By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Do you experience some of these upper respiratory symptoms – seasonally or randomly throughout the year?
- A runny nose
- Watery eyes
- Itchy eyes, nose, and throat
- Mega-mucous (“it won’t stop!”)
If so, you likely have allergic rhinitis. That’s a fancy medical term for what regular folks call “hay fever,” an annoying onset of persistent symptoms that people often confuse with a cold, but unlike colds, bed rest and fluids don’t do the trick in ending your misery.
According to the American College of Allergy Asthma & Immunology, allergic rhinitis affects approximately 50 million people in the United States, and its prevalence is on the rise. As many as 30 percent of adults and up to 40 percent of children have it.
One byproduct of this growing incidence is that more and more patients are going to emergency rooms for treatments, which is always costlier and may not always be necessary.
“Many people come into the emergency room seeking medications and treatment for an upper respiratory infection which turns out not being severe or needing an antibiotic,” says J.D. Sidana, M.D., a pulmonologist who operates a chain of urgent care centers in Connecticut. “Many patients also mistake seasonal allergies for the flu.”
Allergic rhinitis symptoms are typically caused by airborne allergens like pollen, dust mites, pet dander, and mold spores (we’ll go into each of these and more in greater detail below). The allergens produce symptoms of asthma for another 11 million Americans: coughing, wheezing, and shortness of breath due to narrowed and inflamed airways. This is hardly an American problem. A 2013 study (Steppuhn, et al.) in Germany confirmed that allergic rhinitis is both a risk and an aggravating factor for asthma and that the two commonly coexist.
Beyond any immediate misery associated with seasonal allergies, researchers are beginning to think that allergies in general also increase the risk of cardiovascular disease, and particularly among women.
Researchers in Italy have also found that rhinitis is associated with a greater risk of intermittent claudication (pain in the legs during walking), a symptom of peripheral artery disease, which is in turn, an indicator of future cardiovascular problems.
Seasonal or Perennial Allergies?
Allergic rhinitis can be seasonal or perennial. The former affects you when a particular offending allergen is “in season,” or blooming. Perennial rhinitis, on the other hand, brings on symptoms year round. In such situations, the cause may be pet dander and saliva, dust, and mold.
If you’ve suddenly developed allergies for the first time, it can be challenging to distinguish whether your symptoms are due to allergies or the common cold. As a general rule of thumb, allergy symptoms persist longer, for at least more than a week. You might develop allergies because one or both of your parents did, although allergies to particular types of pollen, for example, do not “run in the family.” You may have been exposed to certain allergens when your immune system was weakened, possibly during a virus or pregnancy. And for sure, experts (Dave, ND, et.al) say, high psychological stress can drain your immune system and make you more prone to upper respiratory infections
What are Allergies?
Allergies are symptoms of your immune system overreacting to one or more substances that do not normally pose a threat to the body. Your body mistakes these substances, called “allergens,” for something threatening, like invading bacteria or viruses. In the case of allergic rhinitis, when you breathe in an airborne allergen, your immune system responds by producing antibodies called immunoglobulin E (IgE) that are specific to the particular allergen affecting you.
When an allergen you breathe in reaches the lining of your nose, it encounters the specific IgE, which then signals the body to release histamine, which then initiates an inflammatory response in respiratory tissues. Histamine can cause the irritation, itching, sneezing, and excess mucous production that characterize allergic “flare-up.” Cells in the nose may then contract, causing congestion and swelling of nasal passages. As you continually breathe in the allergen which continues to bloom around you or simply circulates in the air of your home, your immune system continues to attack it, causing chronic allergy symptoms.
Aside from stocking up on tissue, how can you deal with allergies, especially when there are no known “cures”? Well, there’s actually a lot you can do to make your quality-of-life better. The first thing is to know your enemy. Knowing which allergens affect you and how to avoid unnecessary exposure to them can make life a lot more bearable when “the season hits,” or when perennial allergies plague you at home. Various treatments may also help lessen symptoms or allergic reactions.
Consulting with an experienced doctor can help you determine the nature of the beast you are dealing with by looking at family history, medical records, and performing a variety of tests. My favorite allergy doctors belong to an organization called the American Academy of Environmental Medicine.
However, before seeing a doctor, you may want to do a bit of simple detective work yourself and consider steps to reduce your exposure. Here are some ideas for common allergies, including rhinitis, and sensitivities to chemicals and food as well.
