A Simplistic and Powerful Approach to Seasonal

Allergies

by Chris D. Meletis, ND

Millions of people suffer year around from environmental allergens, yet as we know there is a definitive surge during the spring and summer seasons. According to the scientific research, there has been a strong and growing prevalence of allergic rhinitis over the last couple of decades. I can also attest to this increased prevalence by the number of patients whom I see with this problem in clinical practice. The number of people who suffer from seasonal allergies also is reflected in the billion-dollar industry of prescription and over-the-counter drugs to control allergic symptoms.

The Centers for Disease Control reports that hay fever symptoms result in 14.1 million annual visits to primary care physicians.¹ Overt allergic disease affects 20% of the US populace, with an impact on some 50 million Americans.^2,3 Of those who suffer, 35 million are specifically afflicted with seasonal hay fever. If one adds in to the statistics asthma and chronic obstructive pulmonary disease, the numbers become even more staggering. Without question, allergic disease is a serious health crisis and is currently ranked the 6th leading cause of chronic disease in the US.²

There are some interesting observations that have been documented in the medical literature relative to risk of allergic rhinitis that presents with allergy-induced inflamed runny or stuffy, itchy nose and sneezing. Research has indicated that individuals who live in higher-pollution regions, have a family history of allergies, who were fed formula or food early in infancy, who were born during peak allergy season, and who received antibiotics at an early age have an increased risk of developing seasonal allergies (Table 1).

Proactive Stance

The skilled clinician knows that proactively tackling allergic symptoms before the avalanche of symptoms cascades throughout the mucous membranes including the eyes, nose, throat and sinuses. Individuals who suffer from environmental allergens also know that the risk for developing secondary health concerns is all too real; these include sinusitis and sinus infections, middle ear infections and fluid accumulation, bronchitis, and asthma.

Clinically there are four steps that I implement with all my patients with allergic rhinitis.

1. minimize exposures
2. control histamine levels naturally
3. enhance mucous membrane resistance
4. lessen inflammation

Minimize Exposures

The microscopic pollen released by trees, grasses and weeds or molds and mildews and animal dander are common culprits for those of us who are nasally challenged.

Minimizing exposure is critical – total burden is the real factor. Many people can get away with a quick passing exposure for a few moments, yet anything other than one’s personal threshold will start a cascade of events that can have long-lasting consequences for hours, days and sometimes weeks. So try to incorporate the following simple ways to help keep exposure to a minimum.

• Keep your home’s doors and windows closed.

• Use the air conditioner rather than opening a window.

• Limit outdoor activity, particularly in the morning (5 a.m. to 10 a.m.) and mid-evening.

• Keep track of pollen counts in your area and don’t exercise outside during your allergen peak.

• Don’t go outside more than necessary on windy days.

• Keep your car windows up and sun roof closed and keep air on recirculate while driving.

• Shower prior to going to bed, including your hair, because pollen will collect on you throughout the day.

• Change your clothes after being outside; otherwise you will contaminate your inner sanctum.

In addition to avoiding environmental triggers, minimizing the proverbial “straws on the camel’s back” is critical, so I routinely will food sensitivity/allergy test patients, so that allergens introduced via the GI tract aren’t further burdening and triggering allergic responsiveness.

Controlling Histamine Levels Naturally

What all allergies have in common is the antigen (allergen) stimulation of two related cell types: mast cells and basophils (type of white blood cells). Mast cells line the blood vessels in the connective tissue of the lungs, inner eyelids, gut, ear, nose, throat and skin. Both mast cells and basophils are full of granules of histamine and other allergic chemical mediators. When allergen/antigens in the blood contact mast cells or basophils in sufficient numbers, a burst of histamine and other allergic mediators is released into the bloodstream. It is the histamine and other allergic mediators that trigger the misery of allergic reaction: runny, itchy nose and sneezing, watery, itchy red eyes, tickling and itching in ears, nose and throat, skin rash, headache, asthma, etc.

A number of natural substances that can help ameliorate this process are of interest to allergy sufferers. Quercetin is a powerful inhibitor of antigen-stimulated histamine release from basophils and mast cells, even at low levels (5–50 micromoles, or 1.51–15.1 mcg/ml).^3,4 Unlike most antiallergy substances, quercetin is highly effective at inhibiting histamine release during both the first and second stage of basophil histamine release.^5,6 Clinically focusing on stabilizing these histamine-rich cells can help minimize an allergic burst of reactivity. Quercetin has been shown to decrease asthmatic reactions in animal models similar in effectiveness to the pharmaceuticals cromolyn sodium and dexamethasone.⁷ Using similar animal models, quercetin has also been shown to inhibit anaphylactic smooth-muscle contraction.⁸

The anti-inflammatory effects of quercetin might be due to inhibition of the production and activity of leukotrienes and prostaglandins, and inhibition of histamine release by basophils and mast cells.⁹ Preliminary evidence suggests that quercetin inhibits antigen-stimulated histamine release from mast cells of patients with allergic rhinitis.¹⁰ Over the last 20 years, quercetin use has helped countless patients in my clinical practice.

