WEBVTT - Ep 161 Allergies Part 1: Pollens, nuts, & bugs

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<v Speaker 1>My name is Caitlin.

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<v Speaker 2>I'm thirty two years old, and for most of my

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<v Speaker 2>life I hadn't experienced severe allergies or allergic reactions to anything,

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<v Speaker 2>except for cats sometimes. I went to school in Nebraska,

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<v Speaker 2>and after college I got a job in Denver and moved.

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<v Speaker 2>The first year living in Denver was awesome. I got

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<v Speaker 2>really into all the outdoorsy things that Colorado has to offer,

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<v Speaker 2>like camping and hiking and skiing. But about a year

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<v Speaker 2>into my time in Denver, in the spring of twenty seventeen,

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<v Speaker 2>seasonal allergies and hay fever hit me on like anything

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<v Speaker 2>I had ever experienced before. Every day that spring, I remember,

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<v Speaker 2>I would wake up with a sore throat, hives, and

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<v Speaker 2>swollen eyes. My eyes would have allergic conjunctivitis and chemosis,

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<v Speaker 2>which is when tiny bubbles form on the surface of

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<v Speaker 2>your eye from all the allergens and pollen in the air.

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<v Speaker 2>I had a constant runny nose and couldn't breathe. I

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<v Speaker 2>had a lot of sinus infections. I also couldn't hear

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<v Speaker 2>very well because of all of the post nasal drip

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<v Speaker 2>that would happen and settle in over I was beyond

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<v Speaker 2>exhausted all the time and unable to go outside much

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<v Speaker 2>at all. Every time I would leave my house, I

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<v Speaker 2>would get hot, painful hives on any part of my

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<v Speaker 2>skin that was exposed. I remember taking cold showers all

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<v Speaker 2>the time to try to keep my hives from spreading

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<v Speaker 2>all over my body, and at the time I was

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<v Speaker 2>only using over the counter allergy medications, which only helped

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<v Speaker 2>a little bit. I worked downtown in an office, and

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<v Speaker 2>so riding the train into the office, interacting with coworkers

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<v Speaker 2>and clients, and wearing business casual clothing was incredibly uncomfortable

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<v Speaker 2>and embarrassing sometimes. And this is all before COVID times,

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<v Speaker 2>and I was still really new at my job, so

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<v Speaker 2>asking to work from home was a challenge. I was

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<v Speaker 2>also really bummed because I couldn't eat a lot of

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<v Speaker 2>fruits that grew on trees where you typically eat the skin,

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<v Speaker 2>because the pollen grows with the fruit instead of on

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<v Speaker 2>the hard outer layer. So fruits like peaches and apples

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<v Speaker 2>were off limits because I would break out in hives

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<v Speaker 2>on my neck and face and sometimes experience breathing issues.

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<v Speaker 2>And sadly, Colorado is famous for their palasaid peaches, and

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<v Speaker 2>I could never have them, even though it was my

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<v Speaker 2>favorite fruit growing up. Unfortunately, things got exponentially worse the

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<v Speaker 2>following fall due to a mold issue in the rental

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<v Speaker 2>house that I was living in. I was exposed to

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<v Speaker 2>penicillium mold spores, which had a compounding effect on my

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<v Speaker 2>already maxed out immune system, and I ended up developing

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<v Speaker 2>severe asthma. I was playing roller Derby at the time,

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<v Speaker 2>and I remember showing up to practices and scrimmages feeling

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<v Speaker 2>like I was breathing through a wet cloth draped over

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<v Speaker 2>my nose and mouth and felt like I would pass

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<v Speaker 2>out after one warm up lap.

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<v Speaker 3>I was devastated.

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<v Speaker 2>I didn't know what was wrong with me, and I

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<v Speaker 2>was trying so hard to get into the sport and

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<v Speaker 2>develop a community in my new place, but I was

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<v Speaker 2>not able to keep up at all. I ended up

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<v Speaker 2>taking a leave of absence to avoid further damage and

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<v Speaker 2>started seeking professional help. I had skin testing done in

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<v Speaker 2>January twenty eighteen, and it was pretty awful. Almost every

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<v Speaker 2>single allergen that they had tested me for came back

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<v Speaker 2>with a flaming positive. After this, I was introduced to

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<v Speaker 2>my allergist and met my immunotherapy team. I got started

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<v Speaker 2>with allergy shots by doing a procedure called a rush

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<v Speaker 2>treatment to try to get my body as close to

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<v Speaker 2>my maintenance DOWS for allergy shots as soon as possible.

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<v Speaker 2>I was not able to finish the entire rush treatment

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<v Speaker 2>because my body started to go into shock, which is

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<v Speaker 2>actually typical for the procedure. After that, I began regular

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<v Speaker 2>allergy shots every three weeks for the next five years.

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<v Speaker 2>I was also put on a prescription strength antihistamine, two,

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<v Speaker 2>over the counter antihistamines two Inhaler's, and an EpiPen in

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<v Speaker 2>the event I went into anaphylaxis. I was not allowed

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<v Speaker 2>to eat or touch anything that would cause any sort

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<v Speaker 2>of reaction, and I had to avoid being outside on

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<v Speaker 2>high pollen days. Springtime was always the worst for me

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<v Speaker 2>due to the presence of tree pollen, and I would

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<v Speaker 2>always see more intense reactions during that time of year

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<v Speaker 2>to my allergy shots. Fortunately, I completed my immunotherapy in

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<v Speaker 2>July twenty twenty three and have been pretty good ever since.

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<v Speaker 2>I'm still on the prescription strength antihistamine and one of

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<v Speaker 2>the over the counter antihistamines for any allergies that might

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<v Speaker 2>pop up, as well as both Inhaler's for the now

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<v Speaker 2>permanent asthma, but overall things are pretty manageable for me.

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<v Speaker 2>I remember asking my allergist, why now, why did allergies

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<v Speaker 2>hit me now and here and like this and never

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<v Speaker 2>before in my life? And she explained to me that

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<v Speaker 2>I'd probably experienced what they call a honeymoon period when

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<v Speaker 2>I first moved to Colorado. My body is non reactive

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<v Speaker 2>to the new allergens because it had never seen them before,

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<v Speaker 2>but almost always a second time around or the following

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<v Speaker 2>season that your body encounters the allergen, it overreacts and

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<v Speaker 2>produces an excessive histamine response. This whole experience has been

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<v Speaker 2>a very long and painful journey, and it took a

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<v Speaker 2>huge toll on my mental health at the time. I'm

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<v Speaker 2>not entirely sure how long I'll be without allergic reactions,

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<v Speaker 2>hopefully forever, but I still get hives from time to time.

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<v Speaker 2>Everyone's body reacts differently, and sometimes you become allergic to

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<v Speaker 2>new things that you weren't before. Every reaction I do

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<v Speaker 2>have now is manageable. My asthma is still very much there,

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<v Speaker 2>but I've learned to live with it, and I'm also

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<v Speaker 2>really excited to report that I can have feaches and

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<v Speaker 2>apples again. My life has been completely changed because of

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<v Speaker 2>this experience. I'm so fortunate to have the support that

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<v Speaker 2>I do, and I cannot think my Meta Coole team

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<v Speaker 2>and my family and my friends enough for taking such

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<v Speaker 2>good care of me Throughout those five years. I've learned

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<v Speaker 2>so much about something I never even thought twice about

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<v Speaker 2>for two thirds of my life that ended up having

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<v Speaker 2>a major life altering impact on me. The human body

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<v Speaker 2>is so intensely weird in particular sometimes, but I'm so

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<v Speaker 2>grateful that I was able to get through this experience

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<v Speaker 2>and to be where I am now, even with the

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<v Speaker 2>lasting effects it has left me with.

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<v Speaker 3>Ooh, that gosh sounds truly miserable. Yeah, truly miserable.

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<v Speaker 1>Oh my goodness.

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<v Speaker 3>I always think like, oh, yeah, I have seasonal allergies.

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<v Speaker 3>Sometimes I barely do. Yeah, I have the hint of.

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<v Speaker 4>A seasonal allergy. And to deal with we have seasonal allergies,

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<v Speaker 4>the I know, and to deal with it just like,

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<v Speaker 4>oh my goodness.

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<v Speaker 3>Yeah, all yeah, And when it's everywhere, it is ever escapable,

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<v Speaker 3>you cannot ever escape it.

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<v Speaker 1>Yeah yeah, you just breathe it in.

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<v Speaker 3>That's brutal. But I'm glad that you're finding some more relief. Now,

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<v Speaker 3>thank you so much, Kaylin for sharing your story with us.

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<v Speaker 1>Thank you.

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<v Speaker 3>Hi.

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<v Speaker 1>I'm Aaron Welsh and I'm Aaron Allman Updyke.

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<v Speaker 3>And this is this podcast will Kill You.

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<v Speaker 1>And today we're talking about allergies today and next week

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<v Speaker 1>today or next week?

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<v Speaker 3>You know, what do we get ourselves into here?

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<v Speaker 1>Eron the same thing that we always do aeron, which

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<v Speaker 1>is a very very large topic. Yeah, yeah, here's the deal,

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<v Speaker 1>everyone listening. Here's what it's going to go like. This

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<v Speaker 1>week we are going to talk about allergies. I'm going

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<v Speaker 1>to call it capital A allergies. That is all of them,

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<v Speaker 1>food allergies, seasonal allergies, all of the allergies. What does

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<v Speaker 1>that mean? What is an allergy? Even we'll talk about it,

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<v Speaker 1>and we'll talk about how we figured out what our allergies,

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<v Speaker 1>why do we have them, those kinds of things. Next

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<v Speaker 1>week we'll focus on what do you do if you

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<v Speaker 1>have allergies? And how did we figure that out? How

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<v Speaker 1>do we treat them? And what are some of the options.

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<v Speaker 3>In that respect.

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<v Speaker 1>That's the way that we're trying to split it up.

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<v Speaker 3>We'll see how it goes, I think it will go great.

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<v Speaker 2>Aaron.

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<v Speaker 3>You have nothing to be worried about.

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<v Speaker 1>You.

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<v Speaker 3>You always do an amazing job.

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<v Speaker 1>I'm so she gets nervous every time.

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<v Speaker 3>She's so nervous all the time, and I'm like, you're

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<v Speaker 3>you do a great job.

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<v Speaker 1>As soon as we start, thank you. As soon as

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<v Speaker 1>we start to record the biology section, my stomach every

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<v Speaker 1>time goes like you. So, it's already there, but I'm

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<v Speaker 1>looking forward to it.

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<v Speaker 3>I think they're going to be a great couple of episodes.

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<v Speaker 3>There's a lot of stuff that we're getting to explore

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<v Speaker 3>from sort of this big picture perspective on the energies

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<v Speaker 3>that we haven't really although we have covered allergies or

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<v Speaker 3>allergy related conditions like asthma in the past. I think

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<v Speaker 3>this is a fun opportunity for us to kind of go, Okay,

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<v Speaker 3>let's take a step back. What are the patterns that

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<v Speaker 3>we see. How does this work across the board?

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<v Speaker 2>Right?

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<v Speaker 1>Really big picture here? Yeah, so yeah, yeah, but before

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<v Speaker 1>we can start on that, it's quarantin any time.

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<v Speaker 3>It is, Aaron, what are we drinking this week?

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<v Speaker 1>We're drinking the allergy shot. Yeah, pretty straightforward, pretty straightforward.

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<v Speaker 3>But we won't talk.

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<v Speaker 1>About allergy shots other than this today. We'll talk about

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<v Speaker 1>them next week.

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<v Speaker 3>It's true.

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<v Speaker 1>What's in the allergy shot erin?

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<v Speaker 3>You know, it's just a little tropical delight. You know,

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<v Speaker 3>it's got some it's got some rum in it. It's

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<v Speaker 3>got some tropical fruit juices like some pineapple, some orange.

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<v Speaker 3>It's it's delicious and it's a small contained thing, so

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<v Speaker 3>you know, it's great. We'll post the full recipe for

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<v Speaker 3>the allergy shot quarantine and the non alcoholic placey Berita

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<v Speaker 3>on our website. This podcast will Kill You dot Com,

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<v Speaker 3>as well as on all of our social media channels,

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<v Speaker 3>which if you're not following us on social media, you

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<v Speaker 3>really should be, because you know there's some pretty good

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<v Speaker 3>content if we do say so ourselves, and.

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<v Speaker 1>We do we do every time. If you haven't checked

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<v Speaker 1>out our website yet, check that out. It's phenomenal. This

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<v Speaker 1>podcast will kill You dot Com. We have sources from

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<v Speaker 1>all of our episodes. We have transcripts from all of

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<v Speaker 1>our episodes. We have a link to our bookshop dot

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<v Speaker 1>org affiliate account and our Goodreads list. We have links

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<v Speaker 1>merch we have more things.

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<v Speaker 3>We have two things. The website is a great magical place.

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<v Speaker 3>Check it out, new.

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<v Speaker 1>Pictures, new pictures, promo codes, this podcast okay dot com

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<v Speaker 1>check it out.

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<v Speaker 3>And then one last thing before we get started with

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<v Speaker 3>the actual content of the episode, and that is to

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<v Speaker 3>please rate, review, and subscribe. It really does help us

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<v Speaker 3>out and we appreciate everyone who has ever left a

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<v Speaker 3>review or subscribed or rated. You know.

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<v Speaker 1>Yeah, Also tell your friends maybe they're not listening yet,

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<v Speaker 1>and then you would have something else.

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<v Speaker 3>To talk about, like allergies.

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<v Speaker 1>Like allergies, speaking of things to talk about.

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<v Speaker 3>Should we get started, let's.

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<v Speaker 1>Right after this break. This is either going to be

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<v Speaker 1>very shocking to people listening or entirely unsurprising, probably for

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<v Speaker 1>longtime listeners. But it's actually a little hard to put

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<v Speaker 1>a very strict definition on the word allergy.

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<v Speaker 3>Aaron, there is a paper that I found that was

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<v Speaker 3>the evolution of the term allergy. I think I read

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<v Speaker 3>that paper over time.

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<v Speaker 1>Yeah, I think I read that paper. I tried not

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<v Speaker 1>to read history and evolution papers, but I think I

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<v Speaker 1>did read that one. But we will do it because

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<v Speaker 1>in part because we have to, because we're doing an

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<v Speaker 1>episode on allergies, so we have to tell you what

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<v Speaker 1>we're talking about. But I think that by the end

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<v Speaker 1>of this and next episode, everyone will appreciate that, like

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<v Speaker 1>the deeper you get into the weeds, the more messy

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<v Speaker 1>this idea of allergy really becomes. But we'll try and

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<v Speaker 1>keep it a little less messy and just cover the

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<v Speaker 1>general basics. So the American Academy of Allergy, Asthma and Immunology,

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<v Speaker 1>and the UK's National Health Service and most other major

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<v Speaker 1>medical and public health organizations agree on the basics of

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<v Speaker 1>what an allergy is. An allergy is an abnormal, over

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<v Speaker 1>the top immune response to substances that typically do not

0:12:23.679 --> 0:12:29.240
<v Speaker 1>and really kind of should not cause any substantial immune response. Aaron,

0:12:29.240 --> 0:12:33.560
<v Speaker 1>you'r smiling, which I know means that this should not

0:12:33.720 --> 0:12:36.040
<v Speaker 1>maybe doesn't apply, but that's the way that I think

0:12:36.080 --> 0:12:36.480
<v Speaker 1>about it.

0:12:36.679 --> 0:12:38.280
<v Speaker 3>There's some discussion, we'll get there.

0:12:38.360 --> 0:12:43.040
<v Speaker 1>I can't wait. But so these substances, the stuff that

0:12:43.080 --> 0:12:46.680
<v Speaker 1>our immune system is recognizing and reacting to in this

0:12:46.800 --> 0:12:50.720
<v Speaker 1>over the top way. These things are called allergens, and

0:12:50.760 --> 0:12:53.640
<v Speaker 1>we've talked a lot on this podcast about the idea

0:12:53.679 --> 0:12:59.000
<v Speaker 1>of antigens. Antigens are just the stuffs that our immune

0:12:59.000 --> 0:13:04.440
<v Speaker 1>system sees and recognizes and then responds to allergens are

0:13:04.480 --> 0:13:08.839
<v Speaker 1>just antigens. They really are just antigens. The only differences

0:13:08.880 --> 0:13:11.719
<v Speaker 1>and the reason that they classify them differently is that

0:13:11.800 --> 0:13:15.040
<v Speaker 1>they are stuff. And first of all, they're usually almost

0:13:15.040 --> 0:13:18.920
<v Speaker 1>always proteins, except as we talked about in Alpha gal

0:13:19.240 --> 0:13:22.360
<v Speaker 1>when they're not. But they are almost always some type

0:13:22.360 --> 0:13:26.240
<v Speaker 1>of protein. And for most people these things that we

0:13:26.320 --> 0:13:31.480
<v Speaker 1>call allergens, our immune system sees them but usually goes ah,

0:13:31.679 --> 0:13:35.120
<v Speaker 1>forget about it, like just ignore that one. But in

0:13:35.240 --> 0:13:39.800
<v Speaker 1>people with allergies, these specific kinds of antigens that we

0:13:39.840 --> 0:13:45.640
<v Speaker 1>call allergens trigger a severe hypersensitive response. So let's talk

0:13:45.640 --> 0:13:47.680
<v Speaker 1>about how that ends up happening.

0:13:48.400 --> 0:13:52.200
<v Speaker 3>Okay, real quick, So all allergens are antigens, but not

0:13:52.240 --> 0:13:54.440
<v Speaker 3>all antigens are allergens exactly.

