Allergies appear in many forms: food, environmental, pets, chemicals, lotions, potions, medications, even natural substances. You may have noticed that you suddenly have allergies you never had before. I have had countless patients say to me, “Doc, I don’t know, but my allergies seem to get worse every year, and they’re active longer. Why is this ?
Usually there’s a very simple explanation. I tell my patients how I think of it.
Imagine a cup that is half full. Then add dust mites, cat and dog dander, pollen, ragweed, mold, chemicals in our environment (which we’ll address in a moment), medications, poor food choices, etc. Soon the 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. 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.
For allergy sufferers these symptoms include sneezing; nasal stuffiness, itching or discharge; itching anywhere else; rashes or hives; burning/itchy, watery eyes; difficulty thinking and/or concentrating; fatigue; headaches (usually from the nasal congestion) and swelling, the list can go on. These symptoms can be mild to extreme. Mild is more of a nuisance for most, while extreme can be life threatening (anaphylaxis).
Let’s address two of the main causes of allergies. First, food. Many people wonder about the difference between a food intolerance or sensitivity versus an allergy. 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.” Essentially, food intolerance is a local gastrointestina l response, which is non-immune mediated and generally produces few systemic issues. Food allergies are immune-mediated, have many more systemic symptoms, and can even lead to anaphylaxis in some susceptible individuals. Food intolerances are much more common than food allergies, which affect only about 5% of the population.
Second, a very contentious and contemporary allergy issue: the environment.
There are more than 83,000 chemicals registered with the U.S. Environmental Protection Agency (EPA). Most of these have not been thoroughly tested for their effects on human health (let alone our beloved animal friends). The Centers for Disease Control’s (CDC)
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 U.S. population.
Key findings from the report include widespread exposure to some commonly used industrial chemicals, first available exposure data on mercury in the U.S. populatio n, and first-time assessment of acrylamide exposure in the U.S. population, just to name a few. The research literature clearly points to many of these chemicals acting as neuroendocrine disruptors that get stored in fat tissue, organs and the fatty sheat hs surrounding nerves, wreaking havoc on many of our systems. Two of these systems are our immune and detoxification systems. As the body is overburdened by attempting to rid itself of these chemicals, it can become “preoccupied” and over-reactive. What was normally an inert, benign substance (such as your beloved cat, for example), now causes symptoms. In next month’s issue I will address the topic of environmental medicine and detoxification.
How are we to deal with this? 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 kinds), leukotriene inhibitors (mostly used with asthma), mast cell stabilizers, anti-inflammatory medications, and/or steroids. Another method that many are familiar with is immunotherapy (desensitization) or allergy shots, where very small amounts, in gradually increasing doses, of the offending substance(s) are injected into the subcutaneous tissues. Sometimes this is done orally.
These medications are not without their side effects. The most common with anti-histamines (particularly first generation) are drowsiness, dry mouth, urine ret ention, difficulty concentrating, and blurred vision. Leukotriene inhibitors’ common side effects include headache, earache, sore throat, respiratory infections, heartburn, fever, stuffy nose, cough, and rash. Mast cell stabilizers can cause throat irritation, coughing, or skin rashes. Eye drops may cause burning, stinging, or blurred vision.
Allergy shots tend to be painful and can cause anaphylaxis. Although they can help a lot of people, evidence has shown them to be clinically efficacious only in asthma, allergic rhinitis, and insect venom. Inhaled corticosteroids have side effects of nasal irritation, and sometimes there is nasal bleeding or perforation of the nasal septum.
Long-term use of oral/systemic corticosteroids can cause osteoporosis and a depressed immune system.
By definition, an allergen is an IgE-mediated and Th2-cell immune response.
Physical disruption of tissue and various substances can trigger histamine release directly, independent of IgE. 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.
My treatment approach, as with most naturopathic physicians, is to first reduce allergen burden as much as possible, and second, to change this Th2 dominant immune response to the less inflammatory Th1 response. This will help to calm the over-reactive immune system and mitigate allergy symptoms. Third is to heal the gastrointestinal tract.
