When most people think of allergy symptoms, they think of sneezing, watery eyes, congestion and runny nose, but there are also lesser-known signs of allergies like chronic sinus infection, nasal polyps and chronic ear infections. Even asthma, COPD, urticaria (hives) and eczema are treated symptomatically as chronic illnesses when they are actually the body’s allergic reaction to allergens in the environment. Other allergy symptoms may be: fatigue, muscle and joint pain, frequent colds, asthma, and recurrent bronchitis.
The Allergic Response
The allergic response is best characterized as a specific inflammatory response of the immune system against environmental agents that contact the skin or mucosa. The primary immune cells involved in allergic responses are IgE antibodies. When exposed to an allergen, these immune cells trigger an immediate inflammatory response which presents as swelling, redness, and pain. Once stimulated, these immune cells produce other pro-inflammatory substances which perpetuate the inflammatory response. Prevention of this allergic reaction requires some understanding of the process that leads to activation of allergy-specific immune cells. The pathways involved in the triggering of these immune cells and their release of inflammatory substances are well known targets of anti-inflammatory or anti-allergy drugs.
Common Allergens
Allergens can be any substance (usually a protein) that can elicit an IgE-mediated response. From a clinical perspective, airborne allergens can be classified as perennial or seasonal.
- Perennial allergens would include things such as mold spores, dust and dust mites, animal dander (especially cats), and specific chemicals (cleaning agents and certain powders). Patients having airborne allergy symptoms lasting more than 2 hours per day for more than 9 months would be deemed to have perennial airborne allergies.
- Seasonal allergies will typically follow a predictable pattern based on the growing season.
- Tree Pollen: Pollen from many trees, grasses and plants are particularly allergenic due to the ease of which they become airborne. The first major allergen of the season begins when trees begin to release pollen. Trees with little or no visible flowers have a higher pollen count since they rely on the wind rather than insects for pollination.
- Grass Pollen: Summer months are typically the time for grass pollen allergies. These can come from commercial crops such as corn, and are less of a problem in urban areas where grass pollinates less frequently due to frequent mowing.
- Weed Pollen: Fall is the most intense allergy season in the central U.S. due to the large amount of weed pollen that becomes airborne such as Ragweed. Other common weed allergens are the pollen of pigweed, sage brush, lamb’s quarter and certain thistles. Interestingly, the common term “hay-fever” is actually a misnomer since neither hay (alfalfa) nor fevers are typically associated with allergies.
- Fungal Spores: Fungal spores are high at all times except during times of snow cover (typically late November through February). Fungal spores can be kicked up any time a person is walking through grass or leaves, cutting or stacking wood, or just being in a damp outside location. Fungal spores are so ubiquitous and long lasting it may be difficult to determine where the source of spores may be coming.
Seasonal allergies are often predictable in many individuals and are frequently self-diagnosed and self-treated conditions. Over –the- counter antihistamines and decongestants are advertised and purchased widely during the common allergy seasons. Natural therapies for the prevention and treatment of airborne allergies are discussed below.
Avoidance
Assuming one knows exactly what the off ending allergens are, the most obvious and beneficial thing that a person can do is avoidance. Spending time in air-conditioned areas, including cars, will filter out many of the off ending allergens. Additionally, some relatively cheap air filter/purifiers are able to remove many potential allergens. Using dehumidifiers to reduce humidity levels is another way patients can reduce moisture-related increases in indoor allergens such as dust mites and mold spores. For patients with dust mite allergies, reducing the number of dust collecting items in their homes (carpets, curtains, stuff ed animals, cloth furniture) and the use of vacuum cleaners with HEPA filters will be advantageous.
Allergy Testing
Identification of the offending allergen(s) is an important first step in treatment of allergies. Skin tests are often the simplest means by which to test a reaction to common allergens. Since there are numerous mast cells (immune cells which produce the common allergy symptoms) within the layers of the skin, a dilute solution of a common allergen will produce a classic wheal and flare reaction when applied to a scratch on the skin of a sensitive person. There are several blood tests available to detect the presence of antibodies (IgE or IgG) that cross-reacts with different allergens.
