What happens when an allergist steps into the online world and starts breaking down headlines in real time?

In this episode, I sit down with Dr. Zachary Rubin, board certified allergist and immunologist, content creator, and now author of All About Allergies. We talk about why allergy misinformation spreads so easily, why “allergy” is not a catch all term, and how social media has unexpectedly made him a better clinician.

We also get honest about the current state of medicine. Burnout. Insurance barriers. The time crunch in clinic. And why rebuilding trust between families and physicians starts with better communication, humility, and human connection.

This is a conversation about nuance in a world that craves certainty, and why meeting families where they are matters more than ever.

In this episode, we discuss:

• Why “sensitization does not equal allergy” and what that actually means

• The difference between allergy, intolerance, and sensitivity

• Why food sensitivity tests are often misleading

• The truth about local honey and seasonal allergies

• Shellfish allergy and contrast dye myths

• Egg allergy and flu vaccine misconceptions

• Why 90 percent of reported penicillin allergies are not true allergies

• How timing and rash characteristics matter when evaluating antibiotic reactions

• The explosion of biologic medications and the hidden burden of insurance approvals

• How social media can improve doctor patient communication

• The role of humility and nuance in rebuilding trust

• Humanizing doctors and why connection is powerful medicine

To connect with Dr. Zachary Rubin follow him on Instagram @rubin_allergy, check out all his resources at linktr.ee/rubin_allergy and buy his book “All About Allergies!”: ⁠https://www.penguinrandomhouse.com/books/790561/all-about-allergies-by-zachary-rubin-md⁠   

00:00 Allergy Is Not a Catch-All Term

02:37 Why Dr. Rubin Went Online

09:27 Why This Book Had to Exist

12:59 What Parents Are Most Anxious About Today

15:10 Why Food Allergy Testing Is Often Misused

16:38 Allergy vs. Intolerance vs. Sensitivity

22:01 The Obsession With Blood Work

24:57 The Systems Problem in Medicine

34:08 Rebuilding Trust in Medicine

38:51 How Social Media Made Him a Better Doctor

43:53 Allergy Myths That Need to Go

48:57 The Penicillin Allergy Problem

50:55 Rashes, Timing, and True Drug Reactions

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00;00;00;01 – 00;00;22;16

Dr. Zach Rubin

Where somebody says they’re allergic to a food. And they’re at a restaurant. They get a plate. It actually has it in front of them. They still eat it anyways and they say no it’s okay. I just have a little bit of intolerance. Right. So having that language is so important. Allergy is not a catch all term.

 

00;00;22;18 – 00;00;48;10

Dr. Mona

Welcome back to the show doctor Mona here. And you’re listening to the PedsDocTalk podcast. And it has been six years of the show. Six years. And I’ve been practicing for almost 11. I’ve been a mom for six. I mean, I can’t believe this. I started the show three months after Ryaan was born, and it has grown to be one of the most amazing mediums, and I love to be on, and I have to thank you for that, because in order for the show to continue to grow, you have to listen to it.

 

00;00;48;11 – 00;01;08;22

Dr. Mona

You have to download, subscribe, all the things. So thank you. And I’m excited because I get to have an amazing guest on the show today that you probably know. But first I want to ask you some questions. Have you ever wondered if your child really has a food allergy, or if it might be something else? Have you been told to avoid a medication because of a penicillin allergy from years ago, but no one ever checked it.

 

00;01;08;24 – 00;01;35;24

Dr. Mona

And in a world where health information is everywhere, how do we know what is evidence based and what is just loud? Today’s episode is about allergies, myths that refuse to die, and how we rebuild trust in medicine, and a time when families feel overwhelmed. And have you guessed who my guest is today? Have you guessed? I’m joined by Doctor Zachary Rubin, a double board certified pediatrician and allergist immunologist, nationally recognized medical educator, and the voice behind at Rubin Underscore allergy.

 

00;01;35;25 – 00;02;06;00

Dr. Mona

I think many of you may follow him where he shares clear, accessible guidance with millions of followers across many platforms. He’s also the author of the new book, All About Allergies A Compassionate Practical Guide to Understanding and Managing Allergy. In this conversation, we talk about what allergies are, the difference between allergies and intolerance, says myths he wishes would finally disappear, how allergy testing is often misunderstood, and how we humanize doctors again so families feel supported instead of judged.

 

00;02;06;02 – 00;02;29;26

Dr. Mona

Make sure you subscribe and download this episode and a few of your favorites. That support helps the show grow and continues to bring you amazing conversations that matter. And after you listen, do a favor and go on our social. Share this episode. Share the video that we posted in the carousel. Tag Pete’s dog talk. Tag the Pete Stop Talk podcast and at Reuben underscore allergy so we can keep this convo going.

 

00;02;30;01 – 00;02;37;02

Dr. Mona

Let’s dive in today.

 

00;02;37;05 – 00;02;39;22

Dr. Mona

Thank you so much for joining me today, Doctor Zach.

 

00;02;39;29 – 00;02;42;18

Dr. Zach Rubin

Thank you so much for having me. I’m really excited to be here.

 

00;02;42;20 – 00;03;00;12

Dr. Mona

My you know, my first question for you is you are like anytime there’s like a news story that goes up, like, you know, you are like the first person to create a video. And I’m just like, it’s like a running joke in my team. I’m like, listen, I don’t have time, but Zach will probably get something up and then that’ll be great and I can share it.

 

00;03;00;14 – 00;03;17;10

Dr. Mona

So how has this evolved for you? I mean, one, you were obviously a practicing allergist immunologist. You’re busy. What made you want to get online? And also, what is your secret to like being able to like, get videos out so fast? I love it. I’m like, yeah, this is amazing.

 

00;03;17;12 – 00;03;37;21

Dr. Zach Rubin

All right, I’ll spill the beans. Yeah. So basically what happened was I finished my fellowship right when the pandemic started. So I moved from Saint Louis to the Chicago area when everything was shut down. There were no events for me to meet. Pediatricians, internists, go to hospital events. All of it was closed. Everybody was just trying to survive, as you may recall.

 

00;03;37;26 – 00;04;04;25

Dr. Zach Rubin

It was really difficult to meet people and to build a practice because I’ve been a small private practice. So I decided to go to social media to connect with people. And I went on old med Twitter, you know, and we were all chit chatting there. I’m sure you remember that too. Yeah. And I connected with a lot of people there, and I quickly realized how much bad information was being shared about the pandemic, about various health related issues, something that I rarely use social media prior to the pandemic.

 

00;04;04;25 – 00;04;21;03

Dr. Zach Rubin

And I kind of thrust myself into this as I was trying to build my platform, trying to build a practice. At the same time, I had a lot of extra time on my hands to figure out how to do the whole process. As you know, it’s a lot of work to come up with what you’re going to say.

 

00;04;21;05 – 00;04;42;12

Dr. Zach Rubin

Content creation, everything like that. I mean, at that time, TikTok, didn’t even have an auto caption feature. You had to handwrite everything in. So it was it was a lot of extra work, but I gained a lot of those skills then. And also, I have a background in video editing and audio editing back before I was digital because as a kid, movies.

 

00;04;42;14 – 00;05;03;17

Dr. Zach Rubin

So I knew how to edit VHS tapes. And so that that was built into my DNA, so to speak, at a young age. And so that helped me become very adaptable to technology. So about April 2021, there was a medical student in Canada who asked me to go to TikTok to to start making videos. And I was like, I don’t know if I could do this because it’s a dancing platform.

 

00;05;03;17 – 00;05;25;06

Dr. Zach Rubin

I thought it was for kids. I had no idea how many professionals were there teaching people. So when I started creating content there, people people really resonated with it. I was creating things that was just succinct, trying to explain these different concepts, and it just has slowly grown over time that when you post almost every day, you will build an audience.

 

00;05;25;06 – 00;05;42;27

Dr. Zach Rubin

And I’ve gone around the country and in Canada and give talks about this, about how anybody who’s a professional can make a difference on social media because we already have the expertise. We just got to put ourselves out there and break down the barriers, between patients and physicians by just talking with people where they are getting their information.

 

00;05;42;27 – 00;05;50;21

Dr. Zach Rubin

Most people are online getting their info and so when I see news information coming out, I have all these push notifications on my phone there.

 

00;05;50;21 – 00;05;51;16

Dr. Mona

So there we go.