0:13:54.520 --> 0:13:57.120
<v Speaker 1>It's like all squares are rectangles, but not all rectangles

0:13:57.160 --> 0:14:00.839
<v Speaker 1>are squares. Got it, So let's see how that ends

0:14:00.920 --> 0:14:04.960
<v Speaker 1>up happening. We went over the basics of this actually

0:14:05.040 --> 0:14:07.679
<v Speaker 1>very recently in our alphagal episode, but we're going to

0:14:07.760 --> 0:14:11.320
<v Speaker 1>go over it again because the basics of this are

0:14:11.320 --> 0:14:16.400
<v Speaker 1>applicable to essentially all types of allergies with an asterisk,

0:14:16.679 --> 0:14:18.600
<v Speaker 1>because there are a lot of things that people might

0:14:18.640 --> 0:14:22.360
<v Speaker 1>call allergies that don't fit this mold. But when we're

0:14:22.400 --> 0:14:25.760
<v Speaker 1>talking about allergies for this episode, this is the type

0:14:25.760 --> 0:14:27.440
<v Speaker 1>of process that we're going to be talking about. Is

0:14:27.480 --> 0:14:29.800
<v Speaker 1>the pathway I'm about to explain, and here it goes.

0:14:30.280 --> 0:14:33.920
<v Speaker 1>The pathway starts with an exposure, and then there's a

0:14:33.960 --> 0:14:38.880
<v Speaker 1>process called sensitization which is making these specific type of

0:14:38.920 --> 0:14:43.680
<v Speaker 1>antibodies called IgE antibodies, and we'll get there. Then there's

0:14:43.960 --> 0:14:48.840
<v Speaker 1>re exposure, and then there's an allergic response. So we

0:14:48.880 --> 0:14:52.360
<v Speaker 1>can go into detail on each of those parts. First,

0:14:52.800 --> 0:14:57.280
<v Speaker 1>of course, we have to be exposed to analergen and

0:14:57.320 --> 0:15:01.280
<v Speaker 1>we can be exposed to analergen in so many different ways.

0:15:01.640 --> 0:15:03.680
<v Speaker 1>It can be in the air so we can breathe

0:15:03.680 --> 0:15:07.680
<v Speaker 1>it in, and they often call those arrow allergens because

0:15:08.400 --> 0:15:11.560
<v Speaker 1>if we don't have confusing terminology for every single thing,

0:15:11.600 --> 0:15:14.520
<v Speaker 1>then what are we even doing in medicine. Or it

0:15:14.560 --> 0:15:18.120
<v Speaker 1>can be in our food. We can scratch these allergens

0:15:18.160 --> 0:15:20.800
<v Speaker 1>into our skin, a tick could split them into us,

0:15:20.800 --> 0:15:23.440
<v Speaker 1>as we recently learned, we could rub them into our

0:15:23.480 --> 0:15:26.960
<v Speaker 1>eyes any way that they get in. Eventually, these allergens

0:15:26.960 --> 0:15:29.600
<v Speaker 1>make it into our bloodstream. And as soon as they

0:15:29.600 --> 0:15:33.040
<v Speaker 1>make it into our bloodstream, our immune system is all

0:15:33.080 --> 0:15:37.160
<v Speaker 1>over it. So let's say, as an example, it's cat dander.

0:15:37.520 --> 0:15:40.960
<v Speaker 1>There's a specific protein called feld one or fell d

0:15:41.080 --> 0:15:43.920
<v Speaker 1>one that's in cat skin, saliva, and urine, and that's

0:15:43.960 --> 0:15:47.400
<v Speaker 1>the thing that's the allergen in cat dander. So once

0:15:47.480 --> 0:15:50.480
<v Speaker 1>cat dander makes it into our bloodstream, a whole bunch

0:15:50.480 --> 0:15:53.720
<v Speaker 1>of cells like our macrophasias, our dendritic cells, blah blah blah,

0:15:53.760 --> 0:15:57.240
<v Speaker 1>all these immune cells they find this stuff, all of

0:15:57.280 --> 0:16:00.400
<v Speaker 1>these allergens and antigens and the cat dander protein, and

0:16:00.440 --> 0:16:03.600
<v Speaker 1>they bring it to our T cells. And our T

0:16:03.880 --> 0:16:06.800
<v Speaker 1>cells are the ones I Aaron went back to my

0:16:06.960 --> 0:16:11.360
<v Speaker 1>Vaccines episode notes to be like, how did I explain

0:16:11.400 --> 0:16:15.280
<v Speaker 1>this once upon a time? Our T cells are the

0:16:15.320 --> 0:16:17.680
<v Speaker 1>ones who are The way that I think about it

0:16:17.720 --> 0:16:21.080
<v Speaker 1>is they're kind of responsible, and this is an oversimplification

0:16:21.800 --> 0:16:27.080
<v Speaker 1>for either doing something or like not doing much of anything.

0:16:27.600 --> 0:16:29.720
<v Speaker 1>They're going to be the ones who like open a

0:16:29.760 --> 0:16:33.000
<v Speaker 1>door or don't open a door to make the rest

0:16:33.000 --> 0:16:35.760
<v Speaker 1>of our immune system react or not react.

0:16:36.080 --> 0:16:39.240
<v Speaker 3>They're like the major part of the decision tree exact.

0:16:39.560 --> 0:16:41.720
<v Speaker 3>Is there going to be a cascade of events after this,

0:16:42.000 --> 0:16:43.240
<v Speaker 3>or do we shut it down right now?

0:16:43.520 --> 0:16:47.200
<v Speaker 1>Exactly exactly. And it turns out that we have a

0:16:47.240 --> 0:16:50.520
<v Speaker 1>lot of different kinds of T cells in our bodies,

0:16:51.200 --> 0:16:55.080
<v Speaker 1>and depending on what they're reacting to what they find,

0:16:55.960 --> 0:16:59.440
<v Speaker 1>they can open one of many doors in our immune system,

0:16:59.720 --> 0:17:04.159
<v Speaker 1>and which door they open fundamentally changes all of the

0:17:04.200 --> 0:17:08.879
<v Speaker 1>downstream immune response that we see. So when T cells open,

0:17:09.119 --> 0:17:12.359
<v Speaker 1>say door number one, they're going to release a whole

0:17:12.400 --> 0:17:17.160
<v Speaker 1>bunch of cytokines, right, these inflammatory things that will help

0:17:17.200 --> 0:17:21.480
<v Speaker 1>our immune system to let's say, find bacteria or viruses

0:17:21.560 --> 0:17:26.000
<v Speaker 1>and target them and eliminate them. If T cells instead

0:17:26.200 --> 0:17:29.360
<v Speaker 1>open a different door, call it door number two, then

0:17:29.400 --> 0:17:35.320
<v Speaker 1>they release different cytokines, different inflammatory stuff, and then they're

0:17:35.359 --> 0:17:39.480
<v Speaker 1>maybe going to look for worms or parasites or something

0:17:39.560 --> 0:17:42.920
<v Speaker 1>like that. Now, of course, in reality, our immune system

0:17:43.000 --> 0:17:44.840
<v Speaker 1>is doing all of these things and opening all the

0:17:44.840 --> 0:17:46.920
<v Speaker 1>doors at the same time, and there's more than just two.

0:17:47.400 --> 0:17:50.800
<v Speaker 1>But it turns out that what happens in the process

0:17:50.920 --> 0:17:55.480
<v Speaker 1>of allergic sensitization, this is our second step in the pathway,

0:17:56.280 --> 0:17:59.080
<v Speaker 1>is that the proportion of doors that our T cells

0:17:59.080 --> 0:18:03.320
<v Speaker 1>are opening is skewed, and it's skewed towards door number two.

0:18:04.640 --> 0:18:07.040
<v Speaker 1>So it just so happens that when our T cells

0:18:07.080 --> 0:18:10.359
<v Speaker 1>decide when they see an allergen, to open a whole

0:18:10.440 --> 0:18:14.000
<v Speaker 1>bunch of doors number two, it ends up telling our

0:18:14.080 --> 0:18:17.119
<v Speaker 1>B cells, which are the ones that make antibodies, to

0:18:17.240 --> 0:18:21.440
<v Speaker 1>produce a specific kind of antibody, and that is IgE,

0:18:22.800 --> 0:18:27.560
<v Speaker 1>And that's the sensitization step of an allergy formation. And

0:18:27.600 --> 0:18:31.600
<v Speaker 1>we talked about these IgE antibodies in our alphagal episode,

0:18:32.080 --> 0:18:35.240
<v Speaker 1>But antibodies in general are like flags that our immune

0:18:35.280 --> 0:18:39.960
<v Speaker 1>system uses to recognize and respond to harmful stuff more quickly.

0:18:40.400 --> 0:18:43.960
<v Speaker 1>We have to see a pathogen or an antigen or

0:18:44.000 --> 0:18:47.360
<v Speaker 1>an allergen make an antibody, and then the next time

0:18:47.400 --> 0:18:49.760
<v Speaker 1>we see it is when that antibody does its job.

0:18:50.720 --> 0:18:54.280
<v Speaker 1>And we talked about this particular IgE antibody that it's

0:18:54.400 --> 0:18:57.840
<v Speaker 1>different from the ones we think of that we use

0:18:57.920 --> 0:19:02.359
<v Speaker 1>for something like vaccine responses because they're bound to cells

0:19:02.400 --> 0:19:06.960
<v Speaker 1>like our mass cells and our base of fills. So sensitization,

0:19:07.200 --> 0:19:12.480
<v Speaker 1>we're making these weird, kind of weird IgE antibodies. Once

0:19:12.520 --> 0:19:18.879
<v Speaker 1>we've been sensitized, then we have to see that allergen again.

0:19:19.359 --> 0:19:22.560
<v Speaker 1>We have to be re exposed to that same allergen.

0:19:23.080 --> 0:19:27.879
<v Speaker 1>So you made IgE against cat dander, and then you

0:19:28.000 --> 0:19:30.119
<v Speaker 1>go back to your friend's house who has a cat.

0:19:30.880 --> 0:19:34.359
<v Speaker 1>And because this IgE is all over our mass cells,

0:19:34.680 --> 0:19:38.680
<v Speaker 1>it's going to find and bind to that cat dander protein,

0:19:39.280 --> 0:19:44.160
<v Speaker 1>and that binding of the mass cells to the allergen

0:19:44.880 --> 0:19:48.920
<v Speaker 1>triggers a reaction that causes those mass cells to burst

0:19:49.040 --> 0:19:53.919
<v Speaker 1>open and spew forth a whole bunch of highly reactive

0:19:54.040 --> 0:19:59.239
<v Speaker 1>inflammatory stuff. It's things like histamine, leukotrienes, a bunch of

0:19:59.240 --> 0:20:03.320
<v Speaker 1>things called inter luken's, all of this stuff that tells

0:20:03.320 --> 0:20:07.080
<v Speaker 1>our immune system something really serious and horrible is happening

0:20:07.400 --> 0:20:10.679
<v Speaker 1>and everyone needs to get on board. It activates our

0:20:10.680 --> 0:20:14.080
<v Speaker 1>immune system in a really extreme way. And it can

0:20:14.160 --> 0:20:17.040
<v Speaker 1>do this on both these short time scales like immediately,

0:20:17.200 --> 0:20:21.240
<v Speaker 1>these immediate responses, but then it also triggers these longer

0:20:21.400 --> 0:20:25.359
<v Speaker 1>term like delayed responses, as well as the rest of

0:20:25.400 --> 0:20:30.679
<v Speaker 1>those inflammatory stuffs are floating around our body. That's the

0:20:30.760 --> 0:20:32.000
<v Speaker 1>actual allergic reaction.

0:20:33.080 --> 0:20:43.280
<v Speaker 3>Okay, okay, question, what's your question? So IgE is involved

0:20:43.359 --> 0:20:47.720
<v Speaker 3>in this allergic pathway and also parasites, But you know,

0:20:48.200 --> 0:20:50.880
<v Speaker 3>you'll get there. We'll get there. Yeah, But there are

0:20:51.040 --> 0:20:54.640
<v Speaker 3>so many different types of antibodies. So is IgE generally

0:20:54.960 --> 0:21:01.040
<v Speaker 3>associated with this speedy, almost immediate response and the other

0:21:02.040 --> 0:21:07.400
<v Speaker 3>antibodies like, why what do they do? Not to turn

0:21:07.400 --> 0:21:10.360
<v Speaker 3>listen to an immunology episode, but what do they do?

0:21:10.720 --> 0:21:14.480
<v Speaker 1>Yeah? So all antibodies are serving as ways to quickly

0:21:14.680 --> 0:21:20.160
<v Speaker 1>identify and respond to very specific antigens. Right, So each

0:21:20.440 --> 0:21:23.960
<v Speaker 1>different antibody we have like bajillions of antibodies in our body,

0:21:24.520 --> 0:21:28.159
<v Speaker 1>all of them are responding to one specific protein or

0:21:28.200 --> 0:21:31.400
<v Speaker 1>one specific carbohydrate or whatever. It is, one specific thing.

0:21:32.840 --> 0:21:36.200
<v Speaker 1>But things like IgG antibodies the way that I think

0:21:36.240 --> 0:21:39.239
<v Speaker 1>of them, and immunologists might tell me this is not

0:21:39.359 --> 0:21:40.960
<v Speaker 1>a great way to conceptualize it, but the way that

0:21:41.000 --> 0:21:43.520
<v Speaker 1>I think of them is they're more like a flag.

0:21:43.960 --> 0:21:47.479
<v Speaker 1>So they attach on they find like a bacteria or something,

0:21:47.520 --> 0:21:50.560
<v Speaker 1>and they attach themselves to it, and then our other

0:21:50.600 --> 0:21:53.800
<v Speaker 1>immune cells as they're floating around, they see that flag,

0:21:53.880 --> 0:21:57.760
<v Speaker 1>that IgG flag before they see the bacteria, and they're like, oh, hey, guys,

0:21:57.800 --> 0:22:01.080
<v Speaker 1>that's an antibody flag, so we should find that thing, right,

0:22:01.119 --> 0:22:03.119
<v Speaker 1>and then they can go and find all the bacteria

0:22:03.160 --> 0:22:06.159
<v Speaker 1>that have all these flags on them. The difference with

0:22:06.240 --> 0:22:10.720
<v Speaker 1>IgE is that it's not just a flag. It's attached.

0:22:10.720 --> 0:22:13.440
<v Speaker 1>It's not free floating. It sometimes can be, but it's

0:22:13.440 --> 0:22:17.160
<v Speaker 1>not free floating in our bloodstream. It's attached to these cells.

0:22:17.600 --> 0:22:21.600
<v Speaker 1>And something about the process of when that antibody that's

0:22:21.600 --> 0:22:25.919
<v Speaker 1>attached to a cell attaches to its antigen that we

0:22:26.000 --> 0:22:29.479
<v Speaker 1>call allergens. In the case of allergies, it triggers this

0:22:29.600 --> 0:22:34.760
<v Speaker 1>response in the mass cell itself that causes an explosion

0:22:35.080 --> 0:22:39.400
<v Speaker 1>of the inflammatory stuff that's inside of that mass cell.

0:22:39.680 --> 0:22:42.040
<v Speaker 1>And we don't see that with other types of antibodies

0:22:42.040 --> 0:22:45.480
<v Speaker 1>because they're not bound to cells. So it's like a

0:22:45.600 --> 0:22:48.719
<v Speaker 1>longer process, even though it's all much quicker than like

0:22:49.160 --> 0:22:52.080
<v Speaker 1>making the antibodies the first time that you're ever exposed

0:22:52.119 --> 0:22:52.920
<v Speaker 1>to something.

0:22:52.880 --> 0:22:56.879
<v Speaker 3>And compared to IgE, is the response to other types

0:22:56.920 --> 0:23:03.200
<v Speaker 3>of antibodies generally speaking, more directed, more precise, or is

0:23:03.240 --> 0:23:08.399
<v Speaker 3>it also the systemic sort of like just again scorched earth?

0:23:08.480 --> 0:23:11.600
<v Speaker 3>I think is the phrase that I used in Alpha gal.

0:23:12.119 --> 0:23:14.399
<v Speaker 1>Yeah, that's a really it's a really good question. I

0:23:14.440 --> 0:23:20.399
<v Speaker 1>think it's tough because the antibody response itself, even in

0:23:20.440 --> 0:23:24.240
<v Speaker 1>the case of IgE, it is very highly specific, right,

0:23:24.359 --> 0:23:29.120
<v Speaker 1>like your IgE is only attaching to cat dander protein. Yeah,

0:23:29.440 --> 0:23:32.959
<v Speaker 1>but yes, because you have this then immediate release of

0:23:33.040 --> 0:23:38.280
<v Speaker 1>all these general inflammatory stuff, you see a quicker onset

0:23:38.320 --> 0:23:43.159
<v Speaker 1>of a more widespread reaction than you would potentially with

0:23:43.359 --> 0:23:47.280
<v Speaker 1>other antibodies because you just don't have that. It doesn't

0:23:47.320 --> 0:23:50.360
<v Speaker 1>mean that you don't have like a widespread immune response

0:23:50.440 --> 0:23:53.119
<v Speaker 1>in other scenarios, because we definitely can. That's how you

0:23:53.119 --> 0:23:55.959
<v Speaker 1>could end up with like sepsis from a bacterial infection

0:23:56.000 --> 0:23:59.359
<v Speaker 1>and blah blah blah. But yeah, that's it is not

0:24:00.760 --> 0:24:05.040
<v Speaker 1>that same antibodies kind of causing the problem here, I

0:24:05.040 --> 0:24:07.720
<v Speaker 1>guess is the way that you can think of it, right, Right,

0:24:08.720 --> 0:24:11.320
<v Speaker 1>it's just bizarre, it is. It's a really weird and

0:24:11.400 --> 0:24:13.480
<v Speaker 1>interesting especially like I know you're going to talk erin

0:24:13.480 --> 0:24:15.879
<v Speaker 1>about the kind of evolution of this, and like it

0:24:15.960 --> 0:24:19.879
<v Speaker 1>is really really interesting and weird to think about why

0:24:19.920 --> 0:24:25.080
<v Speaker 1>we evolved this type of response. It's really interesting.

