Episode 94: Environmental and Food Allergies: Testing and Treatment with Dr. Dana Gibbs, MD
Show Summary:
Today we are excited to be joined by Dr. Dana Gibbs, an expert in the field of allergy testing.
Allergies affect millions of people worldwide, and understanding their underlying causes is crucial for effective treatment. In this episode, we'll dive into the world of allergy testing, exploring the latest advancements, debunking common myths, and uncovering practical strategies to help individuals manage their allergies and improve their overall well-being.
Dr. Dana Gibbs brings a wealth of knowledge and experience to the conversation, having dedicated her career to the study and treatment of allergies. If you've ever wondered about the science behind allergies or sought answers to your own allergy-related questions, you won't want to miss this enlightening discussion with Dr. Dana Gibbs on allergy testing..
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Full Transcript:
Dr. Danna Gibbs
suffering with allergies is not necessary, and that there are good treatments that can cure you from your allergy. And so to seek out a practitioner who knows what they're doing and knows how to take care of it is a real reasonable thing. And truthfully when I've looked at the economic implications of this, especially if there's asthma involved, because asthma and allergy are like this, that it's actually cost effective. So, you know, I use a one particular patient of mine all the time as an example. And she was on. I don't know, I think it might have been Simba court or one of these fancy maintenance inhalers. And she was going to the doctor 3456 times a year getting antibiotics, getting steroids, all that stuff. And I added up in dollars, all the money that she had spent in a year treating, treating what I later figured out was allergies for her. And the first year of my treatment was equivalent to what she spent, except that she wasn't sick. And then the second year of my treatment was half what she spent the year before, and so on and so on. And so so that's I guess that's the takeaway. You don't have to suffer with it. There's, there's things you can do, and it's not ridiculously expensive.
Dr. Andrew Wong
Welcome to another episode of capital Integrative Health podcast. I'm your host, Dr. Andrew Huang, and today we're excited to be joined by Dr. Deanna Gibbs, an expert in the field of allergy testing. allergies affect millions of people worldwide, and understanding their underlying causes is crucial for effective treatment and prevention. In this episode, we'll dive into the world of allergy testing, exploring the latest advancements debunking common myths of allergy testing and treatment and uncovering practical strategies to help you manage your allergies improve your overall well being
Dr. Andrew Wong
Dr. Danna Gibbs brings a wealth of knowledge and experience to this conversation about allergies. Having dedicated her entire career, after a certain point where she realized that surgery wasn't the be all end all for all of her patients with end and sinus issues to the study and treatment of allergies. If you've ever wondered about the science behind allergies, or sought answers to your own allergy related questions, you won't want to miss this enlightening discussion with Dr. Dana Gibbs on allergy testing. Welcome Dr. Dennett gifts to the podcast. Thanks so much for coming on today.
Dr. Danna Gibbs
Hi, thank you. I'm so excited to be here. It's gonna be really fun. Yes,
Dr. Andrew Wong
yes, it will. And now you've been practicing as a otolaryngologist for a while and specifically in the field of allergy for over 20 years. I'd love to talk to our listeners, if you would share a little bit about kind of what drew you to, to allergy and kind of what you have been doing the most about what you've been doing over the last 20 years. I know you said you kind of pivoting a bit in your practice. Talking about allergy for a sec. Yeah,
Dr. Danna Gibbs
okay, well, so you know, when you go through or learn Golgi residency, you really focus a lot on surgery and surgical skills and you know, learning how to do all the procedure like stuff that's part of Otolaryngology. And, and that's wonderful. And I really enjoy that part of things. But when I got out into private practice, and I'd been in practice about a year, year and a half, and I realized that not all my patients were getting better, you know, I do this beautiful sinus surgery, and they would come back all stuffy old polyps and I, you know, I was lucky enough to live in a town where there were general allergist, and so I would send the patients off to the general allergist. And they would come back with a prescription for Allegra and I'm like, well, that's not really what I had in mind when I sent you to the specialist, you've got these recurrent infections and these polyps and this swelling and I think you need to be on allergy treatment. And e and t is, you know, allergy is part of is a core part of of EMT just because of the fact that there's so much upper respiratory, you know, disease from from here to here, which is where EMTs go so you know it was aware of it but I had not really dived in deep and done the fellowship and all that stuff. And so I actually started doing that education kind of out of self defense because I you know, I really my main interest was I want to get my patients better and what with whatever modality works and so I went to the courses and I started learning and I ended up getting the fellowship and starting a different practice actually moved from one the practice I was into another one so that I could accommodate the ability to treat allergy. And I did that for several years, and I joined a bigger group and I managed the allergy clinic for that bigger group, in addition to doing my normal EMT, and really the patients, a lot of them don't end up needing surgery when you treat better allergy issues. And so it's just like, let's pick a treatment modality that doesn't make you groggy doesn't make you sleepy, doesn't give you a medicine head, and makes you feel better. And it's a permanent solution. It's a long term. Okay, you're cured now, solution to a problem that probably 20% of Americans have. And so yeah, I was very, was very enthused with that.
Dr. Andrew Wong
And we look at from a functional medicine perspective, we're kind of talking a little offline about, you know, root cause you're trying to find root cause allergies, one of the big root causes of inflammation and can can lead to chronic disease, correct?
