Here’s a transcript of some of the questions and answers from Dr. Ricaurte’s talk on asthma and allergies for over one hundred people at COUNTRY Financial’s ‘Lunch & Learn.’ She covers questions about pollen allergies, skin testing, and more!

Special thanks to the staff coordinators and audience members at COUNTRY Financial who helped to make this event possible!

Q: How much effect does… exposure have to developing allergies? Like, let’s say you live in the country and so you get a lot more pollen or whatever. Is that gonna make it more likely that you develop allergies?

Dr. Ricaurte: So the question is: how significant is our exposure to allergens in making us more or less likely to develop those allergies? Interestingly, we used to think having animals in the house with our children at a young age was a bad thing. Now, there’s mixed data that’s always changing, and now it appears that often having cats and dogs in the house can be beneficial to our children to help prevent allergies. Because, to become allergic to something, you have to have those genetics [that make you prone to] allergies and you have to be exposed. And so exposure is the most important and strong trigger after genetics. So the more we’re exposed to something, the more likely we are to become allergic. We don’t really get used to our cat; we don’t quit becoming allergic to our dog. We just, instead of having that sudden “when you walk in the house [and get] itchy, sneezy eyes,” like we do when we go to our relatives house with a cat, when you live with our pets that we’re allergic to, we transfer into a more chronic form of allergy [with] chronic inflammation and congestion… So, yeah, exposure, how many years, like our children don’t often develop seasonal allergies until they’re a few years old [because] it takes a few years of exposure to develop that and so forth… Using air conditioning can be preventative, using dust mite covers can be preventative and help… modify and decrease our risk of becoming allergic.

Q: A couple of skin test questions. One is can skin tests identify allergic triggers that are airborne, and two is what percentage of triggers do the skin tests rule out?

Dr. Ricaurte: So, skin testing is our most reliable way to diagnose the allergies. We can skin test to foods and to environmental allergens. So, a common panel of skin testing if you came in with maybe allergies or maybe asthma would include pollen, trees, grasses, weeds. It would include mold; it would include dust mite and various animals. And, we can do foods, as well. We can allergy test any food. Many of them are commercially made extracts, but if it’s an unusual food, we’ll have you bring it in. And, you’ll bring, like, mango, and we’ll skin test from the flesh of that fruit and put it on your skin. The skin is a very accurate mirror of our internal allergies because our allergic antibodies are in our blood, so they’re everywhere. So, that’s why the skin is a great way to do the skin testing. If we scratch you with ragweed, and you’re allergic to ragweed, it will show up even though you only have symptoms [in the nose and eyes]… It’s highly accurate. Skin testing is super reliable for environmental things, much more than blood. And for food, the cool thing about food, if your food skin tests are negative, they’re 95% accurate. So, a lot of us think we have a lot of food allergies or sensitivities, but if we skin-test you to foods, and they’re negative, 95% sure you’re not allergic. Sometimes, we will need to do blood testing for food, as well; that can get a little complicated. But, [for] environmental [allergies] all you usually need are skin tests.

Q: Do sinus infections often start as allergic reactions or something? Because I always think I have an allergy, but then you go to Walgreens and there are 8,000 things to pick from. And I never know which one to pick.

Dr. Ricaurte: So the question is: how can we tell if it’s allergies or a cold or turning into a sinus infection or what comes first? It’s really all about plumbing, especially if you have nasal allergies. When there’s chronic inflammation and limitation to drainage, when you’re exposed to a virus it’s more than likely to get stuck and turn into a sinus infection.  So, if already there’s inflammation and the plumbing and drainage is not good… people are more likely to get a sinus infection when their allergies are bad. So, often it’s a combination of [bad allergies] and then you’re exposed to a virus or you were on an airplane… All of those things cause more inflammation… And it’s tricky because it’s not always the color [of your mucus], too. I do tell people if it’s watery and clear, it’s allergy, most likely. Once it starts getting thick or sticky, even if it’s clear, that’s probably infection. We don’t always know if it’s viral or bacterial, but we can help you sort it out.

Q: I’m allergic to the green bean plant when I’m working in my garden. I break out really bad on my arms. And I can eat green beans, and I’m fine. If I’m allergic to the plant, am I going to develop to where I can’t eat them, as well? …And I wear long sleeves, but I still break out. Is there something I can put on [to protect myself]?

