Articles

Allergies

Introduction

An allergic reaction is an inappropriate immune reaction to an otherwise harmless substance. Allergens can be environmental, chemical, or food-based. Common allergens include dust mites, pollen, animal dander, and certain foods. Allergens can be absorbed into the body through the skin, respiratory tract, or gastrointestinal tract. Allergens are proteins or low-molecular weight substances that the body identifies as antigenic. This creates an immune response known as a hypersensitive or allergic reaction. The production of chemical mediators in these allergic reactions may produce symptoms ranging from mild to life threatening.

Under normal conditions, the immune system is highly adept at recognizing and destroying the myriad of foreign substances capable of invading the body (i.e., bacteria, viruses, parasites). The complex mechanisms of immune defense usually work in tandem with the host tissues of the body, averting secondary damage and destruction. The immune system consists of several branches, each with its own protective functions. B-lymphocytes (B cells) and plasma cells produce a series of plasma proteins known as immunoglobulins. Immunoglobulins are antibodies capable of recognizing, destroying, and positioning antigens for removal from the body.

Antibodies are antigen-specific, meaning they combine with only certain antigens in a "lock and key" fashion. There are five classes of immunoglobulins: IgE, IgA, IgG, IgM, and IgD. The most significant immunoglobulin in allergic disorders is IgE. The IgE molecules bind with antigens to trigger the release of chemical mediators from mast cells. Other antibodies such as IgG and IgM are being implicated in food intolerance reactions, causing a whole different set of symptoms, which could include neuropathy, intestinal symptoms, and problems with energy production.

The production of antigen-specific IgE antibodies requires the direct interaction between macrophages, T cells and B cells. Macrophages initially bind with antigens and present them to T cells. T lymphocytes (T cells) assist in antibody production by secreting lymphokines, which direct the activity of the B cells. Once IgE antibodies are formed, they attach to the mast cells concentrated in the mucous membranes and under the skin. When circulating antigens contact IgE antibodies attached to the mast cells, it triggers the degranulation and release of inflammatory mediators that produce allergic reactions to the skin, lungs, and gastrointestinal tract. These mediators include histamine, eosinophil chemotactic factor of anaphylaxis (ECF-A), leukotrienes, kinins, platelet activating factor (PAF), bradykinin, serotonin, and prostaglandins. (1)

The etiology of allergic reactions is unclear. Some immunologists suggest that allergic reactions stem from an evolutionary response to parasitic infection. (2) This theory proposes that the human immune system has developed a high sensitivity to parasites, which increase white blood cell production, and the release of pro-inflammatory factors. In developed countries, where parasitic infestation is relatively low, allergies are more common than in less developed countries. It is thought that when the immune system is fighting parasitic infections, it does not have the resources to defend against less threatening agents. Another theory is that people with dysbiosis may have a heightened allergic response.

Genetics appear to play a significant role in allergies, as the propensity to manufacture IgE antibodies is inherited. Children whose parents both have allergies are twice as likely to develop allergies themselves. (3) The term atopy refers to the inherited tendency toward allergies, but not to one specific form (hay fever, asthma, eczema, etc.) Repeated exposure to allergens and environmental pollutants may stimulate the production of IgE antibodies. (4) The prevalence of atopic allergies, such as asthma and eczema, has risen steadily since the 1960’s, perhaps in correlation with increasing levels of pollutants. (5) Another correlation to eczema is inner ear infection (antibiotic use) to eczema to asthma. One factor in the development of allergic reactions is the absent or weak response of the T suppressor cells. In non-allergic individuals, suppressor T cells inhibit exaggerated antibody responses. In allergic responses, this function of the T cells is not as effective.

Statistic

American Academy of Allergy, Asthma and Immunology in San Diego, 1999.

    50 million people suffer from allergies. Of these, 1/6 have allergic asthma. 6 million have non allergic asthma caused by exercise, chemical pollution, and smoking.

Centers for Disease Control, 2004.