Dr. Danna Gibbs
Yes, absolutely. So, you know, and it's funny, they Bandy about this is 20%. Number as far as the number of people in the US who who have or will develop an allergy, I kind of think it's probably higher than that. And I think the more that you have other sources of inflammation in your body, you know, stress is a source of inflammation, toxins, processed food, all the etc. The more I think the more you get into the the allergy kind of paradigm, I think it just amplifies it. I
Dr. Andrew Wong
know, Dana, like for us in our practices in the DC area, which is literally the swamp, right. You still live in, you know, upstate New York, but then I came down here and develop allergies, or I used to live in, you know, Arizona or something, and then came down here, and, you know, so it's an interesting kind of mix of people that end up in DC. But certainly, one thing that is in common that I've seen from a lot of patients, a lot of people, you know, talking to us about this is that they develop more allergies when they come to you know, certain areas that might be more predisposed to that.
Dr. Danna Gibbs
Yeah, you know, and one thing that may be the case is, you know, particularly because I've had that exact same experience with people coming to the Dallas Fort Worth area, which is where I'm at, coming from the Midwest, or Minnesota or upstate New York, or, you know, out west or, or wherever, or even upper east coast, but they're always coming from somewhere colder to somewhere warmer, where we have a longer season. And so I think a big part of it is the longer season, but I think a big part of it is also the urban life, there's more pollution, there's more. You know, there's more convenience food, there's more. There's just more of everything that's not fabulous about American life, as far as
Dr. Andrew Wong
we're gonna get. Yeah. Right. Standard American Diet, SAD diet, how that's so yeah, affects allergies and the immune system. Let's kind of talk about, I think what we'll do is we'll go into some of the testing which you're an expert, and in terms of like how first are we going to see and assess if a patient has allergies, so we can start with an overview of testing and then we can get more into some of the guidelines, some of the protocols you might recommend, you know, some of the lifestyle and nutritional factors, that'd be great. So, so we know that you know, if anyone ever out there has ever had a tissue and needed to blow their nose, or, you know, had some sort of, you know, pollen on there, we know that you know, most people know what an allergy is. But let's talk about what an overview of allergy testing is. What is that? And why is it important for individuals to really understand what they might be allergic to?
Dr. Danna Gibbs
Okay, so the one of the mainstays of allergy treatment is to try to avoid what you're allergic to well, you can't do that if you don't know what you're allergic to. You know, a lot of people are like, Oh, I'm allergic to pollen Well, you know, pollen is what can 1000 different species of plants who knows and so if you know specifically what you're allergic to, then you can go on the pollen.com website or wherever you go, Oh, oak trees are hi today. So maybe I should plan that run where I'm going to go outside or maybe I should wear some kind of a filter mask or you know, something like that. So there's just so many different things that you can be allergic to that a specific tests really does help. You know, how to one how to avoid what you're allergic to. But the second thing, specific allergy testing does is helps the docs know How to treat you. So we, in my clinic use a combination of skin testing techniques called prick testing. And then intradermal testing, which are the prick test is done with little plastic prongs that are dipped into the liquid allergen material that we get from a particular manufacturer. And it'll be ragweed mix, or it'll be oak tree, or it'll be Bermuda grass, or Timothy grass or dog hair or whatever, it'll be one of those particular serums. It's not a shotgun, it's a very, very specific thing that we test for. So the prick test is what I call a safety test, it's a slightly lower sensitivity test. If you get a positive test on it, you can pretty much be guaranteed, okay, you have a sensitivity to either that exact same thing or something that your body recognizes as almost exactly like that thing. Then the second test that I do, based on the results of the initial testing, is I go down to something called an intradermal test. And that's put on a little bit like a TB test, just barely under the skin with a very, very tiny needle. And then you sit there and you wait 10 minutes, and then you wait 10 more minutes, and you're looking for the size of the little bump or the little hive that develops around the shot spot to tell you okay, not only is that a positive, but how strong of a positive is it? And that's one of the reasons I really liked that intradermal test is because it gives me some quantitative, how sensitive is this patient to that particular one. And then I can use that, that information from the combined prick test plus intradermal tests to make a very, very customized allergy serum for a patient. If they decide, yes, I want to go on allergy shots, or yes, I want to go on allergy, sublingual drops, which we'll talk about a little bit. There is a third way to do allergy testing, which is by something called an in vitro tests. So it's either Rast or quest calls, there's ImmunoCAP. Or there's there's various companies that will do this. And then you draw blood and send it to the lab or you put blood onto a piece of a special kind of piece of paper and you send it out to a lab and then they tell you, does your blood carry antibodies to x, y, z? Whatever it is. My experience with that test is that it's also you know, if it's a positive, then yeah, there's something there. And if it's negative, it doesn't necessarily mean that you're absolutely not allergic to that thing. So a little bit of a disadvantage there. Great.
Dr. Andrew Wong
Great. Well, thank you for that overview, just have a couple of sub questions. We'll move on to some other topics on this, but you kind of mentioned three major tests, two of them are more, you know, through the skin that skin pick tests, which, which you know, we're familiar with the intradermal test, and then the in vitro wrasse hazards of blood draw. How sensitive is the prick test that you said, that's kind of the first line there? How sensitive is that approximately?
