Today, Explained: Why Are My Allergies Getting Worse?
Vox Media Podcast Network
Release Date: May 18, 2025
Hosts: Sean Rameswaram & Noel King

Introduction: The Rising Tide of Allergies

Seasonal allergies have long been a common nuisance, but recent trends suggest they are becoming more severe and widespread. In the episode titled "Why Are My Allergies Getting Worse?", Vox's Today, Explained delves into the factors contributing to this uptick, exploring both environmental changes and advancements in medical treatments.

Understanding the Causes of Worsening Allergies

Nilou Tumala, an ear, nose, and throat surgeon at NYU Langone Health, provides an in-depth explanation of the biological and environmental factors exacerbating allergy symptoms.

• Pollen Production and Immune Response

  At [02:34], Tumala explains, “When trees grow, they produce pollen... when certain individuals breathe in this pollen, it triggers an immune response inside their bodies.” This immune response leads to the release of histamines, causing symptoms like nasal congestion, sneezing, and increased mucus production.

• Climate Change's Role

  The season has not only become longer but also more intense. Tumala highlights at [03:33], “Over the past 30 to 50 years... the pollen season is about three weeks longer... and there's about 20% more pollen in the air.” Warmer temperatures and altered precipitation patterns enable trees to bloom earlier and retain pollen longer, extending the allergy season into the fall.

• Future Projections

  Addressing climate change's trajectory, Tumala states at [05:03], “Studies... show that the pollen allergy season will continue to lengthen and that there will continue to be more pollen in the atmosphere as carbon dioxide levels increase.”

Impact of Severe Allergies on Daily Life

The hosts share personal anecdotes illustrating the debilitating effects of allergies:

• A listener, Melanie Pozdil from Chicago, notes her post-pandemic surge in severe allergies ([01:11]).
• Dorian discusses lifelong struggles, particularly during spring ([01:21]).
• Trey shares how allergies have affected him for over a decade, impacting his daily activities and sleep ([06:16]).

Nilou Tumala elaborates on the broader implications at [07:24], mentioning secondary concerns such as:

• Sleep Disruptions: Difficulty breathing affects sleep quality.
• Cognitive Impairment: Allergies can hinder attention and performance, especially in children, impacting their academic achievements.

Indoor Air Quality: The Hidden Culprit

Transitioning from outdoor allergens, the podcast explores indoor air pollution's significant role in exacerbating allergies.

Joseph Allen, director of Harvard's Healthy Buildings Program, provides a comprehensive overview:

• Prevalence of Indoor Pollutants

  At [10:49], Allen emphasizes, “The majority of outdoor air pollution you breathe happens indoors... Indoor air pollution can be 5, 10, or even 100 times higher than outdoor air.”

• Sources of Indoor Allergens

  He lists various indoor allergens, including:

  • Pet Allergens: From cats and dogs.
  • Pest Allergens: Such as cockroaches and rodents.
  • Volatile Organic Compounds (VOCs): Released from cleaning agents and cooking.

• Historical Context and Building Standards

  Allen takes listeners through the evolution of building air quality standards, noting shifts from Florence Nightingale’s emphasis on fresh air ([13:16]) to the “sick building era” of the 1970s and the subsequent resurgence of ventilation awareness post-COVID ([13:31]).

• Disparities in Air Quality

  He highlights socioeconomic disparities, observing that schools in predominantly Black communities or those with high rates of free/reduced lunch programs often have poorer ventilation rates ([15:14]).

• Improving Indoor Air Quality

  Allen offers actionable advice at [16:07], recommending:

  1. Maximizing Outdoor Air Intake: Keeping windows open when possible.
  2. Upgrading Filtration: Utilizing higher-grade MERV 13 filters or portable HEPA air purifiers.
  3. Monitoring Air Quality: Investing in affordable air quality monitors to track pollutants like CO₂, VOCs, and radon.

The Treatment Landscape: From Over-the-Counter to Innovative Solutions

Dylan Scott, Vox's health reporter, discusses the current state and future of allergy treatments.

• Limitations of Over-the-Counter Medications

  At [19:11], Scott critiques existing antihistamines and nasal sprays, stating, “...they don't probably work as well as any of us would like to see.” He expresses frustration with the limited efficacy and user experience of current options.

• Emerging Treatments: Omalizumab (Xolair)

  Scott introduces Xolair, a monoclonal antibody initially approved for asthma, now being explored for allergic conditions. At [20:37], he explains:

  “People who took Xolair who got an injection shortly before the allergy season started, they reported having fewer symptoms... better quality of life during the allergy season.”

  • Mechanism of Action: Xolair works by blocking IgE antibodies, preventing the immune system from overreacting to allergens ([22:53]).
  • Broad Applicability: It holds promise not just for seasonal allergies but also for food, insect, and mold allergies, potentially serving as a universal allergy treatment ([23:58]).

• Challenges and Considerations

  • Cost: Scott mentions, “The list price on Xolair is $1,500 a pop,” highlighting the financial barrier for many patients ([25:32]).
  • Insurance Coverage: As Xolair is used off-label for allergies, insurance companies are hesitant to cover it without FDA approval for this specific use ([25:32]).
  • Research Funding Concerns: Scott voices worries about the sustainability of allergy treatment advancements due to potential cuts in federal research funding ([26:43]).

Conclusion: Navigating a Future with More Severe Allergies

The episode underscores the multifaceted nature of worsening allergies, attributing it to both environmental changes and limitations in current medical treatments. While emerging solutions like Xolair offer hope, challenges such as high costs and the need for robust research funding remain significant hurdles. Additionally, improving indoor air quality emerges as a crucial step in mitigating allergy symptoms. As climate change continues to influence pollen production and allergy seasons extend, the need for comprehensive strategies to address both prevention and treatment becomes increasingly urgent.

Notable Quotes:

• Nilou Tumala [03:33]:
  “Over the past 30 to 50 years... the pollen season is about three weeks longer... and there's about 20% more pollen in the air.”

• Dylan Scott [19:11]:
  “Antihistamines... they don't probably work as well as any of us would like to see.”

• Joseph Allen [16:07]:
  “If you do a couple things, you want to bring in more outdoor air, upgrade your filtration and measure the air.”

This comprehensive exploration by Today, Explained offers valuable insights into the escalating challenge of allergies, emphasizing the interplay between environmental factors and healthcare responses. As listeners, understanding these dynamics empowers us to take informed steps toward managing and mitigating allergy symptoms in an evolving world.