A Trusted Voice on Allergies and Asthma: Dr. Zachary Rubin, Pediatric Allergist-Immunologist at Oak Brook Allergies

Lindsey Smith

Hi, I'm Lindsey Smith, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. Today, we're diving into a topic that touches millions of families, the rise of allergies, asthma, and immune-related conditions in children, and what it means to navigate these concerns today at a time when science is evolving quickly and misinformation is everywhere.

I'm thrilled to be joined by someone who has become a trusted voice in the space. Dr. Zachary Rubin. He's a double board certified pediatrician and allergist immunologist practicing in the Chicago area. Dr. Rubin is also a nationally recognized medical educator and public health advocate sharing practical evidence-based guidance on allergies, asthma, and vaccines with an audience of more than four million followers.

He also has a new book, All About Allergies. In it, he breaks down dozens of allergy conditions and immune-related diseases, offering clear explanations and practical treatment options for families. 

Today we'll explore Dr. Rubin's journey, his approach to communicating complex medical topics, and how digital platforms can be leveraged to strengthen public health. Dr. Rubin, thanks so much for joining us.

Dr. Rubin

Thank you so much for having me.

Lindsey

So let's get started with learning more about you and what first got you interested in medicine and particularly pediatrics.

Dr. Rubin

Absolutely. So I grew up being lucky because my dad's a pediatrician. And so I saw what medicine was like at an early age prior to hospitalists being around. So he would be on call. I'd wake up at two in the morning. He'd be in the hospital doing a spinal tap in the ER and then admitting that patient, seeing them, rounding on his other patients, going to clinic, rounding on them again. And it was just a calling and something that I really gravitated towards growing up.

And so I decided early on I want to go to medical school. I went to Case Western Reserve University in Cleveland, Ohio. I was there for undergrad and medical school. Then I went to do my pediatrics residency at University of Illinois Chicago and then completed a fellowship at WashU in St. Louis for allergy immunology. And so I had finished my fellowship right when the pandemic started. And so I had moved from St. Louis to the suburbs of Chicago where I'm at now at a small private practice.

And it was nearly impossible for me to connect with people because there were no social events. Everybody was trying to survive what was going on at the time. And so I took to social media to start connecting with people and it was very common for health care workers, physicians, scientists and the like to be on Twitter. And that's where I connected with a lot of different people from all over the world.

I realized very quickly, my gosh, there was so much bad information online, a lot of misinformation, and people were getting confused about what was going on. So I started educating and slowly but surely I went from Twitter to then TikTok and Instagram and YouTube, all the different platforms, just working on video content and text formats, just trying to educate people about infectious diseases, pediatrics, about all these different topics and my own specialty now in allergic diseases. 

And now there's over four million people following me, which I never thought would happen. Here talking with you today, it's such an honor and to be able to reach to the masses about allergic diseases and demystifying them is truly an honor.

Lindsey Smith

Yeah, thank you so much for sharing that. It's always interesting to hear everyone's path into medicine. And I know you mentioned your father, who is a pediatrician, being a real source of inspiration in your book, All About Allergies, which we're going to get to here in a little bit. But before we do, can you come back to talking a little bit about what drew you to really focus on allergies and immunology?

Dr. Rubin

Absolutely. So I initially thought I was gonna be a pediatrician and that was it. Not just because of my dad, but I love taking care of kids and everybody I worked with was just tremendous. So it felt like a good fit for my personality. But then I started doing other rotations throughout my fourth year medical school and I did an allergy rotation and I said to myself, wow, this offers so much more for me that I actually really enjoy on a day-to-day basis in terms of being in the clinic. In general pediatrics, you’ll see patients with a lot of continuity for the first couple of years, but then it's like an annual visit for most people. 

With allergy, you're seeing them multiple times a year. It doesn't matter how old they are, depending on what's going on, you're seeing them all the time. You're trying to keep people out of the hospital and the evidence and the science behind it in terms of what we know about the immune system and how it abnormally responds to foreign substances, which is the basis of allergy. It's constantly evolving and rapidly changing and that's exciting to me because I wanted to be in a field that I could grow with and also one of the unique aspects of it is you could be a pediatrician and take care of adults. There's only a couple other specialties that does that. That's palliative care and sleep medicine and then allergy. So you could be an internist take care of kids and vice versa. 

