Seasonal Allergies: Alleviating Symptoms Through Practical Means
By Tina Beaudoin, ND
When I was growing up, seasonal allergies only seemed to affect a small amount of individuals and even then, it appeared to be a minor nuisance with some mildly itchy eyes and sneezing. However, more and more of the population experience seasonal allergies and report that the symptoms are much more than a mild inconvenience. According to the CDC, over 19 million adults and six million children in America were diagnosed with hay fever in 2014. The percent of the population affected by seasonal allergies continues to steadily rise as urban living, pollution and climate change exacerbate symptoms. As more people move into cities, they are exposed to increased levels of air pollution, which aggravates respiration and increases their allergic reaction. Combine this with high stress levels (which stimulates histamine release) and the patient experiences an even greater exacerbation of symptoms. It’s also worth noting that dehydration and hypoglycemia1 also result in enhanced histamine release, another great reason to stay hydrated and keep your blood sugar stable!
Seasonal allergies are the result of an inaccurate immune system that is mistakenly reacting to what should be experienced as harmless airborne substances, namely pollens. When people with hay fever come into contact with certain pollens (from trees, grasses or weeds) or even mold spores, their mast cells release histamine and other inflammatory cytokines into the blood stream, which then leads to watery, itchy eyes, running and/or stuffy nose, sneezing, sore throat and itching of the throat or ears.
Educate Patients on Therapeutic Options
There are numerous pharmaceutical and nutraceutical options for patients to choose from when it comes to seasonal allergies and it’s important to know the benefits and drawbacks of each option. Antihistamines are the most common conventional treatment for hay fever, which work by binding and blocking the activity H1 receptors in the body. Antihistamines do not block the release of histamine nor facilitate the metabolism or break down of histamine. There are first generation antihistamines, which cross the blood brain barrier and are sedating and have the following adverse effect profile: seizures (rare), nausea, vomiting, dry mouth, epigastric distress, thrombocytopenia and agranulocytosis. Benadryl (diphenhydramine) and chlotrimeton (chlorpheniramine) are popular brand name first generation antihistamines, noting that these drugs are contraindicated with CNS depressants and MAO inhibitors. In 2015, the Journal of the American Medical Association published a study that found diphenhydramine (Benadryl, Nytol, Sominex, Theraflu, Triaminic Allergy, etc.) use significantly increased the risk for dementia in older adults.2
Claritin (loratidine), Clarinex (desloratadine), Zyrtec (cetirizine) and Allegra (fexofenadine) are common second generation antihistamines that do not cross blood brain barrier and are generally non-sedating. Desloratadine has the following common adverse reaction profile: headaches 14%, irritability 12%, diarrhea 15-20%, upper respiratory tract infection 11-21%, cough 11% and fever 12-17%. Cetirizine has the following common adverse reactions: drowsiness 14%, headache 11-14%, and insomnia 9%. The lists of contraindications and drug interactions with each antihistamine are quite long and should be reviewed for patients on multi-pharma combinations.
Reduce Risk Factors and Aggravations
Decrease antigen exposure in your bedroom:
- Encase pillows, comforters, mattresses, and box springs zippered, allergen-impermeable, dust-proof casings.
- Avoid purchasing foam rubber pillows and mattresses as they are more likely to harbor molds.
- Avoid memory foam as it is highly allergenic.
- Wash blankets, sheets, and mattress pads every week in hot water! Use hypoallergenic/ additive free detergent. Hot water kills dust mites. Cold or warm water does not. Put all pillows in dryer for 30 minutes weekly to kill dust mites.
- Keep closet doors in bedroom closed and wet dust furniture in bedrooms weekly
- Avoid common dust collectors, such as cloth wall hangings, stuffed animals and piles of clothing in bedroom.
- Install a high-quality HEPA air purifier to remove airborne allergen particles, molds, animal dander and pollutants. Austin Air HealthMate is a great option for the bedroom and IQ Air filters for living areas.
- Change filters on a heating system every season: 3M Ultra Allergen 1 is readily available and a good option.