Drug Therapies
Antihistamines: This class of drugs are often the first therapy used by allergy sufferers, as they are widely available as both OTC and prescription drugs. As the name of this class of drugs implies antihistamines block the ability of histamine to bind to its receptors thereby releasing many of the histamine-related effects. By blocking the histamine receptors, antihistamines are used for reducing sneezing, itchy eyes and nose, and slowing the pace of a runny nose. One of the most popular (and typical) of the first generation of antihistamines is diphenhydramine (Benadryl®), which works by blocking specific histamine receptors. These older forms of antihistamines can cross the blood-brain barrier and cause sedation, drowsiness and other related CNS side-effects. In fact, it is because of this side effect that many of the antihistamines are used as sedatives and hypnotics. Newer antihistamines, such as loratadine, certirizine and fexofenadine, do not cross the blood-brain barrier, dramatically reducing potential sedating side effects when taken at the appropriate dose.
Topical Steroid: These glucocorticosteroids supplied through nasal sprays, function much the same way corticosteroids alter inflammatory pathways. They are mainly indicated in long-term allergic conditions that are not responding to antihistamines, although they are sometimes combined with antihistamine therapy.
Leukotriene inhibitors: the asthma drug montelukast, which functions by blocking leukotriene receptors, has also been used as a monotherapy or in combined therapy with either antihistamines or topical steroids for airborne allergies and asthma.
Bronchodilators and Decongestants: The most commonly used product in this class is ephedrine or pseudoephedrine (Sudafed®) containing products. They reverse congestion by constricting the blood vessels within the nasal mucosa, reducing swollen membranes allowing sinus drainage and improved air conduction. Ephedrine and pseudoephedrine are also capable of acting as bronchodilators. Care should be taken when patients with heart conditions, high blood pressure, or on MAO-inhibitors take these drugs; and they should be limited to no more than a few weeks.
Immunotherapy
Allergen immunotherapy involves the subcutaneous injection of a dilute solution of the offending allergen in increasing doses over several months. Essentially, immunotherapy attempts to stimulate production of other types of antibodies (IgG especially) which will then proliferate and bind to the allergen in the place of IgE. Since IgG antibodies do not have receptors on mast cells, they will not stimulate an allergic response. It is not uncommon for many people to take “allergy shots” at regular intervals throughout the year and may require years of therapy for long-term benefit. Sublingual immunotherapy treatments are also available and may prove to be similarly beneficial when compared with the more long-standing subcutaneous injections. (1,2)
Diet and Allergy Risk
Foods have a profound effect on the immune system and can influence the relative risk of airborne allergies. Eating foods rich in anti-inflammatory compounds normally reduces the inflammatory and allergenic profile of an individual. For instance, diets high in omega-(n-3) fatty acids (EPA, DHA, ALA), reduce the risk of allergenic sensitization and symptoms associated with airborne allergies. Maternal fish oil supplementation (3.7 g/day n-3, 56% DHA) in atopic women (off spring considered at high risk for allergic diseases) significantly increased breast milk levels of the protective antibodies. Children born from these mothers have reduced levels of allergen-specific immune responses. (3,4) Children at high risk for atopic diseases had reduced allergy related cough at age 3 if they were supplemented with fish oil from 6 months to 3 years. (5) It is clear from numerous studies that children and adults who consume a variety of fruits and vegetables have a lower risk of airborne allergies and associated asthma.
Probiotics
It is well established that gut microflora has a profound influence on overall human health. While maternal and infant use of certain strains of probiotic organisms have shown a reduction in certain atopic conditions such as eczema, as well as a reduced IgE burden; the use of probiotics in the treatment of airborne allergies is relatively new. (6) Several strains of probiotics have been shown to limit some airborne allergies symptoms, reduce allergen specific IgE-antibodies. (7) The overall benefits of consuming probiotics through dietary supplements or fermented foods should lead most physicians to recommend them to patients suffering from airborne allergies.
Quercetin and Flavonoids
Flavonoids are the general term used to describe over 4000 different compounds in plants containing the flavone ring. These compounds are very diverse and include the flavones, isoflavones, flavanols, catechins, anthocyanidins and chalcones among others. Among the flavonoids, quercetin and its closely related compounds have been widely studied for their mast cell modifying activities and related anti-inflammatory potential.