So my patients, I won't lose them. They'll grow up and I get to grow old with them and that level of relationship building is really beautiful to me.  I didn't know that until I started working in it. And so I did multiple elective rotations in it. I published some research on primary immune deficiencies during residency and became a fellow in allergy immunology and I take care of all families now in my private practice and I love it.

Lindsey Smith

And this specialty impacts so many families. I think I read somewhere that an estimated thirty to forty percent of people globally suffer from one or more allergic conditions. You can tell that your passion for taking care of families really shines through when you're speaking about that. Can you talk about the trends that you're seeing in childhood allergies and asthma today?

Dr. Rubin

Yeah, so over the last thirty years we have seen significant rises in children and adults developing various allergic diseases from seasonal allergies or hay fever, often referred to as allergic rhinitis, to asthma, to eczema, also known as atopic dermatitis, to food allergies. And the reasoning behind that is multifactorial. It's not one issue. This is something that's not only in the United States that's happening, but in many industrialized nations, including the UK, in Canada, in Australia, just to name a few. 

I'm going to give you a few examples of why. That’s the case. So, we have noticed that the temperatures globally, on average, are rising and because of that, that allows for plants that release pollen into the wind to pollinate longer and also with higher carbon dioxide levels as we burn greenhouse gases, that's a big part of photosynthesis. We know that higher atmospheric CO2 levels correlate with higher pollen counts. So we're releasing pollen grains at larger quantities for a longer duration. So more and more people are saying, wow, this year is the worst I've ever had my allergies. And people who never had allergies are complaining that they are having seasonal allergies that they didn't before. A lot of that is from this chronic exposure, maybe due to air pollution. 

Some studies suggest an association between low vitamin D levels and developing food allergies or other allergic diseases and our understanding of vitamin D is evolving and we're still trying to figure out the level that we would need to help intervene to potentially be preventive, but that's still up for debate and we don't really know. 

We know that the exposure and the timing really matters. So for food allergies,if you delay exposure of allergenic foods like peanuts, you could increase the risk of food allergies developing. Eczema rates are increasing and eczema is a gateway to developing other allergic diseases. We call it the atopic march. That allergic diseases really start at the skin, not necessarily in the gut or the respiratory tract. So that when you have a disrupted skin barrier, your immune system in your skin is different than other parts of your body. So when it gets exposed to foreign substances, it starts creating these allergy antibodies -- their proteins are called immunoglobulin E or IgE for short -- you become sensitized is what that is and then subsequent exposures increase your risk of developing an allergic disease whether it's allergic rhinitis asthma or food allergies

Lindsey Smith

That's really helpful context. And I know the landscape is changing so quickly, so it's really great to hear how you're kind of thinking about this. For families that are starting down this path for the first time, what are the most common misconceptions around allergies and immune concerns in kids?

Dr. Rubin

There are several. One of the ones that I would hope that a platform like yours is able to also create more educational content on is the concept of sensitization versus allergy. It’s a basic immunology concept, but even physicians and students alike have a hard time understanding that it's actually completely different clinically. 

And the reason why I say it this way is that if I was to take a group of people and do allergy testing for either a skin test where we take a substance and scratch your skin with it to see if you get a hive to say, it's a positive test or a blood test measuring for those antibodies directly...if you have a positive test, it just means you're sensitized, as I mentioned earlier, the antibody is present. But to have the clinical disease where you have symptoms when you are exposed to it and it's reproducible, that's allergy. That's what that is. And they don't always correlate. 

You could have a positive test and not be allergic and that's where potential overdiagnosis can happen with food allergies and hay fever, that we're pointing our fingers at the wrong substance. And depending on the timing of that test, you could theoretically increase the risk of creating a problem that didn't exist and have a whole host of complications. We mentioned delayed exposure could cause you to develop the allergy, but you could also have increased anxiety, depression, and nutritional problems, feeding difficulties. In the testing that we do, it's really important to get the context of the history before you actually go out and obtain the test. 