POLLEN ALLERGY (a.k.a. HAY FEVER)
Pollen is a fine powder released by trees, grasses, and weeds that initiates reproductive processes in plants. It is carried, often over great distances, by the wind as well as by insects like bees. Different plants bloom during different seasons. Recognizing when you are most affected can help you determine which plants may be the culprits behind your symptoms. As a rule of thumb, trees bloom in the spring, grasses in the summer, and weeds in the fall.
There’s truth to the phrase, “spreading like weeds”: weeds are the most prolific producers of pollen, and are widely responsible for allergic rhinitis. As an example, if your allergies are acting up in late summer or fall, chances are, you may be allergic to ragweed, or perhaps sorrel, mugwort, nettle, redroot pigweed, lamb’s quarters, and tumbleweed.
Trees that commonly provoke allergic reactions include birch, oak, ash, hickory, alder, elm, box elder, hazel, mountain cedar, willow, and hornbeam.
As far as grasses are concerned, pollens from Timothy, rye, Kentucky blue, orchard, Bermuda, redtop, sweet vernal, and Johnson grasses all are common allergens.
Internet technology has made identification of possible problem-pollens a much easier task these days. Go to www.pollen.com and type in your zip code to access information about the relative pollen count in your area as well as which plants are in bloom. Pollen count is a measure of the concentration of pollen in the air (grains of pollen per square meter of air collected over 24 hours).
Here’s a couple of pollen “dos and don’ts”:
Don’t plan to get away on vacation during peak allergy season. Most authorities say that wind can carry pollen over vast distances. Moreover, you may develop an allergy to new vegetation once you are repeatedly exposed to it.
A better solution (along with one or more treatments listed further on in this article) is to know when pollen count is high in your area and stay indoors with the windows closed as much as possible. If you have to work outside, wear a face mask to help prevent allergens from entering your respiratory tract.
Allergic rhinitis may also be caused by the inhalation of mold spores, the seeds or reproductive pieces of fungi. Molds generally grow in various places where moisture and oxygen are present, and produce millions of spores. Typical areas in your home include damp basements, closets and bathrooms (especially the shower), places where you keep fresh food, refrigerator trays, garbage cans, humidifiers, air conditioners, upholstered furniture, and mattresses.
Reducing exposure helps you avoid symptoms of allergic rhinitis as well as infections. Aspergillus is a common indoor and outdoor mold that can get into in the lungs and cause severe inflammatory asthma or infections in people with compromised immune systems.
Some molds produce toxic substances – called mycotoxins – that can cause lung diseases and liver cancer.
You can usually recognize mold as patches of growth or discoloring on walls and ceilings. They may emit a musty, earthy, or foul odor. To remove mold on hard surfaces, scrub it away with detergent and water, then dry the area completely. Bleach diluted in water (one cup to a gallon) effectively kills mold, but don’t mix it with other cleaners. The combination can produce toxic fumes. Alternatively, use a spray bottle with a solution of water and a few drops of tea tree oil (a natural antibacterial and antifungal) to clean moldy surfaces. Wear a face mask, gloves, and goggles when cleaning mold to avoid inhaling or otherwise making contact with the spores.
Prevent mold growth in your home by controlling the amount of moisture available for mold spores to grow. Keep indoor humidity low: below 50 percent. In the bathroom, keep mold to a minimum by opening the windows or running the bathroom fan when showering. Clean bathroom surfaces with water and tea tree oil before mold has a chance to form. Fix water leaks.
DUST AND DUST MITES
Ever see particles floating in a ray of sunlight? Those floaters contain much more than meets the eye, and represent, in fact, a common allergic threat.
House dust consist of many things, including environmental bits and pieces that trigger symptoms: fabric fibers, lint, stuffing materials, feathers, animal dander, food particles, bacteria, fungus, mold spores, plants, insects, cockroach saliva and feces.
Dust mites are microscopic organisms that reside on the dust present in the bedding, upholstered furniture, and carpets of your home or workplace. Their waste products release offending proteins that commonly cause allergic rhinitis and asthma symptoms worldwide. These critters thrive in the summer or in any warm, humid house, regardless of season, and die off in the winter.
There are several actions you can take to reduce the dust and dust mite threat:
- Allergically speaking, hardwood, tile, or linoleum floors are preferable than wall-to-wall or shag carpeting. You can cover them with washable throw rugs.
- If you live on carpeted floors, vacuum them often with a machine that has a HEPA (high efficiency particulate air) filter.
- Machine-wash your floor rugs in water at least 130 degrees Fahrenheit, the temperature necessary to kill dust mites.
- Frequently dust off blinds and furniture with a wet cloth, and don’t let your fans accumulate too much dust before you clean them.