0:24:25.080 --> 0:24:27.479
<v Speaker 3>Especially when it seems like it can come at a

0:24:27.520 --> 0:24:31.280
<v Speaker 3>great cost. It can when it kind of runs away.

0:24:31.359 --> 0:24:36.280
<v Speaker 3>So what right, there's such a huge range of allergic responses, right,

0:24:36.359 --> 0:24:38.840
<v Speaker 3>it can just be like it she knows, it can

0:24:38.880 --> 0:24:43.679
<v Speaker 3>be coughing, it can be whatever, Like, yeah, what determines

0:24:43.760 --> 0:24:47.879
<v Speaker 3>whether the response to an allergen is mild versus extreme

0:24:48.160 --> 0:24:49.360
<v Speaker 3>all the way to anaphylaxis.

0:24:49.560 --> 0:24:51.880
<v Speaker 1>So let's talk about what the different responses can be,

0:24:51.880 --> 0:24:55.760
<v Speaker 1>because we are talking really generally about this big picture

0:24:55.840 --> 0:24:58.879
<v Speaker 1>allergic response and the symptoms that you're going to get

0:24:59.480 --> 0:25:03.240
<v Speaker 1>will in large part depend on the type of allergen

0:25:03.280 --> 0:25:07.280
<v Speaker 1>that you're exposed to and how you are exposed. So

0:25:07.480 --> 0:25:10.879
<v Speaker 1>if it's a cat dander protein, for example, or even

0:25:11.000 --> 0:25:14.000
<v Speaker 1>like a ragweed pollen or a dust mite or cockroach

0:25:14.080 --> 0:25:17.359
<v Speaker 1>leg fuzz or whatever, then you are being exposed to

0:25:17.400 --> 0:25:21.080
<v Speaker 1>these arrow allergens, right, so you are breathing them in

0:25:21.160 --> 0:25:24.119
<v Speaker 1>for the most part. So then where you're going to

0:25:24.160 --> 0:25:29.639
<v Speaker 1>get this inflammation from this immune activation might largely be

0:25:29.880 --> 0:25:33.119
<v Speaker 1>in say your nose, So you might have an itchy nose,

0:25:33.160 --> 0:25:35.520
<v Speaker 1>you might have sneezing, you might get a runny nose.

0:25:35.840 --> 0:25:38.480
<v Speaker 1>Maybe your eyes will start to itch or water because

0:25:38.520 --> 0:25:41.280
<v Speaker 1>the cat dander is getting into your mucous membranes in

0:25:41.320 --> 0:25:45.600
<v Speaker 1>your eyes and triggering inflammation in your eyes. If, on

0:25:45.600 --> 0:25:47.880
<v Speaker 1>the other hand, we're not talking about an arrow allergen,

0:25:47.960 --> 0:25:50.879
<v Speaker 1>maybe we're talking about something like a peanut protein or

0:25:50.920 --> 0:25:53.760
<v Speaker 1>a soybean protein, or a wheat protein, you're eating that,

0:25:54.440 --> 0:25:57.760
<v Speaker 1>So then you're being exposed through your gut mucus membranes

0:25:57.960 --> 0:26:00.520
<v Speaker 1>or maybe through your mouth because they're there's a whole

0:26:00.560 --> 0:26:04.000
<v Speaker 1>thing called oral allergy syndrome where you have this type

0:26:04.000 --> 0:26:09.480
<v Speaker 1>of itching, watering, numbness, tingling just in your mouth, but

0:26:09.640 --> 0:26:12.560
<v Speaker 1>if it makes it down into your guts before you're

0:26:12.600 --> 0:26:18.560
<v Speaker 1>having allergy response, then maybe you're having nausea, you're having vomiting.

0:26:19.240 --> 0:26:22.679
<v Speaker 1>So it depends in part in the way that you're exposed.

0:26:22.920 --> 0:26:25.200
<v Speaker 1>Is it through your respiratory system, is it through your

0:26:25.200 --> 0:26:28.199
<v Speaker 1>gi tract? Is it limited to one mucous membrane like

0:26:28.200 --> 0:26:31.720
<v Speaker 1>your mouth or your eyes. But then there's more than that,

0:26:31.840 --> 0:26:36.280
<v Speaker 1>right because while this is in some ways a localized exposure,

0:26:36.720 --> 0:26:40.760
<v Speaker 1>unless it's through your skin, then it is still a

0:26:40.920 --> 0:26:45.399
<v Speaker 1>systemic response. So in any of these cases, in any

0:26:45.400 --> 0:26:48.040
<v Speaker 1>way that you're exposed through your skin, through your eyes,

0:26:48.080 --> 0:26:52.320
<v Speaker 1>through your guts, you can also see skin manifestations, and

0:26:52.400 --> 0:26:55.840
<v Speaker 1>most classically in allergies will see these as like wheels

0:26:55.920 --> 0:27:02.119
<v Speaker 1>or hives. And hives are those red raised, usually irregular shaped,

0:27:02.200 --> 0:27:06.719
<v Speaker 1>kind of puffy splotches, and you can see those sometimes

0:27:06.760 --> 0:27:10.600
<v Speaker 1>where you're exposed like if you are eating something that

0:27:10.640 --> 0:27:13.239
<v Speaker 1>you're allergic to, you might start with hives around the

0:27:13.240 --> 0:27:16.880
<v Speaker 1>face or the mouth, but very often and very quickly,

0:27:16.920 --> 0:27:20.919
<v Speaker 1>they can become generalized. It might start with say, puffiness

0:27:20.960 --> 0:27:24.280
<v Speaker 1>around a beasting, but then spread to be hives across

0:27:24.280 --> 0:27:27.719
<v Speaker 1>your whole body. And those kind of skin reactions can

0:27:27.760 --> 0:27:30.679
<v Speaker 1>happen from any allergies. They can happen from cat dander

0:27:30.680 --> 0:27:34.680
<v Speaker 1>allergies and from peanut allergies. And then you mentioned already aaron.

0:27:34.760 --> 0:27:37.320
<v Speaker 1>The most severe thing that can happen with an allergic

0:27:37.359 --> 0:27:41.760
<v Speaker 1>reaction is anaphylaxis. And just like the idea of allergies,

0:27:41.840 --> 0:27:47.000
<v Speaker 1>the definition of anaphylaxis, it's not one perfect universal definition,

0:27:47.840 --> 0:27:51.679
<v Speaker 1>but mostly we think of anaphylaxis as when in the

0:27:51.720 --> 0:27:54.400
<v Speaker 1>case of allergies at least, because you can get anaphylaxis

0:27:54.400 --> 0:27:59.000
<v Speaker 1>without allergies. But it's when an allergic response is affecting

0:27:59.280 --> 0:28:05.080
<v Speaker 1>multiple systems and becomes very extreme. So it's when these

0:28:05.240 --> 0:28:08.679
<v Speaker 1>mast cells and our baso fills are sending out so

0:28:09.000 --> 0:28:13.560
<v Speaker 1>much inflammatory material that our whole body's immune system starts

0:28:13.560 --> 0:28:19.320
<v Speaker 1>to react. What this causes is massive vasodilation, so your

0:28:19.320 --> 0:28:22.000
<v Speaker 1>blood vessels are getting really wide, and that makes sense

0:28:22.440 --> 0:28:27.080
<v Speaker 1>because these immune markers are telling your body, hey, there's

0:28:27.119 --> 0:28:30.160
<v Speaker 1>something big going on. Send us all your blood, Send

0:28:30.240 --> 0:28:32.040
<v Speaker 1>all of the white blood cells, send all of the

0:28:32.080 --> 0:28:35.960
<v Speaker 1>blood to us. So vasodilation sends all of your blood

0:28:36.040 --> 0:28:40.880
<v Speaker 1>different places. But that also causes swelling in part because

0:28:40.960 --> 0:28:44.640
<v Speaker 1>when our vessels expand, they get more leaky, so fluid

0:28:44.760 --> 0:28:47.040
<v Speaker 1>is going to leak out. And if you get that

0:28:47.240 --> 0:28:50.120
<v Speaker 1>swelling in a place like your throat or your mouth

0:28:50.200 --> 0:28:53.360
<v Speaker 1>or your lungs, it can make it really difficult to breathe.

0:28:53.480 --> 0:28:57.560
<v Speaker 1>That's why anaphylaxis, when it causes that throat constriction, is

0:28:57.560 --> 0:29:01.280
<v Speaker 1>a severe, life threatening emergency. It can also be life

0:29:01.280 --> 0:29:05.640
<v Speaker 1>threatening because when our blood vessels expand, that causes a

0:29:05.760 --> 0:29:08.320
<v Speaker 1>drop in blood pressure because your blood vessels are now

0:29:08.360 --> 0:29:11.480
<v Speaker 1>wide open, and because of physics, when you have a

0:29:11.520 --> 0:29:14.040
<v Speaker 1>pipe that's wider, the pressure inside it is going to

0:29:14.040 --> 0:29:17.480
<v Speaker 1>be lower, and that again is a life threatening emergency

0:29:17.480 --> 0:29:20.920
<v Speaker 1>if your blood pressure drops really quickly. So that is

0:29:20.960 --> 0:29:24.920
<v Speaker 1>like the ways that allergies can manifest right, And it's

0:29:25.240 --> 0:29:28.320
<v Speaker 1>such a huge range and so many different ways that

0:29:28.360 --> 0:29:31.480
<v Speaker 1>you can be exposed, which can cause like any in

0:29:31.560 --> 0:29:38.440
<v Speaker 1>all of these But why I have so many questions

0:29:40.240 --> 0:29:47.640
<v Speaker 1>because first, why do some allergens trigger, say, anaphylaxis more

0:29:47.680 --> 0:29:50.080
<v Speaker 1>commonly than other allergens? Yeah?

0:29:50.200 --> 0:29:51.880
<v Speaker 3>What are those bees?

0:29:52.480 --> 0:29:55.720
<v Speaker 1>I mean utter is the most classic, right, and a

0:29:55.760 --> 0:29:59.680
<v Speaker 1>lot of times it is the food allergies that like

0:29:59.760 --> 0:30:03.280
<v Speaker 1>tree nuts, peanuts, things like that, that are even more likely.

0:30:03.840 --> 0:30:06.800
<v Speaker 1>But people can absolutely beastings or another one. Venoms in

0:30:06.880 --> 0:30:10.760
<v Speaker 1>general really commonly cause anaphylaxis. It doesn't mean that you

0:30:10.880 --> 0:30:13.800
<v Speaker 1>can't have an anaphylactic reaction to something like cat dander.

0:30:13.800 --> 0:30:16.840
<v Speaker 1>There are absolutely people who have severe reactions to something

0:30:16.920 --> 0:30:20.480
<v Speaker 1>like cat dander. But I don't know. I do not

0:30:20.720 --> 0:30:23.520
<v Speaker 1>know the answer to that question. And that was something

0:30:23.600 --> 0:30:27.600
<v Speaker 1>that I have so many papers, and none of them

0:30:28.160 --> 0:30:31.640
<v Speaker 1>really even tried to answer that question. What is it

0:30:31.680 --> 0:30:36.400
<v Speaker 1>about particular allergens that are more likely to cause a

0:30:36.480 --> 0:30:38.520
<v Speaker 1>severe reaction versus a less severe reaction?

0:30:38.680 --> 0:30:42.400
<v Speaker 3>I don't know, right, But then it also is individual differences.

0:30:42.720 --> 0:30:45.200
<v Speaker 3>That's like the genetic component of allergies.

0:30:45.440 --> 0:30:45.640
<v Speaker 2>Right.

0:30:45.920 --> 0:30:48.200
<v Speaker 1>So that's the other big question, right, It's why some

0:30:48.360 --> 0:30:52.479
<v Speaker 1>allergens and why some people? Why do some people develop

0:30:52.520 --> 0:30:56.880
<v Speaker 1>allergies and other people don't? And we still don't know,

0:30:56.960 --> 0:30:59.400
<v Speaker 1>but we have a lot more information at least about

0:30:59.440 --> 0:31:20.200
<v Speaker 1>that part of the question. All allergies are really both

0:31:20.480 --> 0:31:24.880
<v Speaker 1>environmental and genetic diseases, so you have to have a

0:31:25.000 --> 0:31:29.680
<v Speaker 1>certain genetic susceptibility in order to develop allergies to begin with.

0:31:30.880 --> 0:31:33.760
<v Speaker 1>But that doesn't mean there's a single gene or a

0:31:33.800 --> 0:31:37.120
<v Speaker 1>couple of genes, or even like a few genes. There's

0:31:37.200 --> 0:31:42.520
<v Speaker 1>like bajillions. That's an exaggeration, but there's a really wide

0:31:42.640 --> 0:31:45.360
<v Speaker 1>range of genes that are associated with an increased risk

0:31:45.400 --> 0:31:48.719
<v Speaker 1>of allergies, and for the most part, we don't know

0:31:49.360 --> 0:31:51.960
<v Speaker 1>what they are or how they work, Like why do

0:31:52.080 --> 0:31:55.040
<v Speaker 1>these genes that we might see in association with allergies

0:31:55.400 --> 0:31:58.880
<v Speaker 1>do they cause allergies? Or why is there that association.

0:31:58.840 --> 0:32:02.920
<v Speaker 3>Right and allergies? Or is it the degree of your

0:32:03.040 --> 0:32:09.960
<v Speaker 3>reaction or is it which allergies or is it yeah, yeah.

0:32:08.640 --> 0:32:10.960
<v Speaker 1>And in all of the literature, a thing that I

0:32:10.960 --> 0:32:13.920
<v Speaker 1>want to get into, even though I already regret it,

0:32:14.000 --> 0:32:16.800
<v Speaker 1>is that one of the biggest known risk factors for

0:32:17.000 --> 0:32:20.880
<v Speaker 1>allergies is this idea of something called a topy.

0:32:21.280 --> 0:32:23.400
<v Speaker 3>I had such a hard time wrapping my head around this.

0:32:23.680 --> 0:32:26.760
<v Speaker 1>I know and you and we can't not talk about it.

0:32:26.800 --> 0:32:30.680
<v Speaker 1>So I'm going to try so a topic diseases, this

0:32:30.800 --> 0:32:36.000
<v Speaker 1>idea of an atopic disease. It includes asthma, egzema or

0:32:36.040 --> 0:32:40.880
<v Speaker 1>atopic dermatitis, and allergies, which includes all of our allergies,

0:32:40.920 --> 0:32:44.320
<v Speaker 1>so food allergies, allergic rhinitis or like hay fever, those

0:32:44.320 --> 0:32:49.120
<v Speaker 1>seasonal allergies, all of that, and the word a topy

0:32:49.280 --> 0:32:53.720
<v Speaker 1>or atopic, it's like, it's not specific. It doesn't like

0:32:54.040 --> 0:32:57.720
<v Speaker 1>that word in and of itself anymore doesn't really mean much,

0:32:57.840 --> 0:33:00.640
<v Speaker 1>and some people mean it to mean this type of

0:33:00.680 --> 0:33:05.600
<v Speaker 1>IgE response, but it's not that simple. But the point

0:33:05.640 --> 0:33:09.120
<v Speaker 1>of it is is that these big four diseases, and

0:33:09.160 --> 0:33:11.480
<v Speaker 1>there might be a couple others that probably are under

0:33:11.480 --> 0:33:16.080
<v Speaker 1>this umbrella, but like eggzema, asthma, allergic rhinitis, and food allergy,

0:33:16.080 --> 0:33:19.760
<v Speaker 1>if you think of these big ones, there is something

0:33:19.840 --> 0:33:23.400
<v Speaker 1>about them that links them all together. And we think

0:33:23.600 --> 0:33:28.120
<v Speaker 1>that part of it might be an underlying genetic susceptibility

0:33:28.600 --> 0:33:32.480
<v Speaker 1>that makes someone more susceptible to all of these at once.

0:33:33.680 --> 0:33:36.760
<v Speaker 1>But really, in a lot of the literature it's described

0:33:36.800 --> 0:33:40.720
<v Speaker 1>as this a topic march. You probably saw that in papers,

0:33:41.800 --> 0:33:46.440
<v Speaker 1>and that's because when we see these four diseases develop

0:33:46.520 --> 0:33:50.360
<v Speaker 1>through life. There's often a progression from one to the

0:33:50.360 --> 0:33:53.920
<v Speaker 1>next to the next, and there's a lot of different

0:33:53.920 --> 0:33:56.400
<v Speaker 1>theories as to why that is and what is this

0:33:56.520 --> 0:34:00.680
<v Speaker 1>relationship between these four big diseases. So I'm going to

0:34:00.760 --> 0:34:04.080
<v Speaker 1>go over what like the thoughts are about what the

0:34:04.120 --> 0:34:08.360
<v Speaker 1>relationship is here. So one suggestion is that it's allergens

0:34:08.520 --> 0:34:11.719
<v Speaker 1>that cause all of this, and it starts by allergens

0:34:11.880 --> 0:34:15.959
<v Speaker 1>causing atopic dermatitis or exema, which is usually the first

0:34:15.960 --> 0:34:18.719
<v Speaker 1>thing that we see, like even in tiny babies who

0:34:18.800 --> 0:34:22.719
<v Speaker 1>don't have asthma and they don't have any food allergies

0:34:22.800 --> 0:34:26.520
<v Speaker 1>yet or anything, they have exema first thing. And so

0:34:26.719 --> 0:34:30.520
<v Speaker 1>one hypothesis is that you start by getting exposed and

0:34:30.680 --> 0:34:36.400
<v Speaker 1>sensitized to certain allergens and first develop atopic dermatitis or exzema,

0:34:36.880 --> 0:34:40.240
<v Speaker 1>and then down the line, because you have been exposed

0:34:40.280 --> 0:34:43.880
<v Speaker 1>and sensitized, you then might develop asthma or other allergies

0:34:44.080 --> 0:34:47.279
<v Speaker 1>as a result of this allergen exposure. That's one hypothesis.

