Allergist Interview: Dr. Scott Carroll on Mucus Color and Writing Down Questions for Your Doctor

This month we interviewed Dr. Scott Carroll of the Atlanta Allergy and Asthma Clinic. He provided us with some compelling information about some topics we all wonder about (but may not discuss easily) – like what those different colors of mucus might mean.

Dr. Carroll is board certified by both the American Board of Pediatrics and the American Board of Allergy and Immunology. He is a Fellow of the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. Dr. Carroll is a past president of the Georgia Allergy and Asthma Society and presently on the steering committee for the Education Research Trust Fund for the American Academy of Allergy, Asthma and Immunology.

Please tell me a little bit about yourself and your history as an allergist.

“Originally, I was a pediatrician. I worked in general pediatrics in the Air Force at Robbins Air Force base for two years before I went back to the University of Michigan to complete a two-year fellowship in allergy, asthma, and immunology. When I was in pediatrics training, I had done my elective periods in allergy and asthma, and that’s when I became interested in the field.

What drew me back was my experience during my elective periods as a pediatric resident. The thing that interested me the most was being able to take care of asthmatics and see that they could be made functional.

Let me explain. When I was going through training, in the ’60s, many asthmatics were stuck sitting on the sidelines. They didn’t think they could exercise, let alone play sports. But I found out in my training that asthmatics’ condition could be improved upon. They could play sports, they could do whatever they wanted to do with the right treatment. It’s extremely rewarding to see people go through a change like that.”

How big is your practice? Is there a particular type of allergy or treatment your practice specializes in?

“Our practice has 19 doctors and clinics in and around Atlanta. The farthest away is in Rome, GA. Each doctor in our practice goes to only two offices so that he can continue to see his own patients. Part of the pleasure of being an allergist is getting to know your patients and their families and what’s going on in their lives. We usually see our patients at least twice a year and when they get sick.

We treat all kinds of all allergies, and every aspect of allergy conditions. We do take care of a lot of people with asthma and chronic sinus infections. Our biggest aim is to keep people out of the hospital. It’s very rare that one of our asthmatic patients winds up being hospitalized.”

What do you love about your job?

“To me, it’s not really a job or work. I’m just going every day to do something that I really enjoy doing. I make a difference in my patients’ lives. I love people, and the interplay that goes on between me and my patients is very rewarding. Allergies run in families, so many times I also get to know and spend time with my patients’ families.”

If you could suggest one thing for your patients what would it be?

I loved Dr. Carroll’s answer to this question, and his obvious commitment to breaking down the doctor-patient barrier. He advises:

“I think that when a patient goes to see a doctor, they should have some idea of the questions that they want that doctor to answer for them. They should write their questions down, so when they leave, they’re sure their questions are answered. Otherwise, if questions remain unanswered, the patient feels that the visit is incomplete – and the doctor doesn’t want that either. In short, my advice is for the patient to take the time to write down their questions and get answers. This promotes a good two-way dialogue.”

What is your favorite allergy relief product?

“My favorite allergy relief ‘product’ is immunotherapy because it’s natural. Immunotherapy, often called allergy shots, builds up immunity to the environment. No medications are involved, and when you administer immunotherapy, you’re treating the cause, not just symptoms.”

Since Dr. Carroll mentioned that he sees a lot of sinus patients, I asked him what products he recommends for treating sinus infections:

“To treat sinus infections, saline products and nasal irrigations are very important. But for these to work well, patients must be disciplined, and many often aren’t. Sometimes irrigating on a regular basis is enough to keep from having to take an antibiotic. Many people with chronic sinus infections have allergies as an underlying cause. Sometimes surgery is necessary if there are polyps or cysts, but anybody with asthma or chronic sinusitis needs an allergy evaluation to find out if something is causing the recurring problem.”

Recently, a friend told me that a doctor had warned her against using a neti pot for a sinus infection because it could spread the infection. I asked Dr. Carroll about this, and here’s what he had to say:

“If one is taught how to use a neti pot properly, it’s very effective at washing out germs. If you were to let the water sit there, that wouldn’t be good; the water has to be able to flow up and around the nasal passages. If it stagnates and you don’t get it out, infection could spread.

Personally, I think that the squeeze bottles are best because you can squeeze the saline solution out at your own comfort level. Don’t sniff while you’re doing this. Instead, let the irrigation flow. Ninety percent of infections get better without antibiotics. If five to seven days go by and the infection is no better or it’s worse, that’s a good indication that antibiotics might be needed.”

I also asked Dr. Carroll about something I’ve heard mixed messages about – and no doubt you have too: the color of mucus as an indication of infection. His response:

“In general, when you have discolored mucus from the nose, it almost always means infection. Yellow or green mucus can either indicate an active infection, or it could be waste material even after the infection has stopped. White or clear mucus usually means that you don’t have infection, but, still, you could.

If an infection is present, you don’t know whether it is viral or bacterial unless you do a culture. This is something that’s rarely done because a culture grown from mucus that comes out of the nose is always contaminated by bacteria, causing it to test positive for bacteria even if the source of the infection is viral. The only way to do a ‘pure’ culture is to extract mucus directly from the nasal cavity, which is only done in extreme circumstances.”

Where do you see allergy treatment going in the near future? In the distant future?

Like many allergists we’ve interviewed, Dr. Carroll is excited at the prospect of sublingual immunotherapy.

“In the near future, within the next two or three years, I think that the biggest change we’re going to see – that’s already happening in Europe – is sublingual immunotherapy (SLIT), allergy drops administered under the tongue.

This allergy treatment, however, is still in its infancy and cannot be used on people who are allergic to multiple things. In addition, it hasn’t been approved by the FDA. Currently, the therapy is for people who are what we call ‘mono-sensitized,’ but about 90 percent of people are allergic to, for example, eight different trees or four different grasses. In the long run, though, SLIT will become more sophisticated, with more antigens in the mixtures. These oral drops may become very effective, even for multiple allergies, but this is a long way off.”