    12% of U.S. children under 18 years of age suffered from respiratory allergies in the past 12 months. Children living in the South (15%) were more likely to have respiratory allergies than those living in the Midwest (11%), Northeast (10%), or West (8%).

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

There are four recognized classifications of hypersensitivity reactions. The most common are types I and IV. Type I reactions are immediate, resulting in anaphylactic reactions within minutes of exposure to an antigen. This type of reaction occurs after initial exposure to an antigen, a subsequent production of IgE antibodies. When antigens contact sensitized mast cells and basophils, chemical mediators are released upon degranulation of the cells. Symptoms are dependent on the route of entry and the amount of allergen, how much chemical mediator is released, and the sensitivity of the organ targeted.

Type I reactions can be local or systemic. Local reactions may include asthma, rhinitis, hay fever, gastrointestinal upset, eczema (atopic dermatitis), and conjunctivitis. Symptoms that are more diverse may include headache, fever, fatigue, diarrhea, and vomiting. (6) Systemic anaphylaxis, a severe and potentially life threatening reaction, typically involves foods or insect bites. Symptoms include hives, pruritus, hypotension, shock, dysrhythmias, edema of the larynx, and vomiting. Seizures may occur. Difficulty swallowing, anxiety, and warmth are subjective symptoms.

Type IV reactions, known as delayed hypersensitivity reactions, appear 24 to 72 hours after exposure to an antigenic substance. Sensitized T cells and macrophages release lysosomes and lymphokines, causing localized tissue damage. Contact dermatitis from exposure to chemicals, plant toxins, or cosmetics is a delayed hypersensitivity reaction. Type IV reactions are typically caused by low-molecular weight molecules (called haptens) that bind with circulating proteins. Symptoms include erythema, pruritus, and lesions on the skin.

Atopic allergies are characterized by degree of severity and the type of tissue affected. Anaphylactic reactions, the most severe form of allergic reaction, produces characteristic respiratory difficulty, shock, and urticaria. Allergic rhinitis and conjunctivitis, the most common manifestations of allergic reactions, are mediated by sensitized mast cells in the membranes of the nose and eyes. Nasal congestion and discharge, sneezing, itchy eyes, conjunctival edema and tearing are classic symptoms. Urticaria, or hives, is a vascular reaction of the skin characterized by round, elevated patches (wheals) with severe itching. Hives are most often caused by a reaction to food or drugs. Hives occur in the superficial portion of the dermis. Angioedema is a similar reaction of the deep dermal or subcutaneous layers of the skin. Urticaria and angioedema may last for as long as six weeks.

Allergic asthma is a hypersensitive immediate reaction of the bronchial tissue in the lungs. Bronchospasm and inflammation of the bronchioles results in difficulty breathing and wheezing. Severe attacks can produce the sensation of suffocating. Pollen, dust, smoke, automobile exhaust, and animal dander are antigens that commonly trigger allergic asthma. Gastrointestinal allergies are mediated by IgE-sensitized mast cells of the GI tract. Exposure to antigens (most commonly food) produces nausea, cramping, vomiting, and diarrhea. Atopic dermatitis (eczema) is a cutaneous eruption of dry, scaling, itchy, cracked, and bleeding patches of skin. Eczema can be triggered by exposure to dust, pollen, or antigenic foods. Contact dermatitis is another form of eczema. This type of reaction, therefore, can be an immediate or delayed allergic reaction.

Local Type I Reactions

    Asthma Rhinitis Hay fever Gastrointestinal upset Eczema (atopic dermatitis) Conjunctivitis Headache Fever Fatigue Diarrhea Vomiting

Systemic Type 1 Anaphylaxis

    Hives Pruritus Hypotension Shock Dysrhythmias Edema of the larynx Vomiting Difficulty swallowing Anxiety Warmth

