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Sneezing and Wheezing

Immune system Immune system

Allergy management includes a mix of environmental modifications and supplementation tied into boosting the immune system.

To everything there is a season. In the spring, it’s time for flowers to bloom, it’s time for grass to grow and it’s time for the pollen count to increase. For the millions of seasonal allergy sufferers in this country, it is also a time for sneezing, a time for itchy and watery eyes, a time for a runny nose, a time for shortness of breath, a time for coughing, and for some, a time for wheezing. In short, the long-awaited spring can be time for general misery.

According to the Asthma and Allergy Foundation of America, allergic rhinitis—also known as hay fever—affects 5.2 million children and 19.2 million adults, but more than 50 million people experience various types of allergies each year. The CDC (Centers for Disease Control and Prevention) has put the number even higher, at 60 million Americans. Though a number of triggers can set off a sneezing fit, pollen is one of the most common environmental allergies. Depending on the climate, the pollen season can last for several months, with tree pollen beginning in early spring, and grass pollen beginning in later spring. Other pollens, like weed pollen and ragweed pollen, usually start causing trouble in July and August, respectively.

Besides pollen, additional common environmental allergens include insect bites and stings. Though the great outdoors is a huge culprit, for some people, indoor allergens include dust mites, mold, mildew and pet dander. Cockroaches are also a common household allergy.

Dr. Chris Terrell, scientific advisor with Natural Path Silver Wings, a manufacturing company based in Tennessee, said that allergies are the sixth leading cause of chronic illness in the United States. Hank Cheatham, vice president of Daiwa Health Development, a California-based manufacturer, cited the same statistic, adding that this results in an annual cost of $18 billion.

Risk Factors

Risk factors for allergies include family history, especially being firstborn; being male; being born during the pollen season; maternal smoking exposure during the first year of life; and early use of antibiotics, said Erika Cappelluti, MD, PhD, MA, FCCP, ABOIM, ABIHM, fellowship director with the Academy of Integrative Health and Medicine based in Arizona.

In fact, genetic background is the strongest risk factor, regardless of living environment or location, noted Jocelyn Strand, ND, director of clinical education and research with Biocidin, a manufacturer headquartered in California. She added that the environment plays a role, as does the human microbiome.

Allergies can manifest at any age.

“While we tend to think that seasonal allergies mostly occur in children, there is a chance that adults can also develop symptoms, particularly if they had previously experienced them as a child,” said Kim Plaza, technical advisor with ADM Protein, a manufacturer headquartered in Florida.

“Allergies affect both children and adults, and sometimes this is due to genetics or environmental causes. Children can outgrow some allergies, but this is not always the case,” said Christophe Merville, D Pharm, director of education and pharmacy at Boiron USA, a manufacturer based in Pennsylvania.

Allergic Responses and Reactions

“There are four classically defined mechanisms of allergic reaction with most reactions involving more than one mechanism. The type 1 reaction, mediated by immunoglobulin E (IgE), is responsible for the common clinical allergic conditions including allergic rhinitis and asthma,” said Dr. Cappelluti. “The classic IgE allergic hypersensitivity reaction is a two-step process whereby a susceptible individual becomes allergic to a substance after 1-sensitization, followed by 2-reactivity. During sensitization to pollen, for instance, high levels of IgE antibodies directed against pollen are produced. These antibodies bind to cells called basophils and mast cells which contain, among other things, large amounts of histamine and other inflammatory molecules. During the reactivity phase, a sensitized individual re-exposed to pollen will undergo a series of changes in the mast cells and basophils which cause them to release the histamine and inflammatory molecules that give rise to allergy symptoms.”

Dr. Terrell elaborated, “There are four types of allergic responses, with the most common being type 1. Type 1 can begin within seconds of exposure and can last up to 30 minutes. This reaction causes the release of histamine, an inflammatory chemical in the body to be released. This histamine reaction causes the body to have an inflammatory response. General and common symptoms include coughing, sneezing, hives, rashes, itchy eyes, a runny nose and a scratchy throat.”

Allergy symptoms in children can be a bit different and can include skin rashes or eczema, stomach upset and asthma, said Cheatham, adding that early identification of childhood allergies will improve a child’s quality of life.

Uncontrolled allergies can impact quality of life, and can, in some cases, be downright dangerous, even life-threatening, particularly those allergies that can cause an anaphylaxis reaction.

“Uncontrolled allergies can lead to chronic issues like: chronic sinusitis, bronchitis, conjunctivitis, snoring and uncontrolled asthma,” said Neeta Ogden, MD, board-certified allergy specialist in New Jersey who sits on the scientific advisory board for Hilma, a manufacturer based in New York. Dr. Terrell added that it can also lead to chronic inflammation, that can in turn cause other health issues in the body.