This is actually true for a lot of fields in medicine, that I do not believe we should be testing to test. You have to look at the evidence of the accuracy of the test. You have to understand what pre-test probability is, which I talk about in the book, that is coming out in February. And we have to know, is this test going to change management? Is it going to make a difference? And if those questions can't be answered, why are we ordering it? Why are we wasting the time, money, and energy on it?

Lindsey Smith

As a parent, I can imagine how reassuring getting that kind of clarity is for parents who are just beginning to navigate allergies and immune concerns. I want to switch gears a little bit and talk about you online. So you are very active in sharing medical education with the public. I want to know what drove you to start posting publicly on social media, and did you ever imagine your platform would become this large?

Dr. Rubin

I never thought it was gonna become this large, I can tell you that now. I thought, you know, this is something that I could use to connect with people because, as I mentioned earlier, I was struggling to build a practice when everything was shut down and everybody was online. So thought I'd meet people where they were and I quickly realized how much incorrect information was out there and it was affecting people. 

I was seeing patients coming in saying, I gave my child this nasal spray that contains iodine in it and that is not something that's necessarily safe and helpful. Iodine, when you give it to a child through their nose, you don't know if it gets systemically absorbed and affects their thyroid gland. You don't know that. And so just because something is sold doesn't mean it's safe and effective. Yet people go online and confidently will say that this is the best way to prevent colds, as an example. And that's dangerous.

People online don't necessarily play by the same rules as we do as physicians who speak with uncertainty and nuance. We have a medical license that we have to maintain and a certain knowledge base that we have to maintain and there's liability that's there. But people online, they can get away with a lot more and when more and more people go online to search for their health-related needs, they start hearing from people who are confident about things and oversimplifying problems, or they'll say something that convinces them to either change their health behavior or start to distrust physicians. 

That's where I say, okay, I really need to be out there and demystify what it means to be a doctor and help people understand that life is a lot more complicated and nuanced and it's very easy for people to cherry pick and oversimplify things. So I am a steady consistent voice online to help point out that this is the accurate information, this isn't. What are ways we can help maintain good health? What are things we should watch out for? Talking about side effects of medications that aren't always discussed online. 

I essentially helped people understand why most people need to move away from medications like Benadryl, as an example. So there's a lot that I bring to the table, and I do it in a way where I'm not just only serious about it, I bring my goofy side to it too. So a lot of people were shocked when they started seeing me as an adult male physician hula hooping to music online, right? And so what is that all about? It's all about showing a hidden talent, showing that I'm just as dorky and normal as everybody else. I don't sit in an ivory tower all day. I'm here to be with people and to have fun at the same time.

Lindsey Smith

I think your work has reached so many people, including me. We're going to be sure to put your social handles in the show notes for everyone else to check out. I think something that really stuck out to me was that your posts do such a great job of cutting through the noise and yet at the same time, we still know there's a lot of misunderstanding and misinformation out there. When it comes to immune health and childhood asthma, what gaps stand out to you the most?

Dr. Rubin

So there's a couple things there. One aspect is the fact that a lot of people are hung up on this concept of boosting the immune system, and also at the same time, people with asthma somehow have a weak immune system. Those are totally myths. So you can't boost the immune system reliably with supplements and you don't even necessarily want to boost the immune system because if you look at that term, it really means you're giving more to have the immune system overreact. That's essentially what asthma, allergies and autoimmune diseases are about...those are abnormal immune system responses to either foreign substances or your own healthy tissue. 

So, you don't really want to boost your immune system. What you want to do is have a balance to it. The immune system does all sorts of things. It helps surveil the body for injury, for infection, for cancer but also to down-regulate self when it sees food to make sure food is safe to consume and not a germ or cause an allergic reaction, right? So, it does

a lot of different things and when people are trying to say they're gonna boost their immune system with a supplement, you gotta ask them what part of the immune system are you boosting? Are you boosting their T cells, their antibodies? What are you actually doing with it? 