Dr. Ricaurte: So her question was: if we react to something on our skin, are we likely to be allergic to it if we eat it? For example, she mentioned green beans in her garden. So, the classic contact dermatitis is poison ivy. We handle poison ivy, and we get a rash. You wouldn’t want to eat poison ivy, obviously. But… like yours when it’s just not a toxic form of a plant, like poison ivy has the toxin which causes the allergy, green beans and lots of other plants are more irritants. So, you probably have very sensitive skin potentially. And so it does not mean you’re more likely to develop a true food allergy if you eat it. It just means your skin is reacting to something about that plant or handling that cat or dog or carpeting. It doesn’t mean we’re allergic in an immunological form of the word, but in an irritant-sensitive form. So, yeah protecting yourself often will [help] people: cover up in your garden, wear gloves, but you can also do barrier creams. Like our children who get bad diaper rash with an antibiotic. It doesn’t mean they’re allergic to the antibiotic when it touches them on the way out; it just means it’s an irritant. So, literally, you can use a barrier cream on our arms when we’re in the garden… And the best barrier cream and protectant is petroleum jelly in the yellow tub with the blue lid. You put that on as a barrier before you got out. It’s also the best moisturizer there is if you have chronic eczema. That’s the base of every eczema cream. That’s the base of every steroid cream you get… We also know in children now, identifying “how do we prevent allergies;” in our infants who have eczema, we know that the skin barrier, if it is compromised, those are the kids who are much more likely to develop food allergies, hay fever, and asthma. So, we know those little kids who have really dry skin or rashes [need to be lubed up with] petroleum jelly. There are a ton of studies out there [about] just using moisturizers as… a primary prevention for all of this. So, if your kids are dry, keep them moisturized, and you don’t have to use petroleum jelly. But, generally the thicker the moisturizer is, the better it works. An oil is the least moisturizing because it’s watery. An ointment is the most moisturizing because it’s very thick and heavy. So, oil is the least, then lotions, then creams, then ointments. Ointments are always best.

Q: You mentioned… moisturizing and plumbing. So, would there be a benefit to using, like, a humidifier in the winter or a vaporizer or something?

Dr. Ricaurte: Absolutely. He mentioned if it’s helpful to do a vaporizer or a humidifier at certain times of the year, and, for sure, that’s true [for] a couple reasons. Dryness is an irritant, so dry air is more irritating and causes more inflammation in our nose and lungs and skin. So, dryness in it of itself can be trouble. We’re much more likely to be exposed to dry air in the winter. In the winter, we often need to add humidity just for the health of our nose, our lungs, our skin. Our goal, all year round, is between 40%-50% humidity in your house. So, in the summer, our houses are too humid. In the summer, when it’s over 40% or 50%, which all of our houses are, if you guys have a little monitor in your house, our houses are usually 60/70% humidity in the summer. You need a dehumidifier  in the summer because [with] too much humidity, you get more dust mites and more mold. You can have mold in your house. And so, in the summer you want to dehumidify; in the winter, you want to add humidity [with] your goal being 40%-50%. I just keeps us healthier everywhere.

Q: Runny, itchy eyes after being outside… is that more caused from the pollen getting into your eyes or pollen getting into your sinuses that are near your eyes or a combination of both?

Dr. Ricaurte: His question was about itchy watery eyes when you’re outside; is it pollen getting in your eyes or related to your nasal allergies? It’s both. So, pollen can get into our eyes; mold can get into our eyes. It’s on our eyelashes, it’s on our eyebrows, it’s in our hair. That’s why when you come in for the day during allergy season, [you should] wash your face, wash your hair, get it off because pollen can actually be right in our eyes and directly cause an allergic reaction. If you have saline drops to rinse, just get that out. Kind of like a saline rinse on your nose, it washes the pollen out. But, an interesting connection you kind of make me think of is because, though, our eyes are very connected to our nose with our allergies, treating your nasal allergies better with the steroid sprays, things like Nasacort and Rhinocort, those types of nasal steroid sprays, actually help your eyes, too. So treating our nose with steroids makes your eye allergies better, too.

Q: You mentioned about Benadryl and taking it day-to-day and [how that can be dangerous]… but how about decongestants? [Do] decongestants [from behind the counter]… affect you medically, as well?

Dr. Ricaurte: Her question is: what about other over-the-counter drugs maybe not being safe, like sudafed? So, [with] sudafed, or pseudoephedrine, the most common side effect is stimulation because it can increase heart rate, keeps some people up at night, [and] can raise our blood pressure. That’s another reason Afrin is so dangerous; people who are hooked on Afrin are at a much higher risk for heart attack and stroke because it raises your blood pressure. So, any decongestant product can absolutely have potentially dangerous side effects. But, even if you have high blood pressure and you’re on medication for your blood pressure, if your blood pressure is well controlled, you can usually tolerate sudafed fine. But, right, you do have to be careful. All of us respond to medications differently. Some people can take sudafed 24 hours a day, and it doesn’t affect them. Other people, they’re like “I can’t do it at night because it keeps me up.” That’s common; it’s a stimulant. So, some people feel a little edgy… but we want to keep people safe and make sure it’s not bumping up their blood pressure or causing any potential problems.