Type IV Delayed Hypersensitivity

    Erythema Pruritus Lesions on the skin

Other

  • Allergic rhinitis and conjunctivitis presents as nasal congestion and discharge, sneezing, itchy eyes, conjunctival edema and tearing
  • Urticaria (hives) is characterized by round, elevated patches (wheals) with severe itching
  • Angioedema is like hives and fluid build-up in the deep layers of the skin
  • Allergic asthma can result in difficulty breathing and wheezing
  • Allergies of the digestive tract nausea, cramping, vomiting, and diarrhea
  • Atopic dermatitis or eczema is dry, scaling, itchy, cracked, and bleeding patches of skin

Treatment Options

Conventional

Treatment of allergic disorders begins with identifying allergens. As allergens vary from person to person, individual testing is necessary. Scratch tests, intradermal tests, and serum antibody detection are the most common forms of allergy testing. Avoidance of all known antigens is recommended, but impractical in many cases. The most common form of allergies, allergic rhinoconjunctivitis, is often triggered by environmental allergens that are extremely difficult to avoid. Treatment is therefore primarily symptomatic.

    Antihistamines are used to block histamine activity, interfering with their ability to cause inflammation and increased mucous production in the upper respiratory tract. Hay fever responds most successfully to antihistamines when therapy is initiated before the pollen count rises. (7) Antihistamines also reduce urticaria and angioedema. Side effects include insomnia, tremor, nervousness, irritability, dry mouth, constipation, urinary retention, tachycardia, blurred vision, and sedation. The side effects of antihistamines often make them intolerable for long-term therapy. Nonsedating antihistamines such as cetirizine, fexofenadine and loratadine are available with a prescription and help avoid some of the unwanted side effects. Decongestants constrict the blood vessels of the mucous membrane, allowing mucous to drain more efficiently. Decongestants may be administered through oral or intranasal routes. Side effects include restlessness, irritability, insomnia, and dependency. The dependency is characterized by a worsening of symptoms once the administration of drops or sprays is discontinued. Cromolyn sodium inhibits mast cell degranulation and the release of chemical mediators that induce allergic reactions. It can be administered intranasally to protect the mucous membranes of the nasal cavity from allergic rhinitis, or ophthalmically for allergic conjunctivitis. In some cases, cromolyn sodium is added to inhalers to augment bronchodilation therapy. Cromolyn sodium is rapidly excreted and has few adverse effects. Steroidal inhalants may be used for severe, chronic allergic rhinitis. They are anti-inflammatory agents that also reduce mucous production. Inhaled corticosteroids are contraindicated during acute allergic asthma attacks, as the powder can further irritate the lungs. Glucocorticoid residue from the spray may create local immune suppression, resulting in thrush of the throat and mouth. Swallowed residue may be absorbed systemically, leading to complications associated with oral glucocorticoid administration.

Conventional treatment of allergic asthma includes anticholinergics (atropine) to relax vagal bronchoconstriction;beta-adrenergics (phenylpropanolamine, pseudoephedrine) which inhibit histamine release and relieve bronchoconstriction; and methyl xanthine (aminophylline) which suppress histamine release and antagonizes prostaglandins. (8) Inhalants containing cromolyn sodium and oral glucocorticoids, which prevent the release of histamine and PAF, are used adjunctively in severe cases of allergic asthma. Side effect profiles of conventional asthma therapy are well known. Tachycardia, gastrointestinal disturbances, nervousness, irritability, peripheral vasoconstriction, diuresis, and increased susceptibility to infection are among the problems associated with anti-asthma pharmaceuticals.

Nutritional Supplementation


Vitamin C

In the 1940s, it was first discovered that vitamin C was useful in the treatment of allergies. (9) In a chronic allergies study, 10 men and women participated for 6 weeks ingesting a placebo for 4 weeks and 2g/day of vitamin C for 2 weeks. There was a significant rise in plasma ascorbate and a decrease in histamine levels of 38% after vitamin C supplementation indicating that vitamin C’s usefulness in allergy treatment may stem from the fact that it metabolizes, or detoxifies, histamine in vivo. (10) Another study demonstrated that 11 people who had either low vitamin C levels or elevated blood histamine levels, given 1 gm of vitamin C daily for three days, had their blood histamine levels decline. (11) A two week randomized study involving 60 patients suffering from perennial allergic rhinitis were administered a solution of ascorbic acid. The solution caused a decrease in symptoms in 74 percent of patients. (12)

