Immunotherapy Options for Environmental Allergies with Dr. Manisha Relan

Transcript Disclaimer:
This transcript was generated using AI software from the original podcast audio and may contain errors, omissions, or minor inaccuracies. It has been lightly edited for readability. Please refer to the full podcast episode for the most accurate representation of the conversation.

Manisha Relan, MD: 0:00

It's daily. It's quality of life. Yes, your allergic rhinitis, your runny nose, your sneezing, your congestion is not gonna kill anybody or yourself. It's not life threatening, but that doesn't mean that it's not taking enjoyment or affecting your quality day to day. Going to visit grandma's house is difficult, or going to school because there's a pet therapy dog there, or going outside and enjoying spring in the state of New York, which we all value after long cold seasons, the ability to be outside and play outside. So I think it's the way that it sneaks up on you and perhaps the most common phrase I hear from my patients is they wish they had done it sooner.

Speaker: 0:40

Welcome to the Don't Feed the Fear podcast, where we dive into the complex world of food allergy anxiety. I'm your host, Dr. Amanda Whitehouse, food allergy anxiety psychologist and food allergy mom. Whether you're dealing with allergies yourself or supporting someone who is, join us for an empathetic and informative journey toward food allergy calm and confidence.

1:01

Today's guest is someone that I have been so happy to meet that I've been so excited to have here as a guest on the podcast. Most of you probably already know Dr. Manisha Relan. Thanks to her comforting and trustworthy social media posts under her account,@pedsallergymd. Dr. Relan is a board certified pediatric allergist educator and advocate who is deeply committed to helping families feel informed, empowered, and less overwhelmed in the world of allergies and immunology. In addition to caring for patients in her clinical practice we all see her out there working hard to translate complex medical information into practical, accessible evidence-based guidance for us that parents can actually use. Dr. Relan is also part of the wonderful team behind the 101 Before One program, teaching parents how to introduce solids to their baby and feed their family. Dr. Relan is also a contributing author to the recent book, Baby Leads The Way, which was created in collaboration with members of the American Academy of Pediatrics and is a great resource supporting families and navigating early feeding and food introduction with competence. So in today's conversation, as part of our new season on immunotherapy, Dr. Relan is here to talk about two evidence-based and usually pretty accessible treatment options for environmental allergies. SCIT, which is subcutaneous immunotherapy or allergy shots, and SLIT, which is sublingual immunotherapy, allergy drops or tablets under the tongue. So if you or your child struggles with seasonal allergies, year-round environmental triggers and you've been wondering whether immunotherapy is worth exploring, this episode will give you clarity. We'll talk about how these treatments work, who they're for, what the commitment looks like, and how to think about the decision in a way that feels regulated and informed, not rushed or fear driven. Dr. Relan is so comforting and reassuring, both due to her warmth and her medical expertise. She brings all of that to this conversation, and I know you're going to feel that too while you listen to this chat.

Amanda Whitehouse, PhD: 2:59

I'm so excited to have you here today with us, Dr. Relan.

Manisha Relan, MD: 3:02

Yeah. Thank you for having me. I'm so excited. This is bread and butter for allergists

Amanda Whitehouse, PhD: 3:07

Well,

Manisha Relan, MD: 3:07

really important topic, so thank you for

Amanda Whitehouse, PhD: 3:10

it's, and it's, there's so much. We've been here just chitchatting about it for half an hour before we even started recording. People love listening to you and the way that you explain things, and so I'm really excited for my audience to get to hear you talk about it.

Manisha Relan, MD: 3:22

Thank you so much. I'm excited for you to, to hear a little bit and maybe ask me more questions. Dig deep if we need to.

Amanda Whitehouse, PhD: 3:27

Absolutely. A lot of people probably already follow you on social media if they found me. They've definitely found you, but could you just give us a little bit about your background and, and your practice?

Manisha Relan, MD: 3:36

Yeah, sure. I am a pediatric allergist, so I did my residency in pediatrics at the University of Rochester, and then I did a fellowship with allergy immunology in Buffalo. So I see all ages. We cross train, all allergists, see all ages. It's just a matter of comfort from what their residency was in. And then we subsequently choose where we wanna practice. So I have landed in private practice and I would say an academically minded private practice is how I describe it. And here I am 10 years later.