For most people, though, allergies, particularly environmental allergies primarily are a nuisance.

So short of hibernating indoors during the height of the allergy season, what is a sneezing, coughing, itchy person to do?

Allergies and the Immune System

Allergies are intricately connected to our immune systems. In fact, an allergy is the immune system in overdrive. “An allergy is an exaggerated reaction of the immune system against allergens. The allergic reaction produces excessive amounts of histamine in the body, which is responsible for the development of hay fever, asthma, nettle rash, etc. The symptoms will vary depending on the person,” said Dr. Merville.

“Normally, the immune system defends the body against infection from foreign substances, called antigens. However, some people develop antibodies against antigens that are typically harmless such as pollens or pet dander. This causes an overreaction and triggers uncomfortable symptoms. Allergic reactions can also occur from exposure to irritants, such as chemical products, certain plants and metals,” he further explained.

“An allergic response is the body’s reaction to external stimuli—whether breathed in through the air or consumed in food—as if that stimulus was a dangerous pathogen that needed immediate removal. So, while you may react very severely to pollen in the spring, a friend may not be as affected by it, just because of the different ways your bodies identify and respond to pollen exposure,” explained Kara Credle, MA, clinical nutrition specialist with Standard Process, a Wisconsin-based manufacturer.

Cheatham added, “The immune system produces substances known as antibodies. When one has allergies, the immune system makes antibodies that identify a particular allergen as harmful, even though it isn’t. When one comes into contact with the allergen, their immune system’s reaction can inflame your skin, sinuses, airways or digestive system.”

“Allergies are the result of the immune system overreacting to persistent or repetitive exposure to harmless substances, resulting in chronic allergic inflammation. This in turn produces long-term changes in the structure of the affected organs and abnormalities in their function. In hypersensitive individuals, first contact with the allergen causes elevated levels of IgE antibodies, which are primed to remember and overreact in the future. On subsequent exposure, these antibodies bind to white blood cells, causing them to release histamine and other inflammatory substances, which cause the symptoms of allergies,” said Plaza.

“As the immune system develops throughout the early years of life, a variety of antigens are presented to the immune system in order for us to become familiar with them, so that the system ‘learns’ to remain dormant upon future exposures to the allergen,” she continued.

Plaza added that the increase in indoor living and the obsession with cleaning could be leading to an overactive immune system. “It has been reported that levels of hay fever and allergic rhinitis are now rising dramatically in cities in comparison to rural areas. Some experts believe the reason for this could be the increase in exhaust fumes which trigger an immune response. Therefore, spending more time outdoors, away from urban areas could potentially help to reduce aggravating triggers in some individuals,” she said.

Allergies also happen in the digestive tract and can produce upper GI (gastrointestinal) tract symptoms. “If you have patients with GI symptoms that don’t resolve with elimination diets, elimination of known food allergens, or removal of food sensitivities (as opposed to allergy), think about the possibility of histamine intolerance,” said Dr. Strand.

Histamine intolerance can look like GI symptoms because, as Dr. Strand further explained, “Histamine receptors are present in all tissues in the human body. Depending on the tissue and the type of receptor, signs vary. There are a variety of histamine receptors in the body labeled H1-H4. Each receptor initiates a different physiological response. But histamine binds them all.”

Conventional Approaches to Allergies

Treating allergies should begin with getting the proper diagnosis. “Getting an allergy test is a good first step to see what you have the most allergic response to. Also try eliminating one major group at a time from your diet for a couple of weeks to see how your body reacts to the change,” suggested Dr. Terrell.

Drug store shelves are filled with over-the-counter (OTC) medications to help relieve the most common allergy symptoms, from antihistamines to decongestants to corticosteroids to mast cell stabilizers, said Dr. Strand.

“Conventional approaches—drugs, decongestants, steroids and antihistamines—are all designed to block or shut down our immune response. If we are breathing something in like pollen that our body perceives is a threat then our body’s first immune response is to create more mucous to trap the allergen and prevent it from getting into the lungs,” said Nathan Jones, founder of Xlear, a manufacturer based in Utah. However, he continued, “Blocking our immune system from working is not usually the best thing to be doing in the long run. By using these drugs, we are not stopping the allergen from getting into the lungs, we are just shutting down our response.”

Conventional approaches, like antihistamines, can also cause such unwanted side effects as drowsiness, dizziness, dry mouth and nausea, said Cheatham.

“Decongestants can have rebound effects. Corticosteroids affect growth and should not be used long-term. Allergy shots attempt to desensitize patients to allergens but can take several years to work,” said Dr. Merville.

Dr. Cappelluti said that in more severe cases, immunotherapy—allergy shots—may be indicated. “Sublingual immunotherapy is a newer form of treatment that is rapidly gaining acceptance in the U.S. In this case, allergen extracts are prepared and administered under the tongue. Consultation with an allergist is recommended in these circumstances,” she said.

