Ask Dr. Mike: What the Hell Is Up With These God-Awful Seasonal Allergies? 

Mike Cirigliano, aka Penn’s Dr. Mike, who explains why seasonal allergies are so bad and what medications might help

       Listen to the audio edition here:

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained. And he’s been named a Philadelphia magazine Top Doc every year since 2008. Now, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at victor@phillymag.com.

Dr. Mike, we just sent four astronauts up for a nine-day lunar flyby — the first manned NASA flight outside of low Earth orbit since Nixon was in the Oval Office — and brought them back safely to earth despite traveling at 25,000 miles per hour at temperatures twice that as the surface of the sun with a basically untested heat shield. And yet, we can’t seem to do much about seasonal allergies. 
Well, we live on a planet that has so many plants and trees. That’s what makes the Earth so amazing. But they can also make people miserable.

How many people have seasonal allergies? 
About one third of the population suffers from what we call either seasonal allergies or allergic rhinitis. It makes you have thickened nasal passages, itchy eyes, runny nose, lines under your eyes, and a little bit of swelling — you just feel miserable. And it can really affect your sleep to the point where you call people like Dr. Mike.

What are most of these people allergic to? Tree pollen? 
Well, without getting too fancy-schmancy here, there are allergens everywhere. But right now, the thing that is making most people miserable is tree pollen. That starts in March but really starts to kick in now and lasts into early summer. That’s followed by grass pollen, which kicks in around June and July.

What medications actually help? 
You have your nasal steroids. I like Sensimist, which is Flonase but with an improved applicator. Some people were complaining that Flonase had a bad smell and a bad taste, and the new design not only reduces those side effects but also gets better penetration into what we call the osteomatal complex. It’s the Grand Central Station of sinus schmutz, where all your maxillary frontal sinuses drain into. You want to keep that open because, if you don’t, you have the possibility of sinus infection. So nasal steroids are critical. The other thing I am a believer in is nasal lavage.

Like a neti pot? 
So, a neti pot looks like a teapot and is from ancient times, before we had polymer plastics. A neti pot also uses gravity, and you have to hold it up and let it drain into your nose. I don’t recommend the neti pot. I recommend something like NeilMed sinus rinse. You put distilled water or boiled tap water or spring water into the squeeze bottle from the box and add this little packet of salt and bicarbonate. If you don’t put that in, it will burn the hell out of you and you’ll never do that again — and you squeeze the bottle and it flushes out all the schmutz.

Dr. Mike demonstrates nasal lavage, which can be helpful in treating seasonal allergies

Why can’t I just use water out of the tap directly? 
There have been cases, especially down South, where there’s an amoeba in the tap water that can get into your brain and kill you. I do nasal lavage in the morning when I wake up and at night before I go to bed. I have a little touch of a deviated septum, and this has kept me out of the operating room. I’m afraid of surgery! For most people, Sensimist and nasal lavage should do the trick in keeping your sinuses clear.

My wife is on the CVS brand of Flonase and Claritin, and she uses eye drops. Plus, she takes Benadryl at night because she can’t sleep with allergies otherwise. Is she doing this right? 
No. Some big mistakes. First of all, I realize why she’s taking Benadryl, but what worries me is that the Benadryl will actually dry her out at night, which will lead to an accumulation of nasal secretions.

We’re actually in New Jersey right now, so should I just pick up some indica weed gummies for her sleeping? 
Oh, God. Here we go. I would suggest we come up with a better plan for her than taking Benadryl at night. The eyedrops are fine, but I think that if she can do the NeilMed twice a day with the Sensimist, she will see improvement and get better sleep. As for antihistamine, I suggest Allegra, which causes the least amount of drowsiness out of Benadryl, Allegra, and Zyrtec.

And if none of this works?
Well, maybe it’s time to see an ear, nose and throat person, or an allergist. There may be a deviated septum issue. Maybe she’ll need immunotherapy. But she should not be suffering. There’s no reason for that. No reason! There’s also avoidance therapy …

I’m guessing this is where you say that she needs to avoid nature. Problem is, she teaches at an outdoor, nature-based school and is literally in the woods all day, every day. 
I imagine she’s not going to want to wear an N-95 mask in the woods. But at home, she should not have the windows open. Put the air conditioner on instead. Also, she needs to wash her hair and her clothes at night to get rid of all of the pollen that has accumulated. If she’s working in the woods, she’s going to have tree and grass pollen all over the place.

She just sent me a link for an expensive air purifier.  
There you go. That’s another one.

I was hoping you would tell me it was a waste of money. 
Put one in the bedroom.

I’m 51 years old and have never experienced any kind of allergy in my life. Am I out of the woods, so to speak? 
You’re never really out of the woods until you die, alright? Any time of life, you can have these allergies. You might not be allergic to something but if you get exposed to it repeatedly, you can suddenly become allergic. Now, if your seasonal allergies are accompanied by a dark discharge from your nose or if you have a frontal headache or your teeth hurt, call me. This can be a sinus infection. And then we need to figure out if you need antibiotics. Sometimes, we’ll need to do a CT scan of the maxillofacial region.

I think I’ll just get a beach house and stay down there until this is all over. 
Well, maybe, maybe not. There’s actually a lot of wind and grass down there. There’s a lot of pollen.

I just can’t win. 
You’re screwed, basically, unless you go into a bubble where there are no allergens and the air is completely controlled, like on Artemis. But we have so much beautiful foliage and other outdoor things, and from a point of view of health, it’s good to get out. The benefits outweigh the risks.

Death Valley or Antarctica, here I come. 
Well, yeah. In Death Valley, you’ll die from heat exposure and dehydration. In Antarctica, you’ll freeze to death.

Or be allergic to polar bear dander. Screwed no matter what.  
No, no, no, no, no. We have technology, buddy. And, you know, it’s part of the fun of being on Planet Earth. Did you see the moon? Who the fuck wants to live over there?