Dr. Danna Gibbs
It's kind of it's kind of intermediate. So it is the first line tests that I would choose for most people. And like I said, you get good data from that if you if you have a positive test on that, then you're going to respond probably to some kind of specific treatment either avoidance and or allergy immunotherapy test treatment. What I find is that there are a subset of people who will test positive for a couple of quick tests but then they all have several negatives and they're like, you know, Doc, I really just know that cats bother me I know they make me sneeze I know that I get hives when I touch a cat. And I'd be like okay, let's put this intradermal test on. And I can choose the strength of the tests that I put on on an intradermal test so I can pick what I call a number two intradermal tests which is much stronger than your prick test. And if I get a positive there then I'm like okay, then I know yes, I'm going to put this into the allergy serum and or you might want to consider you know, giving your cat to Aunt Josie so that, that you're not reacting all the time because I mean, there is no cat owner ever that I have met thinks they're allergic to their cat. Yeah, you know, they really, really need a positive test to believe that they're allergic to it. And then, you know, short of giving up the cat and sending the cat to live somewhere else, there are other things that you can do to reduce your exposure to the allergen. But people don't think to do that. They're like, Oh, I just, I feel the same way all the time. And I'm like, Yeah, I know, your nose is stuffy 24/7 365. And a little bit of that is because of the cat that's living in your house with you and sleeping on your pillow at night. They're
Dr. Andrew Wong
not going to just give away the cat to Aunt Josie without a test. It sounds like No,
Dr. Danna Gibbs
no, never. Never.
Dr. Andrew Wong
All right. All right. Well, hopefully, hopefully those listening out there who you know have on Josie, you know that that may want to cat you know, there we go. But I just have a question about the types of allergens that are out there. So we talked about type of testing, then let's talk about types of allergens. So we have environmental, you know, allergens, mold, mold type allergens, food type allergens. Are there any other categories of allergens there.
Dr. Danna Gibbs
Okay, so so we've got the different pollens, trees, weeds, grass, those are three major three major categories of pollens. And then we have mold spores, and there are dozens of different species of mold spores, you know, it's funny, when you get pom.com, you go on the thing, and they say, mold, and you're like, well, is mold, the same? As mildew is mold the same, you know, as fungus? Yeah, they're all the same. And there's dozens of different ones. And they all glom together in one big category. So when we test mold, we test for the individual kinds of mold. And what we try to do is pick the predominant ones in whoever's geographic area,
Dr. Andrew Wong
then are there certain molds that are, you know, not as inflammatory, not as toxic to the body, or they all kind of potentially could have an inflammatory issue?
Dr. Danna Gibbs
I would say, that is not really known. But there are some molds that produce you know, so So molds can harm people in more than one way. So there are toxins that molds produce. So you've heard of stack abattis, black mold, that's a toxin. Aspergillus produces different kinds of what they call aflatoxins. Those are toxic molds. And they are poisonous if they, if you ingest them, if you breathe them, it's going to make you quite sick. But that's not the same as an allergy reaction to mold, which is more the typical congestion, sneezing, coughing, maybe even wheezing, but not wheezing is not as common with mold. You know, headaches, that kind of thing. That's, that's a totally different thing. And, you know, what, what my experience has been, is that mold tends to be more of a chronic exposure, you know, whereas oak trees, it's like, okay, they bloom from April 1 to April 20. And so you have that acute reaction, and you sneeze and your eyes, water and everything. But mold is different. Mold is more like, you know, you just clear your throat all the time. Or you just kind of low grade headache or use low grade stuffy. And it stays that way all the time. And maybe you can go back and go, Oh, you know what, we did have a leak in the air conditioner. I got the carpet wet, but We dried it up and everything was fine. But ever since then. I've been clearing my throat. Yeah, that's there's mold under there.
Dr. Andrew Wong
Yeah. And then there's foods. So there's a lot of a lot of environmental allergies. And then there's also food allergies, correct?
Dr. Danna Gibbs
Yeah. You know, and one of the things that people don't realize about food allergies is that food allergies can cause every symptom that inhalant allergies can cause and they can be chronic, and they can be acute. So it can be you know, I ate chocolate and now I'm sneezing or you know, something like that, or it can be I'm allergic to dairy products, and I clear my throat every single day all the time. And they don't people don't eat because they don't get acutely ill when they eat it because they've just been exposed to it continuously and chronically. They don't recognize it as a problem. So I see that all the time. See that so often and
Dr. Andrew Wong
you know medicine, medical school, we kind of differentiate mean immunologically between immunoglobulin e IGE reactions, which are more immediate reactions, but also IgG, which is more of a delayed reaction, and we're talking here about food allergies, just to clarify for the listener, we're talking about IGE reactions here on the RAS test for this and yeah. Skin tasting,
Dr. Danna Gibbs
if you Yeah, if you if you send a blood test for a food, then when you order the tests, you specify, do you want IG e test? Or do you want IgG test and you can get both. There is no insurance company that I know of that will pay for a food IgG test. And one of the reasons that is is because it's very vague, and it's like, Okay, I've got this positive food IgG test. Now, what do I do? Because I eat that food all the time, and it doesn't make me feel sick. Well, it's just exactly what I was telling you. If you are kind of chronically exposed to it, then the symptom has become chronic, and you don't see, you don't see it. And my thought, and my impression of food allergies is that there's a lot more that's going on than just IgG, just IgG. So we call it and we break it up, and we say IGE mediated food allergy. And then we say non IGE mediated food allergy, which is a glom of all the other kinds. You know, because there are cell mediated reactions, like, for example, I don't know, I'm going to use Poison Ivy as an example. So poison ivy, you, you, if you have a sensitivity to it, you get it on your skin, you're fine for 48 hours, and all of a sudden you start itching. And then the next thing you know, if you're like me, you've got it from head to toe, because I go systemic with it every single time. And there is no antibody that you can test by IgG or IG. There's nothing that says it's just do you react to it? Or don't you? Yeah, so there's so food, food allergy, is really a very complicated thing. And an IgG test can give you an idea of Okay. I think it's a good idea for you to spend some time not eating this thing, and then go back and try eating it and see what happens. And when people do that, I tell them really no longer than five to seven days. Because what that does is it allows it allows the immune complexes that you get the IgG food complexes that allows those to clear through your kidneys and out of your system. And then your circulating antibody level will actually rise. And so then the next time you eat the food, five to seven days later, you get this bam, acute reaction, you're like, Oh, my God, that really made me feel bad. That's how you know. And that, to me is the gold standard that so you eliminate and then you challenge that's the gold standard on a food test.