Fortunately, there are many natural substances that can change this Th2 dominant state. There are also natural anti-histamines, mast cell stabilizers, leukotriene inhibitors, and medicines that have corticosteroid-like effects. Examples of Th2 down regulators: zinc, astragalus membranaceus (also known as Huang qi), all medicinal and edible mushrooms (avoid the white button in stores and make sure the mushrooms are preferably organic), fish oils. Natural anti-histamines and mast cell stabilizers are vitamin C and flavonoids, freeze-dried nettles (Urtica dioica), and n-acetyl-cysteine. Examples of leukotriene inhibitors include Omega 3 essential fatty acids and Indian frankincense (Boswellia serrata). Examples of corticosteroid modulators include Ashwagandha (Withania somnifera), Black currant (Ribes nigrum) and licorice (Glycyrrhiza glabra). 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 well-trained physician. For example, licorice can cause edema (swelling) and high blood pressure. Too much zinc can chelate out copper, causing heart arrhythmias.
There is also a homeopathic desensitization approach to dealing with allergies. This is in the form of sublingual immunotherapy (SLIT), versus subcutaneous immunotherapy (SCIT), or allergy shots. Outside of the U.S., 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 shots, and a much larger safety profile. One form of SLIT uses homeopathically diluted substances that an individual is allergic to and “desensitizes” that person to the offending substance over a relatively short time (similar to how SCIT works). The clinical efficacy of SLIT is not statistically different from SCIT, and both treatments are clinically effective compared with placebo. I have used this treatment with countless patients and have seen them come off of their allergy medications completely, with little to no side effects.
The above are just a few of the many natural treatments that naturopathic physicians and other integrative physicians employ to help allergy suffer ers 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 possible, and allow the body’s own natural systems to come back into balance. My goal is to eliminate the need for medications or to only use them as a last resort in the worst-case scenarios.
A great example of how naturopathic medicine can help severe allergy sufferers is a patient I saw during my residency. He was a 45-year-old South Korean man who stated he had been suffering from allergies all his life. Since moving to Seattle, Washington and beginning medical school (yes, at the age of 45!), his eyes burned all the time; he had difficulty breathing; his wife said his sonorous snoring kept her up all night; he had difficulty concentrating and thinking; the anti-histamines were making him drowsy; and he was suffering from constant post-nasal drip, which caused a cough. He said he was embarrassed to say this, but his family also complained of extremely malodorous breath.
Upon physical exam, his frontal and maxillary sinuses were tender to palpation on both sides; his eyes were watery and red; he had a thick white coating on his tongue, white posterior streaking on the back of his throat (an indication of post-nasal drip), swollen tonsils and neck lymph nodes. There were also a few small pits in his tonsils (common in childhood that usually close up in adulthood). His ears had a small amount of fluid behind the tympanic membranes (ear drum), along with plenty of cerumen (ear wax). His lungs were clear through the stethoscope.
I gave him my “How to Allergy Proof Your Life” handout, which discusses all the basics of lowering your exposure to common allergens of pets, the house and self. I gave him high dose Omega 3 essential fatty acids and a combination product of flavonoids and vitamin C. I told him besides the post-nasal drip, food was mostly likely getting stuck in those little pits (I have seen this many times), putrefying and causing the bad breath. I suggested he chew his food more thoroughly to create a smaller size and therefore decrease the likelihood that it would get stuck in there. I also suggested swishing and gargling with water after meals.
Like the dream patient all physicians love, he did everything I told him and came back in two weeks and said he couldn’t believe he was 90% symptom free! He reported that his energy was back to normal and he felt great. His wife even stated his breath no longer smelled and he wasn’t snoring. A win-win for everybody!
Dr. Born utilizes integrative medicine to focus on chronic disease, with a strong interest in difficult to treat and refractory cases, gastrointestinal issues, neurological and neurodegenerative disorders, endocrinology, cardiovascular disease and diabetes, autoimmune disease, development and behavioral issues, HIV/AIDS, and geriatrics.