- Avoid stuffed animals, down-filled pillows and blankets, closets full of clothing, heating vents with forced hot air.
- Prevent cockroaches by keeping food in airtight containers, immediately cleaning up liquid and food spills, and using roach traps (always try traps before subjecting yourself and your family to pesticides in the home).
Unfortunately, our cherished four-legged friends are walking allergens. It’s not just their dander that may be making you sneeze, but the proteins in their saliva. Even if they are not licking you, when they lick themselves clean, as cats frequently do, the allergens can get into bedding, furniture, and carpets.
Reduce your exposure to pet allergens by bathing your cat or dog weekly and brushing its fur often. It may help you to wear a face mask when doing this. If bathing a cat seems impossible, try wiping its fur with a wet cloth. Keep cats out of bedrooms. Try limiting the amount of carpeted and upholstered surfaces the pet(s) can lie on, and use (and frequently wash) machine-washable covers on your furniture. Use vacuum cleaners and air filters with HEPA filters.
It may take up to two years to develop an allergy to a household animal, and up to six months after contact with the animal ends for an allergy to cease. If you are severely allergic to pets, be sure to check with the landlord or previous owner when moving into a new residence to find out whether any pets were recently living there.
Certain chemicals can cause allergy-like symptoms, even though the reaction does not involve IgE and histamine. Some people may simply be more sensitive to natural or synthetic chemicals in the environment than others. Common irritants include paints, carpeting, plastics, perfumes, and cigarette smoke that generate a toxic effect on the body.
If you have such sensitivity, you can start protecting yourself in your home environment. Use only natural or “green” cleaning products but still read the labels for any ingredients that may be offensive to you. Alternatively, make your own cleansers. Baking soda is a great scrubbing agent when mixed with unscented powdered or liquid soap. White vinegar mixed with water is good for cleaning glass, counters and floors. Adding tea tree oil and/or lemon juice adds an antimicrobial punch. Wearing a mask while cleaning may help as well.
Allergic reactions or intolerances to food can exacerbate symptoms of allergic rhinitis. While some cases can be severe, and even life-threatening, others cause milder reactions that may be mistaken for a stomach bug, irritable bowel syndrome, mild hives, or skin rash. Food allergies, especially if so mild that they lurk “under the radar,” serve to increase your “allergic load,” or the amount of offensive substances you can be exposed to before allergy symptoms occur. For example, if your capacity is 80 percent full of food allergies, the bucket can easily overflow when seasonal allergens are present.
Symptoms of pollen, dust, and pet allergies may clear up simply by determining an offending food and removing it from your diet. It is not always so simple, however, because the antibodies involved (IgG, not IgE) can cause delayed reactions, appearing a day or two later. It may take an experienced health practitioner to administer the proper testing for delayed reactions to particular foods.
What you can do if you suspect a particular food is to eliminate it temporarily from your diet. If you have no prime suspect, then try abstaining from the top five allergic foods (wheat, dairy, corn, soy, eggs) for three weeks. Then slowly introduce each, one by one, back into your diet and see if any stoke a reaction. You may also want to try avoiding sulfites in food and alcohol.
Before covering treatments, I’d like to emphasize the importance of using an air cleaning device in your home or office. Air filtration helps remove allergenic particles like pollens, molds, animal dander, dust and smoke from your indoor air. You can add one to your heating and cooling system, or get portable ones for individual rooms. The key is to find one with a flow that changes the air in the room 5-6 times per hour and that does not emit ozone, a lung irritant that can trigger allergic symptoms. HEPA (high efficiency particulate air) filters are good, and don’t release ozone.
Sometimes avoidance of allergens isn’t enough. Various alternative and conventional treatments may be necessary to diminish or eliminate allergy symptoms. Consider any combination of the following:
Neti Pot (nasal irrigation)
This method, from India’s Ayurvedic tradition, involves introducing a warm salt water solution sequentially into each nostril to wash away dust, dirt, pollen, and smoke that gets trapped in the nasal passages. Once you get the hang of it, you’ll find the Neti Pot an efficient way of clearing nasal airways daily and reducing chronic exposure to allergens. You can buy a pot for under $20 at health food stores or online.
Herbs and Nutrients
Make your diet healthier. Eat more fruits and vegetables that are packed with nutrients you’re your body needs to stay strong. Reduce your sugar intake. Sugar depletes your body of key nutrients and is a stressor on the body.
Fortify your diet with high-quality nutritional supplements, starting with a multi-vitamin and mineral formula.
