a foreign substance, like a parasite creates that allergic response called sensitization. So that if you consume mammalian meat products like pork, venison, cow. Right. That could cause a severe allergic reaction. And what's odd about it is it doesn't always happen when you do it. And if it does, it's usually delayed by two to four hours. So people would wake up in the middle of the night with hives all over their body or they couldn't breathe or were looking like they were going to die and they had no idea.
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B
That's very scary.
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A
And so that's on the rise as these ticks are multiplying and going further north. So when I was practicing in St. Louis, I saw a ton of these. Now I'm in the Chicagoland area. I've only seen one case, and it wasn't from Chicago and it was somebody who had moved from Tennessee who had it and then came to me. But it's something that you should be on the lookout if you're in the Missouri Valley area as an example, and it's creeping further north, so there's that. Now, your original question about why are allergies getting food allergies getting worse over time, I can tell you it's not vaccines because even though that's being discussed from RFK Jr. It's not that we've already looked into that. There's multiple issues at play here. One that we've known that's kind of low hanging fruit is when do we introduce foods to babies? So there was a time when the American Academy of Pediatrics briefly recommended to delay introduction of highly allergenic foods for babies at high risk. So those who had eczema that was moderate to severe, they'd say, okay, wait for peanuts until they're about two to three years of age, as an example. And it turns out that was not the right way and the science evolved. If we introduce the foods earlier, we're starting to see a decrease in food allergy prevalence in the United States. It's just starting because the recommendations changed in 2015. That's one issue. Another issue is the gut microbiome that we referred to earlier. We do give antibiotics to babies and antacids to babies for very specific reasons. Sometimes it's absolutely necessary. And so in those cases, it could disrupt that normal bacterial flora and could increase the risk of developing food allergies. There are associations that have been reported there. It could potentially be due to vitamin D deficiency. There are associations reported there, C sections as well. And there may be some type of pollutant that's happening, whether it's pesticides on our food or how we process foods. But it's not one issue. It's multiple factors that are leading to this rise in countries like the United States, the United Kingdom, Australia as an example. So it's not just inherent to the United States, but there are multiple places in the world where we are seeing this.
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B
And so, Dr. Ruba, what advice do you have for parents or people who are thinking about becoming parents on how to protect kids from developing food allergies, if that's possible?
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A
So we can't 100% prevent food allergies, especially because there is a genetic factor to all of this. So if you have a family history, you do have a higher risk of having children with food allergies. But there are some things we can do to help lower that risk. As we mentioned earlier, earlier, introduction of these highly allergenic foods tends to decrease that risk. And so talking with your pediatrician about when to do it and how to do it is important. And then if you have a family history of eczema, there is some early evidence to suggest that if you are moisturizing your babies daily, it may decrease the risk of them developing eczema, which we know is a gateway to developing food allergies. So that's still being investigated. It's what I feel is a low risk, potentially high beneficial intervention, that regardless if they have eczema or not, the daily moisturization to protect that skin barrier could help. And the reason being the theory behind it, is your skin's immune system is not the same as in your gut. And so if you have a disrupted barrier and food or other allergens get onto your skin, it could increase the risk of that sensitization process, leading to food allergies, asthma, or even allergic rhinitis or hay fever.
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B
That's super interesting. Turning to seasonal allergies, certainly here in New York City, I feel like we see pollen for much longer than when I moved here 20 years ago. And while that's my kind of anecdotal experience, I know we are also having kind of longer pollen seasons and higher pollen counts. And how are you seeing that show up in your clinic? Are you seeing more seasonal allergies? Are they getting more severe? And also, what advice do you have to parents about how to navigate that for our kids?
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A
Right, so I'm definitely seeing a rise in the number of people complaining of severe allergies. And every year I hear the same question. Why are my allergies worse this year than in any other year? And so there's a lot of myths online spread about concepts of botanical sexism, where it was.
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B
Excuse me, botanical. What is botanical sexism? What does that mean?