Dr. Andrew Wong
You eliminate for longer than seven days, or what eventually happens is I think what you're saying is that the antibody levels start dropping, so you might not be able to know on the reintroduction as much.
Dr. Danna Gibbs
Yeah, yeah, you're not going to get that you're not necessarily going to get that acute reaction. So so if you, yeah, if so if you do that acute reaction thing, and you're like, oh, my gosh, that was really bad, then what you might do is stay off of it for six weeks, and then go back and see what happens. But, you know, this is very nuanced, because there are some foods, like foods that have a mold component to them, where you have to stay off on for a lot longer. So like, you know, fermented beer, for example. It really takes probably six weeks to get that completely out of your system. And you can't you can't just say, Oh, I'm gonna stop drinking beer, you have to eliminate everything that has yeast in it, or can trigger yeast, which is every sugary product at all. So it is complex. I mean, you have to be pretty sick to be willing to put up with doing that.
Dr. Andrew Wong
Yeah, well, maybe they will be so good at sick. You know, that's my my kids say. That's a good thing, I think. Yeah. Have you heard that?
So? Yeah, so yeah, so I
Dr. Andrew Wong
have to find true health. Yeah, yeah. Yeah.
Dr. Danna Gibbs
Yeah. So I there's a certain level of motivation that it takes in order to really be successful at doing food elimination challenges. Yeah,
Dr. Andrew Wong
yeah, exactly. That's a that's a great point. Let's let's go back to kind of the the clinic setting so Let's say someone's coming in for allergy testing, they're gonna get some skin prick testing as a baseline to screening, seeing what's going on. What's involved with that. What should the person expect when they're coming in for just like basic skin prick testing? What does that assurance like?
Dr. Danna Gibbs
I'm sure so you, the first thing you have to do if you're going to come in for testing is that you need to not take antihistamines for a period of about a week is generally what we ask people to do is about a week of no antihistamines, before you come in, because the prick test reaction has to do with the production of histamine in your skin. And if you have anti histamine onboard, then it blocks that reaction and you don't get any result. But But what we do is, you come in you sign a consent forms, we have you fill out, you know, questionnaires makes sure that that we really are aware of any medications that are onboard that might interact badly with everything. And then when we're ready, we will put this little device it's actually I have one if you want to take a look, I have one. Check it out. Yeah, let me let me stand by and I'll just grab it.
Dr. Andrew Wong
Right over here. Dana, while you're getting that I'm wondering, are there any other medications or supplements or anything that the person should be off, you know, before undergoing an allergy prick test? Sure.
Dr. Danna Gibbs
So beta blockers are the big important one they have blockers are a kind of blood pressure medicine that sometimes use for migraines sometimes use for glaucoma, in an eye drop form. And they make it very dangerous for you to have an actual severe allergic reaction. So anytime we're doing a skin test where we're provoking an allergic reaction on somebody, there is a at least theoretical possibility that that reaction could get really severe. And for that reason, we always keep epinephrine handy an epi pen. And if you have been on a beta blocker and you get epinephrine, you can have what we call a paradoxical reaction. So instead of your blood pressure going too low, then your blood pressure can shoot way, way up. And it can create coronary artery spasms or strokes are really severe, frightening, scary things where we can't rescue a person. And so beta blockers need to be off. In my clinic, we said five days, I think I've seen other literature said it only needs to be two or three days. But really, all beta blockers in my opinion should be stopped before
Dr. Andrew Wong
person. So if they can't afford to go off of it, because maybe they had a myocardial infarction before or something like that, then would you just not do the allergy test? Or how would that work? That's
Dr. Danna Gibbs
the kind of person I would do the blood test. Okay. Okay. That yeah, basically, yeah, if you are a heart patient, where the you know, if you were to go to the emergency room, and they were very, very cautious about having to give you epinephrine because it could trigger something, then that's the kind of person I would probably not want to even offer allergy shots to. I would want to pick an alternative safer option. Yeah.
Dr. Andrew Wong
Yeah, that makes a lot of sense. Great. So you got the show until the allergy, so
Dr. Danna Gibbs
I got show Intel. So this is this is what the tray looks like. And I'm gonna hold it right up to the camera. I don't know if you can see the different allergens. A lot of them have different colors to them because the pollens are varying colors of green and yellow brown. But anyway, so it's in this tray. And it's you dip this thing in here, we call it an applicator, and it has tiny little points on the ends of it little prongs that are similar to the old fashioned TV time test. I don't know if a lot of people may remember what those look like. But they're very tiny little points in a tiny circle. And they're made out of plastic and you put them on the person's skin on their back or on their arm. And you kind of rock them from side to side and so they make an impression but they don't break the skin. They
Dr. Andrew Wong
don't hurt I've had this test before I don't think they know my opinion but
Dr. Danna Gibbs
um it depends on Who? Who puts them on? Okay. I actually think the intradermal test hurts less. Okay. But and I think these are a bit uncomfortable, but But yeah, it's not. I mean, people have said, Oh, it's like a bee sting, I'm like, No, it isn't even close to Lafley not definitely not that not even close to like that. Now, once they're on there, if you're allergic, you'll start itching, you'll be sitting there, well, you know, laying on your stomach on the on the thing going.