 

00;05;51;16 – 00;06;20;10

Dr. Zach Rubin

Yeah. So it will tell me immediately that there’s breaking news about something. Or I still look at Twitter from time to time for video clips that are being posted by our Health and Human Services secretary as an example, to see all the the unusual things coming out. And because I’ve been practicing at this for a long time, I have my own system in place that, you know, even before this call, I found a breaking news story and I was able to make a piece of content in three minutes.

 

00;06;20;12 – 00;06;20;27

Dr. Mona

Amazing.

 

00;06;20;28 – 00;06;41;05

Dr. Zach Rubin

Very, very quick. Yeah, I do it, from from the idea to speaking to then doing it. Because when you do something over and over again, you have these scripts in your head, and you know that because you talk with patients every day that there’s certain pieces of information you want everybody to know. So you already have that built into how you talk with patients.

 

00;06;41;08 – 00;06;54;24

Dr. Zach Rubin

And I found that social media has made me an even better doctor, because I can communicate with my patients a lot more clearly. Concretely, I already built a rapport with most of my patients because most of them follow me before they even meet me for the first time.

 

00;06;54;24 – 00;06;55;11

Dr. Mona

Amazing.

 

00;06;55;11 – 00;07;00;18

Dr. Zach Rubin

Yeah, so it really helps on so many levels and I’m really grateful for these opportunities.

 

00;07;00;21 – 00;07;16;25

Dr. Mona

Oh, and I’m so glad that you’re taking the time to talk to him about that and and sharing this trade secret of the push notification. Because that’s the thing is, like, I’m like, I get it through the grapevine or I’m not on social. And then I’m like, how did this happen? And then I’m like, I really am. Like, I’m in the middle of something else or doing something.

 

00;07;16;25 – 00;07;25;21

Dr. Mona

And then I’m like, Doctor Reuben will have that video. And so if you’re not following him, which I’d be surprised because a lot of my followers do follow you. Follow Doctor Beecham. You know, we’re.

 

00;07;25;21 – 00;07;27;15

Dr. Zach Rubin

All in that we’re the same circle.

 

00;07;27;15 – 00;07;46;19

Dr. Mona

Yeah, right. We’re, you know, obviously larger followings on social. But, you know, one of the things that I just really appreciate is, yeah, your ability to take that information, not make it a not make it scary. And just really you’re like your own news channel, right? Like, I love it. I’m like, who needs who needs mainstream media when we have our own platforms and Doctor Reuben giving us what we need?

 

00;07;46;20 – 00;07;47;19

Dr. Mona

I love it.

 

00;07;47;21 – 00;08;08;18

Dr. Zach Rubin

Yeah, I appreciate that. It’s just that sometimes people need to get a little bit more nuance from an expert about whatever that news headline is, because yes, anybody could see that headline on The New York Times, whatever it is. But to get it from the perspective of a physician or a scientist, an expert that has more familiarity with it and can level with people is very valuable.

 

00;08;08;18 – 00;08;13;01

Dr. Zach Rubin

And you do that very well with your platform. When we’re talking about various pediatric ish.

 

00;08;13;02 – 00;08;31;20

Dr. Mona

Yeah. And, you know, one of the fun things when I’m on TikTok. So I’m not I’m not as big on TikTok as I am on Instagram. And then I always have the podcast as my big medium. But when I’m on TikTok and I see a video that I want to respond to, sometimes I see in the comment section like, oh, doctor Reuben had a video responding to this, you should check it out.

 

00;08;31;20 – 00;08;45;26

Dr. Mona

And I’m like, they’re amazing, amazing. We’re here. And I say, why is that? You know, because sometimes I’m not able to create a video. Sometimes you may not be able to, although I haven’t seen that happen yet. But like, I’ll be like, you know what? Let me just share share his stuff. Like, that’s okay. I’ll just share it.

 

00;08;46;02 – 00;09;06;10

Dr. Mona

And then I, you know, I don’t need to do it. And it’s just a nice team effort to approach. Like you said, we have this awesome skill. I, I always joke with a lot of people when I do speaking engagements, that I think that this should be its own subspecialty, like being an online content creator as a health professional, because of the stuff that you learn just by going through it.

 

00;09;06;10 – 00;09;27;17

Dr. Mona

You know, it’s like its own art form, its own specialty to be able to communicate effectively online. And I think you have that. So, you know, we’re living in a moment where parents are flooded with all this health information, misinformation, but also a lot of fear. Right. And you mentioned that beautifully. What pushed you to write all about allergies right now?

 

00;09;27;18 – 00;09;31;13

Dr. Mona

Like what was that sort of impetus to say, you know what, I want to create this book that people can have?

 

00;09;31;13 – 00;09;51;29

Dr. Zach Rubin

Yeah. So I got contacted by one of my followers, who is an editor at the imprint of Penguin Random House and said, you know, I’m looking at the market and there’s really nothing out there that’s a comprehensive allergy book. And I personally suffer from allergies, and so does my child. And so it was a big ask that initially brought this all forward.

 

00;09;51;29 – 00;10;11;26

Dr. Zach Rubin

And I and this was a little this is a couple of years ago. So this is not something that just happened overnight. And I remember sitting there thinking, you know, I don’t know if I have enough time to do this. I’ve never written a book before. I’m very nervous to put myself out there. And my wife was saying to me, you know, if you don’t do this, I’m just going to go straight your book for you.

 

00;10;11;26 – 00;10;35;10

Dr. Zach Rubin

You have. And when she said that, I said, okay, you’re right, I should do this. I’m going to put the time in and after, you know, working with an agent and figuring out the whole book proposal process. Yeah, that’s actually the hardest part, is coming up with the idea and putting that in a document that sells the book before you even write the book.

 

00;10;35;17 – 00;11;02;18

Dr. Zach Rubin

Yeah, that was the hardest part. And so once I got that out there and I had tremendous help from my agents on that, we got offers very quickly for it, for the book, because it really is a need there. There’s really not much out there that is meant for the masses to learn about these allergic diseases for kids and adults, whether it’s asthma, food allergies, eczema, chronic hives, medication allergies, even vaccine allergies.

 

00;11;02;18 – 00;11;24;04

Dr. Zach Rubin

I talk about in the book, all of these topics put in one resource is really a culmination of all the content I’ve created over the years. So once I started writing the book, I made it a part of my daily practice. I’d write every day, and it came naturally. It was really a joy to write it. And I had a tremendous team at bloom, which is the imprint I’m working with.

 

00;11;24;04 – 00;11;44;25

Dr. Zach Rubin

They did such a tremendous job with editing it. My editor was amazing. Just really let me take the reins on everything. So this is really a labor of love to help people meet them where they’re at. And there’s so much we can talk about with this book in terms of normalizing these conversations and debunking misinformation and how to navigate health care.

 

00;11;44;25 – 00;11;46;12

Dr. Zach Rubin

And I’m very excited to share it with the world.

 

00;11;46;18 – 00;12;01;16

Dr. Mona

Congratulations. You know, I am actually in the book proposal process, so I can attest to the fact that it is a very arduous process. It is the hardest and that my agents are the same thing. But there is a joy of getting into it. And, you know, I used to write a lot when I was growing up.

 

00;12;01;16 – 00;12;21;23

Dr. Mona

Like, I’m talking like fiction in like, high school. I was a very specific fiction writer. But I never wrote a book like this. Right? I mean, it’s different. And so and also, we’ve gotten so used to speaking to short form content. And so having to like, write for a book is very different for me. So like, I’m so used to writing my YouTube scripts or writing something for social that I’m going to say.

 

00;12;22;00 – 00;12;37;27

Dr. Mona

And then I was like, oh, I can expand a little bit more. And so it’s really exciting. I’m really excited for you. And I love, obviously not only the fact that it was a UN area that was needed in the book market, but also your reputation as someone online is super helpful, because people trust you. And so I’m really excited.

 

00;12;37;27 – 00;12;59;12

Dr. Mona

I’m excited that people can get this into their hands and my first question about the book is, you know, you’ve been practicing, through the pandemic now. And so families today often arrive already overwhelmed, as me and you both know, before the visit even starts. So when parents walk into your office today, what are they most anxious about when it comes to this topic?

 

00;12;59;12 – 00;13;13;02

Dr. Mona

Allergies, asthma or immune health and has that changed from when you started practicing? Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show.