0:34:48.360 --> 0:34:52.799
<v Speaker 1>Another one that people seem to really really like is

0:34:52.840 --> 0:34:58.480
<v Speaker 1>that exema is the start of this. An exema causes

0:34:58.560 --> 0:35:03.440
<v Speaker 1>breakdown in the skin barrier, and this breakdown allows for

0:35:03.560 --> 0:35:11.480
<v Speaker 1>allergen exposure through the skin and that and I like

0:35:11.600 --> 0:35:13.880
<v Speaker 1>this too, in part because of we've already talked about

0:35:13.880 --> 0:35:16.759
<v Speaker 1>on our Alpha gal episode, the idea that when you

0:35:16.840 --> 0:35:20.560
<v Speaker 1>are exposed to something in an abnormal way i e.

0:35:20.719 --> 0:35:25.799
<v Speaker 1>Through breaks in your skin, that that exposure is what

0:35:25.840 --> 0:35:29.960
<v Speaker 1>predisposes you to this abnormal immune response i e. The

0:35:30.000 --> 0:35:35.080
<v Speaker 1>development of allergies. So that's one hypothesis. And then there's

0:35:35.120 --> 0:35:38.400
<v Speaker 1>a third hypothesis, which is that there's not necessarily a

0:35:38.520 --> 0:35:43.359
<v Speaker 1>causal relationship between exema and allergies and asthma, but rather

0:35:43.560 --> 0:35:48.839
<v Speaker 1>there's an underlying genetic or immunologic pathway that kind of

0:35:48.880 --> 0:35:51.200
<v Speaker 1>pins them all together, and EXAMA just happens to be

0:35:51.239 --> 0:35:54.720
<v Speaker 1>the first one that we see. Right, none of these

0:35:54.960 --> 0:36:00.400
<v Speaker 1>three hypotheses are mutually exclusive, and none of them like

0:36:00.640 --> 0:36:03.759
<v Speaker 1>fully explain the story, right, because there are plenty of

0:36:03.760 --> 0:36:06.239
<v Speaker 1>people with egzma who don't have any other allergies, plenty

0:36:06.239 --> 0:36:09.440
<v Speaker 1>of people with allergies who never had egzma. Asthma oof

0:36:09.680 --> 0:36:13.000
<v Speaker 1>really doesn't fit well into this story, even though there

0:36:13.040 --> 0:36:17.799
<v Speaker 1>are really strong relationships between allergic rhinitis and allergic asthma.

0:36:17.960 --> 0:36:21.040
<v Speaker 3>It's really interesting and I kind of like the idea

0:36:21.160 --> 0:36:25.759
<v Speaker 3>of just the threshold being lowered for that pathway to

0:36:25.840 --> 0:36:29.719
<v Speaker 3>be exaccuated where it's right, oh, you know on once

0:36:29.760 --> 0:36:31.960
<v Speaker 3>it's down, once you travel down that road once, it's

0:36:32.000 --> 0:36:34.520
<v Speaker 3>so easy to go back down that road over and over.

0:36:34.400 --> 0:36:38.360
<v Speaker 1>Again, exactly exactly. And these are not the only hypotheses.

0:36:38.400 --> 0:36:40.840
<v Speaker 1>There's a lot of other ideas as to like what

0:36:41.440 --> 0:36:44.799
<v Speaker 1>ends up causing or what are the risks that are

0:36:45.360 --> 0:36:49.000
<v Speaker 1>contributing to the development of allergies. A lot of it

0:36:49.080 --> 0:36:53.800
<v Speaker 1>might be like environmental exposures starting as early as in utero,

0:36:54.560 --> 0:36:58.920
<v Speaker 1>causing things like DNA methylation or these like epigenetic changes

0:36:59.160 --> 0:37:05.239
<v Speaker 1>that change our susceptibility to asthma, allergies, et cetera. Then

0:37:05.280 --> 0:37:11.120
<v Speaker 1>we also can think of the microbiomes, how does that

0:37:11.200 --> 0:37:16.319
<v Speaker 1>affect our risk of allergies asthma et cetera. We don't know, right,

0:37:16.960 --> 0:37:18.759
<v Speaker 1>but we know that all of these things and I

0:37:18.800 --> 0:37:20.360
<v Speaker 1>know erin you're going to talk more about this, I

0:37:20.400 --> 0:37:24.319
<v Speaker 1>swear I'm almost done. We know that all of these

0:37:24.320 --> 0:37:30.520
<v Speaker 1>things contribute. We just don't understand how, which means that

0:37:30.560 --> 0:37:32.560
<v Speaker 1>we don't yet know how do we prevent all of this?

0:37:32.760 --> 0:37:35.319
<v Speaker 1>And that is like next episode we'll talk a lot

0:37:35.360 --> 0:37:37.480
<v Speaker 1>more about that idea, because that's like where a lot

0:37:37.520 --> 0:37:39.239
<v Speaker 1>of the future research is going.

0:37:39.960 --> 0:37:46.480
<v Speaker 3>And there may not be I think, one unifying cause right, like,

0:37:46.760 --> 0:37:49.080
<v Speaker 3>because one of the questions that I had when when

0:37:49.120 --> 0:37:52.480
<v Speaker 3>reading about these allergies and just like in general life,

0:37:52.600 --> 0:37:56.280
<v Speaker 3>is some people develop allergies at a very young age

0:37:56.480 --> 0:37:58.680
<v Speaker 3>and those allergies stay with them for the rest of

0:37:58.719 --> 0:38:02.440
<v Speaker 3>their lives. People develop allergies at a very young age

0:38:02.520 --> 0:38:06.799
<v Speaker 3>and then over time they no longer have those allergies.

0:38:06.520 --> 0:38:09.920
<v Speaker 1>And that's most true for food allergies. Yes, So it's

0:38:09.960 --> 0:38:12.360
<v Speaker 1>also really interesting to think about, like when are you

0:38:12.440 --> 0:38:15.840
<v Speaker 1>more likely to develop what type of allergy? Because food

0:38:15.840 --> 0:38:19.320
<v Speaker 1>allergies you're more likely to start developing when you're younger.

0:38:20.400 --> 0:38:23.040
<v Speaker 1>Allergic rhinitis usually not till you're older.

0:38:24.480 --> 0:38:28.000
<v Speaker 3>But then yeah, some people can develop food allergies later

0:38:28.040 --> 0:38:31.880
<v Speaker 3>in life. I have several friends who developed food allergies

0:38:31.920 --> 0:38:32.800
<v Speaker 3>in their thirties.

0:38:33.080 --> 0:38:38.600
<v Speaker 1>Yeah, and like what yah, Well, and food allergies also,

0:38:38.640 --> 0:38:41.640
<v Speaker 1>I think gets so much more confusing because there's also

0:38:41.760 --> 0:38:46.480
<v Speaker 1>a lot of other food intolerances or sensitivities that some

0:38:46.520 --> 0:38:50.319
<v Speaker 1>people might classify as allergies and other people would not

0:38:50.480 --> 0:38:54.040
<v Speaker 1>classify as allergies. So a really good example of this

0:38:54.120 --> 0:38:57.760
<v Speaker 1>is something called f PIES, which stands for food protein

0:38:57.880 --> 0:39:02.640
<v Speaker 1>induced enterocolitis syndrome. And this is on a lot of

0:39:02.680 --> 0:39:06.640
<v Speaker 1>like allergy websites, classified as an allergy, but it is

0:39:06.719 --> 0:39:11.279
<v Speaker 1>not an IgE mediated response. But it causes severe like

0:39:11.400 --> 0:39:15.800
<v Speaker 1>vomiting diarrhea sometimes bloody diarrhea in babies that are exposed

0:39:15.840 --> 0:39:19.080
<v Speaker 1>to certain foods, and most kids outgrow this, and then

0:39:19.200 --> 0:39:21.520
<v Speaker 1>in adults there's a lot of different ways that you

0:39:21.560 --> 0:39:25.600
<v Speaker 1>could become intolerant of different foods, some of which might

0:39:25.640 --> 0:39:29.520
<v Speaker 1>be igmediated and some of which are definitely not IgE mediated.

0:39:30.400 --> 0:39:33.880
<v Speaker 1>And so that's where what I said, Like, the deeper

0:39:33.880 --> 0:39:36.200
<v Speaker 1>you get into the weeds, like what's an allergy? What's

0:39:36.239 --> 0:39:41.200
<v Speaker 1>not an allergy, it can get confusing. So, yeah, allergies

0:39:41.239 --> 0:39:48.200
<v Speaker 1>are very interesting. Erin tell me, Yeah, why can I

0:39:48.200 --> 0:39:48.560
<v Speaker 1>ask you?

0:39:48.600 --> 0:39:51.680
<v Speaker 3>Why you can ask? Okay, let's see if I can

0:39:51.719 --> 0:40:21.600
<v Speaker 3>answer right after this break. Allergies are so ubiquitous these

0:40:21.680 --> 0:40:25.520
<v Speaker 3>days that we don't often stop to think about just

0:40:25.800 --> 0:40:30.319
<v Speaker 3>how weird they are. Like, here's this extreme thing our

0:40:30.360 --> 0:40:34.800
<v Speaker 3>body does in reaction to a seemingly innocuous substance like pollen,

0:40:35.120 --> 0:40:39.520
<v Speaker 3>like a peanut and that reaction can at times kill us. Yep,

0:40:39.719 --> 0:40:42.800
<v Speaker 3>it's not the peanut or the shrimp itself doing the harm.

0:40:43.120 --> 0:40:46.960
<v Speaker 3>It's how our body responds that inflicts the damage friendly fire,

0:40:47.680 --> 0:40:51.480
<v Speaker 3>whether it's seasonal allergies to ragweed, environmental allergies like to

0:40:51.640 --> 0:40:54.879
<v Speaker 3>cat dander, food allergies like to tree nuts, or some

0:40:54.920 --> 0:40:58.000
<v Speaker 3>other type of allergy. We all know someone who has

0:40:58.040 --> 0:41:01.560
<v Speaker 3>allergies or we have them ourselves, and we wished we didn't,

0:41:01.600 --> 0:41:07.359
<v Speaker 3>at least speaking for myself, at the least, allergies are annoying, disruptive,

0:41:07.680 --> 0:41:11.600
<v Speaker 3>and at the extreme they can be deadly. Why do

0:41:11.719 --> 0:41:15.120
<v Speaker 3>our bodies react in this way? What have almonds ever

0:41:15.160 --> 0:41:19.920
<v Speaker 3>done to us? And on top of that, has it

0:41:20.080 --> 0:41:23.520
<v Speaker 3>always been like this? In this first episode of this

0:41:23.640 --> 0:41:27.120
<v Speaker 3>two parter on allergies, I want to explore those questions,

0:41:27.160 --> 0:41:31.160
<v Speaker 3>the significance of allergies in an evolutionary context, and a

0:41:31.160 --> 0:41:34.000
<v Speaker 3>little bit of how our knowledge of allergy has changed

0:41:34.040 --> 0:41:37.600
<v Speaker 3>over time. Ultimately, I want to try to get at

0:41:37.680 --> 0:41:41.880
<v Speaker 3>whether allergies are increasing infrequency and why that might be

0:41:42.080 --> 0:41:45.239
<v Speaker 3>sort of unifying all of this, and then next week

0:41:45.320 --> 0:41:47.840
<v Speaker 3>I'll pick it back up at how we devised ways

0:41:47.880 --> 0:41:51.520
<v Speaker 3>to deal with the self attack using medications, allergy shots,

0:41:51.520 --> 0:41:56.359
<v Speaker 3>the EpiPen, and so on. Almost universally, allergy or an

0:41:56.400 --> 0:42:01.600
<v Speaker 3>allergic response is described as an overreaction, an exaggerated response

0:42:01.680 --> 0:42:06.360
<v Speaker 3>to an innocuous environmental trigger like pollen, like dustmites, like peanuts.

0:42:07.080 --> 0:42:10.960
<v Speaker 3>Since scientists first characterized allergies in the late eighteen hundreds

0:42:11.040 --> 0:42:15.360
<v Speaker 3>early nineteen hundreds, they referred to the phenomenon as an idiosyncrasy,

0:42:15.880 --> 0:42:20.000
<v Speaker 3>a biological contradiction where our bodies harm us in an

0:42:20.040 --> 0:42:24.160
<v Speaker 3>attempt to protect us. But more recently some researchers have

0:42:24.280 --> 0:42:28.880
<v Speaker 3>called into question two assumptions that underlie this premise of allergy.

0:42:29.680 --> 0:42:34.719
<v Speaker 3>Number one, that this reaction is always an overreaction, and

0:42:34.840 --> 0:42:39.520
<v Speaker 3>number two, that the substances triggering an allergic response are

0:42:39.719 --> 0:42:41.160
<v Speaker 3>truly innocuous.

0:42:41.360 --> 0:42:44.480
<v Speaker 1>Oh, I can't tell you how excited I am about this.

0:42:44.800 --> 0:42:48.480
<v Speaker 1>I read I'm a full disclosure. I read one paper

0:42:48.840 --> 0:42:52.239
<v Speaker 1>that talked about some of the evolutionary hypothesis of the

0:42:52.280 --> 0:42:54.520
<v Speaker 1>worms and things that I was like, this is my

0:42:54.680 --> 0:42:58.239
<v Speaker 1>favorite thing I have ever. Yeah, because you're right, like,

0:42:58.360 --> 0:43:00.320
<v Speaker 1>that is the that is an underlie I said it

0:43:00.360 --> 0:43:02.520
<v Speaker 1>at the very top, this is how we define an allergy.

0:43:02.880 --> 0:43:06.000
<v Speaker 1>And those assumptions no one that I have read or

0:43:06.040 --> 0:43:11.600
<v Speaker 1>spoken with has ever questioned, and I love questioning it.

0:43:11.600 --> 0:43:15.040
<v Speaker 3>It's important, right, Like, yeah, maybe it is an overreaction,

0:43:15.200 --> 0:43:19.720
<v Speaker 3>and it is in some certain situations, like definitely an overreaction,

0:43:19.920 --> 0:43:22.440
<v Speaker 3>as in, it is out of proportion to the threat

0:43:22.480 --> 0:43:26.160
<v Speaker 3>that whatever that thing causes. Right, but maybe not all

0:43:26.320 --> 0:43:27.839
<v Speaker 3>of the time.

0:43:27.840 --> 0:43:30.440
<v Speaker 1>Right, right, There is a there has to be a

0:43:30.480 --> 0:43:35.000
<v Speaker 1>reason that that response exists, exactly, So just calling it

0:43:35.040 --> 0:43:38.320
<v Speaker 1>a straight overreaction makes our immune system seem dumb.

0:43:39.760 --> 0:43:46.480
<v Speaker 3>Right, a little overprotective, like stop helicopter. Yeah, allergies are

0:43:46.520 --> 0:43:49.840
<v Speaker 3>incredibly widespread, and they have grown in prevalence over the

0:43:49.880 --> 0:43:53.560
<v Speaker 3>past century. More on that later. They're so widespread that

0:43:53.600 --> 0:43:57.160
<v Speaker 3>it's difficult to just discard them as a quirk of

0:43:57.200 --> 0:44:00.239
<v Speaker 3>the immune system, as our immune system being dumb, as

0:44:00.400 --> 0:44:05.399
<v Speaker 3>just an overreaction with no benefit to that overreaction. As

0:44:05.400 --> 0:44:09.000
<v Speaker 3>we all know, an extreme allergic reaction can be deadly.

0:44:09.560 --> 0:44:13.400
<v Speaker 3>And while maybe that reaction is just a peculiar aspect

0:44:13.560 --> 0:44:16.560
<v Speaker 3>of our immune system, might it also be that there's

0:44:16.600 --> 0:44:21.239
<v Speaker 3>a very good reason that we still possess it. And importantly,

0:44:21.560 --> 0:44:25.680
<v Speaker 3>are those two scenarios mutually exclusive? Or is it both

0:44:25.719 --> 0:44:29.160
<v Speaker 3>a quirk and an advantage. Since the early days of

0:44:29.200 --> 0:44:32.520
<v Speaker 3>allergy research in the first decades of the twentieth century,

0:44:32.719 --> 0:44:37.040
<v Speaker 3>allergies were labeled a modern disease, a quote unquote pathology

0:44:37.120 --> 0:44:41.239
<v Speaker 3>of progress, the natural consequence of us living what was

0:44:41.280 --> 0:44:47.080
<v Speaker 3>perceived to be increasingly unnatural lives, sedentary lifestyles, spending large

0:44:47.080 --> 0:44:51.480
<v Speaker 3>amounts of time indoors, the growth of cities, consuming processed foods,

0:44:51.880 --> 0:44:54.920
<v Speaker 3>using chemicals in the home and the environment, and so on.