Amanda Whitehouse, PhD: 4:09

One of the things that we really wanted to get across was the importance of timing as far as addressing seasonal allergies. So, before we talk about the treatments, could you just tell us what you mean by that as far as when is the most effective time to start considering these things?

Manisha Relan, MD: 4:23

Yeah, I would say anytime is the right time. It's like what's right for you? So my answer when patients ask me, parents ask me, I will say, when you can commit. When can you commit? Because it is a total commitment. It is a three to five year program. It is not quick, it is not fast, and allergy immunotherapy, so is the big word, or allergen immunotherapy is a big, fancy word for allergy shots. You have a buildup phase and you have a maintenance phase in traditional allergy immunotherapy. And so the buildup phase is usually once a week and the maintenance phase is every four weeks. And it can be three to four years to cover up for the total five year program. And that's an average situation. There's always gonna be exceptions. There's gonna be people. People that need a longer, people that need a shorter, there is also a kind of form of immunotherapy called cluster. And so the schedule is fast and sometimes allergists will desensitize a patient to what they're allergic to in a like few weeks or within a couple of months, or even a few days depending on what the specific situation is. This is rare, but does happen and sometimes it's needed. So what's needed for you?

Amanda Whitehouse, PhD: 5:38

This is probably the area of immunotherapy I know the least about because we, we haven't actually done it in my house, but I've heard of people doing that for insect stings. Is that one of the most common to do that? It's cluster. Okay.

Manisha Relan, MD: 5:48

And that's why I was kept it kind of vague because I was like, well what allergen are we talking about? Aero allergen, venom for bee stings. Those are the two forms of immunotherapy we have. So we do not have food immunotherapy for shots, but we do do under the tongue immunotherapy for food.

Amanda Whitehouse, PhD: 6:08

Okay, so you talked a little bit about the schedule. Could you give us more specifics about what it actually looks like if the family commits? It sounds like especially a big commitment upfront, long-term commitment, help them understand what they're signing up for if they choose this.

Manisha Relan, MD: 6:23

well, I like to always have a caveat and I tell people life changes. So we try to do our best. We say, all right, this seems like a good time for us to start the buildup because you know, it, the way that we make the immunotherapy vials, we mix the potion as I call it, based on the skin test or blood test results for the patient. So it's a very individualized, specific therapy. Based on what you are allergic to in the environment. And then once we mix the dose, then we dilute it. So we do either four or five dilution set. And so you start with the one-to-one concentration, which is your allergen and a little bit of like a preservative kind of solution, but it's not really preservative. It's usually glycerin. And then you dilute down. So you dilute one to 10. You did one to 100. One to 1000 is the average, or you could start even at one to 10,000. So you start at a very diluted dose. You work your way up the volume, then you change the vial, and you go up the volume and you change the vial. So you'll have multiple vial sets. And so it's basically training your immune system by starting with a very diluted amount of allergen to desensitize you.

Amanda Whitehouse, PhD: 7:40

When people show up for an appointment for this, I know there's a waiting period. Tell them what the daily routine looks like if they're coming in once a week and then eventually once a month.

Manisha Relan, MD: 7:48

Yeah, when you're doing the buildup, it's once a week. And so you come in, in our office in particular, we try to digitize. So you'll, we have a little swipe your card, kind of system. It alerts the nurses in the injection room that the patient is here, they will pull out the vials. And this helps to reduce error so that you know exactly whose name is attached to what vial. You have to scan the vial to activate, to get the right dose. So you call the patient in, you pull up the, the right vial, the right dose. You ask them how they tolerated shots last week, so we're always checking in. To make sure that there were no big local reactions, because that's the biggest side effect of allergy shots is right when the arm where the injection is given can get red, puffy, itchy. We should have really clarified, we talk about shots, but this is subcutaneous, so this isn't the same as receiving, a vaccine which goes into the muscle, which is painful. Subcutaneous injections are typically not painful. I make the joke that there's no nerves there, so otherwise it would hurt us all. And so the shots are typically well tolerated because. As long as you have some subcutaneous tissue to hit. so if you're doing well from last week, then we also ask if there's been any changes in your health. So blood pressure, cardiac history is really important to assess. There is certain categories of medications which an allergist will want to know that you're taking or not taking. And so changes in your health is really important. And then of course, if you're pregnant that also changes. There's some rule modifications that take place.