 

00;13;13;05 – 00;13;41;06

Dr. Zach Rubin

Oh, right. So when I started practicing, a lot of the anxiety was towards the pandemic and managing food allergies through its as well as vaccine issues. So in my area, there are other allergies, but in our specialty, one of the things that we do is adverse reactions to vaccines. So it’s part of our specialty. And so I became one of the de facto experts on dealing with these different issues.

 

00;13;41;07 – 00;14;01;16

Dr. Zach Rubin

You may remember early on there were cases of anaphylaxis to Covid vaccine. There were cases of Covid, right, with the Moderna vaccine and those large local reactions and all these changing guidelines. So I had a lot of anxiety towards all right. It is what I’m experiencing a real serious reaction to. I need to get a booster, what I do with that.

 

00;14;01;22 – 00;14;25;09

Dr. Zach Rubin

And so that was a very, difficult time because we were essentially building the ship and driving at the same time. So, so that was challenging. And I was collaborating with a lot of experts, which social media helped me connect with various experts at Harvard as an example. And, and we were creating patient databases and really trying to figure out, like, what was going on with these vaccines in terms of adverse events.

 

00;14;25;09 – 00;14;49;13

Dr. Zach Rubin

And then as things started to settle out, we had a lot better understanding about what was considered to be a true serious adverse event versus something that was less worrisome. And how do we manage it? But it took time. So so that that issue has not been a major topic of conversation in recent years. I would say a lot of the anxiety that my patients face are more geared towards food allergies specifically.

 

00;14;49;16 – 00;15;10;08

Dr. Zach Rubin

So they’ll come in already either with a diagnosis of food allergies or suspected from their pediatrician, or they come to me directly because they know who I am, or they’re looking for me as a second opinion. Because one of the big issues when it comes to allergy testing is it’s not always the most accurate form of testing, depending on how you use it.

 

00;15;10;08 – 00;15;37;15

Dr. Zach Rubin

And I talk about in the book in detail about sensitivity, specificity, pretest probability, and how does that impact our testing strategies for allergies? Because the adage that I learned in fellowship is sensitization does not equal allergy. When you get a positive test that only means you have an antibody present called IgG or immunoglobulin E that could bind to that specific substance like peanut butter, as an example.

 

00;15;37;17 – 00;15;55;27

Dr. Zach Rubin

And maybe that could lead to an allergic reaction. But it depends on the context of the test. If I was to test four people in a room, 1 to 2 of them would have a positive test. Even if they’re eating the food. If we do a full panel. So full panel testing is not necessarily helpful when it comes to food allergies.

 

00;15;55;27 – 00;16;14;13

Dr. Zach Rubin

Yet I have that coming in in my office on a regular basis, where people had a panel test done ten years ago, and now I’m stuck with a laundry list of food allergies that may or may not be real. Or maybe it’s too late to intervene, and it becomes very difficult to tease that out and figure out how can we make someone’s quality of life better and safer?

 

00;16;14;19 – 00;16;38;26

Dr. Mona

Yeah, and I think you just said it like there’s a lot of mislabeling that I think parents do or for themselves if they have these situations or for their child. Between the differences of allergy intolerance or sensitivities, do you go over that in the book? And if you don’t or if you do, if you want to just give like a little bit of like, you know, high level sort of how to differentiate for a family and why it’s important for us to know that it’s different.

 

00;16;38;26 – 00;16;56;18

Dr. Mona

And I think, you know, part of like, for example, my, our nanny, has a gluten intolerance, right? And so my son says, oh, mommy, he’s she’s allergic to gluten. I’m like, well, let’s use the right terminology. And I’m explaining to a six year old, you know, it’s hard. It’s important for me. Like, I’m like, you know, I want I want him to understand.

 

00;16;56;18 – 00;17;17;23

Dr. Mona

Although I know he’s not going to retain that probably right now that there’s a difference. Right. And also that just because you don’t like something doesn’t mean you’re allergic to something. And I say that because we should never be diminishing what a true allergy is. So yeah, explain that sort of difference between allergy intolerance and sensitivity. And maybe it has to tie into like blood work or you know, how someone responds.

 

00;17;17;23 – 00;17;18;02

Dr. Mona

Right.

 

00;17;18;02 – 00;17;36;12

Dr. Zach Rubin

So in my food allergy chapter in the book, I go over this in detail in different ways. So I actually have a screenplay that I wrote, a fake screenplay, because when you go on social media or you see SNL skits, they commonly make fun of this where somebody says they’re allergic to a food and they’re at a restaurant, they get a plate.

 

00;17;36;12 – 00;17;54;16

Dr. Zach Rubin

It actually has it in front of them. They still eat it anyways, and they say, no, it’s okay. I just have a little bit of intolerance. Right? So having that language is so important. Allergy is not a catch all term. It is an abnormal immune system response to a foreign substance. But even within that there are different subtypes.

 

00;17;54;16 – 00;18;20;07

Dr. Zach Rubin

And I go over several of them. Whether it’s a classic Ige mediated food allergy or something called food protein induce enterocolitis syndrome, like sneeze or eosinophilic esophagitis or aeaae, those are all not the same. But food can trigger symptoms through different ways the body works, whether it’s normal or an abnormal pathway. So when we talk about food allergy, most people refer to it as an IgG mediated allergy.

 

00;18;20;07 – 00;18;46;02

Dr. Zach Rubin

That’s when you have a blood test or skin test that’s positive. And even at tiny doses, if you eat it, you could have mild symptoms or you could have potentially serious, life threatening symptoms called anaphylaxis. And we try to prevent anaphylactic shock, which is the true life threatening situation. I go over the difference in my anaphylaxis chapter between anaphylaxis and anaphylactic shock because they’re often used interchangeably, but they are not the same.

 

00;18;46;09 – 00;19;12;13

Dr. Zach Rubin

They really are not. So if I get a test that’s positive for, peanuts and they have a history of either hives, swelling problems, breathing like wheezing, repetitive coughing, vomiting, or a combination of those symptoms, or even in rare cases, a drop in their blood pressure. And it’s reproducible even if small amounts. That’s a food allergy versus an intolerance is a digestive problem.

 

00;19;12;15 – 00;19;36;08

Dr. Zach Rubin

You eat something even at larger amounts, and you don’t have the right enzymes or the right bacterial milieu to break that food down properly. And if that happens, you could get a lot of excess gas production in your guts. You could have pain, you could have diarrhea, sometimes even nausea. That’s what an intolerance is. And the testing is not really widely available.

 

00;19;36;08 – 00;19;56;13

Dr. Zach Rubin

There is something called a hydrogen breath test. I never order because it requires somebody to consume the offending food. You know, milk for lactose intolerance. Sit there for a while, breathe into a tube. Because if you have an intolerance, you make excess hydrogen gas from the bacteria that are trying to make up for the fact that you don’t have an enzyme called lactase to break down the sugar molecule, lactose.

 

00;19;56;15 – 00;20;14;29

Dr. Zach Rubin

So we’re going to cause harm to prove a point. I don’t like doing that with tests. Yeah, right. I try to minimize harm with anything that I do. So clinically, if somebody already tells me, yeah, whenever I consume this particular food, it always gives me this problem and it’s bloating, abdominal pain, whatever. I’ll say, hey, let’s avoid it for two weeks.

 

00;20;14;29 – 00;20;35;10

Dr. Zach Rubin

Let’s see what happens. And if your symptoms go away, great. If you put it back in your diet and it comes back, that is diagnostic. That’s a clinical diagnosis. On the other hand, sensitivity is a nonspecific term, and it’s very challenging to try to rewire people in thinking about this, because it is true that food can cause symptoms.

 

00;20;35;17 – 00;20;53;23

Dr. Zach Rubin

There’s no doubt about it. We know many different ways that it does, but to be able to say that somebody is sensitive to a food that when they eat it, they start having headaches or having other symptoms that are not in a specified pathway. I don’t have a test to prove to that person that this is why it’s happening.

 

00;20;53;25 – 00;21;16;29

Dr. Zach Rubin

I have to go based off the clinical history. So there is something called non celiac gluten sensitivity where they may not have the classic intolerance symptoms, but they have other nonspecific symptoms. And they test negative for celiac disease. But they swear that every time they eat gluten containing products it has a problem. And then when they stop eating it they feel much better.

 

00;21;17;01 – 00;21;38;13

Dr. Zach Rubin

I believe my patients, but I don’t have a test to corroborate. That is the major difference. What you see online though, are people selling food sensitivity tests, which most of the time they’re measuring for an antibody called IgG. That is something we naturally make in response to seeing food in our body as a way to decrease that immune response.