Dr. Andrew Wong
That's when you needed the meditation and the breathing and
Dr. Danna Gibbs
meditation, breathing perfect. And you'd lay there for 20 minutes to get the results of the test, and then once we see how big and you'll get a little circle, a little bump, or we call it a wheel, it's a little dome shaped lump. And we measure the different sizes of them. And by the size of it, you can kind of get an estimate of how strong the reaction is. And that's called a wheel. And we measure that at 20 minutes. And that tells me in my case, that tells me whether I want to put a stronger intradermal test on or a weaker integral Mold Test. And that's that's the way I've done it for 20 years in my office. Now you don't have to do that intradermal tests once you've got a positive on a drug test, you can move straight to treatment with that.
Dr. Andrew Wong
Got it if you want to do the intradermal might be if you're clinically suspecting that and the prick test was negative or something. Good.
Dr. Danna Gibbs
Yeah, that's, that's exactly right there. There's Yeah, that's one situation where I absolutely do get interrupted intradermal test is when you suspect, but you have a negative test, then I'll go, You know what, let's put on a stronger test and
Dr. Andrew Wong
see, you know, for the blood test, can you base your treatment off of the blood test result? If someone had positive Rast, you could you could start doing allergy shots or drops? Oh, yes. That's great. Great. That's really helpful. Because I think also, like I said, in our area, we're in the swamp. So you know, some people have, you know, maybe mold exposure or even certainly allergy exposures. And then once allergies, so let's say the so now we have, you know, a positive test on the allergy testing, what what kind of treatment protocols do you recommend? I think we can maybe start with sort of traditional treatments, like you mentioned, are there anything else besides traditional treatments that you would recommend as well? Your
Dr. Danna Gibbs
Okay, so, so allergy treatment is, is always in three parts. The first one is avoidance. So whenever you can, you want to try to reduce your exposure to allergens, that's, you know, simple things like buying a HEPA filter and running it in your bedroom, making sure that you don't have carpet in your bathroom that could get damp and then grow mold. Using the higher quality air filters in your air conditioning system at home, send your dog to the groomer once a week. You know, avoid leaving your windows open during those gorgeous breeding days, when everybody wants to open the windows, then you get to keep your eyes closed, because that's when the pollen is highest, you know, simple things like that. So that's that's the first prong. That's the first pillar of the treatment. second pillar is drug treatments. So I'm en t so I treat a lot of nose problems. And we use an awful lot of topical nasal steroids, Fluticasone Mometasone. And I find those those work really, really well. Particularly if the patient knows what time of year they're going to have their symptoms, then they'll start a couple of weeks ahead of time, then a lot of times they will not need to add other drugs on top of that they'll do really, really well. Just with that, particularly if their their symptoms are only one season or two seasons out of the year. The antihistamines are, you know pretty well known diphenhydramine, which is Benadryl and then there's the newer versions, the 24 hour allergy tablets that you can buy at any pharmacy, they're all over the counter now. The old old trade names are Claritin, Zyrtec, Allegra, those those kinds of things. You can go to the drugstore and buy those without a prescription. Now my impression is that patients really need guidance in what they're going to choose for those times when they need something. And so I have a questionnaire, a checklist that I go through with them and I say, pick one from this category one from this category one from this category and use these and really try to avoid the You're very short acting super MultiSymptom sedating, you know, contains a lot of pseudoephedrine kind of stuff that just, there's so much going on with them, that you can't really tell what's working, what isn't. So I encourage people to avoid those. Another thing that I really, really find very, very helpful is these nasal saline washes, like, you know, just a spray, or a neti pot, or very these various devices that you can use to rinse out your nose with distilled water mixed with salty, salty solution, I find those to be very, very helpful. And so I'm always using a combination of all that stuff in order to try to get people the maximum benefit. And then the third thing is, and particularly if they've already tried those first two things and haven't gotten enough relief would be to move on to the allergen immunotherapy, which would be more traditionally, allergy shots. Everybody's kind of heard of allergy shots, I think. But there are some people who have this wrong impression. And they say, Oh, I get an allergy shot every spring. And I'm like, no, no, no, what you got was the steroid shot, that's you went to urgent care, you got a steroid shot. That's Yes, steroids are a way to take care of allergies, but they have side effects. They have long term consequences in your body, they they promote, I don't know SIBO, they promote? Cancer, no, they there's all kinds of reasons why you don't want to serious
Dr. Andrew Wong
side effects, quite serious, quite serious side effects, long
Dr. Danna Gibbs
term and even some shorter term. And so I really encourage people unless they are thinking of going to the emergency room because they're having such a bad asthma episode or something like that encourage people not to use steroids, except for the topical steroids that we already talked about. But allergy shots are a slow build up of the actual serum that we use to make that allergy test, we use that same serum, and we make a custom set of all the allergens that are positive, and gradually build up the strength of that a little higher, a little higher. I personally have people come in once a week, some clinics, it's twice a week. I don't encourage going home with allergy shots.
