“I’m okay, it’s just my allergies,” is a phrase heard all too often. Among the most common, allergies are also some of the most often disregarded symptoms. Allergies and allergy-related diseases such as allergic rhinitis, atopic dermatitis, food allergies and allergic asthma are extremely common, impacting tens of millions of American men, women, and children each year.1 Asthma Canada reports 1 in 5 Canadians suffer from respiratory allergies. The symptoms associated with allergies occur when the body is exposed to something that the immune system over-reacts to. The appearance of allergy symptoms can be associated with any number of triggers such as foods, creams, touching certain materials (even other people!), insects, pets, pollen, dust, and mold. The body’s immune response causes the symptoms we commonly refer to as allergies. The immune response results in effects on the body which can be mild or severe and can range from sneezing, coughing, itchy eyes, watery eyes, runny nose (often called rhinitis), and a scratchy throat, to rashes, hives, swollen respiratory passages, lowered blood pressure, breathing difficulty, asthma and even death in the most extreme cases.
What causes allergies and asthma?
The cause of this immune overreaction is largely unknown, but both genetic susceptibility as well as environmental influences can be important factors.2 Heritability rates for susceptibility to allergic disease can vary but have been found to be as high as 95% for asthma, 91% for allergic rhinitis, and 84% for atopic dermatitis.3 It is clear that genetics only account for an increase in susceptibility, and cannot be attributed fully for the dramatic increase in allergic disease worldwide.4 Food Allergy Research and Education reports a CDC statistic showing a 50% increase in food allergy prevalence in children between 1997 and 2011, and a 300% increase in peanut allergies during 1997-2008. 5 Environmental influences and triggers likely also play a role. Large studies such as the International Study of Asthma and Allergies in Childhood and the European Community Respiratory Health Survey Study have revealed striking patterns showing increased prevalence of asthma in first world, English speaking countries and non-English speaking Western European countries over developing nations. These studies have further shown that asthma incidence increases in developing nations as they begin to embrace more “Westernized” lifestyles.4 All of these factors correlate to a lifestyle and environmental role in the development of allergic disease and asthma.
Naturopathic approaches to allergies and asthma
From a naturopathic medical perspective, allergic symptoms are quite often associated with disruption to the microbiome in the gut, as well as to dysfunction of other organ systems including the adrenal glands/endocrine system, digestive disturbance beyond the microbiome, and altered immune responses. Determining the cause of a patient’s allergic symptoms, including allergic asthma, is at the forefront of a naturopathic treatment protocol. Root cause identification may involve laboratory testing, diet-symptom tracking via logs and observations, as well as special diets called elimination and challenge diets. In terms of management and treatment, dietary avoidance, environmental modifications such as home air purifiers and specific cleaning routines, as well as a variety of herbs and supplements may be implemented based on patient presentation.
Fraser Smith, ND, MATD
Fraser Smith, ND, MATD
AANMC President, Assistant Dean of Naturopathic Medicine and Associate Professor, National University of Health Sciences
Uncovering the root cause of allergic symptoms is imperative, and at the same time, can be challenging. There are several testing methods that are commonly employed to assess what a person’s specific allergies are. These include blood testing using various techniques to assess antibodies and immune reactions, testing blood levels of biomolecules associated with allergic responses such as allergen-specific IgE, histamine, and tryptase, scratch testing, and others. The type of testing most appropriate can also vary by the type of allergy being tested for.
When examining aeroallergen sensitization, testing is often done in a combination approach to ensure all sensitized allergens are accounted for. Although there have been many recent advances in testing allergen specific IgE levels, it has been found that using only one testing method may lead to a misdiagnosis with every fourth allergically sensitized patient as being found non-reactive.6 Many studies show that there is discord between testing for serum-specific IgE and skin testing results suggesting that the two methodologies act in a complimentary manner and should not be used interchangeably.