 

00;21;38;20 – 00;21;56;22

Dr. Zach Rubin

So how does your body know that food is not a germ? It has to have checks and balances. And IGA is one of the ways. But the test will say, oh, if you have a positive test, you should get rid of that food. Well, everybody who comes to my office is an adult with that packet, with that test, they’re all positive for coffee because almost everybody drinks coffee.

 

00;21;56;29 – 00;22;01;23

Dr. Zach Rubin

So any times you’re exposed to something it just says you’re exposed to it doesn’t mean anything clinically.

 

00;22;01;26 – 00;22;21;07

Dr. Mona

You know, I already brought up one thing about the the blood work. You know, as a general pediatrician, that first line for a lot of families, there is an obsession with the blood work. And you already mentioned that a lot of the blood work may not always be accurate because of testing strategies. And so a lot of it is collaborated or connected with the clinical picture.

 

00;22;21;11 – 00;22;37;14

Dr. Mona

Do you see that there’s been do you see that sort of sentiment too, that people are obsessed almost with, like, I want the documentation, I want the blood work, I want some sort of test to confirm this, or you’re able to kind of explain them out of it in terms of, hey, it has to do with this whole picture of everything that we’re seeing, right?

 

00;22;37;14 – 00;23;03;14

Dr. Zach Rubin

So when people come in initially, if if they don’t know me or haven’t talked to me before, they will initially say, I want these tests. Yeah. And this is why it will make me feel better. And so I’m lucky that the way that my practice is set up, that I have a little bit more time with my patients, which I’m very grateful for, that because it gives me the opportunity, just like we are right now, having a little bit more of a deeper discussion into the risks and benefits of testing.

 

00;23;03;19 – 00;23;23;28

Dr. Zach Rubin

We often online get demonized as saying we don’t give informed consent. And that is far from the truth. Yeah, I do that with testing. And so I always encourage people, hey, if your doctor, your PCP is going to order tests, ask them why are they ordering it, how accurate it is, how is it going to change my management, and what are the risks and benefits of doing that test?

 

00;23;24;00 – 00;23;43;02

Dr. Zach Rubin

Because it it can cause anxiety. It can cause unnecessary testing. Can cost money for people. So I always a very sensitive to that because just to give you an example, when I order one IGI test for a specific food, if it’s a blood test, the lab, I get it through. They charge about 30 bucks per food.

 

00;23;43;05 – 00;24;01;05

Dr. Zach Rubin

So you can imagine if you’re doing a panel that’s going to be hundreds, if not thousands of dollars for people, depending on how many foods they want to put in there. If it’s not covered by insurance. So I really try to break down the risks and benefits of these different tests. And most of the time people actually will say, oh, you know what?

 

00;24;01;07 – 00;24;17;12

Dr. Zach Rubin

I think you’re right. Because my goal, as well as I’m sure your goal, is we want our patients to feel better, to be healthy. Yeah. We don’t want to give them more problems than when they come out. Right. We want to clarify things that we know and also be humble and say, hey, you know what? I’m not exactly sure what’s going on here.

 

00;24;17;12 – 00;24;36;16

Dr. Zach Rubin

Let’s get more data. Let’s get more time, get a little bit more history and information. And I strongly encourage pediatricians and internists to do this whenever they’re faced with an adverse reaction. That’s an allergic reaction. There are many times where you have a one off situation, and you may never be able to explain why that happens and that it never happens again.

 

00;24;36;18 – 00;24;57;27

Dr. Zach Rubin

Yeah, reproducibility really helps. And if unfortunately, if it reaction happens again and again, you can then write down what was going on and keep that and bring it to the doctor and say, hey, I noticed that when I eat these three things, this happens pretty quickly and it’s happened multiple times. Okay, let’s look at that. Not a whole blanket full of testing.

 

00;24;57;27 – 00;25;04;18

Dr. Zach Rubin

It’s like looking for a needle in a haystack. But when you look for that needle, you’re poking yourself along the way. And it could be permanent damage, potentially.

 

00;25;04;23 – 00;25;26;05

Dr. Mona

You know, one thing that I. I listen to that really struck a chord with me is the fact that you mentioned that you have time with your patients. Right. And I, I think that that’s the beauty of being online, like you said. Right. We’re able to have these conversations on the podcast, but also you’re able to explain in like in, like a video or if it’s a little longer than three minutes, that social like that Instagram can allow this nuance, right?

 

00;25;26;05 – 00;25;49;23

Dr. Mona

The explanation and the why I think so many parents feel disillusioned, feel upset by the medical system because of the fact that many doctors do not have the time, nor take that moment to like, explain. And I, as a general pediatrician, I’m not saying that, oh, you need to spend all the time, but I because I know there’s a systems issue here, but how much can we help and solve just by being able to explain what you just said, right?

 

00;25;49;23 – 00;26;10;18

Dr. Mona

That hey, here is why I’m taking doing this, this testing. Here’s why I’m not. What are your concerns? What are your comments? You know, I as a gen PS, what I usually get is that family who comes in with a rash or something very nonspecific, like, you know, and they’re like, I want to do like that pan testing, like, can you just test for things?

 

00;26;10;18 – 00;26;32;24

Dr. Mona

I’m like, well, that’s not how testing works, but tell me more. And that meant as a gen piece that I would run late. I don’t have as much time with my patients. But then I think about how how much we could, how much we could help our patients and how how much they wouldn’t go to alternative clinicians, you know, clinicians that don’t have our evidence based education because they’re feeling seen and heard.

 

00;26;32;24 – 00;26;42;29

Dr. Mona

And I’m sure you feel the same, that if we just had that moment to explain to, you know, debunk myths with our patients in our office that they would feel more confident and supported when many times they’re not.

 

00;26;43;04 – 00;27;07;11

Dr. Zach Rubin

100%. I mean, the problem that people may not realize is that in primary care or even in a specialty like mine, I have an a little bit of a of kind of both worlds. I’ll explain in a second. But when you don’t do a lot of procedures, you have to rely on seeing a lot of patients to keep the lights on because the insurance does not reimburse well for just an office visit.

 

00;27;07;13 – 00;27;31;16

Dr. Zach Rubin

And so people need to remember that you see patients, but then you have billers and coders, you’ve got secretaries, you’ve got nurses, medical assistance, office managers. Like you have to have everybody paid for their salaries. You you rent a building out, you have equipment fees. You know, if you have vaccines in your clinic or I have allergy injections in mine, you have a lot that you have is overhead.

 

00;27;31;19 – 00;27;57;24

Dr. Zach Rubin

And so if you don’t have some type of procedural work going on, it’s harder to be able to spend more time with your patients. And that’s the sad reality of the system that it does not prioritize preventive medicine by being able to reimburse the time that you spend properly. And what people don’t realize is we have so much documentation to do on top of that, and fighting with insurance companies, and it causes quite a bit of burnout.

 

00;27;57;24 – 00;28;14;01

Dr. Zach Rubin

And we’ve seen a huge shift. I don’t know if you know this, but my dad’s a general pediatrician. So like you mentioned with this, and I saw the evolution of medicine throughout my entire life, that’s really helped me appreciate what I’m doing now, but also what it was like before, because there were no hospitals when we were kids.

 

00;28;14;04 – 00;28;32;04

Dr. Zach Rubin

The pediatrician did everything they would, you know, go to the E.R., do the spinal tap, admit the patient to the to the hospital. They’d have a service where they’d round on their patients, go to clinic, answer calls while they were seeing patients, then go back to the hospital after the clinic and round again. And it was rinse and repeat and see a great continuity of care.

 

00;28;32;07 – 00;28;53;09

Dr. Zach Rubin

But at the same time, it was not sustainable as the insurance changed and and things became much more different in the hospitalist medicine, fill that gap. And now we have a diversity in terms of physician assistants and nurse practitioners to try to help out, because we can’t see enough patients as doctors and be able to give enough time.

 

00;28;53;09 – 00;28;59;07

Dr. Zach Rubin

Can you imagine if we didn’t have nurse practitioners or physician assistants, how many more patients we’d have to see and how little time we’d have for them?