Enhance Mucous Membrane Resistance

The first and most important way to protect your mucous membranes from irritation other than avoidance to unnecessary exposure is to maintain proper hydration. This can be as simple as drinking at least a minimum of 64 ounces of clear fluids per day and limiting caffeine intake. Moist membranes are more resilient and less likely to become irritated. Additionally, if you have sufficient hydration, a quick flow of mucus from the nasal passages or tearing of the eyes can naturally rid the body of the burdensome exposure more efficiently opposed to allowing it to cozy up to your mucous membranes for long term mast and basophil stimulation.

The next important step in protecting your mucous membranes is to ensure that you are immunocompetent to the best of your individual capacity. This is where the specific yeast ferment referred to as EpiCor can play a significant role, as it has been shown to increase natural killer cells, phagocytosis, enhance your CD4/CD8 ratio, and most importantly for this conversation enhance your sIgA. It is this immune coating of the mucous membranes that helps protect against foreign substances and prevent the spread of infection that can readily occur with ongoing irritation and longstanding presence of mucus. As I share with my patients, the human body is moist and warm, and with excess mucus, we become a “human petri dish,” which serves as the host of opportunistic infections.

The immune properties of EpiCor have also been shown to help directly with allergies. In a double-blind, placebo-controlled trial, subjects were given either EpiCor (1000 mg) or placebo for 5 weeks. At the end of 5 weeks, the salivary sIgA increased while the serum IgE decreased. Though not reaching full statistical significance due to the nature of this pilot trial, this was a strong trend. These results helped confirm the findings of a previous trial supporting the efficacy of EpiCor. On the other hand, the decreased serum IgE suggests the important immune-balancing effects of this substance.

Since this trial was conducted in the spring when allergies are a problem for many people, one would expect serum IgE to increase, since this immune parameter is associated with allergies. This was seen in the controls. However, in the EpiCor group, the levels stayed nearly at baseline, giving laboratory confirmation of the subjects reporting fewer allergy problems than usual. This was also reflected in a standardized questionnaire showing fewer health complaints with the EpiCor group. It was also observed that cytokine profiles were shifting in the EpiCor group – from Th1 (pro-inflammatory) to Th2 (pro-adaptive) and vice versa – again demonstrating the immune balancing properties of EpiCor.¹¹

A study published in the journal Urologic Nursing confirms EpiCor’s immune-enhancing effects. In the new randomized, double-blind, placebo-controlled clinical trial, researchers studied 116 people recently vaccinated against the flu. Subjects received either daily supplements of EpiCor (500 mg) or a placebo. The University of Michigan scientists collected data on the subjects at the study’s start and after 6 and 12 weeks.

The researchers found that the subjects given EpiCor experienced significantly fewer cold and flu symptoms and significantly shorter duration of symptoms, compared with subjects taking the placebo. Among the 116 study participants, those who did have symptoms experienced a reduction in the duration of symptoms by 14% after taking EpiCor. The overall occurrence of cold and flu symptoms was reduced by 21% in the EpiCor group.¹¹

Gingko:

Not Just for Cardiovascular Health

Another study found that Ginkgo biloba leaf extract significantly decreased the release of pro-inflammatory mediators after an antigen challenge in anaphylactic lungs using animal models.¹³ Additional research has shown that topical treatment with ginkgo for allergic contact dermatitis has been shown to significantly decrease skin reactivity in 68.2% of the subjects studied.¹⁴

Lessen Inflammation

It is essential to control inflammation when it comes to allergic response, to avoid the “-itis” factor. With allergic irritant exposure, inflammation arises increasing mucus production as seen with all these regional inflammatory responses, rhinitis, sinusitis, pharyngitis from postnasal drip, or bronchitis Inflammation furthers the irritation of the tissues and in the case of the airway, it also further narrows it, making it hard to breathe and increasing congestion.