The amount of vitamin C necessary to provide therapeutic benefit can vary substantially from individual to individual. Since diarrhea is one of the few side effects from taking too much vitamin C, it is considered safe to recommend taking 3 or 4 grams of vitamin C in divided doses throughout the day during allergy season. If diarrhea or loose stools occur, gradually decrease the dose until they subside. Linus Pauling, who was a firm believer in educating people about the benefits of vitamin C, suggested that people with seasonal allergies consider increasing their vitamin C intake to bowel-tolerance level during allergy season. (13)


Quercetin

This agent has been reported to reduce allergic reactions by inhibiting the release of histamine from mast cells. (14) Quercetin belongs to a class of compounds known as bioflavonoids, which frequently occur in nature along with vitamin C. Quercetin in conjunction with vitamin C reportedly helps to reduce the severity of symptoms in individuals with hay fever. (15)


Omega-3, Omega-6

Some individuals with allergic conditions have been found to have lower delta-6 desaturase enzyme activity, which inhibits the conversion of alpha linolenic acid (omega-3) and linoleic acid (omega-6) to their longer-chain metabolites. This in turn inhibits the production of the important anti-inflammatory prostaglandins. Clinical trials indicate that appropriate fatty acid supplementation often alleviates a broad range of allergic-type inflammatory conditions. (16)

Alpha linolenic Acid :Also known as omega-3, it is the precursor to the series 3 prostaglandins (PGE3), which are anti-inflammatory in nature. The omega-3/omega-6 fatty acid ratios tend to be out of balance in the diets of many people in the United States. Proper adjustments of dietary fatty acids can play a key role in the successful management of inflammation associated with atopic diseases. (17) This involves decreasing the intake of oils high in omega-6 (corn, safflower, and sunflower oils) and increasing the intake of omega-3. Flaxseed oil is a rich source of omega-3 as well as fish oils. A minimum of an extra 400 IU of natural vitamin E should be taken daily when consuming supplemental omega-3.

Gamma linolenic acid (GLA): This is the elongated metabolite of linoleic acid (omega-6). Studies reveal that many people with allergic conditions have adequate plasma levels of linoleic acid, but a deficiency of GLA. This indicates reduced activity of the delta-6 desaturase enzyme activity resulting in a subsequent decrease in the conversion of omega-6 to GLA. The administration of supplemental GLA has proven to be of therapeutic benefit for patients with conditions such as atopic eczema. (18) Two of the best sources of GLA are borage oil (23%) and evening primrose oil (10%).


Lactobacillus, Bifidobacteria

Probiotics containing lactobacillus acidophilus and bifidobacteria are important supplements for individuals with food allergies or intolerances. In one study, every child that was suffering from symptoms related to food allergies was found to have deficiencies of lactobacillus and bifidobacteria, along with an overgrowth of Enterobacteriaceae. (19)

Herbal Supplementation


Grape Seed Extract

Proanthocyanidins (PCO's), the active constituents in grape seed, are flavonoid-rich compounds and free radical scavengers. It has been reported to enhance the absorption of and work synergistically with vitamin C. (20) It has been used for supportive care in allergies and asthma. PCO's have been reported to inhibit the release of mediators of inflammation, such as histamine, leukotrienes, and prostaglandins, (21) , (22) mechanisms that would be beneficial in multiple inflammatory processes such as allergies and asthma. In contrast, a study involving forty-nine seasonal allergic rhinitis sufferers compared the effects of 100mg grape seed extract twice a day against placebo. The evaluation of multiple endpoints demonstrated no significant differences between the treatment and placebo groups. (23) Proanthocyanidins are reported to neutralize several classes of free radicals, including hydroxyl, lipid peroxides, and iron-induced lipid peroxidation. (24) , (25) , (26) They may inhibit the enzyme xanthine oxidase. (27)