 

00;28;59;10 – 00;29;17;14

Dr. Mona

Yeah. And also, I mean, I’ve seen it in Gen pedes. I don’t know what’s happening in the allergy pedes allergy world, but there’s just been such a mass exodus of general pediatricians, and that happened after the pandemic. You I think people most of my listeners probably know this, but general pediatricians, pediatricians in general do not make a lot of money.

 

00;29;17;14 – 00;29;39;15

Dr. Mona

Right. And so when you had the pandemic happen, the stress load, the expectations of documentation, having to see high volume, like you mentioned. And I dealt with that too, I was very burned out and it was very hard for me. It would carry that burnout carries over into patient interactions, into family life. You know, burnout is not something that’s isolated into a silo.

 

00;29;39;15 – 00;30;01;20

Dr. Mona

And it was so hard to see. And I kept cutting back hours. And then I saw a lot of my peers leave the practice or, you know, especially my my fellow mothers, because, you know, they would want to be there. Like, what is the point now? Like, I’m splitting myself between my family and my and my career and it’s like, not worth it any more from a financial aspect to be one foot here, one foot there.

 

00;30;01;23 – 00;30;26;09

Dr. Mona

And that’s a sad reality that just from the system that’s kind of created the lack of an ability to communicate the insurance, you know, the insurance companies involved, the lack of reimbursement. We are losing such good clinicians. And it concerns me about the future of pediatrics, you know, and I, I really am grateful to have you, other creators online that not only speak to the debunking, but I also got online in a way to reclaim our profession.

 

00;30;26;09 – 00;30;43;26

Dr. Mona

Right. Like I want us to regain trust in pediatricians in allergists all of the all the people that are providing that sort of nuance. Because like you said, we care about informed consent. We care about the child. We don’t want to see your child because we have so many other children to see. You know, we love you, but like we don’t need it.

 

00;30;43;27 – 00;31;02;22

Dr. Mona

We want you to stay home. We want you to be better. And I think, I think is such an important thing that parents need to understand, when they, you know, see what we’re doing and what we’re trying to accomplish. And I think that systemic issue of medicine is something that people don’t always hear. And I think it’s important for them to hear, to know that it’s not the fault of the clinician.

 

00;31;02;22 – 00;31;04;07

Dr. Mona

Like we’re trying our best.

 

00;31;04;11 – 00;31;28;00

Dr. Zach Rubin

Right? I totally agree. You know, as an example, in the allergy world, for me, that’s a little bit different than pediatrics, is that we have seen an explosion of different therapies we can use over the past ten years through something called biologics. And if people aren’t familiar with that, those are antibodies that are grown in the lab that are specific to you know, one particular part of your immune system.

 

00;31;28;00 – 00;31;54;15

Dr. Zach Rubin

As an example. And we have several of these medications that can treat severe asthma, severe eczema, even food allergies. Now, and it’s it’s booming across many subspecialties. It’s not just allergy, but, in the specialty world, we’re expected to prescribe these medications, right. But what people don’t see in the background is how much paperwork and time and aggravation it is to get these things approved that are not compensated.

 

00;31;54;17 – 00;32;17;05

Dr. Zach Rubin

You don’t get compensated for all the work in the background to get these expensive medications approved by insurance companies in the phone calls and the prior authorizations, that many people just refuse to do it. Now because, yeah, it’s just too much work that is uncompensated. But it’s it’s such a detriment to patients that we have to have significant reforms in health care.

 

00;32;17;05 – 00;32;35;07

Dr. Zach Rubin

And so, you know, there’s always a debate about do we need to change to a nationalized system like you see in Canada or in the UK and whatnot? And I think it’s very difficult in the United States when we have state laws and federal laws, to be able to get everybody politically motivated to change the entire system.

 

00;32;35;07 – 00;32;55;23

Dr. Zach Rubin

And I hope that it does change if we need to, because we’re we’re really on the brink of collapsing with the way that things are going. And right now, we’re in a system where there’s basically a bull in a China shop with no plan to fix the damage. That’s being done. That’s very concerning, but we don’t need to get into that unless you want to.

 

00;32;55;26 – 00;33;19;24

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh, yeah. No, I mean, that is a, we should have another conversation about that on another show. But I think that pandemic opened up the very fragile state of the educations system and health care system in the United States have spoken about that on other shows as well, or other episodes about how it was always not good.

 

00;33;19;24 – 00;33;40;17

Dr. Mona

And then when you had it all come to fruition and you’re like, wow, this is really not great. And it’s basically it’s teetering like there’s obviously like it’s so close to collapsing. And I already think that it is collapsing because of the lack of patient satisfaction, the lack of clinician satisfaction, the two people that are the most important people in a health care system are not happy, you know?

 

00;33;40;17 – 00;34;08;01

Dr. Mona

And so that’s something that’s really important to me. You know, how I, I want to ask one question about this because we’re on that thought. And then I want to go back to, allergy meds because I’m curious of your thoughts. But this, you know, despite all of this, families still want guidance that they can rely on. From your perspective, what can we do as clinicians to help or even content creators, educators, to help rebuild trust between parents and the medical community, knowing the system that we’re in.

 

00;34;08;03 – 00;34;35;05

Dr. Zach Rubin

Right. I think we have to take a step back. And whenever we explain things that don’t seem to make sense, always explain how there can be some good intentions and what’s being said. And here’s what the kernel of truth is, and why this other piece of information is not true. And then also being humble about it and being respectful about it because you I mean, there’s so many different things out there right now that are just absolutely ridiculous.

 

00;34;35;08 – 00;35;00;10

Dr. Zach Rubin

But if we come with the same level of ridiculousness and disrespect that were being met with, it’s going to be harder to build that trust back. So so the way that we present that information, I think is important and just showing genuine care by being there as a regular presence, I think makes a difference. And it’s something that I’m seeing in real time that when I’m out and about in public now, I don’t know about you, but I’m starting to have people recognize me.

 

00;35;00;12 – 00;35;08;15

Dr. Zach Rubin

Yeah, in public. And it’s something I never expected to happen in my life. But I was at in Italy recently for the Olympics and yeah.

 

00;35;08;15 – 00;35;08;26

Dr. Mona

I saw.

 

00;35;08;26 – 00;35;29;05

Dr. Zach Rubin

I’m, I’m at a, train station and a mom comes up to me says, Doctor Ruben, I’ve been following you for a while. My child has food allergies, and you’ve made a huge difference. And so you always gotta remember, when you’re creating content, you are impacting people more than you realize. Even if you have five followers, 15 or 50 million, it doesn’t matter.

 

00;35;29;05 – 00;35;53;20

Dr. Zach Rubin

The number. You’re going to impact more people than you realize. I tell this to physicians all the time. When I give talks at different places in the country, it doesn’t matter how many followers you have because you will impact more people online than you do in your clinic. It’s just the metrics always are true of that. I mean, yeah, I could see 20 to 20 patients in a day, give them good care, but I could put one post out there and 500,000 people will see it.

 

00;35;53;23 – 00;36;12;12

Dr. Mona

It is a powerful medium like I. I agree with you. And that has started to happen a lot more for me as as the platform grows, of course, and it’s a very humbling experience when it happens, you know, and I think that’s why you’re doing so well on the platform is that the people who do well on social also are very humbled and grateful for that reality.

 

00;36;12;14 – 00;36;35;15

Dr. Mona

Right? Like when that person comes up to me, it’s not oh, oh yeah, it’s me. Every time my husband, even with my husband’s with me, I get so I get a little bit shy or almost like, wow, like, thank you so much or get a little teary eyed of like, thank you so much for trusting me. You know, like, I, I’m so grateful for this platform and yeah, for me, the other day we went to dinner and there was a woman who was like star struck and the star struck moment.

 

00;36;35;15 – 00;36;53;15

Dr. Mona

I’m just like, no, no, no. And like, she got teary eyed seeing me and she was like, yeah, she’s a grandma. And she was like, hey, like, you have helped me. So much to be a better grandma Nonna like you at an Italian restaurant. And I’m like, thank you so much. And like, you’re just so emotional. And I was like, I got emotional because I’m like, listen, I just do it like you.

 

00;36;53;16 – 00;37;10;00

Dr. Mona

Because we love it. And it has its own ups and downs as we both know, right? We deal with a lot of negative commentary, a lot of anger, a lot of the algorithm, you know, nonsense that we deal with. But at the end of the day, how beautiful it is that we can impact millions around the world.