- Do not keep clothes that have been dry-cleaned in a bedroom.
- Avoid mothballs, furniture polishes and air fresheners. Substitute non-toxic, environmentally friendly alternatives for chemical-based products.
Bring on Supportive Therapeutics to Calm Immune Response
Bioflavonoids are great antioxidants that help stabilize mast cells that inhibit release of histamine:
Quercetin: Effective mast cell inhibitor, inhibiting the release of histamine, interleukin-8 (IL-8) and tumor necrosis factor (TNF), and inhibiting the formation of prostaglandin D2.3 Dose: 1-3 grams, 2-3 times daily.
Hesperdin Methyl-Chalcone (HMC): Tends to have better oral absorption and is very helpful in acute situations as part of combination formulas. Dose: 200-600 mg/day in divided doses.
Nettle leaf: Antagonist and negative agonist activity against the H1 receptor and the inhibition of mast cell tryptase (preventing degranulation and release of a host of proinflammatory mediators) that cause the symptoms of hay fevers. It also inhibits prostaglandin formation through inhibition of Cyclooxygenase-1 (COX-1), Cyclooxygenase-2 (COX-2) and Hematopoietic Prostaglandin D(2) synthase (HPGDS) and central enzymes in pro-inflammatory pathways.4
EPA and DHA are great long-term interventions for supporting a healthy inflammatory response rather than the exaggerated, prolonged response we see in hay fever. Ideally should be started 2-3 months prior to allergy season.
Vitamin C supplementation has been shown to inhibit the release of histamine. Vitamin C depletion has been correlated with histaminemia and elevated serum histamine levels.5,6 There is limited research that looks at the effects of vitamin C on hay fever and while it is not a primary therapeutic for allergies, it is often helpful in combination formulas that include the aforementioned flavonoids. In addition, vitamin C is a common deficiency with more than 40% of teenagers and adults in the US not getting
enough of this essential vitamin in their diet. Dose: 500-3,000mg/day in divided doses.
B Vitamins and Minerals
B vitamins and minerals are essential to the metabolism or breakdown of histamine, specifically B1, B6, B5, B12 and folate as well as magnesium, copper and vitamin C. Note that the first step in the primary histamine metabolism pathway involves methylation and if your patient is a poor methylator, this could impede the breakdown of histamine and increase their symptoms. Make sure you patients are at least replete in these nutrients and increase and decrease dosing based on acute and maintenance dosing needs.
Homeopathics: While this writer does not have expertise in this area of therapeutics, it is worth mentioning that there are a variety of effective homeopathic combinations. There are also homeopathic desensitization treatment options to consider, known as sublingual immunotherapy (SLIT) or subcutaneous immunotherapy(SCIT).
Support Optimal Digestive Function: As the majority of the immune system is found in the digestive tract, include a thorough evaluation of GI function and treat accordingly. A low histamine diet will also decrease the total histamine burden.
By Dr. Tina Beaudoin, ND
- Brown RE, Stevens DR, & Haas HL. The physiology of brain histamine. Prog Neurobiol. 2001 Apr;63(6):637-72.
- Gray SL et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015 Mar;175(3):401-7.
- Weng Z et al. Quercetin is more effective than cromolyn in blocking human mast cell cytokine release and inhibits contact dermatitis and photosensitivity in humans. PLoS One. 2012;7(3):e33805. doi: 10.1371/journal.pone.0033805. Epub 2012 Mar 28.
- Roschek B Jr1, Fink RC, McMichael M, Alberte RS. Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Phytother Res. 2009 Jul;23(7):920-6.
- Hael et al. Intravenous infusion of ascorbic acid decreases serum histamine concentrations in patients with allergic and non-allergic diseases. Naunyn Schmiedebergs Arch Pharmacol. 2013 Sep;386(9):789-93.
- Shaik-Dasthagirisaheb YB et al. Role of vitamins D, E and C in immunity and inflammation. J Biol Regul Homeost Agents. 2013 Apr-Jun;27(2):291-5.