In regard to food allergies, there are numerous laboratory assays that can be performed such as radioallergosorbent tests (RAST), immunoblotting, basophil activation (BAT), leukotriene LTC4 release, cellular allergen stimulation tests (CAST), and others. Other methods such as skin prick testing and fecal testing are also common. Skin prick tests (SPT) are quite common as they are inexpensive and relatively low risk, however skin prick testing to foods has a low specificity and a low positive predictive value.7 This means that a positive result, unless confirmed by other clinical data such as a diet-symptom log, does not allow for a definitive diagnosis of a food or environmental allergy. There is also non-standardization of measurement of positive reactions as evidenced by the identification of cut-off values for the SPT reaction diameter for certain food allergens (milk: 8 mm, egg: 7 mm, peanut: 8 mm), however they have not received universal acknowledgement.7 Allergen specific IgE testing is also common, but can be extremely costly. Specific IgE levels above the diagnostic cut-off value gave a 95% predictive value for a symptomatic allergy.7 When combined with compatible clinical history, this gives this type of testing the advantage of being able to confirm a diagnosis of food allergy without the need for further challenge testing. However, it is important to note that there are a number of variables that can impact the outcome of testing, such as age and the length of time the person has been avoiding the food. Not all food reactions are mediated by IgE, as is true of many cases of sensitivities to foods. In these cases, an elimination diet followed by a re-challenge phase are critical for identifying and treating food sensitivities.8 This type of testing is considered the gold standard for diagnosis of food allergy.9
Jenn Dazey, ND, RH (AHG)
Jenn Dazey, ND, RH (AHG)
Core Faculty in the Department of Botanical Medicine, Bastyr University
Balancing the gut microbiome
In humans, the gastrointestinal tract is inhabited by a large, complex group of microbes that play a distinguished role in maintaining health. Collectively, this group includes trillions of bacteria, fungi, parasites, and viruses that are known as the microbiome. A person is first exposed to microorganisms as an infant, during delivery in the birth canal and through the mother’s breast milk.10 As time goes on, the microbiome evolves with the individual and exposures to various environmental factors as well as variations in diet can impact the microbiome leading to improved health benefits or increased risk of disease. The microbiome has numerous important functions including producing various nutrients such as vitamin K, prevention of colonization by intestinal pathogens, and modulation of the immune response to name a few.11 The diverse role of the micro biome has led to the idea that its modification may be a target used to restore and maintain balance of the overall individual. Introducing pre and probiotics are a means to accomplish this. Prebiotics and probiotics may be consumed in the form of raw vegetables and fruit, fermented pickles, or fermented dairy products. Another source may be supplemental formulas and functional food. Studies examining the use of probiotics in patients with allergic rhinitis (hay fever) found that adjuvant use of probiotics resulted in improvement in quality of life.12 Probiotic use has also resulted in increased symptom control as evidenced by decreasing scores on questionnaires designed to assess control of allergic rhinitis and asthma symptoms.12 Additionally, a meta study examining the use of probiotics in the treatment of allergic rhinitis examined 22 double-blind, placebo-controlled studies. Seventeen trials showed significant benefit of probiotics clinically. Eight trials showed significant improvement in immunologic parameters, and all five studies with Lactobacillus paracasei strains revealed clinically significant improvements compared with placebo.13 It is interesting to note that many cultures have historically incorporated fermented foods as part of their daily diet.
