Allergy Treatment: Know Your Options

"As the allergy season goes on, your nasal passages become more and more inflamed from daily exposure to pollen," says Dr Dykewicz.

About 20% of Americans suffered from hay fever, which occurs when your immune system overreacts to pollen.  As the body attempts to neutralize the pollen, it releases histamines and other substances that trigger watery eyes, a runny nose, and congestion (which is caused by inflammation).

Research published in the February 2014 issue of the journal Otolaryngologic Clinics of North America shows that people with seasonal allergies have a 10-fold greater risk of developing asthma, and they may be more prone to sinus infections.

Avoidance of Pollens

The simplest strategy to fight allergy is—steering clear of pollen as much as possible.  Here are some tactics you can adopt:^[23]

• After spending time outdoors, pollen can be collected on your hair and clothing.  When returning home, consider:
• Take off or change your shoes
• Change your clothes
• Take a shower 
• Consider showering at night so that you don't transfer pollen to your bedding
• Using a saline nasal rinse at the end of the day will help wash pollen out of your nose
• On really high pollen days,^[1,2] you might consider staying inside as much as possible.
• Filter indoor air.
• Consumer Reports recommends:^[6]
• 3M Filtrete Elite Allergen 2200 MPR
• Whirlpool AP51030K
• Hunter 30547

Allergy Medications

The best treatment for you depends on the severity of your allergies:^[6]

1. Your symptoms are annoying but tolerable.
• Practice the avoidance tactics
2. Your symptoms interfere with sleep or everyday activities
• Consider OTC antihistamines in eye drops or pills
• You have two choices in antihistamines:^[5]
  
  
  1. The first-generation drugs
  • Including diphenhydramine (Benadryl Allergy and generic)
  2. The second-generation drugs
  • Including loratadine (Claritin and generic)
  • They are far more selective for peripheral histamine H1-receptors. However, they're more likely to cause drowsiness
  • All the second-generation antihistamines are equally effective^[6]
• So consider choosing by price
• Antihistamines can be taken whenever your symptoms flare (they become effective in 1 to 3 hours) or daily if the pollen count is high or you're experiencing symptoms more than several days per week.
• People respond differently to antihistamines, so if you don't get relief from one type, try another.
• Try nasal sprays—they deliver antihistamines directly to nasal passage and they are said to have an anti-inflammatory effect.
• Nasal forms work faster than oral decongestants (15 to 30 minutes) and may not cause as much drowsiness. However, they can cause dependency and rebound (see Warnings).
3. You have daily symptoms and antihistamines aren't enough
• Consider nasal steroid spray because it reduces inflammation, relieves watery, itchy eyes and helps stave off a congestion-related headache (see also Warnings).
• For the best results, start using sprays at the beginning of the allergy season (as soon as the weather warms up).
• The sprays take up to 12 hours to work, and you may not experience the full effect for a week.
4. You have daily symptoms and no drug seems to help
• Consider immunotherapy, also known as allergy shots.
• They can eliminate the need for medication in some people, but they require a major time commitment.  (author's note: I have tried this and it didn't help me that much).
• A standard course of immunotherapy—which is customized by the type of allergies you have—involves getting regular injections at a doctor's office for three to five years.
• Soon there may be a more convenient alternative: sublingual immunotherapy
• It involves placing purified allergens under the tongue to build up your resistance.
• Some studies show they might not be as effective as traditional shots.  Plus, sublingual therapies contain single extracts, and people usually allergic to more than one.
• Try the new therapy, known as sublingual immunotherapy, which does not require frequent doctors’ appointments or supervision.^[29]

Alternative Treatments

There are a number of alternative remedies available that may help diminish the sneezing, coughing and irritation caused by allergies:^[7-12]