 

00;37;10;00 – 00;37;22;07

Dr. Mona

And like I cannot, and in Italy, that is so random. I think you share that on your story that you were like, you got to approach that is so wild. And that must have made you feel humbled and also just really proud of the work you do. I love that.

 

00;37;22;09 – 00;37;43;13

Dr. Zach Rubin

I am so proud of what I’ve been able to do over the past six years. My wife I love it creates content. She’s an immunologist. Yes. An inventor. She’s amazing. And so it makes for fun conversations at the dinner table. Yeah, about the different things that we experience. And, I just love being a part of this team.

 

00;37;43;13 – 00;38;08;23

Dr. Zach Rubin

I feel like you and I are on the same team. There’s several others that that do this, and it really is meeting where people where they’re at. And I think the reason why people kind of are grateful for it is the fact that, as we mentioned earlier, we don’t have enough time to be able to go over everything in clinic, and oftentimes people will leave, and then they have 20 questions that they know not to ask or didn’t have time or a chance to do it, or there was a lot of distractions.

 

00;38;08;23 – 00;38;28;12

Dr. Zach Rubin

If they have kids in the room, you know, it gives an additional opportunity to learn somebody from somebody they trust. And trust is more valuable than any amount of money that you could have. The that is the most important thing in life is to have that. And I’m proud that, I have a platform. I’m proud of your platform.

 

00;38;28;12 – 00;38;31;23

Dr. Zach Rubin

It’s just amazing the kind of work that we can accomplish in the digital space.

 

00;38;32;01 – 00;38;51;15

Dr. Mona

You mentioned earlier in the conversation how your online work has really translated into being a better clinician in the office. What about that experience online translated to those changes that you saw. Like is it the fact that you listen more? Is it the fact that you’re able to communicate better? I’m very curious on how that has translated to your inpatient experience.

 

00;38;51;18 – 00;39;20;11

Dr. Zach Rubin

Yeah. So there’s a couple ways that it’s improved my practice. One as you mentioned is communication skills. So it gives me time to practice outside of the clinic to then use those skills of how do I take a complicated concept, distill it down to something that is bite sized, easily understandable for as many people as possible and share that with people, and also doing in a way that not only tells you I’m certain about X, but uncertain about Y.

 

00;39;20;14 – 00;39;44;16

Dr. Zach Rubin

What whatever that may be. It’s really important to show that level of empathy and and helping people understand that sometimes we have to live in the gray zone, that that is so important that the confidence and the absolute certainty, it’s not good medicine. We don’t always have 100% confidence in the decisions that we make. So the communication piece, when you practice over and over again makes that a really good experience.

 

00;39;44;22 – 00;40;09;24

Dr. Zach Rubin

I also learned from the people asking me questions online that I may not have thought about. Right. There may be a very specific, nuanced question that you don’t always encounter in clinic, but then you’d be surprised that like a couple of weeks later, it comes up in your clinic or on the other hand, the misinformation online? I’ve had patients come in believing something because of what they heard online, and because I knew that existed.

 

00;40;09;24 – 00;40;16;28

Dr. Zach Rubin

I knew how to combat it better rather than being caught off guard and saying, wait, there’s people selling iodine sprays?

 

00;40;17;00 – 00;40;18;19

Dr. Mona

Yeah, yeah, really.

 

00;40;18;22 – 00;40;48;23

Dr. Zach Rubin

Like people are actually buying those products and not understanding that there’s potential risks that we can’t quantify yet, nor has it been properly tested for efficacy. Right. And so this is the same thing with the supplements and all of the different wellness trends, like being aware of those issues help us guide conversations better. And then also if you’re online enough and peop enough people know you when they come in as a new patient and they say, you know, doctor, when I came because I failed you online, I’m not joking.

 

00;40;48;23 – 00;40;54;21

Dr. Zach Rubin

I had a family drive from Kentucky to Illinois to see me like an eight hour drive to see me, because were.

 

00;40;54;21 – 00;40;55;11

Dr. Mona

Using.

 

00;40;55;14 – 00;41;06;10

Dr. Zach Rubin

Get my opinion on something and I I’m forever grateful for those experiences when people will fly or drive to see me. I even had a family give me a hula-hoop from.

 

00;41;06;15 – 00;41;25;03

Dr. Mona

Oh yeah, we didn’t even get to talk about how amazing of a hula hoop or Doctor Reuben is. By the way, you should probably if you follow him. You know, I love seeing doctors be humans. By the way, this is like the best part about social right? Like this humanization of like the interest that you have. Like, right now I’m a Lego builder, I love dancing.

 

00;41;25;03 – 00;41;25;27

Dr. Zach Rubin

I saw the Legos.

 

00;41;25;27 – 00;41;42;15

Dr. Mona

I love like I’m obsessed. My I have a few on my bookshelf right now, but like I love that. Again, adding the personalization of the doctor online I think adds more trust, right? That, hey, I’m human. I have the same feelings. I understand why you might be scared of this. Like, this is not me talking from above you.

 

00;41;42;17 – 00;41;46;06

Dr. Mona

It’s talking with you, right? And making this a team effort. And I love that.

 

00;41;46;08 – 00;42;07;07

Dr. Zach Rubin

Yeah. We don’t live in ivory towers. We. We are everyday humans. And so the hula hoop was something I started early on in my content creation because it was a, a talent I developed as a kid. I actually used it in my college admissions essay and explain how if I put my mind to something, I will accomplish anything, even if it’s as trivial as a hula hoop.

 

00;42;07;07 – 00;42;32;26

Dr. Zach Rubin

I taught myself how to do it as a nine year old and and became good at it. And it’s fun. It’s a good form of exercise. It encourages people that it’s okay to be weird. You can be a dog to be a little, little edgy, a little eccentric, and weird. Yeah. Me too. You know, I do. I play, I play video games, I love Legos, I hula hoop, you know, I’ve got three dogs, we got fish like my wife and I do all sorts of crazy things, you know, we’re having fun.

 

00;42;32;26 – 00;42;52;21

Dr. Zach Rubin

We work hard and play hard. Yeah. And that’s not something that, you know, you necessarily see if you just see your doctor in the, in the the stark, white, sterile room. Right. Like you don’t get that in the night in you and I don’t wear lab coats like I hate. Yeah. I think it’s, you know, it’s something that is it scares people in my mind, you know.

 

00;42;52;21 – 00;43;12;21

Dr. Zach Rubin

And I get it. There’s a there’s reasons to do it all that whatever. But but, you know, I’m always about meeting people where they are at and, and making sure that people feel comfortable because the bottom line is we get the utmost privilege to hear people’s stories of all sorts of issues that they’re facing from a health standpoint.

 

00;43;12;21 – 00;43;35;16

Dr. Zach Rubin

Right? And so to have them open up will make our jobs that much easier, to develop a stronger differential diagnosis, to understand if they’re even taking their medications correctly, if they’re going to admit that. Right. So, so having that ability to bridge, make it build a bridge to build a rapport and have these deeper discussions is priceless.

 

00;43;35;23 – 00;43;53;04

Dr. Mona

I love it. And again, I’m just so excited about your book and going back to, you know, the allergy conversations. One question I will have for you. So just start thinking about this is what is your favorite chapter? Okay. But before that, because if you have to choose a favorite chapter for me before that, I want to talk about some allergy myths that you wish would die.

 

00;43;53;06 – 00;44;21;02

Dr. Mona

You know, obviously some ideas just refuse to die online. You mentioned about the home allergy testing. That could be one of them. But what is like 1 or 2 or maybe three if you have them, allergy myths or misconceptions that you just wish would disappear because maybe they cause harm, they cause fear. What would those be? Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show.

 

00;44;21;04 – 00;44;38;05

Dr. Zach Rubin

So the the the low hanging fruit, so to speak, is the local honey treating allergies. That is something that I and I talk about in the book. The first time I ever heard that was when I was in New York. I was applying for fellowships for allergy, and my aunt picks me up and she goes, oh, so you’re going to be an allergist?

 

00;44;38;05 – 00;44;54;11

Dr. Zach Rubin

You should tell your patients to eat local honey. And I said to myself, Like, what do you mean by that? She’s like, yeah, I was told that, you know, if you eat the local honey, you have this pollen. It’s kind of like allergy shots. And I was like, oh, that kind of makes sense. Now remember, you know, this is me being a pediatrician.