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A
Yes. So there was a horticulturalist named Thomas Ogren who made this claim. It's a theory where he cherry picked an article from the 1940s from the USDA saying, well, you see, city planters only wanted to plant male trees. And because male trees make pollen and they didn't want to have female trees that make fruit litter, the city, they don't want free food. So, you see, it's the male trees. It's the patriarchy. But the reality is that most trees in the cities are both male and female. They're hermaphroditic. So that doesn't. That name only goes viral because it makes people upset about a common problem and it oversimplifies it. But the reality is, is that climate changes temperatures and CO2 levels rise. We have more pollen every year, and the pollen gets released earlier in the year and stops later in the year. So, as you mentioned, it's getting a lot warmer in New York over the years. And so pollen counts are also rising at similar rates. So what do I tell families to do? You first want to get tested to make sure we know what you're actually allergic to so you can learn ways to reduce exposure to whatever it is. It may not be pollen. It could be something else. As an example, we talk about when to start medication. So if you are somebody who deals with allergies in the spring, you want to start your medications two to four weeks beforehand. So they build up in your system and you're better prepared for it. And then we may employ immunotherapy or allergy shots to train the immune system to be less reactive to those allergens.
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B
And are indoor allergens getting worse too? Are we more worried about mold, dust mites, other things?
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A
It really depends on where you live. It's a function of the housing that you're in and whether that's present or not. And also the air pollution, too. We can't test for air pollution in the same way that we test for pollen or mold. And that's become a significant problem. And we're seeing too more data looking into even just gas stoves that the stove tops, when they're releasing the gas in the fire, you have like nitrogen dioxide, which can be very irritating to the airways, as an example. So we're seeing stronger associations between developing allergic diseases and just having a gas stove.
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B
So turn the fan on over the stove.
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A
Exactly. Keep the windows open if you can get that ventilation going to reduce that exposure.
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B
You know, I was so struck by the biological sexism anecdote a couple minutes ago, and I'm curious, what are some other persistent bits of misinformation or myths that you hear from folks around allergies?
- [35:28]
A
So one of the first myths I ever heard actually came from my aunt when she found out that I was going to become an allergist. She said, oh, make sure you tell your patients to eat local honey. It will treat their allergies. And I always thought that that sounded kind of true on the surface, but really actually doesn't make sense. So honey for those above 12 months old can be really helpful for sore throat or cough as a natural cough suppressant. But this concept that local honey can treat your allergies like allergy shots because there's pollen in the honey really doesn't bear out, because the pollen that's in honey is not the ones you're allergic to. So when you have an allergy to something in the environment, you have to have a lot of exposure to it. When you smell pretty flowers, the ones that bees actually pollinate, those pollens are sticky, heavy. You never breathe those in on a regular basis. So it's not possible to be allergic to those. So it's a persistent myth to sell honey, which I have no problem with.
- [36:24]
B
Big Honey. Big Honey is behind this.
- [36:26]
A
Oh, yeah. But, but no, I mean, there's. The wellness industry is a multi trillion dollar business. And that's part of it, is tell little tiny myths Here and there. Because if you're told to do that and not actually seek out the right medical advice, if you have uncontrolled allergies that can affect your mood, your sleep, increase your risk of ear infection, sinus infection. So untreated allergies is not something, and I'm going to joke here, it's not something to sneeze at.
- [36:53]
B
You made me laugh. Thank you, Dr. Rubin. We like to end the show on a segment called Fact or Fiction. So the one I want to start with is something that I certainly have heard my entire life. That vitamin C and zinc, particularly in the winter, help boost your immune system and help you avoid getting sick and hopefully help you recover more quickly if you do get sick. So vitamin C and zinc boost immunity. Fact or fiction?
- [37:22]
A
That's fiction. My question back to you is, how do these things boost your immune system? When people say that, I would love to know how they actually boost it. I have no idea. Nobody knows. What do you mean? Increase the antibody production, your T cell responses, complement proteins. I mean, what are you actually boosting?