Natural Approaches to Allergies

Some patients take homeopathic medicines to help relieve allergy symptoms. Comparing them to allergy shots, for example, homeopathic medicines are less concentrated. “Homeopathic medicines can be used to complement the allergy treatment and very often give satisfactory results. They are even used in many countries as a first line of treatment for allergies, precisely because they are less invasive and more cost-effective. If your patient is leading an active life, then you certainly don’t want to prescribe a treatment that will interfere with their normal everyday functioning. This is where homeopathic medicines can help relieve bothersome allergy symptoms and, in the worst cases, decrease the need for heavy medication,” said Dr. Merville.

“Over time, a healthy immune system depends on many things including a healthy diet. Getting vitamins and minerals from your food is ideal, but supplementation is often necessary. Some of the most important vitamins and minerals necessary for proper immune function include vitamins D, C, E, B6/12 and A, folate, selenium, zinc and iron. There may also be a role for probiotics in the treatment and prevention of seasonal allergies. Turmeric, elderberry, echinacea and ginger appear to support immune function as well,” said Dr. Cappelluti.

Other natural approaches, said Credle, include natural nasal sprays (like a neti pot); acupuncture; microbiome support with probiotics; strengthening immune barriers with herbs like goldenseal; or nutritional supplements that act as antioxidants to relieve allergy symptoms, like quercetin and N-acetyl cysteine.

Dr. Cappelluti agreed that one of the most effective natural approaches for allergic rhinitis is nasal irrigation with saline. She also recommends an anti-inflammatory diet.

Avoidance of the known allergen is common sense, but if you’re allergic to invisible microbes in the environment, it’s hard to keep allergic reactions at bay completely. However, there are some things you can do to modify your environment.

“It is important to avoid exposure to peak pollen counts and resist the temptation to open windows. Air conditioners can be used to filter the air, and showering before bed can remove allergens to help reduce contamination of the bedding. To reduce dust mite allergen, remove carpeting, if possible, keep allergenic animals out of the bedroom, replace curtains with shades or blinds, and encase mattresses and pillows with mite-impermeable covers. Regular cleaning with vacuums equipped with HEPA filters can reduce allergen burden in the home,” said Dr. Cappelluti.

Dr. Cappelluti added that there may be a role for acupuncture or Chinese herbs as part of a traditional Chinese medicine approach to allergies.

State of the Market for Natural Products

For natural products targeting allergy relief, the market is in an upswing. For homeopathic medicine specifically, Dr. Merville said, “More and more patients appreciate that homeopathic medicines complement a healthy lifestyle and allow them to relieve a wide variety of allergy symptoms easily and affordably. Homeopathic medicines particularly appeal to parents, who are concerned about what goes into the family medicine cabinet.”

“The market has been growing quickly for the past 10 years. Before that most people would just listen to whatever their doctor told them to use, and they would go overboard with the steroids, antihistamines and decongestants,” said Jones.

Plaza said that there has been a substantial shift away from prescription allergy medicines to OTC solutions. “The move away from prescription medication may be more cost effective for the individual, especially considering that many sufferers of allergies take multiple preparations, such as nasal sprays, tablets, eye drops and ointments,” she said. “While OTC preparations are generally still drugs, it could imply that consumers are open to the idea of trying natural remedies and it is an opportunity for practitioners to discuss alternative preparations.”

Natural Products to Support Allergies

Dr. Cappelluti said that some of the most effective natural ingredients for seasonal allergy symptom mitigation include butterbur, fish oil, magnesium, vitamin C, quercetin and stinging nettle.

Xlear makes a nasal spray and irrigation bottles, originally invented by a physician to wash bacteria out of the upper airway. “Adding the xylitol to it not only blocked bacteria and viruses from adhering, but it also kept the nasal mucosal layer hydrated so it trapped more pollen and other allergens and allowed the body to wash it away before it became a big allergic response,” said Jones.

Standard Process offers several products specific to supporting allergy symptoms. These include Allerplex, which contains vitamin A, and AllergCo, a MediHerb product, which contains albizia, Chinese skullcap and nigella.

Boiron makes several homeopathic medicines to support allergy symptoms; homeopathic medicines do not cause drowsiness, nor are
they contraindicated with existing conditions. “Allium cepa 6C is a homeopathic preparation of the onion bulb that can help with an allergic or viral runny nose. Allium is used when nasal discharge is clear, watery and an irritant in the nostrils as well as spasmodic, fitful sneezing and itchy eyes usually from hay fever at the first stages and improved by cold air,” said Dr. Merville.