 

00;44;54;11 – 00;45;21;14

Dr. Zach Rubin

Not not an allergist yet. Like, I had never heard about this. It sounds plausible on the surface. But then I realized, like, one of the cool things about my fellowship is we would take nature walks and we would learn about the different plants in our environment. I was in Saint Louis, so we go to Forest Park and it was a lot of fun meeting up with with some locals who would teach us about the forestry and the different trees, and it helped us kind of conceptualize the recommendations we make from an environmental standpoint.

 

00;45;21;16 – 00;45;44;18

Dr. Zach Rubin

And one of the things I learned early on was there’s something called Thomson’s postulates that explain why we are allergic to arrow allergies. And and some of the postulates explain you need to be exposed to the substance in large quantities. It needs to be easily, released in the air. So when you think about local honey, the pollen that’s actually in there is from insect pollinated plants.

 

00;45;44;18 – 00;46;04;06

Dr. Zach Rubin

They’re heavier, stickier pollen grains. You don’t smell those on a regular basis. You don’t get exposed to it. But the birch trees that are outside or the ragweed release millions upon millions of pollen grains every day, and you get exposed to that. And that’s what causes the allergy. So there’s not really an appreciable amount of that type of pollen, the local honey.

 

00;46;04;11 – 00;46;23;27

Dr. Zach Rubin

So you’re not magically fixing the problem. You get a tasty treat that helps with a sore throat. And of course, those who are 12 months and older. So it really should be marketed that way rather than saying it’s going to cure your allergies. Because I joke about this, but allergies are not something to sneeze at because it really impacts your overall lifestyle.

 

00;46;24;04 – 00;46;41;15

Dr. Zach Rubin

If you can’t breathe through your nose and you’re itching and you’ve got watery eyes, you got red eyes, you got rashes, you’re coughing. That causes difficulty concentrating, right? So if you’re working, you can’t work as well and you’re not sleeping as well. And we all know sleep is one of the most important parts of your health. It can increase your risk of hypertension.

 

00;46;41;17 – 00;47;00;02

Dr. Zach Rubin

It can really shorten your life span if you don’t sleep well. So it’s all interconnected. You can have increased risk of ear infections and sinus infections if you have uncontrolled allergies. So if you’re given a recommendation that seems harmless on the surface but delays proper care, you end up with these secondary complications. Where are we at? We’re kind of stuck with it.

 

00;47;00;02 – 00;47;19;02

Dr. Zach Rubin

That’s why that needs to go away. It never seems to go away, but I keep talking about it every year during this time of year, that’s one another one which is more niche. But important for you and I. Working in health care is a lot of hospitals. When they screen for people who get IO donated. Contrast guy for a CT scan is an extreme right.

 

00;47;19;07 – 00;47;38;14

Dr. Zach Rubin

So that’s the day we inject to be able to light up organs to quit. And we do a CT scan, we can say, oh, I can see what the lungs look like better, or the kidneys or whatever organ you want to look at. That dye contains iodine in it. And in the 1970s, there was a case series that reported an association between shellfish allergic patients and having reactions to these dyes.

 

00;47;38;16 – 00;47;55;28

Dr. Zach Rubin

And at that time they thought, oh, well, I guess if you have a shellfish allergy, you can’t have eye ordinated contrast dye. And so there’s these screening tools that are still being used in many hospitals that will say, okay, do you have a shellfish allergy? Well, I don’t know. Can you get this dye? Like people are still confused about it.

 

00;47;56;02 – 00;48;23;10

Dr. Zach Rubin

The reality is when you have a shellfish allergy, it’s nothing to do with the iodine. It’s tropomyosin, the muscle fiber protein that causes the reactions. So that association has been tested out, been debunked and debunked and debunked. And yet it still lingers. That’s that’s a it’s a very niche thing. But still from a public health standpoint, from a system standpoint and how our hospitals operate, they need to be getting rid of that because it doesn’t make any sense anymore.

 

00;48;23;12 – 00;48;31;16

Dr. Zach Rubin

It’s a problem. There’s also the issue related to egg allergies and flu vaccines.

 

00;48;31;18 – 00;48;32;07

Dr. Mona

Yes, yes.

 

00;48;32;08 – 00;48;40;17

Dr. Zach Rubin

We used to be very cautious about it, but we know that the amount of egg protein in it for the vast majority of people can safely get those vaccines. I can go on and on, as you know.

 

00;48;40;19 – 00;48;41;11

Dr. Mona

Oh, I love it.

 

00;48;41;14 – 00;48;43;28

Dr. Zach Rubin

So many different things we could talk about.

 

00;48;44;00 – 00;48;57;19

Dr. Mona

Yeah, I think, mine, mine as a gene would have been the, the, the testing like the home testing thing is I know that’s not a myth, but it’s more of a product situation. And then I think one of the biggest ones is that I’m allergic to penicillin.

 

00;48;57;21 – 00;48;58;23

Dr. Zach Rubin

Yes. So right.

 

00;48;58;23 – 00;49;00;28

Dr. Mona

About like. So. Yeah. So. Yeah. Tell me about that.

 

00;49;00;28 – 00;49;24;19

Dr. Zach Rubin

Yeah. So it’s the most commonly reported drug allergy in the United States. Roughly 10% of people think they’re allergic. But newer research suggests that if we test them out, about 90% are not actually allergic. And there are many reasons for this. One is you may have actually had an allergic reaction, but most of the time, after ten or more years of abstinence, the allergy goes away.

 

00;49;24;21 – 00;49;24;29

Dr. Mona

 

00;49;25;05 – 00;49;44;02

Dr. Zach Rubin

Just many people outgrow the allergy. The other is there are people who avoid it because their parents are allergic. They think family history has a strong beta of it. And that is just not true. Flat out false. Unfortunately there are also situations where a baby gets a rash after having, you know, an Imax. Cicilline, which is a penicillin based antibiotic.

 

00;49;44;05 – 00;50;03;17

Dr. Zach Rubin

And and you sit there as a pediatrician and you’re like, well, it’s probably okay, but I’m not exactly sure. And the parents are very scared by this. It’s easier to say, avoid it and not think about it. Rather than challenging it and taking on additional liability on top of the whole health care system thing, which is it’s not really reimbursed.

 

00;50;03;17 – 00;50;20;01

Dr. Zach Rubin

Well, if you’re going to do a direct drug challenge where they take it in your office, you have to have nursing staff one on one with them and all that. And it’s not always reimbursed by insurance, like people have to pay out of pocket to like, have that kind of a procedure done, which is a big problem.

 

00;50;20;04 – 00;50;38;24

Dr. Zach Rubin

Especially in like the private practice setting. But but beyond that, you know, there are many people who look at side effects of drugs and think, that’s an allergy, like abdominal pain. And diarrhea is not an allergy to antibiotics. It’s an expected side effect because you’re killing off not just bad bacteria but good bacteria. And so this is a major public health problem.

 

00;50;38;28 – 00;50;55;12

Dr. Mona

I think a lot of the things is the rash that kids get right, like the rash that comes with the with taking an antibiotic, they think it’s the antibiotic. But it could also just be, in my experience, also the virus that also came with that, that bacteria. So for example, ear infections, we know that the virus can cause it.

 

00;50;55;19 – 00;51;10;12

Dr. Mona

But that rash is what I think throws a lot of pediatricians off too. And I think you probably agree with that. And so what is it? Obviously, we know that there a child who gets a rash could have a Sicilian allergy, but is there a differentiation of that rash?

 

00;51;10;17 – 00;51;30;24

Dr. Zach Rubin

Yeah. So I do talk about it extensively in the book. So I want people to check it out. Love it. But what I think is important for people to recognize is the timing makes a big difference. So if you were to say that the child got amoxicillin and they finished their 7 or 9 day course, like however long you’re prescribing it for, and then the rash comes a day or two later.

 

00;51;30;27 – 00;51;54;20

Dr. Zach Rubin

That’s not that’s not an allergic reaction that we’re concerned about. Sometimes it could be. But when we talk about the concerning drug reactions, the IgG antibodies, what we worried about, you can make IG antibodies to penicillin. And it’s breakdown products like we call them major minor determinants. That can cause anaphylaxis. That’s what people need to recognize is the scary stuff.

 

00;51;54;20 – 00;52;19;19

Dr. Zach Rubin

And so if you had a situation where on day two of the antibiotic, 30 minutes after a dose, they get hives, I’m scared. I’m concerned. My my hair is raising in the back of my head. That could be something that would lead to a problem and needs to be avoided. And then there’s different classes of antibiotics. We also have to worry about like, okay, first generation cephalosporins as an example, because you have to think about some other things in addition to it.