- [37:42]
B
They give little capes. They give little capes maybe to the little orange. Vitamin C. Capes.
- [37:47]
A
I mean, vitamin C is just gonna make expensive pee.
- [37:50]
B
Expensive pee?
- [37:52]
A
Yeah. Yeah. I mean, if you. Obviously if you're deficient in a vitamin, you gotta supplement, you should take it.
- [37:58]
B
Yes.
- [37:58]
A
But people who are out and about healthy, they don't have underlying chronic issues. If you take different supplements or vitamins, oftentimes it just gets excreted. And so I like to joke a little bit that you're just emptying your pockets and making expensive pee.
- [38:17]
B
I'm not going to forget that either. Kids should be playing in the dirt and trying to get as much stuff on them as possible because it helps build their immune system. Fact or fiction?
- [38:30]
A
That's a bit of a fact in the sense that we should encourage kids to play outside, not just for exercise and social benefit. But exposures to healthier microbes does have an impact on the immune system that as it's developing, you need certain exposures, not infections. I want to make that very clear. It's not infections. It's the healthier, what we call old friends hypothesis that there are certain microbes that you do need some exposure to. So if you're getting your hands into dirt, little things like that are not that big of a deal. It's partly why we see lower rates of allergic diseases in the Amish community, because with their traditional farming practices, they're exposed to healthier microbes. But if you're in an urban environment, you're not necessarily getting that same type of exposure. So it's not always hyper cleanliness. It's just what is the right exposure.
- [39:22]
B
But don't eat the dirt.
- [39:23]
A
Oh, don't eat the dirt.
- [39:24]
B
No, don't eat the dirt. At home allergy tests with food swabs or mail in kits are accurate. Fact or fiction?
- [39:32]
A
Fiction. So the problem with at home testing for allergies is sometimes they're not even testing for a clinically relevant thing like food sensitivity tests. They're testing for something called igg, which is an antibody you make naturally in response to just eating food to protect you from having an allergic reaction. So the problem with doing it at home is you don't have expert interpretation because these tests are not easy to interpret, and it may end up causing false positives, meaning it says you're allergic to something when you're not and create a lot of unnecessary anxiety and potentially nutritional problems.
- [40:06]
B
You can cure allergies. Fact or fiction?
- [40:09]
A
Unfortunately, it's fiction. There's really no cure for allergies at this point. The immune system decides when it wants to stop being allergic to things and tolerate them. You know, if you have a baby who's allergic to eggs, they're more likely than not to outgrow that and be able to tolerate eggs later in life, but peanut and tree nuts, a lot less likely. So cat allergies tend to be persistent throughout life, but some people now and again will lose that allergy. But when we do allergy shots, it's not technically a cure because the treatment can reverse on itself. If you stop it, it may go back to being allergic in the future.
- [40:45]
B
Since you mentioned cats, I do have to ask, as someone who had a cat as a child whom I loved very much, even though my mother was allergic to cats, it was a great act of love for her to permit me to have a cat. I'm curious, if you are allergic to cats, can you now get a hypoallergenic cat? Is that real fact or fiction?
- [41:07]
A
That's fiction. There's no such thing as a hypoallergenic cat, despite what people may tell you. Or dogs for that matter. If your cat has saliva, urine, and skin cells, they can produce allergens. And especially for cats, even a small amount can provoke severe allergic reactions for people. For me, as an example, I used to be severely allergic to cats until I put myself on constant immunotherapy, on constant shots. I would wheeze at my brother's place.
- [41:30]
B
I was about to say, why did you do this to yourself? Because someone in your life also had a cat?
- [41:35]
A
Yes, yes. My brother and sister in law have two cats. I think they actually just recently fostered some too. So now when I go over there, I'm just mildly itchy, but it used to be pretty severe for me as an example. So there are newer technologies being developed and there's a type of cat allergy food that you can give cats to neutralize some of the allergy antibodies in their skull.