Amanda Whitehouse, PhD: 9:24

Okay. And so you touched already on two of the big things that I know make people feel a little scared when we talk about this. I think one is the shots, and how much they're going to hurt. Do you mind talking about that a little bit more? You mentioned that it doesn't, but how do you address that with patients when they are

Manisha Relan, MD: 9:39

Yeah.

Amanda Whitehouse, PhD: 9:39

many very afraid of needles?

Manisha Relan, MD: 9:41

Yes. And that's a very valid point. It's true. It's real. And I don't like needles either. For the record, it's a necessary evil. Sometimes we have to adapt to the world that we're living in. I'm very honest with my patients and I tell people you have to give something a try. And it's really for the. What is the goal? Like why are we even doing immunotherapy? It's because the medications are not effective enough. Or we have other chronic medical conditions such as asthma that are being driven by an underlying allergy process that's necessitating the need to step up therapy. And in what other field of medicine do you get to have individualized treatment based on your own skin tests vials made just for you. on your clinical history, maybe in the world of cancer immunotherapy and not a place I wanna go to. Usually if you can get through the first couple of injections, people realize it's not painful. The kids realize that it's like doesn't hurt and then people start to feel better. I would say like that's the biggest reason people come back is it takes about six months minimum. Up to one year and the first year of doing immunotherapy for some efficacy to be noticed, and about 50% will notice it. And that's a pretty big number.

Amanda Whitehouse, PhD: 10:59

I was hoping you could talk about that more because I think we, we tend to just focus on the negatives and the fears, but you had mentioned really wanting to emphasize the, the potential benefit and what people aren't considering as far as how the allergy as is, is affecting their lives.

Manisha Relan, MD: 11:13

Yeah. Well, it's daily. It's quality of life. Yes, your allergic rhinitis, your runny nose, your sneezing, your congestion is not gonna kill anybody or yourself. It's not life threatening, but that doesn't mean that it's not taking enjoyment or affecting your quality day to day. Going to visit grandma's house, is difficult, or going to school because there's a pet therapy dog there or going outside and enjoying spring in the state of New York, which we all value after long cold seasons, the ability to be outside and play outside. So I think it's the way that it sneaks up on you and, and perhaps the most common phrase I hear from my patients is they wish they had done it sooner.

Amanda Whitehouse, PhD: 11:54

Yeah. Yeah. Which is very telling that they were maybe reserved about it and then experience is such a positive benefit.

Manisha Relan, MD: 12:01

Yeah.

Amanda Whitehouse, PhD: 12:02

I'm curious if you notice this too, I always talk to my patients about how sleep is affected and in kids we don't really notice it, but the long-term impacts of that. And if, if kids are not sleeping well, they may not be awake and screaming all night, but if they're not getting good rest, their learning, their health, their growth, so many things are affected by that.

Manisha Relan, MD: 12:19

Their mood, they're cranky.

Amanda Whitehouse, PhD: 12:20

Mm-hmm.