 

00;52;19;22 – 00;52;40;12

Dr. Zach Rubin

But like I mentioned, the timing makes a huge difference. The characteristics of the rash may also help. And that’s that’s something that clinicians need to just be aware of. You know, the difference between we see urticaria or hives and something that is not. And so the hives is what really is telling for a concerning reaction. As an example.

 

00;52;40;15 – 00;52;43;18

Dr. Zach Rubin

And to make this confusing and little funny though, I love.

 

00;52;43;18 – 00;52;43;28

Dr. Mona

That there are.

 

00;52;44;03 – 00;52;59;15

Dr. Zach Rubin

There are other types of reactions that are rare, but people need to know about, like Stevens Johnson syndrome, toxic epidermal necrosis, or serum sickness like reactions like, like there’s different ways amoxicillin can cause problems. And in those situations you always avoid it.

 

00;52;59;20 – 00;53;22;15

Dr. Mona

So one thing that I’ve learned from this conversation is that the world needs a book about allergies. Yeah. I mean, I mean, and look at that. You’re right. Because again, there’s so much to know. There’s so much to nerd out a lot. Nerd out about. Right. Like in terms of all this information that you’re giving and sort of that you know, whether you are suffering with any of these things, obviously asthma, food allergies, hay fever, or you just want to be educated.

 

00;53;22;20 – 00;53;37;08

Dr. Mona

For me personally, I don’t I don’t have any of these issues, but I can’t wait to read it for my patients. Right? Like, I’m so excited for it to be a great resource for Gen Pedes. Anyone who takes care of children. What would you say is your favorite chapter if you could choose one? I know it’s like it’s trying to.

 

00;53;37;08 – 00;53;40;27

Dr. Mona

It’s like trying to pick a favorite child. But tell me the favorite one.

 

00;53;40;29 – 00;53;59;03

Dr. Zach Rubin

Yeah. So I will tell you, it’s nearly impossible to pick a favorite. But yeah, I’m going to do just to put myself out there, I’m going to pick the hardest chapter that I had to write. Sorry. I have an entire chapter on mast cell disorders. It’s something that’s talked about a lot on social media. I see a lot of patients with various issues related to it.

 

00;53;59;03 – 00;54;17;25

Dr. Zach Rubin

So the culprit cell that causes most of the problems for people who deal with allergies is the mast cell. It’s part of your innate immune response. First line of defense against foreign invaders, but also helps with wound healing. So it’s a jack of all trades, and it’s found in various tissues in your body, from your skin to your gut, etc..

 

00;54;17;27 – 00;54;40;00

Dr. Zach Rubin

And so some people make too many of them. We often call that master psychosis. Yeah, it can live in your bone marrow and in very rare situations can actually be a type of leukemia. There’s mast cell leukemia as an example. I’ve never seen that knock on wood, I hope I never do. But that that actually happens. And then there are people who have mast cell activation syndrome or M CAS.

 

00;54;40;02 – 00;55;08;24

Dr. Zach Rubin

And that’s where their mast cells are overreactive to benign stimuli. And it causes severe recurrent symptoms in multiple organ systems. So these are folks who have flushing and hives on and off. They have terrible abdominal complaints. They may have cardiovascular problems like postural orthostatic tachycardia syndrome, palpitations, chronic fatigue, anxiety, depression. So it affects many aspects of their body and they have elevated markers.

 

00;55;08;27 – 00;55;27;10

Dr. Zach Rubin

And and being able to explain that in a chapter has been very challenging. I actually interviewed one of my followers who’s who’s now a good friend of mine, who told me her story, and I use that as the main focal point for the chapter because a lot of my chapters, I tell stories about my patients or followers I interviewed for the book, because that’s how we learned in medicine.

 

00;55;27;10 – 00;55;53;07

Dr. Zach Rubin

In modern medicine, we learn through cases, and we discuss those cases even in the first or second year of medical school, that’s often done. And so I give those stories, and then I bounce back between what we know about it, what we don’t know about it, the challenges with diagnosis, the challenge with management. It’s a it was the most difficult chapter to write, but also gave me a lot of joy writing it, because I know a lot of people were desperate to have additional resources, and so I was very happy to provide that.

 

00;55;53;14 – 00;56;07;00

Dr. Mona

I love it, I’m so excited about your book being out there. Congratulations. What is something that you’re just really excited about and looking forward to in your life or a professional life? What’s what’s going on that you’re that’s making your heart happy right now?

 

00;56;07;02 – 00;56;30;12

Dr. Zach Rubin

Well, I just came back from Italy in the Olympics. Love it. And it was amazing to see the diversity, the culture, the food was amazing, the architecture, seeing elite athletes. And just what, what inspires me about the Olympics is that you see people who are dedicated to a craft, and they they are the highest level in the entire world.

 

00;56;30;12 – 00;56;50;09

Dr. Zach Rubin

They worked so hard to get to that point. And then I look at myself and I say, you know, I spent my entire adult life to become a doctor, and now I’m spending a lot of time in the space of medical education digitally. And and so it really makes me think about how grateful I am to be in this space and to have worked as hard as I have.

 

00;56;50;15 – 00;56;56;03

Dr. Zach Rubin

So I get to celebrate all those accomplishments, you know, recently and over the next couple of weeks with the book launch.

 

00;56;56;08 – 00;57;20;20

Dr. Mona

I am so excited for you and I love thank you for sharing your story about the Olympics. I mean, I, I watched from afar, but I can just sense that same level of like admiration for people committing to their art. And obviously I think of any performance as art. Right? So whether you’re an athlete, content creator, creating videos, all of it is something like that really just shows how much you’ve been working hard and sharing that with the world is such a beautiful thing.

 

00;57;20;27 – 00;57;29;00

Dr. Mona

Thank you so much for joining me today. Where can people go to get the book? Where can they go to stay connected? Tell us all of that because we’ll be adding that to the show notes too. Yeah.

 

00;57;29;00 – 00;57;55;08

Dr. Zach Rubin

So my book all about Allergies is found pretty much wherever you get your books. So whether it’s Barnes Noble, target, Powells, Books-a-million, Amazon, your local bookstore, many indie bookstores are going to be carrying it. Many people have been requesting their libraries to get it to. So, you know, you can always check it out from a local library. It’s really anywhere you can Google all about allergies by Zachary Rubin, Doctor Rubin I’m on basically all the social media platforms.

 

00;57;55;08 – 00;58;15;12

Dr. Zach Rubin

Most of the handles of the Rubin underscore allergy. There’s a few differences I have a link tree to for people, if they go to you know, my TikTok as an example. But, I’m just here for everybody. I mean, I’m here to help educate, demystify things. You know, there’s a lot going on in the world right now, but I’m happy that you and I are charging the way to help, with providing good information.

 

00;58;15;15 – 00;58;26;10

Dr. Mona

Thank you for being in that support team. I love following you. I know if people are not familiar with who you are, they will be following you now and get the book. And thank you again for joining me today.

 

00;58;26;12 – 00;58;30;01

Dr. Zach Rubin

Thank you again for having me.

 

00;58;30;03 – 00;58;49;01

Dr. Mona

That wraps up today’s episode. But remember, if you like this conversation, there’s so much more of it in Doctor Rubin’s book and also on a social media. Conversations like this remind me why I love connecting with fellow health creators who are using their platforms for good. Doctor Rubin is doing the work. Educating with clarity has this push notifications on.

 

00;58;49;01 – 00;59;08;08

Dr. Mona

I mean, doing all the things to help families feel less afraid and more informed. If this episode helps you rethink allergies, testing or the noise you see online, please subscribe. Download the episode and share it with someone who needs it. That is how we grow this community. And remember, if you want to go deeper, support Doctor Rubin by grabbing his book All About Allergies.

 

00;59;08;08 – 00;59;29;03

Dr. Mona

Even if you don’t need it, just buying it supports his work. Head over to my socials at PedsDocTalk to join the conversation on our latest post, and tag the PedsDocTalk podcast and Rubin underscore allergy and let us know your biggest takeaway. Thank you for being here, as always, for staying curious and for choosing thoughtful Evidence-Based Parenting and Health Information.

 

00;59;29;09 – 00;59;30;25

Dr. Mona

I’ll chat with you all next time.