• Eating locally-produced honey
• In a 2011 study,^[8] which found that patients diagnosed with birch pollen allergy found significant relief when they consumed birch pollen honey daily from November to March. 
• However, Dr. Mercola warns that:
• Honey itself can also trigger in some cases severe allergic reactions, including anaphylactic shock. 
• Honey is high in fructose, which, in excessive amounts, can exacerbate pre-existing insulin resistance and wreak havoc on your body.
• Flushing your nasal cavity with a neti pot
• Acupuncture^[10,24]
• A new study published in the Annals of Internal Medicine found that patients who received acupuncture treatment for seasonal allergic rhinitis reported improvements in symptoms and decreased use of medication compared to those getting standard treatment or sham acupuncture.
• However, the effect only lasted as long as they maintained their treatments.
• Treat your leaky gut syndrome
• “Healing and sealing” your gut has been shown to help alleviate allergy symptoms.^[7,12]
• Consider fermented foods^[16]
• Consider probiotics and prebiotics^[14,26]
• “Not all probiotics work for allergies.” said Jennifer Dennis, the first author on UF’s latest study.  However, she and the other UF researchers found a combination of probiotics (i.e., lactobacilli and bifidobacteria) that does
• Eating “right”
• Patients with asthma and allergic rhinitis may benefit from hydration and:
• a diet low in sodium, omega-6 fatty acids, and trans fatty acids
• but high in omega-3 fatty acids (i.e., fish, almonds, walnuts, pumpkin, and flax seeds), onions, and fruits and vegetables (at least five servings a day). 
• Avoid GMO and processed foods
• Both GMO and food additives (in most processed foods) have been shown to cause food allergies. 
• Both GMO and food additives decimate the beneficial bacteria in your gut, thereby having a negative effect on your immune system
• Avoid junk foods
• Recent research has also found that junk food increases a child’s risk of asthma and allergies.
• Avoid foods that may worsen pollen allergies^[11]
• If you are allergic to ragweed, you may have cross-sensitivity to melons, bananas, tomatoes, zucchini, sunflower seeds, dandelions, chamomile, and Echinacea. 
• If you have a grass allergy, you may also react to peaches, celery, tomatoes, melons and oranges. 
• Consider "White Ingredients" (白色食材)^[9,13]
• Traditional Chinese medicine often say "white ingredients "can help improve respiratory health:
• Asian Pear (水梨)
• Winter melon (冬瓜)
• Huái shān (淮山) or shān yào (山藥)
• Lotus root (蓮子)
• Pine seed (松子)
• Daikon (白蘿蔔)
• Cauliflower (白花椰菜)
• Following Chinese traditional doctor's suggestions:^[15]
• Avoid eating sugary or icy foods.
• When your allergy symptoms flare up and lose appetites, eat less and eat lighter foods. You can even consider skipping meals and drinking water only to give your body a break to recoup.
• Try eating foods full of digestive enzymes such as pineapple (bromelain) and papaya (papain).  It may be more helpful eating them with an empty stomach.

Warnings

Antihistamines sometimes cause dry mouth, headaches, and drowsiness, but a bigger drawback is that they tend to become less effective with long-term use.

The major hazard with nasal-delivery decongestants, particularly long-acting forms, is a cycle of dependency and rebound effects.^[3] The 12-hour brands pose a particular risk for this effect.

• With prolonged use (more than 3 - 5 days), nasal decongestants lose effectiveness and can cause swelling in the nasal passages.
• The patient then increases the frequency of the dose. As the congestion worsens, the patient may respond with even more frequent doses.
• This causes dependency and increased nasal congestion.

The following precautions are important for people taking nasal decongestants:

• When using a nasal spray, spray each nostril once. Wait a minute to allow absorption into the mucosal tissues, and then spray again.
• Do not share droppers and inhalers with other people.
• Discard sprayers, inhalers, or other decongestant delivery devices when the medication is no longer needed. Over time, these devices can become reservoirs for bacteria.
• Discard the medicine if it becomes cloudy or unclear.
• DO NOT USE NASAL DECONGESTANTS FOR LONGER THAN THREE DAYS.