Eyebright, an herb that acts as an inflammation modulator, can be taken in supplement form or made into a liquid solution. Boil eyebright leaves and flowers, let the water cool, then strain the solution through cloth to use as an eye wash or nasal irrigation.
Another helpful anti-inflammatory is nettle leaves. Frequently drink nettle tea, or take a tincture under the tongue.
Quercetin is a bioflavonoid nutrient with powerful anti-inflammatory properties. Found in red and yellow onions, cabbage, broccoli, and apples, quercetin may be taken in supplement form.
Research (Choi SM, et. al) indicates that acupuncture treatments may be helpful to alleviate symptoms of allergic rhinitis.
Stress weakens the immune system and makes you more vulnerable to colds and allergies. That’s a fact.
The following practices can help you reduce the stress in your life:
- Meditation and deep breathing.
- Make time for fun and relaxation.
- Get enough rest (here are some natural sleep remedies).
- Seek counseling help for issues in life that are causing chronic stress.
You may not think about such things as allergy “medicine,” but indirectly they can have a big impact on the intensity of your symptoms.
Earthing, or grounding, is one of the simplest things you can do to bolster your resistance to allergies and your health overall. Earthing means connecting to the Earth’s natural, gentle energy by going barefoot outside (when conditions and time allow) or using specially conductive sheets and mats indoors when you sleep, relax, and work.
These over-the-counter drugs prevent or assuage allergy symptoms by preventing the attachment of histamines to your cells. Antihistamines can cause side effects such as drowsiness, and lack of alertness and concentration, so you may want to seek a non-sedating product. People with heart disease, high blood pressure, or breathing problems like asthma should avoid taking antihistamines.
Steroids and Other Allergy Medications
Such drugs can be used in combination with antihistamines, but only for a few days at a time. Topical nasal steroids are safe at recommended doses, and chromolyn sodium, a nasal spray may also help. Decongestants can help bring symptom relief by suppressing excess mucous production. Eye drops with olopatadine hydrochloride, which inhibits the release of histamine, may help relieve itchy eyes.
Immunotherapy (Allergy Shots)
Think of these as temporary vaccines. Designed to decrease the immune system response, immunotherapy exposes you to small amounts of allergens that stimulate your immune system to build up antibodies. The limited dose helps your body avoid “over-reactive” immune system activity later on. However, immunotherapy must really be continued over the long term to remain effective. This approach can be really effective for some but not for others. Each person responds differently.
While natural treatments are generally preferred, integrative healing combines the best of conventional and alternative therapies. If your allergy symptoms are making you miserable or you’re having difficulty breathing, try employing antihistamine medications or other conventional remedies for a short time to give your immune system a rest, then continue on with natural solutions. With allergies, a multi-strategy approach is often the best bet for breathing easy again. If your symptoms persist and get worse, always seek professional help.
References and Resources:
- American College of Allergy, Asthma & Immunology. Allergy Facts. Acaii.org, accessed April 23, 2014.
- Steppuhn H, et. al, Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults: results from the German national health telephone interview survey (GEDA) 2010. BMC Pulm Med, 2013;13:46. Published online at www.ncbi.nlm.nih.gov/pmc/articles/PMC3718654/#!po=3.33333
- Ferrari M, et al. Rhinitis is associated with a greater risk of intermittent claudication in adults. Allergy. 2014. 69(4):472-78. Published online at http://onlinelibrary.wiley.com/doi/10.1111/all.12354/abstract
- Dave ND, Xiang L, et. al. Stress and Allergic Diseases. Immunol Allergy Clin North Am. Feb 2011; 31(1): 55–68. Published online at www.ncbi.nlm.nih.gov/pmc/articles/PMC3264048/#!po=2.94118
- American Academy of Environmental Medicine web site.
- “Airborne Allergens: Something in the Air,” The U.S. Dept. of Health and Human Services National Institutes of Health National Institute of Allergy and Infectious Diseases.
- “Indoor Air Pollutants and Toxic Materials.” Chapter 5 of the Healthy Housing Reference Manual, available at the Centers for Disease Control and Prevention.
- “Guide to Air Cleaners in the Home.” The United States Environmental Protection Agency (EPA), May 2008.
- “A Brief Guide to Mold, Moisture and Your Home,” EPA.
- Choi SM, Park J-E, et. al. A multi-center randomized controlled trial testing the effects of acupuncture on allergic rhinitis. Allergy. 2013; 68: 365–374. Published online at www.onlinelibrary.wiley.com/doi/10.1111/all.12053/full
© Stephen Sinatra, MD. All rights reserved.