0:44:55.920 --> 0:44:58.440
<v Speaker 3>Allergies are not the only disease said to result from

0:44:58.480 --> 0:45:02.520
<v Speaker 3>industrialization and develop If you remember back to our gout episode,

0:45:02.600 --> 0:45:07.200
<v Speaker 3>that was another one. Yeah, And in the case of allergies,

0:45:07.480 --> 0:45:10.759
<v Speaker 3>there might be something to it. So Aarin you talked

0:45:10.800 --> 0:45:13.440
<v Speaker 3>about how when someone is exposed to an allergen like

0:45:13.480 --> 0:45:17.680
<v Speaker 3>a DustMite, their body begins producing IgE antibodies, which is

0:45:17.719 --> 0:45:21.680
<v Speaker 3>part of what triggers this rapid cascade of symptoms. As

0:45:21.680 --> 0:45:24.719
<v Speaker 3>it turns out, our body ramps up production of IgE

0:45:24.960 --> 0:45:30.919
<v Speaker 3>in response to another external threat helminth parasites, so dust, MTE,

0:45:31.120 --> 0:45:37.359
<v Speaker 3>hookworm very similar initial responses. One major difference, though, is

0:45:37.400 --> 0:45:41.320
<v Speaker 3>in the long term in people who are chronically infected

0:45:41.320 --> 0:45:45.880
<v Speaker 3>with helminth parasites that IgE production eventually scales down and

0:45:45.960 --> 0:45:50.040
<v Speaker 3>the entire inflammatory response is suppressed in part by the

0:45:50.040 --> 0:45:54.120
<v Speaker 3>parasite itself, which allows these parasites to kind of fly

0:45:54.280 --> 0:46:00.480
<v Speaker 3>under the radar. That suppression doesn't happen in an allergic response. Instead,

0:46:00.560 --> 0:46:03.840
<v Speaker 3>it can just ramp up and up and up until anaphylaxis.

0:46:04.760 --> 0:46:09.280
<v Speaker 3>And so, when researchers described IgE antibodies in nineteen sixty

0:46:09.280 --> 0:46:13.680
<v Speaker 3>seven and began linking them to different exposures to things

0:46:13.880 --> 0:46:18.600
<v Speaker 3>like allergies like parasites, a hypothesis emerged that we have

0:46:18.680 --> 0:46:23.600
<v Speaker 3>this exaggerated allergic response and increasing rates of allergies in

0:46:23.680 --> 0:46:29.000
<v Speaker 3>regions where parasitic infections are low because those parasites are

0:46:29.040 --> 0:46:33.520
<v Speaker 3>not suppressing the immune system. So fewer parasites, more allergies,

0:46:34.560 --> 0:46:39.840
<v Speaker 3>and more parasites, fewer allergies. Essentially, the hypothesis goes improved

0:46:39.880 --> 0:46:45.120
<v Speaker 3>sanitation and treatments for parasites reduced exposure to those parasites,

0:46:45.239 --> 0:46:50.240
<v Speaker 3>which makes our board immune system go into overdrive overreacting

0:46:50.280 --> 0:46:54.959
<v Speaker 3>to any stimulus, aka the hygiene hypothesis or the old

0:46:55.000 --> 0:47:00.480
<v Speaker 3>friends hypothesis. Now, this might be part of what's going on,

0:47:01.080 --> 0:47:04.040
<v Speaker 3>because some studies show that regions with higher rates of

0:47:04.120 --> 0:47:09.399
<v Speaker 3>chronic parasite infestation tend to have lower rates of allergy,

0:47:09.480 --> 0:47:14.120
<v Speaker 3>and in experiments using mice, those chronically infected with helmets

0:47:14.320 --> 0:47:21.040
<v Speaker 3>are protected from developing allergies. Pretty compelling evidence. Also, some

0:47:21.080 --> 0:47:24.799
<v Speaker 3>of the genes associated with asthma are also associated with

0:47:24.960 --> 0:47:29.560
<v Speaker 3>increasing susceptibility to some parasite infections, so these genes might

0:47:29.560 --> 0:47:32.879
<v Speaker 3>make you both more likely to develop asthma and more

0:47:32.920 --> 0:47:38.040
<v Speaker 3>susceptible to parasite infections. The hygiene hypothesis does have some

0:47:38.200 --> 0:47:42.319
<v Speaker 3>compelling support when it comes to allergies or allergy like diseases,

0:47:43.239 --> 0:47:47.040
<v Speaker 3>but in recent decades some researchers are starting to question

0:47:47.239 --> 0:47:50.879
<v Speaker 3>whether it's the only thing going on. If you look

0:47:50.920 --> 0:47:54.759
<v Speaker 3>at the vast array of substances that trigger an IgE response,

0:47:55.040 --> 0:47:58.680
<v Speaker 3>only a tiny portion of them are helmets. The rest

0:47:58.840 --> 0:48:06.000
<v Speaker 3>are various nuts, animal products, venoms, chemicals, so very many

0:48:06.040 --> 0:48:10.520
<v Speaker 3>different things that we encounter regularly that are not helmints,

0:48:10.560 --> 0:48:12.360
<v Speaker 3>that are not parasites.

0:48:11.920 --> 0:48:12.880
<v Speaker 1>Not just worms.

0:48:13.400 --> 0:48:18.000
<v Speaker 3>Yeah, if the IgE response evolved in response to helminth

0:48:18.120 --> 0:48:22.839
<v Speaker 3>infections alone, why can it be so deadly? Wouldn't that

0:48:22.880 --> 0:48:26.080
<v Speaker 3>have been selected against at some point and it's hundreds

0:48:26.120 --> 0:48:30.200
<v Speaker 3>of millions years old evolutionary history, because the IgE response

0:48:30.280 --> 0:48:35.120
<v Speaker 3>is very old, not if the benefits outweigh the costs,

0:48:35.440 --> 0:48:38.520
<v Speaker 3>not if there's a reason to maintain it. As to

0:48:38.680 --> 0:48:42.560
<v Speaker 3>what that reason could be. How do toxins sound?

0:48:43.280 --> 0:48:44.120
<v Speaker 1>Love toxins?

0:48:44.160 --> 0:48:44.279
<v Speaker 3>There?

0:48:44.320 --> 0:48:44.960
<v Speaker 1>And you know that?

0:48:45.360 --> 0:48:47.200
<v Speaker 3>I know you do? I know you love? You love

0:48:47.239 --> 0:48:49.160
<v Speaker 3>a toxicologist. You love toxins?

0:48:49.320 --> 0:48:49.600
<v Speaker 2>I do.

0:48:51.480 --> 0:48:56.080
<v Speaker 3>In nineteen ninety one, Marjorie Profit introduced the toxin hypothesis

0:48:56.120 --> 0:49:01.040
<v Speaker 3>of allergy, and this hypothesis suggests that the IG mediated

0:49:01.080 --> 0:49:06.240
<v Speaker 3>allergic response evolved to protect us from immediate danger posed

0:49:06.280 --> 0:49:10.719
<v Speaker 3>by toxins. So a strong IgE allergic response like you

0:49:10.800 --> 0:49:15.160
<v Speaker 3>described AARON is usually very rapid onset, generally speaking within

0:49:15.400 --> 0:49:19.719
<v Speaker 3>seconds or minutes of exposure, and it's often accompanied by

0:49:19.760 --> 0:49:25.880
<v Speaker 3>things like a sudden drop in blood pressure, vomiting, tearing, diarrhea, coughing,

0:49:26.160 --> 0:49:30.000
<v Speaker 3>all things that would help to expel a toxic substance

0:49:30.239 --> 0:49:33.239
<v Speaker 3>or blow it down from reaching vital organs.

0:49:33.440 --> 0:49:38.319
<v Speaker 1>Oh that is such an interesting Oh how did I

0:49:38.360 --> 0:49:39.319
<v Speaker 1>never think about that?

0:49:39.600 --> 0:49:46.399
<v Speaker 3>I how did? Like it's amazing, It's just like, oh yeah, this.

0:49:46.280 --> 0:49:48.520
<v Speaker 1>Is sort of like in your eye. Your body's like

0:49:48.560 --> 0:49:50.960
<v Speaker 1>get it out. Of your eyes, watering the heck out

0:49:51.000 --> 0:49:51.279
<v Speaker 1>of it.

0:49:51.440 --> 0:49:53.560
<v Speaker 3>Right, and allergies do the same things.

0:49:53.840 --> 0:49:54.360
<v Speaker 2>Yeah.

0:49:54.840 --> 0:49:59.480
<v Speaker 1>Oh, I hope there's support for this hypothesis because I

0:49:59.640 --> 0:50:02.160
<v Speaker 1>like it.

0:50:02.160 --> 0:50:05.520
<v Speaker 3>It's fascinating. Yeah, And you know I was asking in

0:50:05.560 --> 0:50:09.080
<v Speaker 3>the biology section. Okay, Well, the IgE response versus other

0:50:09.120 --> 0:50:13.640
<v Speaker 3>types of antibody responses and the allergic response, This IgE

0:50:13.880 --> 0:50:18.480
<v Speaker 3>mediated response is very different than that caused by exposure

0:50:18.560 --> 0:50:22.279
<v Speaker 3>to a pathogen like a virus or bacterium, and this

0:50:22.440 --> 0:50:27.520
<v Speaker 3>allergic response wouldn't really be effective against those infections, which

0:50:27.560 --> 0:50:30.880
<v Speaker 3>our immune system deals with by killing rather than expelling,

0:50:31.440 --> 0:50:35.200
<v Speaker 3>which is what it does to allergens and multicellular parasites.

0:50:35.719 --> 0:50:40.480
<v Speaker 3>Huh uh huh. Profit suggests that some of the allergens

0:50:40.480 --> 0:50:44.120
<v Speaker 3>that we think of as innocuous, like pollens like hay

0:50:44.239 --> 0:50:47.920
<v Speaker 3>dust or shellfish, may not be as harmless as they seem.

0:50:48.680 --> 0:50:52.960
<v Speaker 3>Pollens contain phenolic acids or alkaloids, both of which can

0:50:53.000 --> 0:50:57.160
<v Speaker 3>cause organ or nerve damage. Hay Dust can be contaminated

0:50:57.160 --> 0:51:01.200
<v Speaker 3>by pathogenic fungal spores, and shellfish can have toxins from

0:51:01.200 --> 0:51:02.800
<v Speaker 3>algae or plankton.

0:51:03.920 --> 0:51:08.560
<v Speaker 1>Fung i. Think fungi are are are not well respected

0:51:08.760 --> 0:51:12.440
<v Speaker 1>in this regard in their they trigger a similar especially

0:51:12.520 --> 0:51:15.040
<v Speaker 1>some like asprogillis and things like that that commonly can

0:51:15.080 --> 0:51:19.040
<v Speaker 1>infect like grains and blah blah blah. Yeah, sorry, but

0:51:19.239 --> 0:51:21.240
<v Speaker 1>I love this. I'm really excited.

0:51:21.480 --> 0:51:23.440
<v Speaker 3>Yeah. No, And there's also a lot of like I

0:51:23.800 --> 0:51:26.279
<v Speaker 3>am not getting into asthma here because we did an

0:51:26.320 --> 0:51:29.440
<v Speaker 3>asthma right episode, and so there's there's a that's a

0:51:29.480 --> 0:51:33.440
<v Speaker 3>whole separate literature in many ways, but there are links between.

0:51:33.760 --> 0:51:35.320
<v Speaker 3>Like a lot of these papers that talk about the

0:51:35.320 --> 0:51:39.680
<v Speaker 3>evolution of allergies also group asthma into that, which is

0:51:39.800 --> 0:51:40.640
<v Speaker 3>entirely reasonable.

0:51:41.080 --> 0:51:43.879
<v Speaker 1>Like we talked about a topic disease.

0:51:44.000 --> 0:51:48.320
<v Speaker 3>And there have been a lot of links with asthma

0:51:48.400 --> 0:51:54.120
<v Speaker 3>and fungus as well a fungal exposure. So yeah, super interesting.

0:51:55.719 --> 0:51:59.319
<v Speaker 3>But being able to rapidly recognize and deal with these

0:51:59.360 --> 0:52:03.520
<v Speaker 3>toxic threat that's like these alkaloids, like these toxins from

0:52:03.560 --> 0:52:07.839
<v Speaker 3>algae that could be vital to our survival both from

0:52:07.920 --> 0:52:12.279
<v Speaker 3>an immunological standpoint as well as just us experiencing that

0:52:12.440 --> 0:52:16.680
<v Speaker 3>deeply allergic response and wanting to avoid exposure in the future.

0:52:17.360 --> 0:52:21.120
<v Speaker 3>Are allergies a signal to us? Do they teach us

0:52:21.200 --> 0:52:23.560
<v Speaker 3>which plants or foods to stay away from.

0:52:23.840 --> 0:52:29.759
<v Speaker 1>Arin I I can't tell you how much I love

0:52:29.800 --> 0:52:32.120
<v Speaker 1>this idea because you know what it feels like to me.

0:52:32.600 --> 0:52:35.400
<v Speaker 1>It feels like the difference between like what is a

0:52:35.400 --> 0:52:38.839
<v Speaker 1>weed and what is a desirable plant? Mm hmm, like

0:52:39.160 --> 0:52:42.480
<v Speaker 1>our allergies responses to things that they shouldn't be, or

0:52:42.560 --> 0:52:46.160
<v Speaker 1>actually are they responding to something that we should be

0:52:46.160 --> 0:52:49.120
<v Speaker 1>because we shouldn't be having so much grap like you know.

0:52:49.120 --> 0:52:49.520
<v Speaker 2>What I mean?

0:52:49.680 --> 0:52:52.840
<v Speaker 3>I just yeah, oh.

0:52:52.520 --> 0:52:55.799
<v Speaker 1>I wow, this is mind blowing to me.

0:52:56.560 --> 0:52:59.239
<v Speaker 3>I think if me too, because I had never really

0:52:59.239 --> 0:53:02.399
<v Speaker 3>considered I always was just like innocuous substance overreaction.

0:53:02.880 --> 0:53:08.480
<v Speaker 1>Yeah are cases. Yeah, but peanuts can be contaminated with

0:53:08.520 --> 0:53:09.520
<v Speaker 1>funk a lot.

0:53:09.400 --> 0:53:13.440
<v Speaker 3>Ants, and they also might be like these different foods

0:53:13.880 --> 0:53:19.040
<v Speaker 3>or these different allergens might be the compound structure itself

0:53:19.120 --> 0:53:21.880
<v Speaker 3>could be similar to similar to something else, something that

0:53:21.960 --> 0:53:23.280
<v Speaker 3>is much more toxic.

0:53:22.960 --> 0:53:24.399
<v Speaker 1>Right what you're saying too?

0:53:24.760 --> 0:53:28.799
<v Speaker 3>Yeah, yeah, it's an interesting idea. We love it. But

0:53:28.960 --> 0:53:33.160
<v Speaker 3>is their support for there? I hope so yes there is,

0:53:33.600 --> 0:53:35.960
<v Speaker 3>And is it like the most compelling support in the world.

0:53:36.040 --> 0:53:39.440
<v Speaker 3>I don't know. There are my studies, lab studies, et cetera.

0:53:39.560 --> 0:53:42.160
<v Speaker 3>But still but still still so. There are a couple

0:53:42.200 --> 0:53:45.719
<v Speaker 3>studies from twenty thirteen that found that mice that had

0:53:45.760 --> 0:53:49.880
<v Speaker 3>previously been exposed to venom. One study used a beasting

0:53:50.080 --> 0:53:53.000
<v Speaker 3>and the other used snake venom. The mice that had

0:53:53.000 --> 0:53:57.160
<v Speaker 3>been previously exposed were more likely to survive a big

0:53:57.400 --> 0:54:00.920
<v Speaker 3>second dose of venom that should have been fatal compared

0:54:00.920 --> 0:54:04.919
<v Speaker 3>to those who did not receive that initial dose, suggesting

0:54:05.080 --> 0:54:09.239
<v Speaker 3>that that big IgE response in the second exposure might

0:54:09.280 --> 0:54:13.600
<v Speaker 3>be helpful rather than detrimental. And of course this doesn't

0:54:13.600 --> 0:54:15.920
<v Speaker 3>explain why a beasting in humans can lead to a

0:54:15.960 --> 0:54:22.239
<v Speaker 3>fatal anaphylaxis response, because clearly that is very helpful. Some

0:54:22.320 --> 0:54:25.000
<v Speaker 3>researchers suggest it's too much of a good thing, kind

0:54:25.040 --> 0:54:28.320
<v Speaker 3>of like sickle cellnemia and malaria. Right, having one copy

0:54:28.320 --> 0:54:30.760
<v Speaker 3>of the gene protects you from malaria, but two copies

0:54:30.840 --> 0:54:36.200
<v Speaker 3>leads to disease. While most experimental studies looking at this

0:54:36.320 --> 0:54:40.800
<v Speaker 3>toxin hypothesis have focused on things like beastings, other epidemiological

0:54:40.800 --> 0:54:43.600
<v Speaker 3>studies have taken a broader view of toxins and how

0:54:43.640 --> 0:54:47.000
<v Speaker 3>they can harm us, such as cancer. There's no clear

0:54:47.040 --> 0:54:50.680
<v Speaker 3>pattern when it comes to allergies in cancer, but some

0:54:50.719 --> 0:54:54.560
<v Speaker 3>studies have shown that higher rates of allergies is linked

0:54:54.640 --> 0:54:58.200
<v Speaker 3>to lower rates of cancer. But I would imagine that

0:54:58.200 --> 0:55:01.000
<v Speaker 3>that depends on the type of cancer and the other

0:55:01.080 --> 0:55:03.440
<v Speaker 3>lifestyle and genetic factors.

