Allergies or “Allergic Diseases” are conditions in which an individual’s immune system becomes hypertensive to triggers that are harmless to others. The physiologic response of a “hypertensive” immune system gives rise to the constellation of symptoms experienced in allergies. These range from stuffy nose and runny itchy eyes, digestive complaints, dermatitis, allergic asthma and anaphylaxis, to the potentially life threatening immediate reaction driven by the Immunoglobulin E (IgE) type I response.
Allergy or Intolerance
It’s important to distinguish an “allergy” from intolerance which is often confused or interchanged by both the public and healthcare professionals. According to the guidelines set out by the National Institute of Allergy and Infectious Diseases, food allergy is an adverse health effect arising from a specific immune response that occurs, reproducibly on exposure to a given food. Whereas with intolerance, foods may cause the same reproducible adverse reaction but doesn’t have a likely or established immune system response. For example, someone is “allergic” to cow’s milk due to an immune system response to milk protein (casein or whey) and therefore has a food allergy. But someone who has difficulty drinking milk due to an inability to digest lactose in milk has a food “intolerance” and this may be due to low lactase production or numerous problems with digestive system.
Diagnosing intolerances and allergies can be difficult because both timing and symptoms often overlap or may be confused with other conditions such as: gas, bloating, abdominal pain, diarrhea, constipation, heartburn, fatigue or loss of energy, headaches and migraines, anxiety, depression, mood swings, poor concentration, muscle and joint pain, acne, eczema and psoriasis. Understanding and documenting an exposure “time line” can be very useful.
Diagnosis of Allergies
Specific diagnosis of allergies may begin with an incident where someone recalls a specific exposure and reaction. A visit to Aunt Janice’s house when the kids played with the cat (sensitization) and the sneezing, itching and watery eyes that they complained of on the return visit (re-exposure). Critical information can be gathered from a detailed exposure history. This should include: environmental exposures (home, car, work, recreation and hobbies), the diet record (all foods, beverages, condiments and eating patterns), use of personal care products, changes is clothing, jewelry, exercise and the resolution or change of symptoms during commuting, travel and vacation.
Specific laboratory testing may include food and environmental allergies (IgE-dust mite, molds, peanuts, shellfish, bees and latex), drug (penicillin) or heavy metal exposures (lead, mercury) as well as inflammatory and metabolic markers. For those with insurance it is important to preauthorize testing. Many insurers will only pay for IgE based testing as they still consider Immunoglobulin G isotype (IgG) tests research and therefore it has been slow to be adopted into clinical care. Self-pay options for IgG testing are available and may range from $250 -$800 depending on the complexity of the panel.
Treatment Options
Once diagnosed, there are numerous treatment options for allergies which vary in their degree of success. Avoidance and elimination are still the gold standards but it can be difficult to avoid all trees, grass or dust. Remediate all environmental exposures; eliminate mold, reduce moisture, filter water, remove carpets, use dust mite covers, regularly change hepa filters in furnace and vacuums. Air out and regularly clean home, work environment and cars. When possible use zero or low VOC (volatile organic compound) paints and inert building materials such as glass steel, wood and tile.
With severe and life threatening allergies avoidance in parallel with epinephrine auto-injectors (EpiPen® injection), diphenhydramine (antihistamines such as Benadryl) and selected steroids should be on hand and deployed based on the plan (emergency and ongoing) designed by the healthcare team. Emerging allergen immunotherapies are also being investigated for their potential in treating allergies. These therapies present small doses of the allergen to the immune system in order to “de-sensitize” it. Sublingual immunotherapy (SLIT) uses the tolerogenic environment of the oral mucosa and epicutaneous immunotherapy (EPIT) uses the immune cells of the epidermis to transport antigens to afferent lymph nodes to activate immune responses. SLIT and EPIT have been shown to successfully desensitize patients but additional research is needed to define optimal doses and administration protocols.
