Allergens appear in many forms: food, environment, pets, chemicals, lotions, potions, medications, even “natural substances.” You may have noticed that you suddenly have allergies that you never had before. The all-too-classic scenario presents to your office: “Doc, I don’t know what it is, but I seem to be becoming more and more allergic! I can’t eat certain foods any longer, and certain smells give me a headache and brain fog. What is going on?” Or, another classic patient presentation: I have had countless patients say to me, “Doc, my seasonal allergies seem to get worse every year, and they’re active longer. Why is this?”
Usually there’s a very simple explanation. As I tell my patients, this is how I think of it… Imagine a cup that is half-full of water. The cup is your immune system and the water is everything you’re exposed to. Then add dust mites, cat and dog dander, pollen, ragweed, mold, chemicals in our environment, medications, poor food choices,1 etc, and now that cup is overflowing. Essentially, the immune system can no longer keep in check what it had kept in check for so long.
The Asthma and Allergy Foundation of America defines “allergy” as an overreaction of the immune system to substances that usually cause no reaction in most individuals.1 Essentially, what is normally a benign and inert substance, the body sees as a foreign invader. Through a complex series of chemical messages and reactions, matters get out of control. And allergies are certainly on the rise, affecting approximately 30% of adults and 40% of children in the United States.1
For allergy sufferers, symptoms can include sneezing; sinus congestion, sinusitis, rhinitis, itching or discharge; itching anywhere else; rashes or urticaria; burning/itchy, watery eyes; difficulty thinking and/or concentrating; fatigue; headaches (usually from the nasal congestion) and swelling; the list can go on.2 These symptoms can be mild to extreme. Mild is more of a nuisance for most, while extreme can be life-threatening (eg, anaphylaxis).2
Causes of Allergy
Let’s address 2 of the main causes of allergies. First, food. Before jumping into a discussion of allergies, it’s helpful to distinguish between a food intolerance, sensitivity, and allergy, since this is a common area of confusion. WebMD puts it succinctly: “Food intolerance is a digestive system response rather than an immune system response. It occurs when something in a food irritates a person’s digestive system or when a person is unable to properly digest – or break down – the food. Intolerance to lactose, which is found in milk and other dairy products, is the most common food intolerance.”3 Essentially, food intolerance is a local gastrointestinal (GI) response, which is non-immune-mediated and generally produces few systemic issues. Intolerances can also occur when certain products are added to foods; monosodium glutamate and sulfites are 2 examples.4
Food sensitivities are a bit more convoluted in that they may or may not be mediated by the immune system via immunoglobulin E (IgE), and are composed of individualized adverse reactions to the offending foods.5 This, in part, may help to explain both local GI and systemic symptoms that occur when these offending foodstuffs are ingested, and they aren’t necessarily mutually exclusive. Food allergies, on the other hand, are definitively immune-mediated, induce many more systemic symptoms, even leading to anaphylaxis in susceptible individuals. Food allergies may be immediate (and are IgE-mediated), or delayed-onset (usually T-cell-mediated and occurring 4-24 hours after exposure). Food intolerances are much more common than food allergies, which affect only about 2.5% of the general population.6
The second cause of reactions – and a very contentious and contemporary allergy issue – is the environment. There are more than 83 000 chemicals registered with the US Environmental Protection Agency (EPA).7 Most of these have not been thoroughly tested for their effects on human health (let alone our beloved animal friends). In 2009, the EPA established a “Chemicals of Concern List.”8 The Centers for Disease Control and Prevention (CDC)’s 2011 National Report on Human Exposure to Environmental Chemicals (NHANES), Fourth Report, presented data on 212 chemicals, including 75 measured for the first time in the US population.8 Key findings from the report include widespread exposure to some commonly used industrial chemicals, first available exposure data on mercury in the US population, and first-time assessment of acrylamide exposure in the US population, just to name a few.9 The research literature clearly points to many of these chemicals acting as neuroendocrine disruptors that get stored in adipose, organs, and the fatty sheaths surrounding nerves, wreaking havoc on many of our systems.10-12 Two of these systems are our immune 13 and detoxification 14 systems. As the body is overburdened by attempting to detoxify the toxicants, the immune system may become “preoccupied” and over-reactive. What was normally an inert, benign substance (such as your beloved cat and dog, for examples), now causes symptoms.