Nutritional supplements can provide targeted therapeutic options for the treatment and prevention of allergies. Supplements can address many different factors involved in the expression of allergies and asthma including immune system dysregulation, inflammation, and oxidative stress among many others. Some examples of supplements commonly used in treatment of allergies and asthma include:
Stinging nettles (Urtica dioica) is also commonly called “nettle.” Nettle has a significant research profile as a treatment for allergies and allergic rhinitis.14 National College of Naturopathic Medicine (now National University of Naturopathic Medicine) examined the use of freeze dried nettle leaf for treatment of hay fever, asthma, and seasonal allergies found that the freeze-dried preparation was rated higher than placebo in relieving symptoms after one week.15 Further studies on the use of nettle in preventing lung inflammation associated with asthma have also been promising. Studies using an experimental model of allergic asthma have shown positive benefit in both immune modulation as well as reduction in inflammatory markers with administration of an aqueous extract of stinging nettle.16
Omega 3 fatty acids
The omega 3 fatty acids docosohexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are found in fish oil and are known for their anti-inflammatory properties and protective effects in inflammatory diseases including asthma and allergies. A six month study conducted by Johns Hopkins University examined the role of omega 3 fatty acids in the prevention of environmentally triggered asthma symptoms. They found that having more omega-3 fatty acids in the diet results in fewer asthma symptoms caused by contaminated inside air.17
Quercetin is among the most abundant polyphenols representing the flavonoid subgroup. It is naturally occurring in plant foods such as onions, broccoli, capers, apples, berries, and grapes, herbs like dill, and is also found in tea and wine.18 Quercetin has been utilized in a number of studies examining factors underlying the development of allergies. Quercetin is known for many different properties including its anti-allergic properties such as inhibition of histamine release, decrease in pro-inflammatory compounds, immune system modulation, and inhibition of antigen-specific IgE antibody formation.18 All of these mechanisms can contribute to addressing the underlying cause of allergy symptoms and asthma. In an experimental model of allergic rhinitis, quercetin has been shown to reduce antigen specific IgE levels and well as mitigate the expression of allergic rhinitis symptoms.19
In years past, allergy sufferers were often subjected to extensive series of allergy shots. These were injections designed to aid in reducing the expression of allergy symptoms. Sublingual immunotherapy is a method of allergy treatment that does not involve injections, rather small tablets or liquid drops containing small amounts of specific allergens to build up tolerance and reduce symptoms. Studies have shown that sublingual application of allergen specific immunotherapy is a safe and efficient substitution to injection in the treatment of IgE-mediated respiratory tract allergies.20Meta analysis studies have shown that sublingual immunotherapy reduces allergic diseases symptoms and the need for other medications, improving the quality of life for children with the diseases.20
The diet constitutes an important source of nutrients and non-nutrient components with multiple properties that present a potential opportunity to modulate the risk of asthma and allergies. Elimination diets wherein the offending food is completely avoided can be difficult to follow long term. Contemporary studies have shown that nutrition trends during the early childhood years may produce changes that have a lasting impact on human health at later ages particularly on the respiratory, GI, and immune systems.21 Western diets are characterized by the consumption of highly refined, overly processed, energy-rich foods and beverages. These foods are typically high in fat, sugar, and salt but low in dietary fiber and other nutrients. A decrease in the intake of fresh fruit and vegetables and increase intake of processed foods has previously been linked to an increasing prevalence of asthma and allergies.22 Multiple studies have highlighted evidence of positive effects of fresh fruits, and antioxidant vitamins on asthma.23 Additional studies have specifically looked at the quality and quantity of dietary fats as a source of allergenic response. Research has shown that a high fat diet enables food-induced allergic responses associated with series of negative health effects.24 The quality of fat has also been shown to play a role in increased risk of allergenic response. In a pediatric asthma study, researchers found that for each additional gram of omega 6 fats consumed, children had a whopping 29% increased risk of being in a more severe asthma category.17 Fiber is another nutrient that is consistently lacking in the standard American diet as well as many dietary patterns of many other developed/“Westernized” countries.25 Dietary fiber (especially polysaccharides and oligosaccharides) and its metabolites (SCFAs) have been shown to regulate mast cell function and activation. Mast cell activation can be downregulated by pretreatment with these substances.25 Mast cells are key players in initiating and maintaining inflammation, particularly in allergies and asthma.26
Some parts of our environment are out of our control, particularly outside the home. We cannot control the amount of mold, pollen, or other allergenic inhalants that are in outdoor air. But there are steps we can take inside the home to manage our exposure indoors.
- Rugs, drapes, wall-to-wall carpet, and even overstuffed, upholstered furniture are tremendous collectors of dust and pollen. Removing them, changing them often, or changing styles can help reduce exposure.
- Using specialized air filters like HEPA filters particularly in the bedroom can be helpful. In some cases, whole house filtration systems may also be recommended.
- Avoiding toxic inhalants like perfumes, body sprays, scented candles, room sprays, air fresheners, dryer sheets, and other scented products, especially those with synthetic ingredients.
- Testing home tested for the presence of mold and remediating the source if mold is detected and found.
- Using zippered, allergen resistant covers on mattresses and pillows. According to the Asthma and Allergy Foundation of America, enclosing mattresses works better than air cleaners to reduce allergy symptoms.28
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