With most of the non-life threatening food allergies, an Allergy Elimination Diet and or anti-inflammatory diet is very helpful. During an initial 4-8 week (transition from SAD- Standard American Diet to a safe rotation eating plan) a stricter approach should be taken. In addition to diagnosed allergens, common foods to remove may include: All gluten-containing foods including wheat, rye, oats and barley, which are commonly found in breads, pasta and other products from refined flour. Alcohol, caffeine (coffee, black teas and sodas) and soy milk, soda and fruit drinks that are high in refined sugars. Pork, cold cuts, bacon, hot dogs, canned meat, sausage and shellfish. All dairy (milk, cheese, butter, yogurt, etc.). Foods high in fats and oil, including peanuts, refined oils, margarine and shortening. All refined sugar products (candy bars and other junk food). Afterwards food may be rotated back in but both the frequency and dose must be carefully monitored. Do not start this before the holiday season if you want to be successful.
Natural Alternatives
There are numerous food-based and botanical-based dietary supplements that may be useful in both the treatment and management of allergies. All plans should aim to create a solid digestive foundation which may include the use of pre –or probiotics, broad-based pancreatic enzyme support, essential fatty acids, as well as correcting Vitamin D deficiency and proper hydration.
Specific supplements may include: Polyphenols and polyphenol rich foods (blueberries, raspberries, blackberries), Quercetin (flavonoid glycoside), Turmeric (Curcuma longa), Bromelain (cysteine proteases from Ananas comosus- common pineapple), Butterbur (Petasites hybridus) and Stinging Nettle (Urtica dioica). For the best results in using these or other dietary supplements, partner with your healthcare team and evaluate all potential sides effects and interactions. For example, Quercetin may be metabolized through the CYP2C8 enzyme stem and high doses may affect serum levels of Taxol /Paclitaxel whereas Butterbur may contain pyrrolizidine alkaloids which can be harmful to the liver. Only high quality products that remove and test for pyrrolizidine alkaloids should be used.
In NIH funded preclinical studies conducted by my research team, we have demonstrated that Bromelain can inhibit the inflammatory immune response (white blood cells, eosinophil’s and inflammatory cytokines) in Allergic Asthma (IgE egg model) approximately 50% and if treatment is begun during early sensitization, Bromelain can reduce Allergic Asthma upon re-exposure approximately 90%. Future studies will determine the clinical effects in chronic recurrent rhinitis and seasonal allergies.
Effects of Lifestyle
Allergies and inflammation can be aggravated by an unhealthy lifestyle. Regardless of the allergy take the opportunity to improve as many aspects of your health as possible. If you smoke seek help to stop and reduce the exposure of second hand smoke (an allergen) to other family members and friends. Adopt a proactive stress management plan which may include, exercise, proper hydration and at least 7 hours of uninterrupted sleep. As adipose tissue is pro-inflammatory and may worsen allergic inflammation, work towards achieving a healthy body weight through combined strength training and cardiovascular exercise. Although allergies can be overwhelming a multidimensional approach will help with their management and ultimately help you achieve better overall health.
Submitted by Eric R. Secor, Jr ND, PhD, MPH, MS, LAc, Dipl. Ac.
Dr. Secor is the Associate Medical Director of Integrative Medicine for Hartford Hospital. His formal education includes: BA in Biology CCSU 1993, MS in Acupuncture and ND Doctorate in Naturopathic Medicine from Bastyr University 1998, MPH public health research UConn 2010, PhD in Occupational and Environmental Health UConn 2012. Dr. Secor is one of the only ND, LAcs in the country to complete 8 years of NIH postdoctoral research in immunology, allergy asthma and natural products conducted at the UConn School of Medicine. His Current research interest include: quality control of natural products, assessment of integrative medicine modalities for cancer related pain and quality of life and investigation of Insightfil: A clinic-Based robotic dispensing and adherence system for dietary supplements.