How to Survive Allergy Season

Given the statistics that around 55% of the US population tests positive to one or more environmental allergens, many would like to pull the covers over their head and wait for allergy season to be over. Naturopathic medicine offers many alternatives to pharmaceutical medications for allergies, as well as a multitude of treatments and testing which may alleviate or de-sensitize an individual to allergens. One of the first questions our physicians are often asked is, “How do I know what I am allergic to?” The gold standard or most often recommended testing for environmental allergens is the skin prick testing because it is simple, quick, accurate and inexpensive. Most allergists can perform the test in their offices and provide a list of allergens on the same day. Allergy skin testing is the preferred method, but physicians can perform a blood test to check for allergens as well. Some patients prefer this method as they cannot tolerate the skin prick testing or are taking medications such as antihistamines, steroids or some antidepressants that would interfere with the test results. Others may have poorly controlled asthma or have severe skin conditions such as eczema, psoriasis, or dermatitis, or prefer blood testing for tracking efficacy of current allergy treatments.

An Immunoglobulin E (IgE) test measures the blood levels of IgE antibodies: one of five classes of identified antibodies that are a part of our immune system. Antibodies are proteins made by the immune system that attack antigens such as bacteria, viruses, and allergens. Elevated IgE antibodies are associated mainly with allergic reactions (when the immune system overreacts to environmental antigens such as pollen or pet dander) and parasitic infections. An IgE allergy triggers histamine to be released and causes itching, redness, swelling, and heat in the body. Symptoms of allergies may include hives, itchy eyes or nose, sneezing, nasal congestion, tight throat, and trouble breathing. Symptoms may be seasonal (as with allergies due to pollen or molds) or year-round (as with food allergies). They can range from mild to severe, depending on the individual. There are IgE panels that can be ordered for specific allergens based on where a person lives. At NaturoMedica, we offer our patients the IgE Pacific Northwest Inhalant Panel which covers over 25 known environmental allergens such as local grasses, weeds, molds, and tree pollens in addition to dust mites, cat and dog dander. Our physicians may also order other allergy lab tests if additional allergens that are not on the panel are suspected.

Our physicians review the test results with our patients and discuss an alternative treatment plan which may include sublingual therapy or natural supplements to treat current allergies. Our philosophy of medicine is to find and treat the underlying cause of the allergic reaction. When allergy symptoms are severe we can offer therapies for some much needed relief. When it comes to environmental allergies, avoidance of the known allergen(s) is not always possible and reducing the body’s reaction to the allergens is often the best solution.

NaturoMedica utilizes an environmental allergen protocol to alleviate allergic reactions which is called SLIT (sublingual immune therapy). This therapy is designed for the treatment of environmental allergens. Small drops of the known allergen(s) are placed under the tongue on a daily basis for a pre-determined period of time. Some patients prefer this method of “allergy drops” over “allergy shots” as they find it difficult to handle the “shots”. Additionally, most of the drops can be administered at home, so frequent trips to the doctor’s office are not required. Patients start out slowly and increase the dosage over a period of time to “de-sensitize” or lessen the body’s allergic response to the known allergens. On March 27, 2013, The Journal of American Medical Association (JAMA) published a European systematic review for SLIT in the treatment of asthma and nasal allergies. The review contained 63 studies with over 5,000 participants in which it revealed over a 40% reduction in asthma type symptoms as a result of SLIT therapy. The study also showed moderate benefit and recommended further trials for nasal allergies which included symptoms of nasal congestion, runny nose and itchy eyes. Many of our patients report their SLIT therapy reduces symptoms in as little as a few months but the entire therapy can take up to 1 year or more for relief from allergy symptoms. Please contact one of our physicians to see if SLIT therapy is appropriate for you. Slit therapy is not advised for those with unstable heart disease, autoimmune disease, those with severe asthma and pregnant women are not candidates for SLIT therapy.

In Washington, tree pollination is usually in full swing from February to June. In the Pacific Northwest, alder and birch are the most common allergens. Grass pollination in the West is high in May and June. If you have one grass allergen, you are typically allergic to most grasses with one exception: Bermuda grass. Most people who are allergic to Bermuda grass are not allergic to other grasses. Bermuda grass, orchard, wheat grass, and fescue are common in the West.

If seasonal allergies aren’t enough to deal with, food allergies can make your environmental allergies worse. Food allergens may exacerbate, mask or worsen other allergies. Below is a list of environmental allergens that can be aggravated by certain foods:

PROVEN CONCOMITANT FOODS
POLLEN	FOODS
Ragweed	Milk, melons, bananas, and lettuce
Iva ciliate (Poison ivy)	Wheat
Sage and Mugwort	Potato, celery, and coriander
Pigweed	Pork
Grass	Legumes: Beans, peas, soybeans, cottonseed (cooking fats), grains, apples, carrots, and celery
Marigold	Milk
Cedar	Beef and yeast (Baker’s, brewer’s, and malt)
Elm	Milk
Oak	Eggs and chestnut
Pecan	Corn and bananas
Birch	Hazelnut, apples, carrot, celery, potato, and oranges