0:55:03.000 --> 0:55:07.080
<v Speaker 1>Right, And is it environmental? No, that's interesting and weird

0:55:07.120 --> 0:55:11.200
<v Speaker 1>because there's so much environmental cancer exposure blah blah blah.

0:55:11.200 --> 0:55:14.520
<v Speaker 1>And then environmental allergy. Oh, that's so weird and interesting.

0:55:14.760 --> 0:55:19.440
<v Speaker 3>Yeah, isn't it interesting? And so while the hygiene hypothesis

0:55:19.560 --> 0:55:23.440
<v Speaker 3>or the old friends hypothesis and the toxin hypothesis of

0:55:23.520 --> 0:55:26.480
<v Speaker 3>allergy can help to fill in some of the gaps

0:55:26.560 --> 0:55:30.400
<v Speaker 3>as to the why of allergies, the complete picture is

0:55:30.440 --> 0:55:33.640
<v Speaker 3>not yet clear. Yeah, how can we take what we

0:55:33.719 --> 0:55:37.719
<v Speaker 3>know about helmets and allergies and apply it to treatment? Right?

0:55:38.080 --> 0:55:40.920
<v Speaker 3>Can we make an allergen tree of life to predict

0:55:41.040 --> 0:55:43.400
<v Speaker 3>the groups of antigens that people are likely to be

0:55:43.480 --> 0:55:46.360
<v Speaker 3>sensitive to? Does it have to do with evolutionary distance?

0:55:46.640 --> 0:55:50.640
<v Speaker 3>The farther away something is on that evolutionary tree of life?

0:55:50.680 --> 0:55:53.520
<v Speaker 3>Does that mean that we're more likely to initiate an

0:55:53.560 --> 0:55:59.440
<v Speaker 3>immune response to it? The future of allergy research is exciting,

0:55:59.800 --> 0:56:02.680
<v Speaker 3>and to understand where we go from here, we also

0:56:02.719 --> 0:56:05.640
<v Speaker 3>have to take a look at where we've come from. Yeah,

0:56:06.160 --> 0:56:12.160
<v Speaker 3>are allergies changing and if so, what is driving that change.

0:56:12.320 --> 0:56:15.280
<v Speaker 3>Today allergies are one of the most common diseases across

0:56:15.320 --> 0:56:18.480
<v Speaker 3>the world, affecting ten to thirty percent of the global

0:56:18.520 --> 0:56:21.759
<v Speaker 3>population and up to fifty percent of people in some regions.

0:56:22.440 --> 0:56:25.919
<v Speaker 3>For years, that number has been on the rise, which

0:56:25.920 --> 0:56:28.120
<v Speaker 3>is why you'll hear people refer to this as an

0:56:28.160 --> 0:56:32.760
<v Speaker 3>allergy epidemic, sometimes broken down into two waves, the first

0:56:32.840 --> 0:56:36.200
<v Speaker 3>being respiratory allergies like hay fever and the second being

0:56:36.239 --> 0:56:40.880
<v Speaker 3>food allergies. Of course, allergies themselves are not a new phenomenon.

0:56:41.080 --> 0:56:45.480
<v Speaker 3>IgE antibodies evolved around three hundred million years ago, allowing

0:56:45.560 --> 0:56:49.520
<v Speaker 3>for this allergic response, and we have evidence of allergies

0:56:49.600 --> 0:56:53.719
<v Speaker 3>from ancient times, descriptions of fatal beastings what could be

0:56:53.760 --> 0:56:58.560
<v Speaker 3>allergic rhinitis, and of course asthma. But the heyday of

0:56:58.680 --> 0:57:04.080
<v Speaker 3>allergy awareness pun intended, really only began in the eighteen hundreds,

0:57:04.360 --> 0:57:07.800
<v Speaker 3>with the first description of hay fever in eighteen nineteen

0:57:07.920 --> 0:57:11.160
<v Speaker 3>by John Bostock and the first case series published in

0:57:11.200 --> 0:57:16.200
<v Speaker 3>eighteen seventy three by Charles Blackley. These observations didn't seem

0:57:16.240 --> 0:57:19.040
<v Speaker 3>to be a case of cool. There's finally a name

0:57:19.080 --> 0:57:21.720
<v Speaker 3>associated with this condition that we've noticed for a long time,

0:57:22.360 --> 0:57:26.120
<v Speaker 3>but a recognition of a truly emerging phenomenon.

0:57:26.480 --> 0:57:27.040
<v Speaker 1>Huh.

0:57:27.080 --> 0:57:31.240
<v Speaker 3>Like one summer day in eighteen seventy five, your nose

0:57:31.280 --> 0:57:34.480
<v Speaker 3>starts running and your eyes start itching, and you're sneezing

0:57:34.600 --> 0:57:36.840
<v Speaker 3>all over the place, and you find all of your

0:57:36.840 --> 0:57:39.920
<v Speaker 3>friends and family are similarly affected, and you're just complaining

0:57:39.960 --> 0:57:42.720
<v Speaker 3>about it. You form groups to talk about it. But

0:57:42.840 --> 0:57:45.520
<v Speaker 3>just a few years ago, no doctor had ever heard

0:57:45.560 --> 0:57:48.960
<v Speaker 3>of such a thing. The sudden increase in hay fever

0:57:49.160 --> 0:57:52.200
<v Speaker 3>in Europe and North America around the late eighteen hundreds

0:57:52.280 --> 0:57:59.959
<v Speaker 3>resulted from changes in agricultural practices, changing which crops were planning,

0:58:00.800 --> 0:58:05.480
<v Speaker 3>planting more pollinaceous. If that's a word, it's not. I

0:58:05.480 --> 0:58:07.800
<v Speaker 3>don't think my word document is telling me there's a

0:58:07.840 --> 0:58:10.640
<v Speaker 3>red underline. It's angry, but it's the only thing I

0:58:10.640 --> 0:58:14.280
<v Speaker 3>could think of. Pollinaceous grass varieties to feed the growing

0:58:14.320 --> 0:58:18.480
<v Speaker 3>cattle herds, and an increase in farmed land in the US,

0:58:18.680 --> 0:58:23.240
<v Speaker 3>leading to higher ragweed growth. This marks the beginning of

0:58:23.320 --> 0:58:25.720
<v Speaker 3>the first wave of the allergy epidemic.

0:58:25.880 --> 0:58:29.680
<v Speaker 1>Ladies, it's eighteen hundreds. Okay, yeah, that's way further back.

0:58:29.720 --> 0:58:31.720
<v Speaker 1>I mean it feels like I should have expected, but

0:58:31.920 --> 0:58:33.000
<v Speaker 1>like I don't know.

0:58:33.480 --> 0:58:36.840
<v Speaker 3>And it's hard because like people generally associate asthma with

0:58:36.960 --> 0:58:40.080
<v Speaker 3>the first wave, and that's like nineteen sixties is really

0:58:40.080 --> 0:58:44.040
<v Speaker 3>when those cases started to super ramp up. But if

0:58:44.080 --> 0:58:47.120
<v Speaker 3>we're talking about allergic rhinitis, it really is like eighteen

0:58:47.320 --> 0:58:48.360
<v Speaker 3>eighties roughly.

0:58:48.840 --> 0:58:49.440
<v Speaker 1>Interesting.

0:58:49.520 --> 0:58:52.919
<v Speaker 3>There had been in decades previous descriptions here and there,

0:58:52.960 --> 0:58:59.520
<v Speaker 3>but not like sudden recognition of this, whoa everyone is experiencing?

0:59:00.480 --> 0:59:00.960
<v Speaker 1>Interesting.

0:59:01.280 --> 0:59:05.960
<v Speaker 3>Yeah. In nineteen o six, Clemens von Pirquet coined the

0:59:06.040 --> 0:59:10.640
<v Speaker 3>term allergy to describe the hypersensitivity reaction in serum sickness.

0:59:11.040 --> 0:59:13.320
<v Speaker 3>So when someone was given anti serum, let's say, for

0:59:13.400 --> 0:59:17.280
<v Speaker 3>like diphtheria, to treat their diptheria infection. But they had

0:59:17.280 --> 0:59:20.640
<v Speaker 3>extracted that anti serum from an animal like a horse. Yeah,

0:59:20.680 --> 0:59:23.800
<v Speaker 3>they had, Yeah, caused the infection, got the antibodies all that.

0:59:24.320 --> 0:59:29.960
<v Speaker 3>Then you inject an episode. Interesting, we should but yeah,

0:59:30.000 --> 0:59:34.600
<v Speaker 3>then people got real sick from them. And by that time,

0:59:34.760 --> 0:59:37.600
<v Speaker 3>so around the early nineteen hundreds, other work had shown

0:59:37.840 --> 0:59:42.960
<v Speaker 3>how anaphylaxis can happen, how animals negatively react to the

0:59:43.000 --> 0:59:46.520
<v Speaker 3>introduction of a foreign substance, and the concept of an

0:59:46.560 --> 0:59:50.320
<v Speaker 3>allergic response mediated by your immune system began to gain

0:59:50.400 --> 0:59:54.000
<v Speaker 3>traction because up to this time, germ theory had a

0:59:54.040 --> 0:59:57.640
<v Speaker 3>pretty tight hold on many explanations of disease, and so

0:59:57.720 --> 1:00:01.600
<v Speaker 3>the recognition that it was actually our immune systems causing

1:00:01.640 --> 1:00:04.800
<v Speaker 3>these allergic responses, like the call is coming from inside

1:00:04.840 --> 1:00:07.360
<v Speaker 3>the house, took a bit of time to gain traction.

1:00:08.240 --> 1:00:14.040
<v Speaker 3>Von Pirquet combined a bunch of observations from hyposensitivity, hypersensitivity,

1:00:14.080 --> 1:00:17.480
<v Speaker 3>food allergy, hay fever, beasting reactions, serum sickness, and so

1:00:17.600 --> 1:00:21.920
<v Speaker 3>on to create this organized concept of allergy as it

1:00:22.000 --> 1:00:26.200
<v Speaker 3>relates to immunity, and it created momentum for more research

1:00:26.320 --> 1:00:28.919
<v Speaker 3>in the area, even if it was initially papooed by

1:00:29.200 --> 1:00:30.440
<v Speaker 3>like a lot of his peers.

1:00:30.680 --> 1:00:31.960
<v Speaker 1>Classic Classic.

1:00:32.640 --> 1:00:35.600
<v Speaker 3>The first decades of the nineteenth century saw the formation

1:00:35.720 --> 1:00:39.560
<v Speaker 3>of allergy research groups and clinics across the globe, and

1:00:39.640 --> 1:00:43.080
<v Speaker 3>as far back as nineteen thirty six, the phrase, quote unquote,

1:00:43.080 --> 1:00:48.880
<v Speaker 3>the allergy epidemic was used. Wow, right, much earlier than

1:00:48.920 --> 1:00:49.320
<v Speaker 3>I thought.

1:00:49.640 --> 1:00:50.080
<v Speaker 1>Yeah.

1:00:50.120 --> 1:00:53.880
<v Speaker 3>In nineteen forty six, ragweed hay fever was such a

1:00:53.960 --> 1:00:57.160
<v Speaker 3>huge problem in New York City. That City Council started

1:00:57.200 --> 1:01:04.680
<v Speaker 3>a ragweed elimination campaign. The tides were changing and fast. Asthma,

1:01:04.960 --> 1:01:08.480
<v Speaker 3>which prior to nineteen sixty had been considered a rare disease,

1:01:08.760 --> 1:01:12.120
<v Speaker 3>shot up in incidents, doubling in Swedish Army recruits from

1:01:12.200 --> 1:01:15.760
<v Speaker 3>nineteen seventy one to nineteen eighty one huge rise, as

1:01:15.800 --> 1:01:20.880
<v Speaker 3>did hospital admissions for the condition, which increased tenfold between

1:01:20.960 --> 1:01:24.240
<v Speaker 3>nineteen sixty five and nineteen eighty In Australia, the UK,

1:01:24.440 --> 1:01:29.800
<v Speaker 3>New Zealand, Canada, and the US tend for afterasthma. In

1:01:29.840 --> 1:01:34.120
<v Speaker 3>the nineteen seventies, after the discovery of IgE, researchers observed

1:01:34.160 --> 1:01:40.000
<v Speaker 3>a sharp increase in allergen specific IgE antibodies against environmental allergens,

1:01:40.640 --> 1:01:43.200
<v Speaker 3>growing to over fifty percent of the population in some

1:01:43.320 --> 1:01:46.400
<v Speaker 3>regions like I mentioned, and the second wave of the

1:01:46.440 --> 1:01:50.600
<v Speaker 3>allergy epidemic. Food borne allergies began much more recently. Around

1:01:50.640 --> 1:01:54.120
<v Speaker 3>nineteen ninety is most most papers I read, and that's

1:01:54.160 --> 1:01:58.000
<v Speaker 3>the same time that asthma case is actually plateaued. One

1:01:58.120 --> 1:02:00.960
<v Speaker 3>large study found that between nineteen ninety seven and two

1:02:01.040 --> 1:02:08.720
<v Speaker 3>thousand and eight, allergies to peanuts and tree nuts tripled, tripled, huge. Yeah.

1:02:09.120 --> 1:02:12.800
<v Speaker 3>Reports from Australia indicate a tenfold increase in referrals to

1:02:12.880 --> 1:02:16.600
<v Speaker 3>food allergy specialists and a five fold increase in hospital

1:02:16.640 --> 1:02:21.800
<v Speaker 3>admissions for food related anaphylaxis. This is not just a

1:02:21.800 --> 1:02:26.000
<v Speaker 3>matter of doing a better job of recognizing these allergies, No.

1:02:26.360 --> 1:02:29.000
<v Speaker 1>Especially not with food allergies because the reaction is usually

1:02:29.040 --> 1:02:29.760
<v Speaker 1>so severe.

1:02:30.360 --> 1:02:36.160
<v Speaker 3>Exactly. Yeah, what is driving this explosive rise? Yeah, that

1:02:36.360 --> 1:02:40.720
<v Speaker 3>is the billion dollar question. We don't fully know, of course,

1:02:41.840 --> 1:02:44.920
<v Speaker 3>here is what we do know. We know that while

1:02:44.960 --> 1:02:48.840
<v Speaker 3>this is a global rise, the highest increases are seen

1:02:49.040 --> 1:02:54.360
<v Speaker 3>in more industrialized countries. For instance, following the reunification of

1:02:54.440 --> 1:02:57.720
<v Speaker 3>East and West Germany in nineteen eighty nine, prevalence of

1:02:57.800 --> 1:03:01.040
<v Speaker 3>allergy shot up in East Germany, where it have been

1:03:01.120 --> 1:03:02.640
<v Speaker 3>much lower in previous decades.

1:03:02.800 --> 1:03:05.160
<v Speaker 1>I think that's one of the most interesting examples because

1:03:05.160 --> 1:03:08.480
<v Speaker 1>it's so like discrete and like the regions are so

1:03:08.640 --> 1:03:11.480
<v Speaker 1>close to each other, so it's like not like what

1:03:11.800 --> 1:03:15.080
<v Speaker 1>is it because it's not just like natural environment exposure

1:03:15.120 --> 1:03:15.840
<v Speaker 1>clearly like.

1:03:15.920 --> 1:03:21.440
<v Speaker 3>Weather, right, pollen is not does not respect the Berlin

1:03:21.480 --> 1:03:29.920
<v Speaker 3>exactly yeah. Yeah, And on average, allergies are twenty times

1:03:30.120 --> 1:03:34.440
<v Speaker 3>more common in affluent quote unquote westernized countries compared to

1:03:34.480 --> 1:03:37.920
<v Speaker 3>those with lower incomes. And we know that this rise

1:03:38.000 --> 1:03:41.880
<v Speaker 3>is not limited to allergies or asthma, but it also

1:03:42.480 --> 1:03:47.360
<v Speaker 3>is seen in other autoimmune or immune mediated diseases. We

1:03:47.440 --> 1:03:50.320
<v Speaker 3>know that these diseases are not rising all at the

1:03:50.360 --> 1:03:52.880
<v Speaker 3>same time, or in the same place or at the

1:03:52.920 --> 1:03:57.520
<v Speaker 3>same pace, which could suggest different mechanisms behind the rise

1:03:57.600 --> 1:04:00.280
<v Speaker 3>in each of them. And this has been you to

1:04:00.360 --> 1:04:03.800
<v Speaker 3>challenge the old friends or the hygiene hypothesis, since countries

1:04:03.840 --> 1:04:06.320
<v Speaker 3>that saw the biggest rise in allergies only did so

1:04:06.480 --> 1:04:10.280
<v Speaker 3>beginning really in the nineteen sixties, which was around forty

1:04:10.440 --> 1:04:15.320
<v Speaker 3>years after major sanitation changes would have reduced waterborne pathogens

1:04:15.440 --> 1:04:20.040
<v Speaker 3>and anti helmath campaigns had reduced parasite burden to almost nothing.

1:04:21.240 --> 1:04:25.080
<v Speaker 3>So what could be going on? Most of the predominant

1:04:25.080 --> 1:04:29.080
<v Speaker 3>ideas fall under the hygiene hypothesis or the old friends

1:04:29.160 --> 1:04:32.560
<v Speaker 3>hypothesis or the biodiversity hypothesis, which are kind of like

1:04:32.680 --> 1:04:35.760
<v Speaker 3>more recent offshoots, and both of these suggest that our

1:04:35.840 --> 1:04:39.280
<v Speaker 3>allergies are a result of us not being exposed to

1:04:39.360 --> 1:04:42.960
<v Speaker 3>as many or as diverse microbes and parasites that we

1:04:43.080 --> 1:04:47.560
<v Speaker 3>used to throughout our evolutionary history. Why that would lead

1:04:47.600 --> 1:04:52.080
<v Speaker 3>to more allergies depends on who you ask. Maybe it's

1:04:52.120 --> 1:04:55.840
<v Speaker 3>that with decreasing family size, kids are not coming into

1:04:55.880 --> 1:04:59.120
<v Speaker 3>contact with as many germs at a young age, although

1:04:59.200 --> 1:05:04.120
<v Speaker 3>some childhood pathogens like RSV are positively associated with developing allergies.