Manisha Relan, MD: 12:22

Uh, speaking from experience, watching my own kids. If you're mouth breathing, that also increases risk of dental cavities and just dental things. And so like, it's all an interplay. We're all connected, so how cool to rely on medications in the beginning to bridge the gap. So when you start allergy shots, you still continue your allergy meds. And my goal is to get you on the least number of medications possible for the shortest duration of time possible. And sometimes I'm very successful and sometimes I'm not. There's no magic test to tell us whether I immunotherapy will be effective. So I don't want to mislead anyone. It's not a cure for allergies. It's just a way to build your tolerance and your immune system's tolerance to those allergens. So I like to set realistic expectations and I also, in all honesty, disclose to people like it's about, you know, 10% of people may not notice benefit at all. And so I don't put people through five years of shots if they're not perceiving benefit by year one going into year two. I think that it's important to pivot when things aren't working to accept that some therapies may not be right for you. So there's people that get allergic reactions. That's the second biggest risk of allergy shots. So the, the local reactions is one thing which we can handle. There's meds, there's ways to pinch the, the arm before the shot goes in. You can ice the area, like there's things we can do supportive therapy wise, an allergic reaction involving the whole body. So the potential for a systemic reaction is there, and that's why you have to wait 30 minutes in the office after you get your injections. It used to be 20 and it's always been 30 since my training has taken place. And it is a requirement that you should stay there and be observed and be monitored as long as you're working with a board certified allergist. There are other people, providers that try to do immunotherapy and have different roles, and I cannot speak to that. But what we do is typically 30 minutes in the office, we are observing you. So the chances of having an allergic reaction exist because we're injecting your body with something we know you're allergic to.

Amanda Whitehouse, PhD: 14:34

Can you talk about, just in your experience, how effective they can be or what, what types of improvement people typically see?

Manisha Relan, MD: 14:40

Yeah, so I would say the first thing is decreased symptoms in their peak allergy season. So whether that be runny nose or sneezing, decreased congestion, better sleep, as you alluded, tolerance to pets, so cat and dog environmental allergies. Sometimes people say that they have less asthma attacks. So asthma is a big reason consider immunotherapy. Some people that have eczema, that's dust mite allergy driven. There's some improvement in that. So skin symptoms improve. Nose symptoms. Eye symptoms. Oh, eyes, oh my gosh, eyes. So lemme tell you about eyes for a

Amanda Whitehouse, PhD: 15:16

Yes.

Manisha Relan, MD: 15:18

Allergic conjunctivitis. It can be really hard to treat eye symptoms. We have eye drops. Many children and adults do not like things in their eyes. we have nose sprays because your eye is connected to your nose. So, we use nose sprays for nasal sprays, like nasal steroids for eye symptoms. And people don't like that. You can get nosebleeds. It's uncomfortable. Sometimes people are not spraying it correctly. Technique is a big pet peeve of mine. And so you get limited as to what you can do and I mean, I trained in Buffalo and I remember ragweed season was really hard for you guys. Down here in the central part of New York, spring because it's what everyone dries up from New York City to see is our beautiful fall in the Hudsons, in the Catskills, in the Adirondacks. The beautiful trees. Yeah. They cause problems in the spring the amount of eyelid swelling that I see, the watery discharge, the redness, I mean we see a lot of vernal conjunctivitis is is another diagnosis. It's common here. And so. Eye allergy is really well treated with immunotherapy.

Amanda Whitehouse, PhD: 16:30

Great point. Yeah. My son the eyes used to get so, and he wouldn't let me put the drops in and he would rub and rub and it was worse than the runny nose or the,

Manisha Relan, MD: 16:38

Mm-hmm.

Amanda Whitehouse, PhD: 16:39

throat or any of the other symptoms for him.

Manisha Relan, MD: 16:41

Yeah. And then we worry about like rubbing your eyes too much can cause corneal abrasions and

Amanda Whitehouse, PhD: 16:47

just

Manisha Relan, MD: 16:48

can really. It's just uncomfortable. It's just so hard to go to school to function. And guess what else happens in the spring exams finals? Like it's a busy, busy time of the year and you want to be able to see and enjoy that. Beautiful.

Amanda Whitehouse, PhD: 17:03

And feeling well, and yeah, like you said, enjoy coming out from the cold like we do here in Buffalo. What other misconceptions do people have? What, what things do you think people don't have the right information about? As far as allergy shots go?

Manisha Relan, MD: 17:18

I think people think that's forever. So that's probably the first misconception. It doesn't have to be, it doesn't need to be. People definitely misunderstand the wait time. I think I to sometimes strongly reinforce that because we get in trouble. We are so digitized that we have like a countdown clock in our practice. And so we know who's leaving early and we flag their count and they're only emergencies happen to everybody. We're all parents. We're all humans. You may have to leave early one time, but we can't have that consistently because we have to be observing you for your safety. So I would say those are probably the two biggest. It's a commitment to the schedule. Sometimes it's distance. We didn't talk about the access to care. You know, maybe you don't have an allergist in your community. Maybe the hours for immunotherapy don't work for you. I would say that sometimes is an issue as well. We have almost banker's hours a little bit later. Some do evenings, some do weekends, but we're not accessible for everybody all the time and so sometimes we do immunotherapy out, so we sometimes will rely on our primary care doctors to help us administer immunotherapy, especially in the rural parts. Sometimes the local urgent care will deliver immunotherapy for us, so we have to build community partnerships.