Q: You mentioned that steroids are good [at helping to] stop stuff that’s going on. I’m a chronic sufferer of sinus infections and such. I’ve had some doctors that are all about prescribing steroids, and I’ve had some [that would rather not]. Is there a middle ground…?

Dr. Ricaurte: So, her question was how safe are steroids. We talked about how, number one, just reminding you, inhaled nasal steroids [and] topical steroids are very, very safe for long-term use. Oral steroids we’ll want to be careful with. Oral steroids are life-saving medicines, but certain doctors don’t feel real comfortable with oral steroids. And that’s appropriate… we don’t want everyone handing out prednisone like it’s candy because it can be dangerous if overused. But, it’s very safe when used for short bursts. So, for example, I’ll give steroids to someone four or five times a year at a low dose in the pill form because it can help their sinus infections get better quicker [by] opening things up [and] getting rid of inflammation… Sometimes we need steroids refilled a few times a year for asthma exacerbations or bronchitis. You know, two/three times a year at a higher dose [can happen], and that’s okay. You can do it a handful of times for sinus [issues] at a lower dose, or when it’s a super bad allergy season, and you just can’t take it anymore. Low-dose, multiple times a year is fine, as well. We want to just avoid the chronic, daily use of steroids and get you on better, preventative medication so that’s not such an issue. They’re super, super safe, but it’s good that our doctors aren’t giving it out often. Only the specialists will give it out: the ENTs, the pulmonary, the allergists, sometimes the dermatologist don’t even like prednisone, but it’s often necessary when our eczema’s real bad. So it can be used safely; don’t be afraid to ask for it or use it, but  if you’re doing it multiple times a year try to see a specialist. See if there’s other things to help prevent you from getting there.

Q: This past fall, during a visit to Starved Rock, I had an asthmatic episode, and I was diagnosed as having asthma. Since that time, I haven’t had any episodes. The rescue inhaler has gone unused for months. So, my question is: do you need an asthmatic episode in order to identify the trigger, or is there a way to identify it without an episode?

Dr. Ricaurte: So, this gentleman was in Starved Rock and had an asthma episode. Was it your one and only asthma episode?

[Audience member answered ‘Yes’ to this inquiry.]

Okay, and you hadn’t been on asthma inhalers in the past?

[Audience member answered ‘No’ to this inquiry.]

Yeah, sometimes we don’t know exactly what has triggered a specific episode in the past. Whether it was the exercise or the combination of your seasonal allergies also being active. It’s hard to say. We often can’t figure it out. Sometimes if we think it’s exercise, for example, we’ll provocate. We’ll have you come in and run on the treadmill in the office, and we’ll do the breathing test first and a breathing test after and see if… it’s exercise… Usually [to diagnose the condition as asthma] we want two episodes. So to officially say someone has asthma, you want two separate episodes of coughing or wheezing that respond to asthma medication. So, if you really have only had one episode, maybe it’s not asthma. Maybe it was just, you had a reactive airway episode, and it may never happen again. But, if it does, talk to your doctor about it, and that’s in another important point. If anyone here or our children have daily [inhaled] steroids, and they’re on them all of the time, the goals of treatment are that we’re supposed to try and decrease your asthma inhalers every three months. So, if you’re well-controlled with your asthma, but you’ve been on the same dose of Advair for five years, that’s not okay either… A board-certified allergist would not let that happen, because you’re potentially [being] overtreated. So, often asthma changes, and we can taper your medicines to get to the lowest amount to feel perfect. So, don’t be afraid to raise that conversation, as well.

Dr. Kimberly Ricaurte

Dr. Kimberly Ricaurte

Dr. Kim Ricaurte is a specialist in Pediatric and Adult Allergy, Asthma, and Immunology. After attending Chicago College of Osteopathic Medicine of Midwestern University, she finished her residency and fellowship at Northwestern Memorial Hospital’s McGraw Medical Center in Chicago. Her special interests include Sublingual Immunotherapy, Food Allergy, Asthma, and Dermatology. After working for seventeen years at her private practice in the Chicago North Shore market, she joined the MASA team in 2016.

View Dr. Ricaurte’s full biography here.