And I'm being a little snarky here, but it's to prove a point that scientists and physicians, think in outcome driven measures. We think about what are the clinical trials that have been done, the scientific method, all that processing that goes into it. You say a blanket statement like boosting the immune system, you're not really addressing the underlying issues here. And with asthma and other allergic diseases, this misconception that your immune system is weak, most people don't have immune deficiencies. If you have asthma, it's a hypersensitive immune system. It looks at a substance in the lungs, like pollen, or a change in weather, it causes additional coughing, it causes wheezing, chest tightness. That doesn't mean you're weak. Your immune system is actually, to an extent, too strong for its own good.

And sometimes I joke around, I'm like, you’ve got a jacked immune system when you've got asthma. We’ve got to calm it down. That's why inhaled steroids and other medications can help, it calms the immune system to relax the airways.

Lindsey Smith

That's a really great point and those gaps you're highlighting I think underscore how important clear communication is for these families and for these patients. 

So let's talk about your new book, All About Allergies. It covers everything from patient stories to the history and science behind allergic diseases. What inspired you to put all of this into one comprehensive resource?

Dr. Rubin

Yeah, so one of my followers is an editor for one of the Penguin Random House imprints and she contacted me at one of my offices saying that she and her daughter were suffering from some severe allergic ailments and wanted me to create a book that was all-encompassing because there's not much like that out there that's for the general public. And given my knowledge, my expertise, my ability to communicate to the general public about complicated concepts, she connected me with an agency in New York that then helped me create a proposal that I then sent over to various publishers. 

So, I am now working with Plume, which is an imprint of Penguin Random House, and have a wonderful editorial and marketing team. They've done just a tremendous job with helping me come up with the best way I could really educate as many people as possible and not leave too much out, right? So I have to balance a book that it almost feels like a textbook at times, but really to land where people are at and telling stories that relate to what people are going through, but then also empowering them to take the information that they can go to their doctor and really be able to navigate their health better. 

And that can apply to any aspect of medicine. It's not just allergic diseases, but I have a whole chapter about what do you expect when you go to the allergist office and I have a whole host of questions that you can ask your doctor and ways that you approach to the doctor visit and then thinking about the aspects of testing that are not always black and white and clear and I have that in there plus treatments future directions. It's just it's a comprehensive overview and I'm excited that I just recently finished recording the audiobook. 

So if people like hearing me talk you're gonna hear me read the entire book out and it's basically available wherever you get your books. 

Lindsey Smith

I really enjoyed learning why you decided to write that book. I had the opportunity to read it myself, and as someone without a medical background, I found it both accessible and informative. The personal stories were also a wonderful touch.

Speaking along the same lines of education, as you know, at Osmosis, we are a teaching company and we love to fill knowledge gaps. You've mentioned a couple topics already that you think we should create a video on, but is there any other topics you think we should make a video on that fill a gap that is of particular concern or of interest to you?

Dr. Rubin
Yeah, so outside of the sensitization versus allergy, I would love for you to create more content related to penicillin allergies because it is actually a major public health crisis that people do not talk about enough. It's not really taught in medical school. Just allergy in general is often under discussed -- partly because there's not many allergists and because there’s only so much time for the amount of material we have to go through in medical school -- so it often gets left out. But penicillin allergy is important because roughly ten percent of Americans think they're allergic to penicillin, but if you were to test them, we estimate that about ninety percent of those individuals are not allergic. 

So, we need to find ways for people to understand, hey, are you really at risk for having a penicillin allergy or not if you were to have it again? What was the circumstances in which you were told you were allergic? Was it because you were a baby and had a rash? Do you even know why you have it on your chart? Is it because you have a family member? Is there a family history of penicillin allergy. 

So there's a lot that could be said there in terms of understanding the immunology behind it, the clinical context, the testing that's potentially involved, and why it's so important. Because when you carry that label, it increases your risk of severe outcomes in the hospital setting. And so that is something that is really important to raise awareness about.

Lindsey Smith

That's a great suggestion. And I actually have a child who was told that they have that allergy when they were young. They developed kind of a rash. So really interesting, really relevant. And we're always trying to kind of meet learners where they are. And hearing from experts like you really help us focus on what matters. So thank you for sharing that suggestion. 

In our audience, we also have many students and early career health professionals so I wanted to ask you, what's your advice to them about meeting the challenges of this moment and approaching their career in healthcare?