Other products are Apis mellifica 30C, popular for relieving swelling from insect bites or allergies and can help relieve itchy eyes. Histaminum hydrochloricum 30C is derived from histamine and can provide relief of hay fever, hives or even a reaction to an insect sting. A convenient product, particularly for those new to homeopathy, Boiron offers RhinAllergy, a multi-symptom allergy medicine, with allium cepa and histaminum as the two active ingredients.

Hilma has several products to support allergies, including Indoor/Outdoor Support and Immune Support, Immune Essentials and Elderberry Immune Gummies, and the ingredients are minimal. For example, said Dr. Ogden, “Indoor/Outdoor Support has those essential natural supplements that are well-established therapies for allergy symptoms: butterbur, nettle, spirulina. Butterbur has been shown in studies to be as effective as OTC allergy meds. Immune Essentials, Immune Support offer a layer of protection in terms of anti-inflammatory and maintenance of immune defenses. This is especially helpful during cold and flu season when people may have a flare of indoor allergies, or in April/May or fall when influenza is still an issue and allergy season is in full swing.”

Natural Path Silver Wings’ colloidal silver is designed to support the immune system. “The natural amber colored liquid is highly absorbed. The 50 ppm strength is ideal for daily maintenance, the 250 ppm is an enhanced immune support and they make a 500 ppm extra strength for your highest immune boost. Silver Wings also makes a 150 ppm colloidal silver with echinacea and oregano herbal blend and one with olive leaf extract for added immune coverage,” said Dr. Terrell.

Daiwa Health produces BRM4; its active ingredient is Rice Bran Arabinoxylan Compound (RBAC). The active ingredient is derived from rice bran modified by the enzyme of shiitake mushroom. It is geared toward reducing allergies and “It does so by its anti-inflammatory property and by suppressing the degranulation of mast cells, the storehouse of histamine, which causes the symptoms of allergy,” said Cheatham. He said it can be taken as a preventative measure.

Another product is Daiwa Krill Oil, an omega-3 source which is also an anti-inflammatory.

Dr. Strand also pointed to immunomodulation as another natural approach: using microbiome-balancing therapeutics to balance the off-kilter immune system. Biocidin offers several of these types of botanical products, including Biocidin Liquid, Biocidin Capsules, Biocidin LSF and Proflora 4R.

Based on some studies, live bacteria supplements have been shown to be of benefit to allergy sufferers. ADM Protexin manufactures Bio-Kult Advanced Multi-strain and Bio-Kult Boosted, both of which contain 14 different strains of probiotics from a range of different genera, said Plaza, including lactobacillus and bifidobacteria. The latter product also contains vitamin B12 to assist with the normal functioning of the immune system.

Practitioner Tips

Ordering allergy testing is a great first start to delineating a treatment plan.

“A patient should work with their trusted health care professional to find out the root cause of the allergy, then proactively change or reduce exposure this allergen as much as possible,” said Dr. Merville.

Specifically, added Cheatham, people should develop an allergy management plan with their practitioners. This plan could include taking nutraceutical dietary supplements; keeping an epi pen nearby for severe reactions; keeping a diary to track when and how symptoms arise; wearing a medical alert bracelet for life-threatening allergies; and having a written anaphylaxis emergency action plan. And for children, an action plan should be delivered to their school nurse’s office.

“Lifestyle modifications are such a big part of allergy control along with supplementation,” said Dr. Ogden. “Sleep, hydration and a clean diet can all add to this framework that helps fight allergy and infection. Additionally, in the allergy season minimize exposure by following pollen counts, washing your hair and face at the end of the day, rinsing your nose with saline spray and gently washing your eyes and eyelids. Follow local pollen counts and avoid long hours outdoors on those high-count days or at least have your supplements on board beforehand,” she said. Investing in a HEPA-certified air purifier especially for the bedroom is also recommended, or a cool mist humidifier if winter or indoor allergies are a problem.

Dr. Cappelluti said that it is also important to get adequate sleep, increase water intake for adequate hydration and engage in regular, moderate exercise, which has been shown to be beneficial for host immune defense.

Healthy Take Aways

• According to the Asthma and Allergy Foundation of America, allergic rhinitis—also known as hay fever—affects 5.2 million children and 19.2 million adults, but more than 50 million people experience various types of allergies each year.
• Allergies are the sixth leading cause of chronic illness in the United States
• Lifestyle modifications, including allergen avoidance, regular indoor vacuuming and showering off outdoor pollens before bedtime can help reduce symptoms.

For More Information:

ADM Protexin, www.protexin.com
Biocidin, https://biocidin.com
Boiron, www.boironusa.com
Daiwa, https://dhdmed.com
Hilma Co., www.hilma.co
Natural Path Silver Wings, https://npswsilver.com
Standard Process, www.standardprocess.com
Xlear, https://xlear.com