Conventional Approaches to Allergy
How can we best help our patients? Conventional medicine’s answer, which can be very helpful, is not without its drawbacks. Allopathic medicine’s approach is usually to treat the symptoms and calm down the immune system with the use of anti-histamines (of which there are different classes),15 leukotriene inhibitors (mostly used with asthma),16 mast cell stabilizers,17 decongestants, and corticosteroids.18 Another method that many practitioners are familiar with is subcutaneous immunotherapy, or allergy shots, where very small amounts, in gradually increasing doses, of the offending substance(s) are
injected into the subcutaneous tissues to promote desensitization.19 These medications are not without their side effects. The most common with antihistamines (particularly first-generation) include drowsiness, dry mouth, urine retention, difficulty concentrating, constipation, and blurred vision.20 Common side effects of leukotriene inhibitors include headache, earache, sore throat, respiratory infections, nervousness, behavioral issues, nausea, heartburn, fever, stuffy nose, cough, and rash.18 Mast cell stabilizers can cause throat irritation, coughing, or skin rashes. Mast cell-stabilizing eye drops may cause burning, stinging, or blurred vision.18 Decongestants may raise blood pressure, insomnia, irritability, and restrict urinary flow.18 Short-term use of systemic steroids may cause weight gain, fluid retention, and hypertension. Long-term use may suppress growth in children, adolescents, and teens, and in adults may cause hypertension, diabetes, cataracts, depressed immunity, and osteoporosis.18
Allergy shots can be painful and even cause anaphylaxis in some individuals. Although they can help a lot of people, evidence suggests that they are clinically efficacious only in asthma, allergic rhinitis, and insect venom reactions.21,22
By definition, an allergen is an IgEmediated (Th2-cell) immune response that stimulates histamine release. Physical disruption of tissue and various substances can also trigger histamine release directly, independent of IgE.23 Mast cells are widely distributed, but are most concentrated in skin, lungs, and GI mucosa. Histamine facilitates inflammation and is the primary mediator of clinical hypersensitivity.24
Naturopathic Approaches to Allergy
My personal approach to treating allergy, like most naturopathic physicians, is to treat well beyond palliation, and to cure individuals of their affliction:
1. Reduce allergen burden as much as possible (I give my patients my “How to
Allergy Proof Your Life” handout)
2. Establish a more appropriate balance in the Th1/Th2 immune response. This will help to calm an over-reactive immune system, thereby mitigating allergy symptoms.
3. Heal the GI tract 25-27
Fortunately, there are many natural substances that can restore Th1/Th2 balance. Also available are “natural” antihistamines, mast cell stabilizers, leukotriene inhibitors, and medicines that have corticosteroid-like effects. Examples of Th1/Th2 balancers are: zinc, 28,29 Astragalus membranaceus (also known as Huang qi), 30 medicinal mushrooms (eg, Agaricus blazei,31 Ganoderma lucidum 32) and edible mushrooms 33 (preferably organic, given their high bioabsorption of heavy metals),34 and omega-3 essential fatty acids (EFAs).35 Natural antihistamines and mast cell stabilizers include vitamin C36 and flavonoids,37 and nettle leaf (Urtica dioica).38 Examples of leukotriene inhibitors include omega-3 EFAs,39 and Indian frankincense (Boswellia serrata). 40 Examples of corticosteroid modulators include ashwagandha (Withania somnifera), 41 black currant (Ribes nigrum),42 and licorice (Glycyrrhiza glabra).43
The aforementioned treatments are quite safe and usually very well tolerated. However, some of these herbs should not be used without the guidance of a welltrained physician. For example, licorice can cause hypermineralocorticoidism, with sodium retention and potassium loss, edema and hypertension, due to its aldosterone agonist effects and depression of the renin-angiotensinaldosterone system. These effects are more common with doses of 400 mg/d of glycyrrhizic acid) 44,45; however, some sensitive individuals have experienced these side effects using a dose as low as 100 mg/d of glycyrrhizic acid. 45
Clinically, it is imperative to place patients utilizing larger doses of licorice on high-potassium foods, and possibly potassium supplements as well. Zinc in amounts greater than 50 mg/d can result in copper deficiency over time, leading to arrhythmias and anemia. 46,47
There is also a homeopathic desensitization approach to dealing with allergies. This is in the form of either sublingual immunotherapy (SLIT) or subcutaneous immunotherapy (SCIT), also known as allergy shots. Outside of the United States, SLIT is the most common method of treating allergies. Although they work via different physiological pathways in the body, the advantages of SLIT over SCIT are fewer visits to the physician, no painful injections, and a much larger safety profile.48,49
One form of SLIT uses homeopathic dilutions of substances that an individual is allergic to, which serve to “desensitize” that person to the offending substance over a relatively short time; SCIT works in a similar fashion. The clinical efficacy of SLIT is not statistically different from SCIT, and both treatments are clinically effective compared with placebo.50,51 I have used this treatment with over 500 patients and have seen these patients come off of their allergy medications completely, with little to no side effects.
Prior to implementing SLIT, I find it best to test the patient for their inhalant and food allergies for what they’re truly allergic to, which increases the precision of the sublingual immunotherapy. This is easily conducted via IgE, region-specific blood tests through your local commercial laboratory and which is generally covered by insurance. I use ICD-10 code, T78.40XA, along with other pertinent codes based on what transpires during the intake and physical exam.
These are just a few of the many natural treatments that naturopathic and other integrative physicians employ to help allergy sufferers deal with their symptoms. Again, my integrative medicine approach is not to use these medicines as Band-Aids, but rather to find all the triggers, remove them as much as is possible, and allow the body’s own natural systems to come back into balance, utilizing the aforementioned interventions. My goal is to eliminate the need for medications or to only use them as a last resort in the worst-case scenarios. Among the 500+ patients with whom I have conducted the above procedure, most stay symptom-free for 6-24 months, then only needing the SLIT and “natural” agents for a few short weeks during the height of their allergy season.
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