Amanda Whitehouse, PhD: 18:33

That's a great point. So there are some workarounds, at least for your practice, some flexibility with some of those challenges. But you, you're right. It is a privilege for those of us who have a board certified allergist, if they're within driving distance. Everybody's jobs are different in terms of how much flexibility we have of running two appointments. And then I'm curious for a lot of the other immunotherapy options, insurance doesn't cover, but does insurance typically cover allergy shots?

Manisha Relan, MD: 18:56

Thank you for bringing that up. I was like, don't forget, I wanted to bring that up too. Thank you for bringing that up. So, believe it or not, insurances know that covering you for immunotherapy is more effective to them long term, than paying for all the meds. And medications to me are like bandaids, but treating symptoms. It's symptom management. Symptom control with using nasal sprays, eyedrops, and oral antihistamines or oral other medications. And so you don't get the effectiveness that you get by retraining your immune system really. So the long term benefits of immunotherapy far outweigh

Amanda Whitehouse, PhD: 19:32

right. And if you can get the coverage for it, that's one big factor in your decision making process at least. That is helpful.

Manisha Relan, MD: 19:39

I would say time.

Amanda Whitehouse, PhD: 19:41

Yeah.

Manisha Relan, MD: 19:41

Time is a big factor. So schedule and commitment. That's why I say if you're not ready to commit, please don't even

Amanda Whitehouse, PhD: 19:46

bother doing.

Manisha Relan, MD: 19:47

One year. It's not fair to you. I want you to do what's right for you. And I, I also tell people, shots will follow you wherever you go. So my shots have gone to Italy. Somebody went abroad and so they go to California, we ship them to Florida with the college students so they can follow you. And it's just a matter of receiving on the receiving end, finding an allergist or a physician that will also take care of you. The biggest thing is that they have to be able to treat anaphylaxis. Like that's the big, big, big thing.

Amanda Whitehouse, PhD: 20:17

right.

Manisha Relan, MD: 20:18

there is some precautions. So really unstable asthma we don't do shots for. So unstable cardiac status, unstable blood pressure. So things that could put you at risk to having an allergic reaction or a severe allergic reaction. We have to be careful with.

Amanda Whitehouse, PhD: 20:34

Of course.

Manisha Relan, MD: 20:34

And then age, we didn't talk about age, so there's no real upper limit that I'm aware of other than these contraindications. The youngest I've ever done was five, or just about to be five, and he was already on four allergy meds and asthma and really needed to help control his cat allergy. So taking the therapy at a very young age, and it helped

Amanda Whitehouse, PhD: 21:00

Good. Yeah, I mean, especially, it's hard to think of a kiddo that young having to do it, but also the relief that it must have brought. So that's wonderful.

Manisha Relan, MD: 21:07

Yeah,

Amanda Whitehouse, PhD: 21:08

Okay, so SLIT for environmental we wanted to talk about, that's also an option.