Dr. Andrew Wong
I agree, agree just a little too. You know,
Dr. Danna Gibbs
I'm not going to say that allergy shot reactions happen every day. But when they happen, they're serious. And you need to be somewhere where someone can take care of you. And so I don't encourage people to go to a doctor that will let them take allergy shots home every you know, right from the first day, I just don't think it's a standard
Dr. Andrew Wong
clinic where there's medical personnel in case some type of personnel or chance that it might happen, which exactly there's,
Dr. Danna Gibbs
yeah, there's medical personnel, and they've been trained what to do. I mean, I, I, I have, actually, you know, this, I actually teach an allergy course, and part of one of the modules is what do you do when a bad thing happens, because you gotta be ready. Even if it never happens in your clinic, you have to be ready. So. So you need to know what to do. And you need to be where someone can help you. So allergy shots are not a trivial treatment. And so I you know, I make sure that the patients understand that when they go through and make sure that they always have they, the epi pen, which is the main treatment if you have a severe reaction. But, you know, making this sound like it's so scary, but it's really, so so many people do this and get long, long term relief from it. And it's between three and five years of getting allergy shots and you do go for that first year, at least you go every week, and then you can back it off. After every two weeks, maybe every three weeks, every four weeks is the farthest between treatments that I would recommend that people go. But what you get is 1520 or more years of I don't have allergies and I don't need these treatments anymore. I
Dr. Andrew Wong
feel great. That's so
Dr. Danna Gibbs
so I'm really still a very strong proponent of doing that. Then there's one other way actually there's two other ways that you can treat allergy immuno with immunoassay Therapy, which is either a sublingual drop, that's a custom mix, or there is actually even now oral mucosal immunotherapy, which is where you make the allergy serum into a toothpaste, which is fabulous. Just the coolest thing ever. Because with that you can treat people down to two years old.
Dr. Andrew Wong
They're just brushing their teeth and then they're getting the same feel minutes.
Dr. Danna Gibbs
Exactly. Because the you have the right kind of cells that take up the allergen immunotherapy right in your gums, right in that area around your under your tongue. And in your gum thing. You have lots of these Langerhans cells that are the ones that take up and process the allergens and make them desensitize you. I mean, that's how come little kids generally don't end up allergic to every food they put in their mouth, because they're desensitized as they try just putting
Dr. Andrew Wong
in all this stuff in their mouth and get sensitized to them. And at that we're desensitized I guess. Yeah, yeah. So how long do allergy drops? Take you said shots could take up to three to five years? What about what about what else
Dr. Danna Gibbs
say it's the same. I mean, I'm not I don't want to make it sound like it takes that long to start seeing relief, because that's not true. The relief generally, in allergy shots, I've seen people start getting relief as quickly as about every about six weeks in, okay. And it continues to improve over that first year drops maybe a little bit slower than that maybe three months before you really start seeing some improvement. But still, eventually it gets up there and then but the continuous long term exposure you need in order to get that, okay, long term lasting change, you need about three to five years. So for
Dr. Andrew Wong
some of chronic symptoms, like chronic allergies, I mean, certainly three to six months even wouldn't wouldn't be a long time to you know, wait to see results if they've been suffering for years. Right. Are there any other symptoms besides sort of the usual sneezing, runny nose, you know, watery eyes, things like that, that people associate with allergies that might be associated allergies, but people might not just know, oh, what might be causing caused by allergies really? Right?
Dr. Danna Gibbs
Yes. So I already said it a couple times chronic like throat chronic irritated throat through clearing. Chronic hives. I've seen people who are like, Oh, I take Zyrtec everyday because I get hives if I don't. And I'm like, Well, what are you allergic to? Well, I don't know. My dermatologist just told me to take this. Like oh my goodness. Headaches, nose polyps. Dizziness. Like just feeling Whoo. All the time. Yeah. Yeah. Very, very common. And, you know, repeated sinus infections. You know, a lot of people who get colds over and over again. They don't realize that allergy and it's, it's like, you know what, by the time you've had three colds in a year, you probably ought to get allergy tested. And
Dr. Andrew Wong
yeah, in other words, it's not always a Z Pak deficiency or something.
Dr. Andrew Wong
Yeah, no, it's definitely not ICD 10. That's not a
Dr. Danna Gibbs
it's not a Z Pak deficiency. I see that all the time. People are gonna I need more antibiotics. I'm like, no, what you really are responding to when you do that is, is the steroids that you got along with the Z Pak and what you need is an allergy test.
Dr. Andrew Wong
Are there any roles of a couple of things, any any supplements that you'd like that would be potentially helpful to manage allergy symptoms? I think about close to 10. You know, that's something that I thought about, or stinging nettles or something like that. I don't know if you? Yeah, I mean, we'll take that. So
Dr. Danna Gibbs
I have seen people taking akinesia eCognition. Okay, but I don't I don't love akinesia. For long term, I think there's some negative effects of taking it as a long term thing. I think it's fine to take it when you're acutely ill. But it's not something that I push and recommend. I would say my approach to supplements is more like me, just step back just a second because one of the things that I have seen a lot is patients will come in, they'll get an allergy test. They'll be like, Oh, it's a negative allergy test. I don't have any allergies. And I'm looking at them and we're digging further and we're trying to figure out what's going on. They got their CT scan of their sinuses, there's nothing there. But I do a questionnaire and I say you know what it sounds Like you might have thyroid trouble to me. They're like, Oh, no, no, I have my TSH is always fine. Well, there are more sophisticated ways to check thyroid these days than there used to be. And particularly in the functional medicine world integrative medicine will people are starting to catch on to those kinds of things. And to illustrate my point, I'm just going to tell you a story because I was seeing a lady for really bad sinus one spring and we did her allergy tests, and it didn't show anything. We did her CT scan, it was terrible. It was like, okay, but you know, let's check your thyroid. Okay, looks like you could probably use it. I gave her the natural desiccated thyroid. And then sat back and waited for her to schedule her sinus surgery. Well, six months later, she comes back. And I'm like, wondering, are we going to schedule your sinus surgery? And she's like, Oh, I don't need that anymore. I'm fine. I just need more of the thyroid medicine. That's awesome. Like, what? So so my impression of what's going on there is that there are things that happen to your immune system when you are adrenal suppressed, or thyroid suppressed or are hyper stressed, or having you know, you're overloaded with toxins, or you're overloaded with stress, that dampen your response to the allergy tests, make them hard to find, but also, but also, but also disorder, your immune system and push you towards those allergic symptoms. Yeah. And you can have a patient with a positive allergy test, and they just live a happy life, and they're fine. And they never have a symptom. And you can have somebody with the exact same allergy tests, or less allergy tests, and they're absolutely miserable. And you fix them, as far as their stress and the other things, and all of a sudden their symptoms have gone away, too. So it's like, there's the allergic response. But then there's the host, the host, what I call
Dr. Andrew Wong
host factors. Terrain, terrain factors. Yeah, sure. Right.