QUESTIONABLE CONCOMITANT FOODS - -Suspected but Unproven
Dust	Nuts
Influenza vaccine	Onion
Iva ciliate (Poison Ivy)	Tea
Chenopods	Eggs
Pigweed	Lettuce
Elm	Lettuce and chocolate
Cotton wood	Wheat and tea
Oak	Apples

PROVEN SYNERGISTIC FOODS
Corn	Bananas
Beef	Baker’s and Brewer’s yeast
Cane sugar	Oranges

By far, airborne allergies are the most common type of allergies. Hay fever is an allergic reaction to an airborne allergen, usually pollen. According to conservative estimates nearly 15 million Americans have hay fever. Many of our patients inquire as to what they can do to avoid suffering from seasonal allergies. The only way to reduce or eliminate environmental allergens is to completely eliminate exposure to known allergens. However, the SLIT therapy mentioned above has proven to be highly successful to reduce or eliminate allergic response. In addition, we often recommend the following tips to help allergic sufferers find relief during allergy season:

• Avoid using window fans as they may blow pollens indoors. Keep windows shut during high pollen counts.
• Keep car windows closed and use air conditioners only when necessary.
• Change your clothing once you are inside from the outdoors and place in a laundry room away from your bedroom area (prolonged exposure).
• Wash bedding weekly in hot water.
• In the case of dust mites, be sure to use vent, mattress and pillow covers.
• Do a thorough spring cleaning to reduce allergen exposure.
• Shower and wash hair frequently as pollens may attach to hair and skin.
• If you have pets, keep them off of furniture and away from areas where you sleep. Clean your pets often. There are special shampoos for animals to lower dander/hair issues.
• Minimize outdoor activity when pollen counts are high. Peak pollen times are typically between 10 a.m. and 4 p.m.
• When gardening or mowing, be sure to wear your filter mask.
• If you have an allergic reaction to birch pollen, you may want to avoid apple skins due to cross reactivity during tree pollen season.
• Individuals with allergies to grasses may have additional reactions to melons.

Below are some additional recommendations that can help head off allergies before they start, as well as some drug-free ways to treat symptoms when they do arise:

Diet:
• Increase your essential fatty acids through supplementation as they are natural anti-inflammatories (flax, hemp and fish oil or cold water fish).

• EPA/DHA (capsules) by Metagenics: 2,000 mg per day with meal. 1 capsule per day. May need to increase dosage up to 4,000 mg per day during high pollen counts.
• Finest Purest Fish Oil (liquid) by Pharmax: - 1 tsp daily with meal.

• Try to avoid mucous producing foods such as dairy products including milk, processed sugars and wheat.
• Avoid known food allergens and/or concomitant food allergens to lower your immune system’s response to allergens.

Nasal Irrigation/rinse:
Neti Pot:

• Neti pots have been used for thousands of years in India to flush the sinuses and keep them clear. The International Archives of Allergy and Immunology found that nasal flushing was a mild and effective way to treat seasonal allergies in children, and markedly reduced their use of antihistamines.
• Directions: To flush your sinuses, mix a quarter to a half teaspoon of non-iodized table salt into a cup of lukewarm water and pour it into the pot. Lean over sink and tip head back to insert spout in nostril and pour ½ of solution and allow fluid to come out other nostril. Repeat step for other ½ of solution in opposite nostril. Be sure to blow your nose at the end. You may repeat steps twice per day to rinse away allergens or consult with your physician for recommendations. Using purified water or boiling your water (and then letting it cool to room temperature) to sterilize it is advisable.

QC Nasal Spray by Thorne:

• The flavonoid quercetin strengthens cell membranes of mast cells and basophils (a type of white blood cell), thus preventing them from releasing their histamine. Quercetin also affects enzymes that help maintain a normal inflammatory response. Homeopathic indications for Euphorbium include hay fever, headache, nasal discharge, stuffy nose, sneezing, and post-nasal discharge with a raw, sore throat.
• Directions: 1-2 sprays in each nostril up to 3 times per day or as recommended by your physician.

Nasal Repair by BioGenesis:

• A combination of botanicals, saline and electrolytes which supports nasal and sinus health. Soothing and cooling mucilaginous herbs for nasal membrane comfort, repair and cleansing. The formula contains Urtica dioica which is known for mast cell stabilization and antihistamine support. Most importantly, this preparation is non-habit forming.
• Directions: 1-2 sprays each nostril up to 3 times per day or as directed by your physician.

Supplement Recommendations:

Allergy – by Heel, Inc. (homeopathic remedy):

• For the temporary relief of sneezing and coughing, runny nose, watery eyes, skin rashes and hives. Homeopathic remedies do not interfere or have any known side effects and are very safe and effective for relieving allergy symptoms.
• Directions: Take 1-2 tablets under tongue, hold 30 seconds and swallow up to 3 times per day or more for relief of symptoms.