Manisha Relan, MD: 21:12

So I'm glad you brought it up because this is probably a very common misunderstanding. So sublingual means under the tongue and it again means immunotherapy. So we call it SL slit for short. Slit is interesting for aeroallergens. So speaking of environmental allergies only. There are two kinds of slit options. There's slit drops and slit tablets, and so slit drops are typically formulated by your allergist office. And they are typically using commercial extracts that we would use for allergy shots, but we're diluting them or mixing them. They're doing in different concentrations. Not FDA approved, by the way, but it's just a convenient option. So as we were talking earlier, convenience, schedule, cost, like those are probably the biggest three things I can think of. And so slit is more common in Europe than in America, and it's got its own challenges. There's only certain number of things that we can fit into vials or limited by space. And so as a whole Americans, north Americans tend to be very sensitized. We call it polysensitized, means that they tend to have a lot of positives to aero allergens. And in Europe they seem to be more often mono or just like a few things that they're sensitized to. So it's easier to do single immunotherapy vials. When we do SCIT for injections, we can do like four injections. Very infrequently five if we needed to. And when it comes to drops in the tongue, well multi allergen drops in the tongue have not been as well studied as single allergen. so there's a lot of things that are, and I think you and I were talking about guidelines and how we need more research. We just need a better understanding in totality and good quality research to compare the two in efficacy, but in general, it's an option. So tablets are made by pharmaceuticals, and so there's ones for like ragweed, there's ones for grasses, and then there's one for dust mites. So they're limited options. They don't cover all the, there's no nothing for pets, for example, and nothing for tree pollens, which would be so nice for us here in this part of the state. But there are options. I definitely discuss those options. If it's a possibility, you also have to go through prior authorization. The insurance has to definitely agree and some do not want to cover that. So they'll say, why can you not do injections? Maybe fear of needles. You know, maybe that's why we can't do shots. Or maybe it's just inconvenient, you travel a lot.

Amanda Whitehouse, PhD: 23:57

Right. I didn't even realize those were available in the States because everyone I know who has done them has not been in the us, but the tablets are, with those limitations, they are an option that you could have talked to your allergist about In theory.

Manisha Relan, MD: 24:09

I mean, I've definitely done ragweed and I've definitely done dust mites, and I think I have a patient right now who's still doing dust mites. The interesting thing about the tablets is that there's different rules for ages. There's different rules for when you start them. So dust mites are perennial allergens, right? They're every day. They're always there. So it doesn't really matter when you start those because they're an everyday allergen, but ragweed is seasonal and so there are some restrictions or some rules and guidelines about like starting 12 weeks or starting 16 weeks prior to the allergy season. Maybe you don't have to do it year round. Maybe you can do it before and then during the ragweed season itself. So there's different, guidelines on that. Again, it's just hard to find someone that's only allergic to one thing

Amanda Whitehouse, PhD: 24:52

Right.

Manisha Relan, MD: 24:53

and only or only wants treatment for that one thing.

Amanda Whitehouse, PhD: 24:57

Right, right. And I can see there's a lot of barriers with that too, as far as the accessibility. I don't think as many allergists are offering it, particularly the, the drops, the tablets are limited, like you said by ingredient,

Manisha Relan, MD: 25:09

For us, I would say the cost

Amanda Whitehouse, PhD: 25:11

Okay.

Manisha Relan, MD: 25:11

the biggest thing. Then like there's definitely companies online that will ship you, drops to your house and they'll use blood tests which are not as specific as, or sensitive as allergy, skin testing. So you get like differences in sensitivity and specificity with the different tests that you choose to do. And then I would say most importantly, everything can carry a risk of reaction, right? So if you choose to do sublingual while immunotherapy, we do recommend an epinephrine device be available to the patient because you're gonna do it mostly at home, and it's a daily dosing, so it's different than, than the subcutaneous, which was in the office once a week and then once a month.

Amanda Whitehouse, PhD: 25:53

Right.

Manisha Relan, MD: 25:54

So you also have to have compliance to doing something daily. And then don't forget, it's in the mouth. So the side effects are local. I had one patient that signed up and could not tolerate the itching. It's the oral pharyngeal pruritus is a medical way of saying just her mouth was so itchy, her tongue was so itchy. She's like, I'd rather be allergic and have this itching, like constant.

Amanda Whitehouse, PhD: 26:19

Yeah.

Manisha Relan, MD: 26:19

it's the worst in the first week. It does settle out as you do them daily. But there is like, you know, as with anything, this is a nuanced topic. You really deserve to have the time to sit down with your doctor and discuss your options and. Not everything may be plausible or feasible depending on where in the country you reside, where you know what your options might be and what you're allergic to, and is that even a relevant season for you? So one more point I'd like to just make. Just because you test positive doesn't mean you have the disease. This is very true for food allergies. This is very true for environmental allergies as well. Sensitization doesn't equal disease by itself, and so I don't, I don't want to, and I don't like to overtreat. I don't like to over test. I get into trouble because I don't like over testing, and it's just a matter of like giving you the best quality of your life with what we can.