Quercetin’s potential affects on allergy-related pathways is unmatched by other natural substances. Quercetin has been shown to inhibit the mast cells from destabilizing and degranulating, keeping histamine and other preformed mediators from being released.(8) Like most biologically active flavonoids, quercetin’s pharmacology is quite interesting. The absorption of quercetin is about 20-52% depending on the form. (9) It has been known for some time that the concomitant administration of bromelain, an enzyme derived from the stem of the pineapple plant, can enhance the absorption of quercetin as well as other flavonoids. (10) An added benefit t included with bromelain is its ability to block inflammatory pathways and decrease the viscosity of mucus in the lungs. (11). Quercetin is extremely safe, and includes many other documented benefits (antioxidant, anti-inflammatory, capillary stability etc.) and should be considered part of the foundation of any natural approach to airborne allergies therapy.
Petasites
Petasites (Butterbur, Petasites hybridus), is a perennial shrub. Extracts of both the leaf and the root are commercially available and have become popular for their use in alleviation of pain, especially related to migraine headaches. Compounds found in this plant are known to inhibit and have also been shown to alleviate bronchial asthma and allergies. A leaf extract (CO2) of butterbur delivered in tablets, has been shown to be comparable to 10 mg cetirizine in patients with airborne allergies.(12) In a skin test, it was shown that butterbur extracts do not inhibit the mast cell degranulation process or histamine release from mast cells.(14) This data suggests that butterbur acts on pathways similar to the anti-leukotriene drug montelukast, and is not functionally comparable to antihistamines or mast-cell stabilizers.
Nettles
Among the many plants one would propose to be helpful in the treatment of airborne allergies, the stinging nettle (Urtica dioica L.) would probably not be among them. This
common plant, often called “itch weed”, is known to cause hives or urticaria (hence the Latin name) due to the histamine located in needles under each leaf. However, for years the dried leaves of stinging nettles were used for the symptoms associated with airborne allergies.
Natural Bronchodilators and mucolytics
Asthma is one of the most common allergy-associated consequences. It can be triggered by the same events as allergies (IgE-allergen interaction) and results in the constriction of the bronchioles and increased production of bronchial mucus. While several of the mast cell preformed mediators play significant roles in asthma, increasing research has been targeting other inflammatory mechanisms associated with asthma risk. (15) Quercetin and Gingko biloba have been shown to inhibit these other inflammatory pathways.
Ephedra (Ephedra sinica Stapt.) or Ma Huang has been used in Chinese medicine for thousands of years. (16) The ephedra plant contains 2-3% alkaloids, mostly ephedrine
and pseudoephedrine. These alkaloids were discovered and synthetically produced in the late 1920’s and their use has been wide in over-the-counter and prescription medications for asthma, hay fever and related conditions. These compounds are very effective bronchodilators.
N-acetyl cysteine, or NAC, is a potent natural expectorant/mucolytic agent, although its use has declined in recent decades. NAC has been gaining interest as an antioxidant that acts directly or as a “recharger” of the body’s own antioxidant (glutathione). (17) both NAC and glutathione can decrease the viscosity of mucus, which is increased during asthmatic reactions.. NAC has been used quite frequently in an assortment of lung conditions including COPD, bronchitis, and asthma. Recent data also suggest NAC inhibits the function of immune cells known to be active in allergy-induced asthma, (18)
Conclusion
According to a report published by the American College of Allergy, Asthma and Immunology (ACAAI), a shortage of physicians specializing in allergies will prevail over the next dozen years. (19) This will increase the need for general practitioners and physicians trained in alternative medicine to deal directly with patients needing symptom relief for perennial and seasonal airborne allergies. As we have shown in this review, a number of lifestyle, diet and non-pharmacological approaches may provide superior symptom relief, compared to the available pharmaceuticals with fewer side-effects. These approaches will also improve overall health outcomes, as these agents have wider benefits as probiotics, antioxidants (flavonoids, NAC), immunomodulators and anti-inflammatory agents
Dr. Abida Zohal Wali, N.D.
Our Health Program is a great place to start
At Ocean Pacific Integrative Health Center, we celebrate every person’s uniqueness by providing personalized Health Plans. Our individualized Health plans includes: comprehensive review of your overall state of health, physical exam, IgE and/or IgG blood test, other laboratory tests if applicable and Sublingual Immunotherapy (SLIT) program.