Stinging Nettle

The freeze-dried leaf of stinging nettle has been used in relation to allergies, with some success. (28) A randomized, double-blind study of 92 individuals reported that a freeze-dried preparation of stinging nettle leaf was superior to placebo in relieving the symptoms of allergic rhinitis (itching, watery eyes, runny nose). (29)


Coleus

Coleus is a relatively new medicinal herb in the United States, although it has been extensively researched in India over the last twenty years. There have been studies published supporting its hypotensive (blood pressure lowering) and spasmolytic effects. (30) , (31) Most studies have been conducted with the isolated extract, forskolin, but current research supports that the whole plant may be actually more effective.

Coleus is reported to have two significant mechanisms of action. First, it is claimed to activate the enzyme adenylate cyclase. (32) This action would have the effect of increasing cyclic adenosine monophosphate (c-AMP) within the cells. Coleus reportedly creates c-AMP activation independent of receptor site specificity. (33) The stimulation of c-AMP has an impact on body chemistry in several ways. It stimulates thyroid function, increases insulin secretion, inhibits mast cell release of histamine, and increases the burning of fats as fuels. (34) Coleus is claimed to inhibit platelet activating factor (PAF) by possibly binding directly to PAF receptor sites. (35) , (36) PAF is a key factor in allergic and inflammatory pathways. By inhibiting it, neutrophil activation may be inhibited, vascular permeability reduced, smooth muscle contraction decreased, and coronary blood flow increased. (37)

Homeopathic

Allium cepa

Typical Dosage: 6X or 6C, 30X or 30CBurning nasal discharge, worse indoors; Eyes sensitive to light; Sneezing; Sensation of hook sticking in throat, worse with warm food or drinks

Arsenicum album

Typical Dosage: 6X or 6C, 30X or 30CFeel worn out; Sneezing; Eyes sensitive to light

Arundo mauritanica

Typical Dosage: 6X or 6C, 30X or 30CItching; Burning eyes and runny nose; Ears and roof of mouth itch

Drosera rotundifolia

Typical Dosage: 6X or 6C, 30X or 30CProfuse, fluid discharge; Sneezing

Histaminum

Typical Dosage: 6X or 6C, 30X or 30CMay counteract histaminic release in body

Kali bichromicum

Typical Dosage: 6X or 6C, 30X or 30CNasal congestion with thick, yellow discharge, crusts in nose; Headaches centered in the eyes

Sabadilla

Typical Dosage: 6X or 6C, 30X or 30CViolent sneezing; Watery eyes; Puffy red eyelids; Headache, better from warm drinks

Ambrosia

Typical Dosage: 6X or 6C, 30X or 30CGeneral improvement of ragweed response including sneezing, burning eyes, and runny nose

Acupuncture & Acupressure

Acupuncture Treatment
Chen treated 35 cases of allergic rhinitis with acupuncture and reported satisfactory results. The acupuncture needle was inserted at acupoint Yintang (EX-HN3), with tonification achieved by lifting, thrusting and twirling the needle until the needling sensation was felt from the tip of the nose to the nasal cavity. The needle was retained for 20 minutes. All the patients received treatment once a day with ten days as one treatment course. After one or two courses of treatment, 12 cases were resolved, 14 cases significantly improved, 6 cases improved, and 2 cases with no response. The total effective rate was 94.1%. (38)

Liu, et al. applied acupuncture and moxibustion to treat allergic rhinitis. Needles were first inserted into both sides of the following points: Yingxiang (LI20), Yintang (EX-HN3), Feishu (B13), Taiyuan (L9), and Zusanli (S36). The needling method was as follows: first, puncturing obliquely at point Yingxiang (LI20), and puncturing subcutaneously downward until needling sensation was felt and reached the tip of the nose and the nasal cavity; then, needling at Feishu (B13), Taiyuann (LU9), and Zusanli (S36) with tonification by lifting, thrusting and twirling the needles, and retaining the needles for 30 minutes; while the needles were retained, moxibustion with moxa sticks was used at Yingxiang (LI20) and Yintang (EX-HN3) alternately for 15 minutes. The results: among 35 cases treated, 12 cases showed full recovery, 15 cases showed significant improvement, 6 cases showed improvement, and 2 cases showed no response. The total effective rate was 94.2%. (39)