Amanda Whitehouse, PhD: 27:11

Yeah. Yeah, and that's a great point. This is information for you to take and have a personalized conversation with your provider or, or maybe if you're not getting a great discussion with your doctor, maybe you see if there's another allergist that you can consult with, but it's so individualized and nuanced that it's, it's worth a discussion about your particular situation. Right. And like you said, if you're having, if it's bothering you, if you're having symptoms versus this, this popped up on my skin test too, which, you

Manisha Relan, MD: 27:34

And

Amanda Whitehouse, PhD: 27:35

know,

Manisha Relan, MD: 27:35

good place to find an allergist is the A-C-A-A-I or the quad AI website. You can actually type in those letters and I can, uh, share that with you if you want to put it in the show notes or something. And

Amanda Whitehouse, PhD: 27:47

Absolutely.

Manisha Relan, MD: 27:48

put it right into Google, find an allergist. You just type in a a, a I find an allergist, and it'll take you right to the link. And, you can put in your zip code, your state, your city, whatever you want, and you'll get all this practice information. And you can like kind of not stalk the website, but you can kind of see what your options are in your community, and especially if you're moving or your kid is going to college, this is very commonly underutilized resource.

Amanda Whitehouse, PhD: 28:13

Great point. Yeah, I'll definitely put that in the show notes for people who are listening and tell them where they can find you and all of the good stuff that you share in social media.

Manisha Relan, MD: 28:21

Thank you. I am @pedsallergymd on Instagram, a little bit on threads, and that's all I have time for,

Amanda Whitehouse, PhD: 28:31

It's a lot. It's super helpful. So I love what you're sharing and yeah, there's too many platforms to, to hit them all, right?

Manisha Relan, MD: 28:36

not for right now.

Amanda Whitehouse, PhD: 28:38

You're, you're busy, I think you sounds like you're a little bit busy.

Manisha Relan, MD: 28:41

Thank you.

Amanda Whitehouse, PhD: 28:42

What else do you want to leave the listeners with? Is there anything we didn't get to or just final thoughts that you want to share with them?

Manisha Relan, MD: 28:47

Well, I personally, one of the reasons I went into allergy immunology was because of allergy shots. I found that it was a perfect way to kind of bridge together like my Eastern upbringing with the Western science, and I just love that you can do things outside the box. I love that if we can remix. So if I made things too strong, I could take it down. If it's not strong enough and I'm revisiting you yearly, we do check-ins and so I titrate up if I need to. I just love that it's so individualized and I think it's one of the coolest things we can do is desensitize somebody, build their tolerance from within.

Amanda Whitehouse, PhD: 29:29

That sounds awesome. Thank you so much for sharing about all of it with us

Manisha Relan, MD: 29:32

Yeah. Thank you for having me.

29:34

Dr. Relan and I really hope that this episode helped to clarify the differences between SCIT and SLIT, or helped you feel a little more empowered in thinking about allergy treatment. Here are three steps for you to carry that forward.

Number one, follow Dr. Relan @pedsallergymd for clear and trustworthy allergy education and practical guidance for families navigating allergy care.

Number two, check out baby leads the way, especially if you're in the early feeding stages or want evidence-based support around introducing foods with confidence. And of course I'll put links to Dr. Relan's social media, to the book, and to 101 before one in the show notes to make it easy for you to find all of those resources.

And number three, share this episode with a friend, parent, colleague, anyone who may be weighing immunotherapy options. These decisions feel so much easier when we have accurate, calmly provided information.

And as always, thank you so much for subscribing, leaving your ratings and reviews, and sharing the episodes with other people, who might benefit from this support in our allergy community. I appreciate and am amazed by how you help me to continue growing the show. We will talk again next week.

The content of this podcast is for informational and educational purposes only, and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have any questions about your own medical experience or mental health needs, please consult a professional. I'm Dr. Amanda Whitehouse. Thanks for joining me. And until we chat again, remember don't feed the fear.