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Carl Maronich (Host):   This is the Well Within Reach podcast. I'm Carl Maronich. Joining us today is Mandi Troli. Mandi’s a nurse practitioner with the Riverside Medical Group working out of the Momence office. Mandi, thanks for being here.

Mandi Troli, FNP-BC (Guest):   Thanks for having me.

Host:   Today we’re going to talk about asthma and allergies because, as I'm told, we are in the allergy season. I am fortunate not to be an allergy sufferer, but I know some and I've seen them with teary eyes and things these days. So tell us a little bit about what happens in allergy season.

Mandi:  Well, people have many different responses to environmental things out there. During allergy season, they tend to flare up which can trigger many symptoms that effect everyday living. So allergies, it’s an immune response or an oversensitivity to different things. So it can either be environmental such as like pollen, dust, mold, pet dander. They can even have allergies to certain foods that can trigger it. Unfortunately, allergies and asthma kind of go hand in hand. So if you have asthma and your allergies are not controlled, it can trigger severe asthma attacks as well. Asthma involves the inflammation of the lungs. When it flares up, it constricts the muscles around the lungs, around your airways resulting in wheezing, coughing, shortness of breath. The bronchial tubes tighten, and airflow is reduced to the lungs. So when allergens are provoked, they can actually trigger most asthma attacks. However, they don’t necessarily have to have allergens to have asthma.

Host:   Yeah, yeah. Is there an age when allergies might develop, or can they really come at any time?

Mandi:  They really can come at any time. Even though you don’t have allergies when you're young, you can get them as you get older.

Host:   Can it work the opposite way? Can you have them when you're young and then lose them as you get older?

Mandi:  Yeah. Actually they can change. You can be allergic to say pets when you are younger, but when you get older you're actually allergic to mold and grass. So yeah. Things can change. I don’t necessarily know—In this area, a lot of people are allergic to so many things. It’s really hard to say if anybody really ever outgrows an allergen 100% once they have it.

Host:   Yeah. What are the treatments like for seasonal allergy specifically?

Mandi:  So for seasonal allergy, usually we can snip it in the bud with antihistamines or decongestants over the counter. So I like Zyrtec, Allegra, Claritin, Xyzal, Benadryl, stuff like that.

Host:   If it’s a flower allergy you can nip the bud as well as nip it in the bud, right? That would be another way to go.

Mandi:  Correct.

Host:   Can allergies just go away? You kind of talked about outgrowing them, but in adulthood if you have an allergy can it come and go? Is that something that can happen?

Mandi:  Yes. That’s usually based on seasons and what you're allergic to. So the common—There are different seasons that you can be allergic to. Summer it’s mostly grass. Spring, people are allergic to tree pollen. Fall it’s more like weeds. Winter, usually winter is more like a cold reaction. So it can be more dust mites, pet danger. Stuff that’s found more in the house when you're locked up in the winter.

Host:   Yeah. I tried to convince my mom I was allergic to grass because my shoes always turned green when I mowed the yard, but she wasn’t buying it. I still had to mow the lawn. So I wasn’t able to get out of it from that. Folks that have allergies—particularly if they're just developing for the first time—they’ll probably go to their primary care provider and say hey I'm not feeling well. Is that the normal course it would take? Primary care is probably a great place to start with if you're having allergy like symptoms.

Mandi:  Correct. They can start with the primary care. They come in, they tell their initial symptoms, and primary care can help them decide what the initial diagnosis is, rule out other possible diagnoses to make sure they get them on the right track. Then primary can suggest over the counter meds. Kind of monitor it, have them come back, make sure that the meds are working to truly know that it is allergies that we’re dealing with and not something more severe. Primary care can also initiate certain testing, get them to the correct specialists. There's allergists and they can test for. They do skin tests to check for all sorts of pet dander, trees, plants, all sorts of stuff they can check for.

Host:   Food allergies would go into that as well. An action plan—With asthma specifically I'm thinking about. If someone has asthma—and perhaps they haven’t had an allergy. They don’t know that they're allergic yet and they develop—I'm going to guess they should probably have a more heightened alert if they start feeling the symptoms if they're asthmatic that it could be allergy also. Does that make any sense?

Mandi:  Yes. Like I said before if they have an allergen it can trigger asthma pretty common. I see that a lot in the office. Once I get them on a good allergy regimen, they're so less using that rescue inhaler. It’s better controlled. I have patients they’ll come in and only fill their rescue inhaler once a year because it’s way more controlled that they're not even needing to be on rescue or preventative asthma medicine like Advair or Symbicort.

Host:   Yeah. Exercise. We want to be overall as healthy as we can be. Exercise is a part of that. I'm guessing this can make exercise a little more difficult. Do you talk to your patients about that? What’s the best way to exercise if you're having these issues?

Mandi:  We do discuss that. A lot of it has to do with kids. Sports, exercise induced asthma. So we make sure that they know how to use their rescue inhaler. That they're carrying that rescue inhaler. Pacing activities, making sure that they're allowing to rest. If it is related to allergens, that they’re taking the right medications to prevent that.

Host:   Yeah. Let’s go over again the symptoms. If someone doesn’t have the history of asthma but they're staring to have some kind of odd symptoms, what are the symptoms they should look for that would tell them they should get into their primary care and be looked at for allergies.

Mandi:  So if they're complaining of any shortness of breath, wheezing, chest tightness, constant fatigue with exercise, that is kind of the common symptoms of asthma. So we usually will start with that. We can order testing such as a PFT—which is a pulmonary function test—and determine if they do have restrictive airway disease. We can start them on the right medications. Get them where they have a rescue inhaler, get them a home peak flow so they can make sure that their lung capacity is doing well at home as well as we do check that in the office too. Then depending on the severity of it, sometimes they need to be on Advair or Symbicort, that type of medication to kind of keep it at bay.

Host:   Yeah. So if someone wanted to come to your office, what's the best way for them to make an appointment?

Mandi:  If they're already a Riverside patient, they can call or they can log on to their MyChart if they're already established. There is a phone number if they don’t have a provider in general. They can always call the 855-404-DOCS. That will help them list all of the Riverside providers.

Host:   Yeah. Anything we didn’t cover that you want to mention Mandi?

Mandi:  Allergies and asthma are treatable, but the first step is to make sure that you properly diagnose them. So if you're experiencing any of those symptoms, you should definitely reach out to your PCP so they can get you the right care.

Host:   Yeah, primary care provider. PCP. Mandi Troli, we appreciate you being with us on the Well Within Reach podcast today.

Mandi:  Thank you for having me.