Integrative approaches to seasonal allergies

Photo Cred: Artem Beliaikin/Unsplash

By Bill Reddy, LAc, DiplAc

As the bite of wintertime eases into spring and summer, our natural tendency is to spend more time outside. But it can be a miserable time of year for those coping with allergic rhinitis, or seasonal allergies.

Allergic rhinitis is defined as an immunoglobulin E (IgE), mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens. Typical symptoms include itchy/watery eyes, runny or stuffy nose, postnasal drip, itchy throat, clogged eustachian tubes, and sneezing.  

Common medical approaches include antihistamines, decongestants, leukotriene inhibitors, topical steroids, immunotherapy and, for some, surgical procedures such as an inferior turbinate reduction.

Some pertinent questions practitioners should ask during intake include if a patient has a history of antibiotic or nonsteroidal anti-inflammatory drug (NSAID) use, food allergies, yeast infections, skin problems, irritable bowel syndrome, autoimmune disorder, or has traveled internationally. The goal is health promotion and disease prevention in our patient population, and treating allergies is a prioritized part of the overall effort.

Alternatives to antihistamine medications, without the sedating or drying side effects, include enzymes such as bromelain, flavonoids such as quercetin, and herbs such as butterbur. I’ve found the combination of the first two can be very effective. Quercetin is known to have both antiviral and antibacterial properties, inhibits histamine, and suppresses immune system overactivation, reducing pro-inflammatory cytokines. Bromelain, an enzyme found in pineapple, increases the absorption and bioavailability of quercetin, as well as reducing inflammation and symptoms associated with allergic rhinitis, sinusitis, and asthma. 

Supplementing with 25 milligrams per kilogram of quercetin and 1,000 milligrams of bromelain distributed two to three times per day one half an hour before meals can be helpful. Both supplements have low side-effect profiles, but patients have complained on occasion that bromelain caused them loose stools and heavier than normal menstrual bleeding.

Bromelain has blood thinning characteristics and should be discontinued a week before any surgical procedure. Quercetin has been known to cause blurry vision, dizziness, and headaches, but patients haven’t reported these side effects to me. Butterbur has been shown to ease allergy symptoms, and I’ve recommended it, but more study is warranted.  The unprocessed plant contains pyrrolizidine alkaloids which are known cause liver damage.  Make sure the supplement recommended is processed to remove the alkaloids.

Common dosage is recommended at 50 milligrams twice per day. The National Center for Complementary and Integrative Health warns that butterbur may cause allergic reactions in people who are sensitive to plants such as ragweed, chrysanthemums, marigolds, and daisies, and although well tolerated, can cause side effects such as belching, headache, itchy eyes, diarrhea, breathing difficulties, fatigue, and drowsiness.

Immunotherapy is typically administered sublingually or subcutaneously.  The problem with immunotherapy is that adverse reactions such as anaphylaxis can occur, and very rarely, death.  A safer, and less known approach, is to consume raw local honey. Raw honey is polyphenol-rich with anti-viral and anti-fungal properties that boosts immune function and stabilizes blood pressure and balances blood sugar levels. The usual dosage is one teaspoon per day, starting a month or more before and during hay fever season. 

Acupuncture is known to treat allergic rhinitis and is recommended in the Otolaryngology: Head and Neck Surgery Clinical Practice Guideline for Allergic Rhinitis as a treatment option, based on randomized controlled trials with limitations, observational studies with consistent effects, and a preponderance of benefit over harm.  Studies demonstrate a reduction in serum IgE levels after several weeks of acupuncture treatment. The interesting outcome is that the participant IgE levels continued to decline after the acupuncture treatments ceased. Other studies have measured acupuncture’s effect on IL-6, IL-10 and other blood markers.

In lieu of intranasal steroids, which have systemic effects in addition to local effects, practitioners may want to recommend saline irrigation or lavage. Limited evidence shows effectiveness for up to three months. Unfortunately, studies haven’t evaluated saline rinses beyond three months. Combination therapy works better than intranasal steroids or saline irrigation alone, in my experience.

Stress is also a contributor to allergic rhinitis. My practice is based in Washington D.C., and I see many patients who develop seasonal allergies after moving to the city. The metropolitan area does not have a surplus of pollen but does have one of the worst traffic congestions in the nation, a very high cost of living, and fast pace both in the office and at home.  Studies confirm that patients with allergic rhinitis have higher stress levels than controls based on cortisol, oxytocin, and noradrenalin levels. With that in mind, it makes sense to treat the root of the problem and provide adrenal support. 

There are all several kinds of adaptogenic herbs that are helpful, including ashwagandha, rehmannia, and ginseng. Adrenal extracts, B-complex, trace minerals, zinc, iodine, and chromium can also be supportive. Curcumin has been found to reduce nasal airflow resistance and exert immunomodulatory effects. Mindfulness-based stress reduction can also be beneficial in managing allergic rhinitis.

Children who have undergone caesarian delivery are predisposed to atopic conditions like allergic rhinitis, dermatitis, and asthma, especially if they have a parental history of asthma or allergies. The main driver is a poorly developed immune system since they weren’t exposed to their mothers’ vaginal canal microbiota. This population is difficult to treat. Ordering a comprehensive stool analysis can provide key information about potential pathogens or parasites and health of their gut flora. Pre- and probiotics and microbial ecosystem transplantation can improve their symptoms and accompanying autoimmune disorders. It is also helpful to rule out leaky gut. There are mixed reviews in the literature that a vitamin D3 deficiency may lead to allergic disorders, especially in children.

These recommendations can round out your approach to patients suffering from seasonal allergies.

References

Arshi, S., Ghalehbaghi, B., Kamrava, S. K., & Aminlou, M. (2012) Vitamin D serum levels in allergic rhinitis: any difference from normal population? Asia Pacific Allergy. Retrieved from: https://doi.org/10.5415/apallergy.2012.2.1.45

Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., and Nnacheta, L. C. (2015). Clinical Practice Guideline: Allergic Rhinitis Executive Summary. Otolaryngology–Head and Neck Surgery. Retrieved from:  https://doi.org/10.1177/0194599814562166

Taw M.B., Reddy W.D., Omole FS, and Seidman, M.D. (2015) Acupuncture and allergic rhinitis. Current Opinion in Otolaryngology & Head and Neck Surgery.