The use of bromelain has demonstrated its clinical utility over the years to help ameliorate inflammatory symptoms. When taken on an empty stomach approximately 40% of the bromelain is absorbed into the bloodstream intact.¹⁵ Bromelain stimulates the production and release of anti-inflammatory prostaglandins (PGs), while simultaneously reducing the production and release of pro-inflammatory PGs.¹¹

I have found that vitamin C appears to have a natural antihistamine. It appears to both prevent histamine release and increases the detoxification of histamine. A study found that taking 2000 mg of vitamin C daily lowered blood histamine levels 38% in healthy adults in just one week. People with low levels of plasma vitamin C seem to have higher levels of histamine, so ongoing use of vitamin C to achieve sustained levels clinically appears to optimize the overall benefits.^18–20

Immunomodulation

Perilla frutescens is a plant from the Lamiaceae genus, which also includes basil, sage, mint, and rosemary. Perilla contains rosmarinic acid and luteolin, which are believed to be the active constituents. Several studies have shown that Perilla supplementation is effective in managing allergic symptoms. In a randomized, double-blind, age-matched, placebo-controlled parallel group study, patients with seasonal allergic rhinoconjunctivitis (nose and eye symptoms) were supplementation with an extract of Perilla frutescens enriched for rosmarinic acid for 21 days. The results showed that there was a significant decrease in allergic symptoms including itchy nose, watery eyes, itchy eyes, and overall total symptoms. The study also found a significant decrease in the numbers of neutrophils and eosinophils in nasal fluid of the Perilla-treated group.²¹ In a study using animals, supplementation with an extract of Perilla was shown to decrease mast cell-mediated immediate-type allergic reactions measured by a reduction in plasma histamine levels.²² Perilla frutescens leaf extract was also shown to significantly suppress IgE and IgG1 antibody levels in mice. This study also showed a decrease in the chemical mediators associated with the allergic response.²³ In another interesting study, rosemary extract was evaluated in a mouse model of allergic asthma. The study found that rosemary extract prevent allergic airway inflammation as shown by inhibiting the typical increase in the number of eosinophils, neutrophils, and mononuclear cells around the airways and those in the bronchial lavage fluid upon exposure to dust mites.²⁴ Luteolin has also shown benefit in treating allergic symptoms. One study showed that luteolin suppressed pro-inflammatory mediators and decreased allergic swelling in mouse models.²⁴ Luteolin also significantly modulates airway bronchoconstriction and bronchial hyperreactivity in experimental mice models of allergic asthma. Additionally, the study showed that luteolin decreased the chemical mediators associated with allergies as well as decreased levels of IgE antibodies.²⁵ Other researchers have shown that luteolin suppresses histamine release from mast cells.²⁶

Butterbur:

More than a Herb for Migraines

This is a definite clinical tool that I employ when patients present to my practice with a history of being on prescription antihistamine and other conventional allergy medications. Butterbur exhibits several properties that make it beneficial for the treatment of allergic rhinitis and asthma. It has been shown to relax smooth muscle as well as decrease levels of histamine and leukotrienes. One study showed that supplementation with butterbur in patients with allergic rhinitis significantly decreased nasal allergy symptoms, improved quality-of-life scores, and reduced histamine and leukotriene levels in nasal fluids.²⁷ In a randomized, double-blind, parallel-group study, butterbur was shown to be as effective as cetirizine (Zyrtec) in relieving symptoms of seasonal allergic rhinitis.²⁸ A similar study showed that butterbur extract was as effective as the pharmaceutical fexofenadine (Allegra) for the treatment of allergic rhinitis.²⁹

Conclusion

It is absolutely essential to become proactive at the first sign of allergic symptoms, preemptively controlling histamine release is crucial. To wait for a full-blown allergic reaction that requires a prescription antihistamine (mop) can be compared to mopping up spilled milk; prevention is the goal. In an ideal world, one will have the correct supplements on hand, so that a strong offense to protect the body’s mucous membranes can begin before the full speed of the allergic cascade is underway. Some simple approaches include consuming a formula with the synergistic ingredients of quercetin, bromelain and vitamin C. Many of my patients utilize all natural EpiCor can help create the natural IgA barrier that can confer the extra edge needed to fend off over reactivity and when combined with minimizing exposure to allergens as described above has proven a simple and powerful strategy. An individualized acute intervention often also includes the use of gingko, butterbur, and Perilla as indicated by specific symptom complexity.

Notes

1. US Centers for Disease Control and Prevention. National Center for Health Statistics. National Ambulatory Medical Care Survey; 2002 Summary, Table 13. 

2. American Academy of Allergy, Asthma and Immunology. The Allergy Report: Science Based Findings on the Diagnosis and Treatment of Allergic Disorders, 1996–2001. 

3. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001;108:S2–S8.

4. Nathan RA, Meltzer EO, Selner JC, Storms W. Prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99:S808–S814. 

5. Rosenwasser LJ. Treatment of allergic rhinitis. Am J Med. 2002;113:17S–24S.

6. Pearce F et al. Mucosal mast cells III. Effect of quercetin and other flavonoids on antigen-induced histamine secretion from rat intestinal mast cells. J Allergy Clin Immunol. 1984;73:819–823.

7. Moon H, Choi HH, Lee JY, et al. Quercetin inhalation inhibits the asthmatic responses by exposure to aerosolized-ovalbumin in conscious guinea-pigs. Arch Pharm Res. 2008 Jun;31(6):771–778.

8. Fanning MJ, Macander P, Drzewiecki G, et al. Quercetin inhibits anaphylactic contraction of guinea pig ileum smooth muscle. Int Arch Allergy Appl Immunol 1983;71(4):371–373.

9. Middleton E. et al Quercetin: an inhibitor of antigen-induced human basophil histamine release. J Immunol. 1981;127:546–550.

10. Foreman J. Mast cells and the actions of flavonoids. J Allergy Clin Immunol. 1984;73:769–773.

11. Middleton E et al. The effects of plant flavonoids on mammalian cells: implications for inflammation, heart disease and cancer. Pharmacol Rev. 2000;52: 673–751.

12. Quercetin. Alt Med Rev. 1998;3:140–143.

13. Harczy M, Maclouf J, Pradelles P, et al. Inhibitory effects of a novel platelet activating factor (PAF) antagonist (BN 52021) on antigen-induced prostaglandin and thromboxane formation by the guinea pig lung. Pharmacol Res Commun. 1986 Aug;18 Suppl:111–117.

14. Castelli D, Colin L, Camel E, et al. Pretreatment of skin with a Ginkgo biloba extract/sodium carboxymethyl-beta-1,3-glucan formulation appears to inhibit the elicitation of allergic contact dermatitis in man. Contact Dermat. 1998 Mar;38(3):123–126.

15. Otsuka H, Inaba M, Fujikura T, Kunitomo M. Histochemical and functional characteristics of metachromatic cells in the nasal epithelium in allergic rhinitis: studies of nasal scrapings and their dispersed cells. J Allergy Clin Immunol. 1995;96:528–536.

16. Unpublished study.

17. Moyad MA, Robinson LE, Zawada ET Jr, et al. Effects of a modified yeast supplement on cold/flu symptoms. Urol Nurs. February 2008;28(1):50–55.

18. Taussig S. The mechanism of the physiological action of bromelain. Med Hypoth. 1980;99–104.

19. Kelly G. Bromelain: A literature review and discussion of its therapeutic applications. Alt Med Rev. 1996;243–257.

20. Johnston C, et al. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr. 1992;2:172–176.

21. Shin TY, Kim SH, Kim SH, et al. Inhibitory effect of mast cell-mediated immediate-type allergic reactions in rats by Perilla frutescens.” Immunopharmacol Immunotoxicol. 2000 Aug;22(3):489–500.

22. Ishihara T, Okamoto I, Masaki N, et al. Inhibition of antigen-specific T helper type 2 responses by Perilla frutescens extract. Arerugi. 1999 Apr;48(4):443–450.

23. Inoue K, Takano H, Shiga A, et al. Effects of volatile constituents of a rosemary extract on allergic airway inflammation related to house dust mite allergen in mice. Int J Mol Med. 2005 Aug;16(2):315–319.

24. Ueda H, Yamazaki C, Yamazaki M. Luteolin as an anti-inflammatory and anti-allergic constituent of Perilla frutescens. Biol Pharm Bull. 2002 Sep;25(9):1197–1202.

25. Das M, Ram A, Ghosh B. Luteolin alleviates bronchoconstriction and airway hyperreactivity in ovalbumin sensitized mice. Inflamm Res 2003 Mar;52(3):101–106.

26. Kimata M, Inagaki N, Nagai H. Effects of luteolin and other flavonoids on IgE-mediated allergic reactions. Planta Med. 2000 Feb;66(1):25–29.

27. Thomet OA, Schapowal A, Heinisch IV, et al. Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis. Int Immunopharmacol. 2002 Jun;2(7):997–1006.

28. Schapowal A, Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ. 2002 Jan 19;324(7330):144–146.

29. Schapowal A, Study Group. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res. 2005 Jun;19(6):530–537.