Our SLIT Program is convenient and involves the use of sublingual drops without needles or frequent visit to the doctor. The program consists of two phases: start up and maintenance. The initial treatment lasts 6 months: 10 weeks for the start up and 10 weeks for the maintenance. After 6 months, you and your doctor will evaluate the efficacy of your allergy desensitization program and will decide whether or not to continue with the program.
- To learn more about our SLIT allergy desensitization program, please call our office at 760-944-9300.
- Not sure if SLIT program is right for you, schedule a complimentary consult with one of our naturopathic doctors.
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References:
1. Ciprandi, G., Fenoglio, D.et al. Sublingual immunotherapy: an update on immunologic and functional eff ects. Allergy Asthma Proc. 2007; 28(1):40-43.
2. Pajno, G. B. Sublingual immunotherapy: the optimism and the issues. J Allergy Clin Immunol. 2007; 119(4):796-801.
3. Barden, A. E., Mori, T. A.et al. Fish oil supplementation in pregnancy lowers F2-isoprostanes in neonates at high risk of atopy. Free Radic Res.
2004; 38(3):233-239.
4. Dunstan, J. A., Mori, T. A.et al. Fish oil supplementation in pregnancy modifi es neonatal allergen-specifi c immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial.
J Allergy Clin Immunol. 2003; 112(6):1178-1184.
5. Peat, J. K., Mihrshahi, S.et al. Three-year outcomes of dietary fatty acid modifi cation and house dust mite reduction in the Childhood Asthma Prevention Study. J Allergy Clin Immunol. 2004; 114(4):807-813.
6. Kukkonen, K., Savilahti, E.et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol.
2007; 119(1):192-198.
7. Boyle, R. J. and Tang, M. L. The role of probiotics in the management of allergic disease. Clin Exp Allergy. 2006; 36(5):568-576.
8. Leung, K. B., Barrett, K. E., and Pearce, F. L. Diff erential eff ects of anti-allergic compounds on peritoneal mast cells of the rat, mouse and hamster. Agents Actions. 1984; 14(3-4):461-467.
9. Hollman, P. C., van Trijp, J. M.et al. Bioavailability of the dietary antioxidant fl avonol quercetin in man. Cancer Lett. 1997; 114(1-2):139-140.
10. Shoskes, D. A., Zeitlin, S. I.et al. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999; 54(6):960-963.
11. Braun, J. M., Schneider, B., and Beuth, H. J. Therapeutic use, effi ciency and safety of the proteolytic pineapple enzyme Bromelain-POS in children with acute sinusitis in Germany. In Vivo. 2005; 19(2):417-421.
12. Schapowal, A. Randomised controlled trial of butterbur and cetirizine for treating seasonal airborne allergies. BMJ. 2002; 324(7330):144-146.
13. Lee, D. K., Gray, R. D.et al. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial airborne allergies. Clin Exp Allergy. 2004; 34(4):646-649.
14. Gex-Collet, C., Imhof, L.et al. The butterbur extract petasin has no eff ect on skin test reactivity induced by diff erent stimuli: a randomized, double-blind crossover study using histamine, codeine,
methacholine, and aeroallergen solutions. J Investig Allergol Clin Immunol. 2006; 16(3):156-161.
15. Smith, L. J. The role of platelet-activating factor in asthma. Am Rev Respir Dis. 1991; 143(5 Pt 2):S100-S102.
16. Chan, E. L., Ahmed, T. M.et al. History of medicine and nephrology in Asia. Am J Nephrol. 1994; 14(4-6):295-301.
17. Yim, C. Y., Hibbs, J. B., Jr.et al. Use of N-acetyl cysteine to increase intracellular glutathione during the induction of antitumor responses by IL-2. J Immunol. 1994; 152(12):5796-5805.
18. Martinez-Losa, M., Cortijo, J.et al. Inhibitory eff ects of N-acetylcysteine on the functional responses of human eosinophils in vitro. Clin Exp Allergy. 2007; 37(5):714-722.
19. America Faces Allergy/Asthma Crisis. www acaai org. 2007;
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