Combined Modality Therapy
Wen combined auricular point sticking and warm needling therapies to treat 50 cases of allergic rhinitis. The following otopoints were selected to receive treatment: Lung, Internal Nose, External Nose, Adrenal Gland, Endocrine, Hypersensitivity Area, Spleen, Kidney, and Shenmen. At the selected otopoints and alternating ears, a paste made of Semen Vaccariae was applied and kept in place for between 2-3 days. A unit of treatment called for applying the paste ten times. The warm needling therapy called for puncturing subcutaneously at point Feishu (B13) with a 1.5 cun (1 cun=33 1/3 milimeters) filiform needle, connecting the needle with a needle-warming apparatus, and retaining the needle for 30 minutes. One unit of treatment consisted 10 needling sessions. After 1-3 units of treatment, 23 cases fully recovered, 22 cases significantly improved, and the remaining 5 cases improved. The total effective rate was 100%. (40)

Yu, et al. treated 30 cases of allergic rhinitis with a combination of acupuncture and massage therapy. Yingxiang (LI20) and Biyuan were selected as the main acupoints to receive treatment. Acupuncture and massage were alternated at each acupoint every other day. In addition, acupoints Feishu (B13), Hegu (LI4), Zusanli (S36) were punctured once daily. Of the 30 cases treated, 5 cases full recovered. 21 cases improved, and the remaining 4 cases showed no response. The total effective rate was 86.7%. (41)

Aromatherapy

Aromatherapy for Allergies

Many essential oils possess the following properties: Expectorant, mucolytic, antispasmodic, anti-inflammatory, anti allergenic, immune stimulating, and antibacterial. These properties suggest the effective use of essential oil therapy in allergies. The following oils may be used in a diffuser with a carrier oil, and inhaled as needed:

  • Lavender (Lavendula augustifolia) 5 drops
  • Bergamot (Citrus bergamia) 2 drops
  • Lemon (Citrus Limonum) 1 drop
  • Juniper (Juniperus communis) 1 drop
  • Peppermint (Mentha piperta) 1 drop

Inhaled oils stimulate cilia on olfactory epithelium and thereby pass the message of smell on to the brain. Essential oils have the ability to stimulate any of the brain centers, evoking response.

Caution: Essential Oil therapies should not be used during pregnancy or lactation and should always be used under the direction of an experienced aromatherapist.

Traditional Chinese Medicine

Allergies

Extensive information regarding the treatment of this health condition using Traditional Chinese Medicine is available through the link above.

Diet & Lifestyle

    Avoid allergens as much as possible. There are a variety of air filtration devices for the home. Ozone purifiers and HEPA filtration are state of the art for home use in reducing mold, pollen, dander, and dust mites indoors. Reduce exposure to environmental pollutants, cigarette smoke, and other pollutants. Use hypoallergenic products whenever possible. Drink quality water, either filtered, reverse osmosis, or bottled. Reduce intake of foods that increase arachidonic acid cascade such as meat.

Clinical Lab Assessment

Some of the following laboratory testing can provide information necessary for diagnosis and treatment. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.

Allergy and Food Sensitivity Response Assessment

The severity of allergic response correlates with an increase in stress levels. (42) Allergies may have considerable impact on inflammatory processes. Allergic responses to foods, inhalants, and environmental chemicals and other substances can cause a variety of responses that induce or aggravate respiratory illness. Screening can enable an individual to eliminate or minimize exposure to unfriendly allergens. Direct correlation of impaired digestion or food allergic response is controversial, though some case studies manifest improvements on food elimination diets.

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