Aller-C by Vital Nutrients:

• A potent and effective combination formula. Quercetin and hesperidin (from citrus bioflavonoids) have been shown to be two of the most useful and physiologically active flavonoids. This formula can be used for maintaining and supporting proper levels of enzymes and physiologic factors necessary for normal respiratory and sinus function.
• Quercetin is a natural plant-derived compound called a bioflavonoid, quercetin helps stabilize mast cells and prevents them from releasing histamine.
• Vitamin C works to lower levels of histamine in the body and to help break it down faster. This reduces allergy symptoms such as swelling, sneezing and a runny nose.
• Bromelain is the term used to describe a group of enzymes derived from the stem and fruit of the pineapple plant (Ananas comosus). As a plant enzyme, Bromelain has many advantages as a supplemental ingredient. Bromelain has an “Approved” status by the German Commission E for micro inflammations (allergic reactions and localized internal infections). Other activities associated with Bromelain include inhibition of platelet aggregation, thinning mucous, antibiotic activity and smooth muscle relaxant.
• Directions: 1-2 caps once to two times daily or as directed by your physician.

BCQ by Vital Nutrients:

• BCQ is a powerful herbal combination that provides enhanced support for maintaining a healthy inflammatory response and to reduce minor pain by reducing Substance P in the body.
• Curcuma and quercetin contained in this supplement are powerful antioxidants that provide immune system support. Quercetin has been shown to stabilize mast cells and prevents them from releasing histamine which may create allergy symptoms in the body.
• Directions: take 2 capsules twice daily with meals or as directed by your practitioner.

Natural D-Hist (adult/capsule) and D-Hist Jr (child/chewable):

• Stinging nettles have been shown to be effective when used for hay fever. Quercetin is another constituent in this formula which is a well-known natural antihistamine. NAC is a precursor to one of the body’s most potent anti-oxidants, glutathione. NAC helps to thin mucous.
• Bromelain: is on the approved status by the German Commission E for micro inflammations and also thins mucous.
• Directions:
  • Loading dose: 2 capsules three times per day for 7-10 days
  • Acute: 2-3 capsules as needed

MigraClear by Biogenesis:

• Butterbur: In one study, published recently in the British Medical Journal, a group of Swiss researchers showed how just one tablet of butterbur four times daily was as effective as a popular antihistamine drug in controlling symptoms of hay fever -- without the traditional symptom of drowsiness that sometimes occurs. In a second study, a group of British researchers put their stamp of approval on butterbur's effectiveness in quelling symptoms of grass allergy.
• Directions: 2 capsules twice per day for one month, may reduce to a maintenance dosage or as recommended by your physician.

N.A.C. by Vital Nutrients:

• N-Acetyl-Cysteine (NAC) is a powerful antioxidant. It maintains and supports normal physiologic levels of mucus in the sinus and respiratory system of healthy individuals.
• Directions: 1-2 capsules once or twice daily or as recommended by your physician.

IV Therapy:

• Glutathione: this is the body's natural antioxidant and keeping levels up to par is critical when treating allergies. Very high doses of glutathione must be taken orally to have a therapeutic effect in the body, and it will often be destroyed by enzymes in the digestive tract before it reaches the bloodstream. For this reason, glutathione is best used by the body when administered intravenously.
• NAC: as discussed above, this powerful antioxidant can be very important for allergy treatment. NAC can be administered by IV therapy for those with severe allergies or compromised digestive function.

Many of our patients frequently ask about food allergy testing. We explain that there are several types of food allergens that can be tested including IgE allergic reactions which are an immediate reaction mounted by the body upon exposure to a particular food allergen. The symptoms are often swift and can range in severity but may include the following symptoms: mouth, lip, tongue or face tingling/swelling, throat closing, difficulty breathing, wheezing, to a complete anaphylactic response requiring immediate emergency attention. There are other immune reactions by the body to various food allergens and one that our physicians often check in addition to IgE food allergens is IgG allergic sensitivities. IgG (delayed immune response) is where the body has a delayed response to the food allergen and it can take anywhere from 5 minutes to 3 days for a bodily response. Many patients are unable to identify a particular food or foods that are causing the problem as it may take a few days for the allergic response to occur. As naturopathic physicians, we often focus on lowering the immune burden so that the body is not “overtaxed” with immune stimulants such as food allergens and environmental allergens. As previously mentioned, foods may develop into concomitant allergens as well.

If you would like to discuss your allergic history with one of our physicians, please feel free to contact our NaturoMedica office to set up your appointment. Our physicians are well educated in allergic causes and treatments including pharmaceuticals. Depending on the severity of your allergies and symptoms, we may refer you to an allergist (specialist) as warranted. However, we often review the various options available for allergen testing (skin prick, food and environmental blood tests) and will discuss if SLIT therapy is right for you. Our doctors can offer a variety of nutraceuticals which will not cause the adverse side effects common with allergy medications. Please contact us today as allergy season is now upon us and let one of our NaturoMedica physicians assist you in your healthcare needs.