Dr. Rubin

Yeah, so it's a very challenging time right now because public trust in healthcare workers is essentially at an all-time low. And I think building back trust comes down to being humble and giving a chance to listen to people coming from a place that is non-judgmental. And then if you are able, and this is not always easy, but if you're able to take that little bit of extra time to explain things a little bit more in detail, it goes a long way. 

And lastly, I want to leave everybody with this. Nobody ever has all the answers all the time. That's just impossible. There's so much about the human body that is left to be desired in terms of how we understand not only what goes wrong with it, but even how it works. And it's constantly evolving. And so the testing may be available, may not be available. Sometimes the results don't come back unless you repeat it multiple times. And so we need to understand that it's okay to say, I don't know. We need to live in a little bit of a gray zone. And that's so important for everybody here because the days of being confidently right about everything and in the “pseudo God complex” has to go. We have to come from a place of empathy and understanding and also everybody needs to be comfortable sitting with uncertainty, which is not easy, but sometimes we have to do that in order to move forward and come up with better ideas.

Lindsey Smith

I know our listeners, especially those early in their career, will appreciate that perspective. So just to play those back, be humble, listen, be non-judgmental, explain things in more detail, and remember that nobody knows everything. Thank you so much for sharing that advice with our audience. Before we wrap up today's episode, I wanted to give us a chance to cover anything that we didn't that maybe we should have.

Dr. Rubin

Yeah, so I wanted to get back a little bit to eczema because that's a topic that I'm really passionate about because I actually grew up with severe eczema that impacts so many aspects of your life that you don't think about. If you haven't had a chronic itch, you don't know how debilitating itch can be. It's this kind of gnawing sensation in your brain that makes you want to then scratch some part of your body, if not everywhere. And so it makes it very difficult to sleep and concentrate. 

And there's a lot where people want to do a lot of testing, and I keep going back to this. The testing is only as good as the story that you have and the accuracy that follows with it. And so, I really want people to understand that when we talk about conditions like this, that the bare bones basics of getting really good skincare, it's a lot of work, but even doing something like that can go a long way, and you've got to be patient with it. There's really not quick fixes to a lot of these different diseases that we take care of in allergy and that's just one classic example that I wanted to raise awareness about.

Lindsey Smith

I appreciate you adding that in. And before we kind of round out today's conversation, you also co-host the podcast From Bench to Bedside with your wife. Can you tell us a little bit about that?

Dr. Rubin

Yeah, so we just launched. It's something that we've talked about for the past couple of years. My wife is a PhD immunologist, inventor and entrepreneur. I'm an allergist, immunologist, and pediatrician. And so we come at it from the standpoint of we have an expert in basic sciences and the science behind how medicine evolves and then the clinical aspects of it and we talk about it from the standpoint of current events that are going on with public health, with vaccines, infectious diseases, allergic diseases. And it's a conversation that we've had for long time that we wanted to do it. 

We've just launched our first four episodes that people can check out wherever they get their podcasts. And we go really in depth in a way that if you've heard us talk together on a live stream event before, we do a lot of bantering back and forth. You know, we have a lot of fun with it. We sometimes live stream and so we're answering questions in real time and recording it to help raise awareness about all sorts of aspects of science and medicine.

Lindsey Smith

So be sure to check that out From Bench to Bedside. Together they dig into how science and clinical medicine meet in real life and what that means for patient care. 

Thank you so much for being with us today, Dr. Rubin. We appreciate all the work that you do.

Dr. Rubin

Thank you so much for having me.

Lindsey Smith

That brings us to the end of our conversation today. A huge thank you to Dr. Rubin for sharing his expertise and for the work he does every day to help families navigate allergies, asthma, and immune-related conditions with clarity and confidence. As we've heard, science is constantly evolving and staying grounded in evidence has never been more important.

Whether through his clinical practice, his education efforts online, or his new book, All About Allergies, Dr. Rubin is helping millions make sense of complex health topics in a way that's practical, accessible, and empowering. If you found today's discussion helpful, be sure to check out Dr. Rubin on social media or his new book.

I'm Lindsey Smith. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.