- [41:57]
B
There's a, there's a food that you can give the cat so the cat provokes less of an allergic reaction in someone who has a cat allergy.
- [42:05]
A
Yes.
- [42:05]
B
Oh, wow.
- [42:06]
A
So just to give conflict of interest disclosure, where I trained at Washu and St. Louis, it's right by the Purina's headquarters. So some of the allergists that I trained under, they helped develop this.
- [42:17]
B
Wow.
- [42:17]
A
So it's Purina's pro plan Live Clear formula where it's a, it's a really fascinating way that they developed it. They immunized chickens with the cat allergen protein called Feld1 that's normally found in their saliva. Those chickens made a neutralizing protein called an IGY antibody that gets into the egg yolk. They take the egg yolk, sprinkle it on the food, the cats eat it, and after a month, they measured out almost a 50% reduction in cat allergen proteins.
- [42:46]
B
I'm fascinated by that. What other very cool interventions could you share with us? Are there others?
- [42:54]
A
This is why I love what I do, because we're constantly getting new breakthroughs. So one of the more recent ones is there's the first ever FDA approved medical treatment for a drug treatment for food allergies. It's an older medication that was originally designed to treat food allergies that got shifted towards asthma, chronic hives, nasal polyps. It's called Omalizumab or Zolaire. It's an injection that's given every two to four weeks that blocks the allergy antibodies from activating mast cells. So if you have a peanut allergy, as an example, the clinical trial showed amongst almost 200 kids and adults that if they were to get this for four months, they would be able to tolerate about four peanuts without having a reaction. So it gives you that buffer zone in case something happens, not a cure, but that's a huge step in the right direction. Or we now have EpiPens that have been converted into a nasal spray called Nephi, where instead of having to use a needle to inject yourself for a severe allergic reaction. It's the same device as Narcan, but for anaphylaxis as an epinephrine nasal spray. So we are consistently finding new and novel ways to help treat people with allergic diseases and I'm excited for the future.
- [44:06]
B
Well Dr. Rubin, I'm so grateful for this conversation. I learned so much. I am also more excited for the future because thankfully we have researchers and clinicians like you helping ensure that patients, and particularly kids, have access to what the new science is saying to help keep all of us, but particularly our kids, healthy and safe. You quasi broke my heart about the absence of a full hypoallergenic cat, but you also really did just fire my brain with understanding that there's pet food that hopefully helps protect people like my mom or like you who have severe cat allergies. Really, just thank you so much for your time and really grateful for all that you're doing to help keep us safe and keep us educated in this time of deep, purposeful uncertainty, shall we say? And I hope you and your family have a very happy holiday season. Thank you so much Dr. Rubin.
- [44:59]
A
Thank you so much Rab. It was really nice to meet you.
- [45:07]
B
You can learn more about Dr. Zachary Rubin at rubenallergy on Instagram and his upcoming book is called all about allergies, Everything you need to know about asthma, food allergies, hay fever, and more. Thanks for listening. We're taking a little break for the holidays, but we'll be back next year. That Can't Be True is a production of Limonada Media and the Clinton Foundation. The show is produced by Katherine Barnes Mix in Sound design by Ivan Koraev. Kristin Lepore is Senior Director of New Content and Jackie Danziger is VP of Narrative and Production. Maggie Kralshore is our Managing Director of Partnerships. Executive producers are Jessica Cordova Kramer, Stephanie Whittles, Wax, and me, Chelsea Clinton. Special thanks to Erika Goodmanson, Sarah Horowitz, Francesca Ernst Kahn, Caroline Lewis, Sage Svalter, Barry, Larry Westerberg, Emily Young, and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. And if you can think of someone who might benefit from today's episode, please go ahead and share it with them. There's more of that can't be true with Lemonada. Premium subscribers get exclusive access access to bonus content when you subscribe on Apple Podcasts. You can also listen ad free on Amazon Music with your prime membership.