1:05:04.680 --> 1:05:08.080
<v Speaker 3>So it's like the right germs, right, right, Which germs

1:05:08.400 --> 1:05:13.280
<v Speaker 3>that's the Yeah, Yeah, it's layers, compilators.

1:05:14.440 --> 1:05:17.040
<v Speaker 1>It's almost like our immune system is complicated. I don't

1:05:17.080 --> 1:05:17.400
<v Speaker 1>know what.

1:05:20.360 --> 1:05:23.360
<v Speaker 3>Maybe it's that our use of antibiotics at an early

1:05:23.440 --> 1:05:27.720
<v Speaker 3>age disrupts our gut microbiome and primes us to develop allergies.

1:05:28.480 --> 1:05:31.640
<v Speaker 3>Maybe it's that we spend more time inside and sedentary

1:05:31.920 --> 1:05:35.200
<v Speaker 3>early childhood. Exposure to pets or farm animals seems to

1:05:35.240 --> 1:05:40.080
<v Speaker 3>reduce the risk of allergies, and exercise reduces allergic inflammation.

1:05:40.960 --> 1:05:43.760
<v Speaker 3>I found a study looking at babies born during COVID

1:05:43.800 --> 1:05:47.200
<v Speaker 3>lockdown in twenty twenty, and this study found higher rates

1:05:47.200 --> 1:05:50.840
<v Speaker 3>of allergies in that cohort. So it's like, again, the

1:05:50.920 --> 1:05:55.360
<v Speaker 3>limited exposure to the outside world. Maybe it's the chemicals

1:05:55.360 --> 1:05:59.919
<v Speaker 3>and our soaps, food packaging, microplastics, pollution, ozone, cigarette smoke,

1:06:00.160 --> 1:06:05.480
<v Speaker 3>that disrupts our protective epithelial barriers and sends our immune

1:06:05.480 --> 1:06:10.520
<v Speaker 3>systems into overdrive. If you think about it, the allergic

1:06:10.560 --> 1:06:14.480
<v Speaker 3>response is kind of like a hail marry last resort

1:06:14.520 --> 1:06:18.680
<v Speaker 3>option to protect us from toxins. After our skin or

1:06:18.800 --> 1:06:23.360
<v Speaker 3>skin microbiota, after our guts or gut microbiota, our lungs

1:06:23.440 --> 1:06:26.160
<v Speaker 3>and lung microbiota, lets it get through, right like, there

1:06:26.160 --> 1:06:29.680
<v Speaker 3>are so many other layers of protection, and then maybe

1:06:29.720 --> 1:06:32.640
<v Speaker 3>it's that once it makes it past all those layers,

1:06:33.240 --> 1:06:37.000
<v Speaker 3>then we have this last ditch effort to protect us

1:06:37.040 --> 1:06:40.760
<v Speaker 3>from whatever perceived tosin there is. And if those layers

1:06:40.800 --> 1:06:44.480
<v Speaker 3>are continually broken down by some of the things that

1:06:44.520 --> 1:06:48.760
<v Speaker 3>we encounter in our everyday lives, like processed foods, you know,

1:06:48.840 --> 1:06:52.560
<v Speaker 3>all of these different things that all combine together to

1:06:52.600 --> 1:06:56.040
<v Speaker 3>increase permeability of those barriers, does that then lead to

1:06:56.200 --> 1:06:57.040
<v Speaker 3>increase allergy?

1:06:57.320 --> 1:06:59.000
<v Speaker 1>And I think that's one of the things that makes

1:06:59.040 --> 1:07:01.840
<v Speaker 1>the there's a there's a lot of research being done

1:07:01.880 --> 1:07:04.880
<v Speaker 1>on like is exzema and the breakdown of your skin

1:07:04.960 --> 1:07:07.440
<v Speaker 1>barrier that happens with egzema. Does it also result in

1:07:07.480 --> 1:07:12.960
<v Speaker 1>this abnormal presentation of these toxins or of these allergens

1:07:13.040 --> 1:07:15.880
<v Speaker 1>right where it's like, typically you shouldn't be able to

1:07:15.880 --> 1:07:18.600
<v Speaker 1>be exposed to, say, cat dander through your skin because

1:07:18.600 --> 1:07:20.640
<v Speaker 1>your skin should be able to keep cat dander out.

1:07:20.800 --> 1:07:23.000
<v Speaker 1>But if it gets in that way, does that predispose

1:07:23.040 --> 1:07:24.920
<v Speaker 1>you to And cat dander might be a crappy example,

1:07:24.960 --> 1:07:27.440
<v Speaker 1>I don't know, but like, if you get peanut on

1:07:27.480 --> 1:07:29.920
<v Speaker 1>your skin, peanut protein shouldn't be able to make it

1:07:29.960 --> 1:07:33.560
<v Speaker 1>through your skin. If it does, does that trigger your

1:07:33.560 --> 1:07:36.640
<v Speaker 1>immune response to think that it is something that is pathogenic?

1:07:36.960 --> 1:07:40.720
<v Speaker 1>So that's one of those kind of ideas.

1:07:40.360 --> 1:07:45.520
<v Speaker 3>Right, Yeah, novel exposure roots exactly these things because of

1:07:45.560 --> 1:07:48.520
<v Speaker 3>a decreased barrier in permeability.

1:07:47.840 --> 1:07:49.880
<v Speaker 1>Which is why I think, like the AlphaGo story is

1:07:49.920 --> 1:07:54.000
<v Speaker 1>so interesting in that, like because it applies so much

1:07:54.000 --> 1:07:56.760
<v Speaker 1>to that. So yeah, I don't know, Yeah, it's interesting.

1:07:57.000 --> 1:07:57.360
<v Speaker 2>Aaron.

1:08:00.120 --> 1:08:04.800
<v Speaker 3>Uh, we don't have a single simple answer for why

1:08:04.920 --> 1:08:08.040
<v Speaker 3>tree nut allergies suddenly exploded in the past few decades,

1:08:08.080 --> 1:08:10.320
<v Speaker 3>although I do think that part of it is, at

1:08:10.400 --> 1:08:14.160
<v Speaker 3>least from my reading, our response to them initially how

1:08:14.160 --> 1:08:17.040
<v Speaker 3>it was like, don't expose anymore. If there's the slightest

1:08:17.080 --> 1:08:19.559
<v Speaker 3>bit of reaction, then it sort of Yeah.

1:08:19.760 --> 1:08:23.040
<v Speaker 1>I am really curious. This is jumping so far ahead.

1:08:23.080 --> 1:08:26.720
<v Speaker 1>I'm sorry, but I'm so curious to see what is

1:08:26.720 --> 1:08:29.280
<v Speaker 1>going to happen in the next decade. Like with like,

1:08:29.720 --> 1:08:32.920
<v Speaker 1>because it was our generation that has really high rates

1:08:33.000 --> 1:08:35.160
<v Speaker 1>of things like peanut and tree nut and all these

1:08:35.200 --> 1:08:39.720
<v Speaker 1>food allergies. And it was our generation that very much

1:08:39.800 --> 1:08:43.519
<v Speaker 1>was told by physicians, do not expose your children because

1:08:43.520 --> 1:08:45.719
<v Speaker 1>we don't want them to develop allergies. And it turns out,

1:08:46.120 --> 1:08:48.840
<v Speaker 1>against spoilers, that that was exactly the wrong advice. And

1:08:48.880 --> 1:08:51.519
<v Speaker 1>now we know that because of these phenomenal studies, and

1:08:51.560 --> 1:08:54.920
<v Speaker 1>so early introduction is now the recommendation. So what are

1:08:55.000 --> 1:08:58.240
<v Speaker 1>rates going to be like in kids in five ten years.

1:08:58.280 --> 1:09:01.560
<v Speaker 1>I'm super curious about all this, like how the epidemiology

1:09:01.640 --> 1:09:03.040
<v Speaker 1>is going Is it going to change, I don't know,

1:09:03.160 --> 1:09:03.400
<v Speaker 1>is it.

1:09:03.520 --> 1:09:09.040
<v Speaker 3>To help you? And you know, like we probably won't

1:09:09.080 --> 1:09:14.040
<v Speaker 3>ever have one simple, unifying answer to this. I agree,

1:09:14.200 --> 1:09:16.880
<v Speaker 3>and I will say also, like the hygiene hypothesis or

1:09:16.880 --> 1:09:20.760
<v Speaker 3>the old friends hypothesis, or the toxin hypothesis or the

1:09:20.800 --> 1:09:25.160
<v Speaker 3>epithelial barrier hypothesis, these things aren't attempting to explain away

1:09:25.360 --> 1:09:31.040
<v Speaker 3>all cases of allergies or autoimmune diseases with one bottom line. Instead,

1:09:31.080 --> 1:09:34.360
<v Speaker 3>what they're doing is highlighting patterns of allergy, pointing out

1:09:34.439 --> 1:09:37.160
<v Speaker 3>where we can look next. If it is certain detergent

1:09:37.240 --> 1:09:41.760
<v Speaker 3>compounds causing a rise in asthma because of increased skin permeability,

1:09:42.800 --> 1:09:47.080
<v Speaker 3>why and how. If it is a disrupted microbiome, what

1:09:47.200 --> 1:09:50.240
<v Speaker 3>about it makes it disrupted? And how can we restore balance.

1:09:51.040 --> 1:09:55.120
<v Speaker 3>If it is epigenetic effects, what are those prenatal exposures

1:09:55.120 --> 1:09:59.960
<v Speaker 3>that increase someone's chance of developing allergies? While the comp

1:10:00.000 --> 1:10:03.960
<v Speaker 3>tx nature of allergies makes all of this seem so overwhelming,

1:10:04.120 --> 1:10:07.880
<v Speaker 3>the truth is that people are doing incredible research to

1:10:07.960 --> 1:10:11.280
<v Speaker 3>answer these questions, to get at the underlying triggers of

1:10:11.280 --> 1:10:15.559
<v Speaker 3>different allergies, and it really seems like we're slowly going

1:10:15.600 --> 1:10:18.599
<v Speaker 3>to be able to put the puzzle pieces together, at

1:10:18.640 --> 1:10:22.320
<v Speaker 3>least for some pictures right, for some bits of the allergy,

1:10:22.920 --> 1:10:26.240
<v Speaker 3>and come up with better ways to understand, prevent and

1:10:26.360 --> 1:10:30.360
<v Speaker 3>treat allergies. I love it so now, Aaron, I'll turn

1:10:30.360 --> 1:10:32.639
<v Speaker 3>it over to you to tell us where we are

1:10:32.640 --> 1:10:34.559
<v Speaker 3>with allergies around the world today.

1:10:35.040 --> 1:11:02.840
<v Speaker 1>I'll give it my best shot right after this. So

1:11:02.920 --> 1:11:06.240
<v Speaker 1>you told us already, Aarin, that all of these allergic disorders,

1:11:06.520 --> 1:11:11.639
<v Speaker 1>from hay fever, from seasonal allergies, from food allergies. They're

1:11:11.680 --> 1:11:14.639
<v Speaker 1>all on the rise, that is certainly true, and they

1:11:14.640 --> 1:11:17.679
<v Speaker 1>have been for a while longer than I realized, apparently.

1:11:18.520 --> 1:11:20.880
<v Speaker 1>When it comes to I'll break this down into like

1:11:21.000 --> 1:11:23.880
<v Speaker 1>the allergic rhinitis, which is more you think of as

1:11:23.880 --> 1:11:26.360
<v Speaker 1>the hay fever, the seasonal allergies, it's the runny nose

1:11:26.439 --> 1:11:29.040
<v Speaker 1>and the blah blah blah running eyes. And I don't

1:11:29.040 --> 1:11:31.720
<v Speaker 1>say blah blah blah to discount it because it has

1:11:31.840 --> 1:11:35.600
<v Speaker 1>pretty significant effects on people's lives, as we'll see. But

1:11:35.760 --> 1:11:38.720
<v Speaker 1>a paper from the Lancet from twenty eleven, which is

1:11:38.760 --> 1:11:44.000
<v Speaker 1>old now, estimated that four hundred million people worldwide are

1:11:44.040 --> 1:11:48.880
<v Speaker 1>affected by allergic rhinitis, and this number is likely higher

1:11:48.960 --> 1:11:53.080
<v Speaker 1>today as this, like all allergies, has continued to increase.

1:11:54.360 --> 1:11:58.799
<v Speaker 1>But this varies a lot across the globe. And while

1:11:59.320 --> 1:12:04.559
<v Speaker 1>most of allergic rhinitis develop in like child or teen years,

1:12:05.120 --> 1:12:08.280
<v Speaker 1>sometimes they don't. There's plenty of adults who don't develop

1:12:08.760 --> 1:12:16.040
<v Speaker 1>seasonal or environmental allergies until much later in life. But overall,

1:12:16.160 --> 1:12:19.040
<v Speaker 1>in some areas of the globe, prevalence is as high

1:12:19.080 --> 1:12:22.040
<v Speaker 1>as like seventeen to twenty percent. Those seem to be

1:12:22.080 --> 1:12:26.599
<v Speaker 1>the highest percentage numbers that I saw and across the board,

1:12:26.720 --> 1:12:30.400
<v Speaker 1>even though in the International Study of Asthma and Allergies

1:12:30.439 --> 1:12:33.920
<v Speaker 1>in Childhood, which is also now old because the Phase

1:12:34.000 --> 1:12:37.080
<v Speaker 1>three study finished in like the early two thousands, but

1:12:37.200 --> 1:12:41.240
<v Speaker 1>in this study, the rates of allergic rhinitis were actually

1:12:41.439 --> 1:12:46.840
<v Speaker 1>greatest in Latin America and African countries. But even there

1:12:47.160 --> 1:12:51.080
<v Speaker 1>the prevalence was higher in urban areas compared to rural areas,

1:12:51.160 --> 1:12:53.799
<v Speaker 1>and that pattern is true pretty much across the globe.

1:12:55.240 --> 1:12:59.759
<v Speaker 1>Allergic rhinitis also has pretty significant burdens on our healthcare system.

1:13:00.520 --> 1:13:03.720
<v Speaker 1>In the nineties, way back in the nineties, it was

1:13:03.880 --> 1:13:08.160
<v Speaker 1>estimated to cost one point nine billion US dollars every year,

1:13:08.800 --> 1:13:12.200
<v Speaker 1>and that increased to three point four billion in the

1:13:12.240 --> 1:13:16.439
<v Speaker 1>early two thousands. And that's not even counting indirect costs,

1:13:16.479 --> 1:13:20.160
<v Speaker 1>of which there are enormous indirect costs, things like miss school,

1:13:20.320 --> 1:13:24.439
<v Speaker 1>missed work. Allergic rhinitis especially can result in things like

1:13:24.520 --> 1:13:27.760
<v Speaker 1>poor sleep or sleep apnea. It can contribute which can

1:13:27.800 --> 1:13:30.960
<v Speaker 1>then lead to fatigue, memory problems, mood changes. It can

1:13:31.000 --> 1:13:34.240
<v Speaker 1>make school harder for kids, like, it is not a

1:13:34.360 --> 1:13:36.840
<v Speaker 1>minor like we might think of it as, oh, it's

1:13:37.120 --> 1:13:40.840
<v Speaker 1>just a runny nose. It is not just a running nose. Right,

1:13:42.320 --> 1:13:45.400
<v Speaker 1>Food allergies we have much credier data for.

1:13:46.439 --> 1:13:49.599
<v Speaker 3>Which is interesting to me for some reason. I don't

1:13:49.640 --> 1:13:50.120
<v Speaker 3>know why.

1:13:50.320 --> 1:13:52.280
<v Speaker 1>Yeah, I think I think it's we have credit or

1:13:52.479 --> 1:13:53.439
<v Speaker 1>like global data.

1:13:53.720 --> 1:13:55.040
<v Speaker 3>Okay, but no doubt.

1:13:55.080 --> 1:13:58.320
<v Speaker 1>Food allergies are absolutely on the rise. In some countries,

1:13:58.439 --> 1:14:01.920
<v Speaker 1>as much as ten percent of children have at least

1:14:01.920 --> 1:14:08.080
<v Speaker 1>one food allergy. And food allergies are especially interesting because

1:14:08.840 --> 1:14:13.080
<v Speaker 1>for some foods, up to like seventy or eighty percent

1:14:13.120 --> 1:14:16.719
<v Speaker 1>of kids will outgrow their food allergy, and those foods

1:14:16.760 --> 1:14:19.799
<v Speaker 1>tend to be things like egg and milk, but things

1:14:19.840 --> 1:14:23.719
<v Speaker 1>like peanuts and tree nuts tends to be much less

1:14:23.840 --> 1:14:26.559
<v Speaker 1>likely that kids will outgrow it. Usually it's twenty percent

1:14:26.680 --> 1:14:28.800
<v Speaker 1>or less of kids with a peanut or tree nut

1:14:28.840 --> 1:14:33.200
<v Speaker 1>allergy will outgrow them. Then there's other food allergies like

1:14:33.320 --> 1:14:37.040
<v Speaker 1>shellfish and fish, which not only do we have less

1:14:37.160 --> 1:14:41.920
<v Speaker 1>data for the idea that early introduction can prevent sensitization

1:14:43.120 --> 1:14:46.439
<v Speaker 1>for things like fish and shellfish, but it's also more

1:14:46.560 --> 1:14:49.720
<v Speaker 1>likely that people don't develop those allergies until adulthood.