Dr. Danna Gibbs
Yeah. Okay. Terrain. Yeah, it's a good way to do it. But anyway, so there are so many things that you can do, that will help calm down your allergy, that are not specific to allergies, they are specific to just all the things. Yeah, it feel better, you know, so you go in, and you're like, Okay, I'm going to take an adaptogen, for example, I'm going to take I'm going to take, you know, you mentioned quesiton, I'm going to take NAD I'm going to take, you know, whatever, you know, and I am not huge into the supplements realm, but vitamin D, for example, there's so many people out there who are just pathetically deficient in vitamin D. And, you know, you get them up into the normal range, and they feel a little better. But if you get them up into the well into the middle of the normal range, then they feel good. And their immune system perks back up, and all of a sudden they feel fine. And then those allergies don't bother him anymore.
Dr. Andrew Wong
Yeah, no wonder that vitamin D is about.
Dr. Danna Gibbs
Yeah, so So there's so much there are so much there
Dr. Andrew Wong
so much there. I wonder if the vitamin D, I was just about to say about vitamin D, that it up regulates the T regulatory cells. And I wonder if there's a way that it somehow reduces the allergies through that type of mechanism?
Dr. Danna Gibbs
I would say that, you know, I do know that it has immune effects. And it's entirely possible that that's one of them, because T regs do down regulate the cell mediated part of an allergic reaction, which is is, you know, we didn't really talk about that. But allergy has kind of an early phase and it has a late phase it as the IGE mediated part of the things and then it has a cell mediated part of the things where you get priming and you get the reaction that just creeps up and up and up. And so yeah, downregulating the cell mediated immunity absolutely should help control those symptoms.
Dr. Andrew Wong
So terrain factors, host factors, getting enough sleep, reducing stress, optimized nutrition and movement and activity, things like that. It sounds like that would actually help by strengthening and balancing the immune system it would it would also help with allergies.
Dr. Danna Gibbs
Yeah, absolutely. So, you know, when when you talk to people about stress And about the physiologic responses to stress and you say, you know, when you when your cortisol goes high, it takes you towards I think it's, it's it goes from th one or th two, and that th two is definitely more towards the allergic because that's the mechanism of it, it's a, it's a multi cell mediated reaction that's your body's designed in your body to actually to get rid of parasites. And, and, you know, because parasites in comparison with the size of your body cells, parasites are so large. And so it's, you know, imagine bees attacking a pig that's trying to dig up their nest or something like that, you know, the pig is huge, and the bees are tiny, but they come around and they sting and they sting, they sting. And the collateral damage from from all the stinging going on to the organism spills over into the neighboring cells and causes the inflammation and the the itching and the sneezing and the secretions and must go the muscle, the smooth muscle contraction and all the things that that go on and an allergic reaction.
Dr. Andrew Wong
Yeah, yeah, one more thing on lifestyle, just want to make sure we touch on nutrition, and gut health. So are there any sort of nutritional ideas or plans? Or, you know, certain big points, I would say that you would think about in terms of someone has allergies? Are there certain points that that we might want to consider for nutrition? Sure.
Dr. Danna Gibbs
So nutrition wise, I think you're always better off to go with as much of a paleo type of lifestyle as you possibly can. So eliminating the the processed grains, the processed sugars, the high inflammatory vegetable oils, you know, just all of the standard ingredients and a standard American diet, which, you know, if you're eating fresh vegetables, and whole grains, and fresh fruit, and you know, hopefully, if you're going to meet, then grass fed, just trying to get away from the pro inflammatory stuff is really always a better plan. The other thing with regards to foods is that there's not really any me. So you have to say this right? There. People are not always allergic to the same things. You know, somebody, somebody will go, oh, I cured my self with this diet that eliminates XY and Z. Well, it may be that the reason that worked for that one person is because they were allergic to X or Y, or Z. And they just didn't realize that and so you can't just take that and generalize it to the next person and the next person next person. So on a whole, the kinds of foods that most people are more people are allergic to our corn, soy, wheat, dairy, eggs, yeast, those are those are the big six that people have problems with. But most people are not allergic to all of them. Most people are allergic to one or two of them. And so it's better to do this elimination and challenge testing, like what we were talking about earlier, than it is to just blanket say, okay, you can never have any of these things.
Dr. Andrew Wong
Although it does sound like if we're talking about eliminating those foods that it would be hard to go to the International House of Pancakes or something like that. That has most of those foods in them.