1:14:50.640 --> 1:14:55.880
<v Speaker 3>Why why, Oh you know, I have a quick question. Actually, yeah,

1:14:56.080 --> 1:15:01.439
<v Speaker 3>dose and relationship to response one. You know, one peanut,

1:15:01.439 --> 1:15:06.200
<v Speaker 3>how much peanut or almondors shellfish, shrimp tail?

1:15:06.400 --> 1:15:08.320
<v Speaker 1>You know. So yeah, maybe it's worth talking a little

1:15:08.320 --> 1:15:10.240
<v Speaker 1>bit in more detail about this. So the study that

1:15:10.439 --> 1:15:15.320
<v Speaker 1>showed that early exposure can reduce the risk of peanut allergy,

1:15:15.400 --> 1:15:18.759
<v Speaker 1>the big one was called Leap Learning Early about Peanut Allergy,

1:15:18.760 --> 1:15:20.800
<v Speaker 1>and then there was another one I think called EAT

1:15:21.520 --> 1:15:24.360
<v Speaker 1>and I forget what that acronym stands for. But these

1:15:24.400 --> 1:15:28.000
<v Speaker 1>were like really landmark studies that showed that early exposure

1:15:28.000 --> 1:15:31.080
<v Speaker 1>and early exposure meant like four months of life, but

1:15:31.280 --> 1:15:34.439
<v Speaker 1>definitely earlier than eleven months of life. So before a

1:15:34.479 --> 1:15:38.840
<v Speaker 1>baby turns one year old, you start with exposure to peanuts,

1:15:39.960 --> 1:15:43.920
<v Speaker 1>and you have to have persistent exposure. So it's not

1:15:44.120 --> 1:15:46.559
<v Speaker 1>like give them peanuts one time and then you're good.

1:15:47.280 --> 1:15:50.880
<v Speaker 1>These studies were consistent exposure, like two to three times

1:15:50.920 --> 1:15:54.639
<v Speaker 1>a week every week for the first five years of life. Okay, wow,

1:15:54.640 --> 1:15:57.280
<v Speaker 1>but in those kids and in these studies, they took

1:15:57.560 --> 1:16:01.320
<v Speaker 1>kids who were high risk, kids who either had severe

1:16:02.000 --> 1:16:07.240
<v Speaker 1>eggzema or had a known allergy to egg or In

1:16:07.280 --> 1:16:08.880
<v Speaker 1>some of the studies it was kids who had a

1:16:08.920 --> 1:16:12.840
<v Speaker 1>family history of peanut allergy, so these were high risk

1:16:12.920 --> 1:16:15.440
<v Speaker 1>kids because we know that there's genetics in these associations.

1:16:16.439 --> 1:16:20.400
<v Speaker 1>So in those kids, the reduction in risk of peanut

1:16:20.439 --> 1:16:25.240
<v Speaker 1>allergy was like seventy to eighty percent. It was massive,

1:16:25.680 --> 1:16:29.559
<v Speaker 1>massive reduction in risk, and so across the board. Now

1:16:29.600 --> 1:16:33.040
<v Speaker 1>the recommendation is early exposure, but it has to be

1:16:33.080 --> 1:16:37.040
<v Speaker 1>that consistent exposure, so it's not like necessarily a one

1:16:37.080 --> 1:16:40.559
<v Speaker 1>time dose, like give this much peanut. It's really like

1:16:40.680 --> 1:16:45.200
<v Speaker 1>start small, but continued exposure, so like a little peanut

1:16:45.320 --> 1:16:47.960
<v Speaker 1>on the finger when they're a tiny baby, continuing that

1:16:48.160 --> 1:16:50.840
<v Speaker 1>until they're like eating peanut butter and their oatmeal like

1:16:50.880 --> 1:16:53.640
<v Speaker 1>a couple times a week when they're kids, and that

1:16:53.760 --> 1:16:57.280
<v Speaker 1>significantly decreases the risk. And so that data has now

1:16:57.320 --> 1:17:00.400
<v Speaker 1>been extrapolated to a lot of the foods that the

1:17:00.439 --> 1:17:04.160
<v Speaker 1>earlier exposure to all of the main allergenic foods, and

1:17:04.200 --> 1:17:14.120
<v Speaker 1>in the US, those foods are wheat, soy, tree nuts, peanuts, milk, egg, oh, crap,

1:17:14.160 --> 1:17:19.360
<v Speaker 1>I should have written all of these town fish, shellfish,

1:17:19.439 --> 1:17:23.200
<v Speaker 1>and now sesame. That's the early net. The newest edition.

1:17:24.280 --> 1:17:27.920
<v Speaker 1>So early and consistent exposure to all of those is

1:17:27.960 --> 1:17:31.160
<v Speaker 1>what's now recommended to try and prevent food allergies.

1:17:31.760 --> 1:17:34.200
<v Speaker 3>And we don't know what happens when someone just develops

1:17:34.200 --> 1:17:37.559
<v Speaker 3>an allergy, a food allergy at the age of thirty five?

1:17:37.880 --> 1:17:39.840
<v Speaker 1>No, is it all alpha calerin? I don't know.

1:17:41.280 --> 1:17:43.240
<v Speaker 3>It all comes down to alpha cal.

1:17:43.600 --> 1:17:44.400
<v Speaker 1>Is it the ticks?

1:17:45.040 --> 1:17:45.200
<v Speaker 3>No?

1:17:45.320 --> 1:17:48.400
<v Speaker 1>Yeah, I don't know. Is it a threshold thing like

1:17:48.439 --> 1:17:50.840
<v Speaker 1>we kind of talked about, Is it that maybe they

1:17:50.960 --> 1:17:53.439
<v Speaker 1>had some level of it? Here's the other thing, arin,

1:17:53.560 --> 1:17:57.600
<v Speaker 1>Oh my gosh, there is a proportion of the population

1:17:57.880 --> 1:18:02.639
<v Speaker 1>who if you test them, they develop these IgE antibodies, aka,

1:18:02.720 --> 1:18:07.280
<v Speaker 1>they are sensitized to various things, be they aero allergens

1:18:07.320 --> 1:18:09.840
<v Speaker 1>like cat dander. Cat dander is a good example because

1:18:09.840 --> 1:18:12.839
<v Speaker 1>if you test kids who live in homes with cats,

1:18:13.520 --> 1:18:16.479
<v Speaker 1>a higher percentage of them will have a degree of

1:18:16.520 --> 1:18:20.680
<v Speaker 1>sensitization at a certain age, but a lower percentage of

1:18:20.720 --> 1:18:24.960
<v Speaker 1>them will be allergic, will have that allergic response to kings.

1:18:25.800 --> 1:18:28.960
<v Speaker 1>And so yeah, so like what is it about sensitization

1:18:29.400 --> 1:18:32.960
<v Speaker 1>versus then who of those kids who are sensitized actually

1:18:33.000 --> 1:18:36.800
<v Speaker 1>then will have allergies. We don't exactly know, so is

1:18:36.800 --> 1:18:39.200
<v Speaker 1>there is that what it is for adults who develop

1:18:39.240 --> 1:18:41.559
<v Speaker 1>say a shellfish allergy later in life, that maybe they

1:18:41.600 --> 1:18:44.840
<v Speaker 1>were a little bit sensitized, but it wasn't until that

1:18:44.960 --> 1:18:47.160
<v Speaker 1>built up enough in their system that they had an

1:18:47.200 --> 1:18:48.000
<v Speaker 1>allergic response.

1:18:48.040 --> 1:18:52.559
<v Speaker 3>I don't know, okay, but the quantity of exposure, or

1:18:52.640 --> 1:18:55.960
<v Speaker 3>the amount of allergen that they're exposed to, can lead

1:18:56.000 --> 1:18:58.200
<v Speaker 3>to really different responses than some people. Where some people

1:18:58.200 --> 1:19:01.280
<v Speaker 3>are like even the most minute amount can lead to

1:19:01.320 --> 1:19:04.920
<v Speaker 3>these horrible reactions, whereas other people can have there's a

1:19:04.960 --> 1:19:08.280
<v Speaker 3>threshold where that causes Yes, I guess, okay, one hundred percent.

1:19:08.640 --> 1:19:15.439
<v Speaker 1>Yes, that is absolutely true, and we don't understand why. Okay, ah,

1:19:15.520 --> 1:19:18.000
<v Speaker 1>so yeah, that's like what we know of. When it

1:19:18.040 --> 1:19:21.800
<v Speaker 1>comes to the most severe outcomes, that is anaphylaxis. We

1:19:21.920 --> 1:19:24.280
<v Speaker 1>again don't really have great data here because most of

1:19:24.320 --> 1:19:29.360
<v Speaker 1>the data that we have is on hospital admissions for anaphylaxis,

1:19:30.720 --> 1:19:34.280
<v Speaker 1>and not all people with anaphylaxis have to actually be

1:19:34.320 --> 1:19:37.599
<v Speaker 1>admitted to the hospital. And also it's not always allergies

1:19:37.600 --> 1:19:40.559
<v Speaker 1>that cause anaphylaxis. But at least in some of the

1:19:40.600 --> 1:19:43.519
<v Speaker 1>papers that I found, it's estimated that about zero point

1:19:43.560 --> 1:19:47.720
<v Speaker 1>three percent of the population of Europe will experience anaphylaxis

1:19:47.720 --> 1:19:51.080
<v Speaker 1>at some point in their lives. Wow, okay, yeah, higher

1:19:51.120 --> 1:19:54.559
<v Speaker 1>than I expected. And the data across the board is

1:19:54.560 --> 1:19:57.519
<v Speaker 1>that especially in most high income countries, which is where

1:19:57.560 --> 1:20:03.200
<v Speaker 1>we have data, incidents of anaphylaxis is increasing, which makes

1:20:03.439 --> 1:20:09.400
<v Speaker 1>sense because allergies across the board are increasing. Anaphylaxis, especially

1:20:09.479 --> 1:20:14.160
<v Speaker 1>due to food born triggers, is increasing. Anaphylaxis due to

1:20:14.240 --> 1:20:21.320
<v Speaker 1>alpha gu specifically is increasing big time. But mortality does

1:20:21.360 --> 1:20:25.400
<v Speaker 1>not seem to be increasing, except in Australia, which some

1:20:25.439 --> 1:20:29.240
<v Speaker 1>of the data has had increases in mortality associate with anaphlexis.

1:20:30.320 --> 1:20:33.320
<v Speaker 3>So does that mean that we have developed better tools

1:20:33.400 --> 1:20:34.760
<v Speaker 3>or is that a tune in for next week to

1:20:34.760 --> 1:20:35.000
<v Speaker 3>find it?

1:20:35.120 --> 1:20:36.880
<v Speaker 1>That's a tune in for next week to find out

1:20:36.920 --> 1:20:39.080
<v Speaker 1>how do we treat it? That was my segue erin

1:20:41.240 --> 1:20:41.880
<v Speaker 1>you guessed it?

1:20:43.160 --> 1:20:43.760
<v Speaker 3>I love it.

1:20:45.120 --> 1:20:49.240
<v Speaker 1>So yeah, that's allergies for now, but I can't wait

1:20:49.680 --> 1:20:52.160
<v Speaker 1>for next week to hear about how we figured out

1:20:52.160 --> 1:20:54.519
<v Speaker 1>how to treat these things, and then we'll talk about

1:20:54.960 --> 1:20:57.280
<v Speaker 1>how we treat them and what our thoughts are about

1:20:57.360 --> 1:21:00.719
<v Speaker 1>preventing them in more detail next week.

1:21:01.200 --> 1:21:04.280
<v Speaker 3>But until then, if you would like to learn more

1:21:04.400 --> 1:21:09.960
<v Speaker 3>about things like the how allergies work, the IgE mediated response,

1:21:10.360 --> 1:21:15.280
<v Speaker 3>the evolution of allergies, the rise and allergies. We've got sources.

1:21:14.760 --> 1:21:16.120
<v Speaker 1>For you, so many.

1:21:16.600 --> 1:21:20.280
<v Speaker 3>I have so many, and I highlighted too right here

1:21:20.840 --> 1:21:23.479
<v Speaker 3>just because to list them all out would take another

1:21:23.640 --> 1:21:27.599
<v Speaker 3>ten minutes. So there's one by Dasher and Fernandez from

1:21:27.640 --> 1:21:32.160
<v Speaker 3>twenty nineteen titled Allergy in an Evolutionary Framework that's all

1:21:32.200 --> 1:21:34.960
<v Speaker 3>about the evolution of allergies. And then by Actus from

1:21:35.000 --> 1:21:39.320
<v Speaker 3>twenty twenty one, does the epithelial barrier hypothesis explain the

1:21:39.400 --> 1:21:42.800
<v Speaker 3>increase in allergy, autoimmunity, and other chronic conditions?

1:21:43.400 --> 1:21:49.640
<v Speaker 1>Fascinating stuff for the biology of allergies. Boy, do I

1:21:49.640 --> 1:21:51.599
<v Speaker 1>have plenty of rabbit holes that you can go down,

1:21:52.120 --> 1:21:54.360
<v Speaker 1>But I'm going to shout out like four or five

1:21:54.680 --> 1:21:58.680
<v Speaker 1>main papers that are really high level overviews. One is

1:21:58.720 --> 1:22:00.519
<v Speaker 1>from the New England Journal of Medicae in from two

1:22:00.520 --> 1:22:02.800
<v Speaker 1>thousand and one, so it's old but still good, and

1:22:02.840 --> 1:22:06.280
<v Speaker 1>that is just called Allergy and Allergic Diseases. There was

1:22:06.320 --> 1:22:10.480
<v Speaker 1>one on titled food Allergy from Nature Reviews Disease Primers

1:22:10.920 --> 1:22:13.960
<v Speaker 1>from twenty eighteen, and another one titled food allergy from

1:22:14.000 --> 1:22:16.680
<v Speaker 1>the Lancet two thousand and two, and then two on

1:22:16.720 --> 1:22:20.960
<v Speaker 1>allergic rhinitis, one titled Allergic Rhinitis from the Lancet twenty

1:22:21.000 --> 1:22:25.960
<v Speaker 1>eleven and one titled Allergic Rhinitis Definition, Epidemiology, path of Physiology,

1:22:26.000 --> 1:22:29.360
<v Speaker 1>Detection and Diagnosis from the Journal of Allergy and Clinical

1:22:29.400 --> 1:22:31.800
<v Speaker 1>Imminology from two thousand and one. There's so many There's

1:22:31.840 --> 1:22:33.240
<v Speaker 1>so many more. We're not going to read them all,

1:22:33.240 --> 1:22:35.080
<v Speaker 1>but you can find them on our website, This Podcast

1:22:35.080 --> 1:22:37.320
<v Speaker 1>will Kill You dot com under the episodes tab for

1:22:37.439 --> 1:22:41.400
<v Speaker 1>this episode and everyone we've ever done, they're all there.

1:22:43.479 --> 1:22:46.479
<v Speaker 3>Thank you again, Caitlin so much for sharing your story

1:22:46.520 --> 1:22:51.400
<v Speaker 3>with us and really helping to illustrate that allergy to

1:22:51.920 --> 1:22:55.679
<v Speaker 3>environmental allergens is not just a running nose.

1:22:55.920 --> 1:22:59.559
<v Speaker 1>No, it means so much more. Thank you so much

1:22:59.640 --> 1:23:02.160
<v Speaker 1>for being willing to take the time and to share

1:23:02.160 --> 1:23:04.200
<v Speaker 1>your story with us and all the listeners. We really

1:23:04.200 --> 1:23:04.840
<v Speaker 1>appreciate it.

1:23:05.200 --> 1:23:07.760
<v Speaker 3>Thank you to Bloodmobile for providing the music for this

1:23:07.880 --> 1:23:09.800
<v Speaker 3>episode and all of our episodes.

1:23:10.280 --> 1:23:13.680
<v Speaker 1>Thank you to Leona Scuilatchi and Tom Bryvocal for the

1:23:13.680 --> 1:23:14.400
<v Speaker 1>audio mixing.

1:23:14.920 --> 1:23:16.840
<v Speaker 3>Thank you to everyone at Exactly Right.

1:23:17.160 --> 1:23:19.519
<v Speaker 1>And thank you to you listeners. We hope you enjoyed

1:23:19.520 --> 1:23:21.600
<v Speaker 1>this episode and that you're stoked for next week to

1:23:21.680 --> 1:23:24.320
<v Speaker 1>learn even more about allergies. Yeah.

1:23:24.400 --> 1:23:26.439
<v Speaker 3>Why do EpiPens work the way they do?

1:23:26.720 --> 1:23:27.840
<v Speaker 1>I can't wait to find out.

1:23:28.160 --> 1:23:31.720
<v Speaker 3>Yeah, me too, got some reading to do. Thank you

1:23:31.880 --> 1:23:36.519
<v Speaker 3>also to our wonderful, generous, amazing patrons, We really truly

1:23:36.560 --> 1:23:41.200
<v Speaker 3>appreciate your support so much. Thank you, Thank you well.

1:23:41.320 --> 1:23:43.880
<v Speaker 3>Until next time, wash your hands.

1:23:43.720 --> 1:23:44.719
<v Speaker 1>You feel the animals

1:24:05.640 --> 1:24:09.520
<v Speaker 2>U