Dr. Danna Gibbs
Yeah, well, yeah. So you know, it's funny, because I tried that I tried going, I'm already allergic to eggs. And I tried going gluten free for a while. And I was just like, Okay, I walk into the IHOP. And I can have plain oatmeal with some fruit. And that's the only thing
Dr. Andrew Wong
I actually have that there. Okay. Yeah, that's, that's
Dr. Danna Gibbs
the only thing on the menu that I can have. And so it's just like, Well, okay, so what's the point of going out to eat? No, I mean, if you're, if you're a food allergic patient, the likelihood that you can eat in restaurants becomes fairly immeasurably small. If you're a true for food allergic, and bit, you know, maybe we ought to talk about that really quick, because there are there's food allergy, and then there's food allergy. So talked about? Yeah, so we talked about the difference between IgG and IGE. And people who have IgG II mediated food allergy, which is the kind you can find on an IGE blood test. Those are the kinds of people who have anaphylaxis. Big shock reactions. And you know, those are the ones where you read in the news. Oh, you know, Janie's boyfriend ate peanuts, and then they kissed and she died. You know, because an immeasurably small amount of peanut allergen is capable of triggering this incredibly ridiculously severe reaction
Dr. Andrew Wong
doctor gets, I do want to ask about that, because I know on the test that we use for RAs, there's levels zero through six. So are there certain severity of the IgE, where it's like, it's not as danger of anaphylaxis, so they all kind of potentially, you
Dr. Danna Gibbs
know, they're all They're all potentially at play. And the thing, the thing about IGE that's circulating in your bloodstream is that that's only a small portion of the IDD you have in your body, most of it is tissue bound. Yeah. And so and the longer you stay away, so like if we're going to pick on peanut again, the longer you stay away from Peanuts, the lower your serum level of IGE is gonna get and so you could have a one or a two on a peanut IGE and go and eat a peanut and boom, have a problem. And so if you're if you know you have an anaphylactic reaction to peanut, that is something that board certified allergist are now doing where they do peanut desensitization, where they have like this peanut powder that they can measure out in very exact amounts and and have you every day you take a little tiny bit more, a little tiny bit a little bit more, and you get desensitized to it, that's a real thing. And it actually works, and it saves lives. And but that is not the same as the kind of food allergy you and I are talking about, where I say, you know, go in, stay away from it a week and then challenge it. That is not the same thing at all. There's no no suggestions here that I'm suggesting that people should take something that they know they've had a serious allergic reaction to go and try to eat it on their own. That's not right.
Dr. Andrew Wong
Right. I think the latter thing that we're talking about the kind of elimination and then re challenges a little bit more in talking about IgG reactions where the more Yeah,
Dr. Danna Gibbs
yeah, it's talking about not in a non anaphylactic, non anaphylactic.
Dr. Andrew Wong
Okay, got it that makes it non IGE reactions. Well, thank you so much, Dana, for coming on today. I know there's a very important topic allergies, allergy testing, thinking closing, we just want to ask you about kind of what the most important takeaway for listeners is about allergy testing. And you know, what would you like to leave the listeners with? Sure.
Dr. Danna Gibbs
Mainly, that just suffering with allergies is not necessary, and that there are good treatments that can cure you from your allergy. And so to seek out a practitioner, who knows what they're doing and knows how to take care of it, is a real reasonable thing. And truthfully, when I've looked at the economic implications of this, especially if there's asthma involved, because asthma and allergy are like this, that it's actually cost effective. So you know, I use a one particular patient in line all the time as an example. And she was on. I don't know, I think it might have been symbicort, or one of these fancy maintenance inhalers, and she was going to the doctor 3456 times a year getting antibiotics, getting steroids, all that stuff. And I added up in dollars, all the money that she had spent in a year treating, treating, what I later figured out was allergies for her. And the first year of my treatment was equivalent to what she spent, except that she wasn't sick. And then the second year of my treatment was half what she spent the year before, and so on and so on. And so so that's I guess that's the takeaway, you don't have to suffer with it. There's, there's things you can do and it's not ridiculously expensive.
Dr. Andrew Wong
So test don't guess prevention. What is it an ounce of prevention is worth a pound of cure, allergies could be a root cause of what's going on and all those things. Yeah, go to your health care providers and talk about allergies. And then I think also Danna, we'd like to ask you, do you have any education or clinical websites you'd like to share with our listeners if they want to learn more about kind of what you do and how to work with you and stuff like that? Sure.
Dr. Danna Gibbs
Absolutely. So I have a YouTube channel. You can find me on YouTube at the Dana Gibbs md.com or allergy access MD. Are my two handles on YouTube? I actually have two channels. Now because of some other work that I'm doing, but I put all my all my videos up there eventually. I also have cake. Yes, yeah, it's a multi layer cake. I also have a training. I have a training course for doctors too, so that a lot of that stuff
Dr. Andrew Wong
is up there too. Awesome. Well check that out. Well, thank you so much, Dr. Dannic, for coming on today. Really appreciate that. Okay. All right. Thanks so much. Thank you so much for joining us today for this episode of capital Integrative Health podcast. A quick reminder that the information we share on this podcast is meant for educational and informational purposes only. It's not a substitute for professional medical advice, diagnosis or treatment. We highly recommend that you speak to a qualified health care provider before making any medical or healthcare decisions. If you enjoyed this episode, please take a few moments to subscribe and leave us a review. Your reviews help us reach more people and continue to offer innovative insights and information to better optimize your health and wellness.