Also be warned that improper use of a steroid spray can cause harms:

• The side effects include nasal dryness and irritation, sore throat, headache, and bleeding sores in your nose.
• Improper use can lead to a hole in your septum in rare cases, and long-term use may increase the risk of cataracts or glaucoma.  
• Always consult your family doctor if you're using an over-the-counter steroid spray for more than a month, you have side effects, or your symptoms don't improve.

Photo Credits

• WebMD

References

1. National Allergy Forecast Map
2. NAB Pollen Counts
3. Allergic Rhinitis (The New York Times)
4. Allergy medications: Know your options
5. H₁ antagonist
6. Consumer Reports Best Buy Drugs
• Cetirizine 10 mg tablets
• Loratadine 10 mg tablets (see side effects here)
• Loratadine dissolving 10 mg tablets
• Loratadine liquid 10 mg
• Alavert dissolving 10 mg tablets
7. How to Address Allergies and Asthma Symptoms as “Worst Allergy Season Ever” Begins
8. Allergy Remedies: Fact or Fiction
9. 咳傷身！白色蔬食有助呼吸道保養、修復
10. Acupuncture May Help Seasonal Allergies, Study Finds
11. Foods That May Worsen Pollen Allergies
• Check here for the list of foods to avoid if you are allergic to:
  • Ragweed
  • Birch pollen
  • Grass
  • Latex rubber
12. Leaky Gut Syndrome and Autoimmune Disease
13. 白色食物除秋燥
• 中醫師陳旺全提及，在五色中，白色入肺，這也是一般常聽到秋天可以多吃一些白色食物來滋養肺部的關鍵。
14. Do I need to include probiotics and prebiotics in my diet?
15. 過敏？吃鳳梨、木瓜消炎！｜台灣好食材
16. Health Benefits of Eating Fermented Foods (Travel to Health)
17. Allergy Capitals
• The top 5 cities for 2015 are:
1. Jackson, MS
2. Louisville, KY
3. Oklahoma City, OK
4. Memphis, TN
5. Knoxville, TN
18. How to Survive Springtime Allergies
• Omega-3s
• Stinging Nettle
• Butterbur
• Neti Pots
• Flavonoids
19. The 15 Sneeziest, Wheeziest Cities in America
20. Pregnancy and asthma: Managing your symptoms (Mayo Clinic)
• Some concerns have been raised about the use of systemic glucocorticoids during pregnancy, which has been linked with an increased risk of infant oral clefts, premature birth, low birth weight and preeclampsia.
21. The global pollen problem is getting worse and worse
• Allergies in general are on the rise possibly because of:
• Hygiene hypothesis
• Rising carbon dioxide levels, which has caused plants producing more allergy-causing pollen
• Climate change has increased the potency of pollen (i.e., ragweed pollen)
22. How honey kills bacteria
• High concentrations of the antibacterial compound methylglyoxal (MGO) were found specifically in Manuka honey
23. Your guide to surviving allergy season
24. Acupuncture and Herbs Relieve Hay Fever
25. Pollen Allergy (video)
26. Allergies? Probiotic combination may curb your symptoms, new study finds
27. Health Benefits of Omega-3 Fatty Acids (Travel and Health)
28. Asthama (Wikidoc)
29. A new Could Allergy Drops Be the Key to Allergy Relief?
30. Allergy or Intolerance: How Can You Tell the Difference?
31. Respiratory and allergic diseases: from upper respiratory tract infections to asthma
32. Food Allergy Tests for Kids: What You Need To Know

Leaky Gut Syndrome and Autoimmune Disease

There are many protective barriers existing on human bodies. For example, they can be found in:

• Gut^[17,24]
• Airways
• Skin
• Oral cavity
• Vagina
• Placenta, etc.

Here we will focus on the barrier existing in the gut. In a perfect digestion world, only small building blocks are all that would be absorbed into our bloodstream^[14] – but this is not what happens when you have leaky gut.

Bricks and Mortar Model

The total surface area of the gastrointestinal system is approximately 300 to 400 sq. m.  Only a single epithelial layer separates us from enormous amounts of antigens of both dietary and microbial origin.^[25]

All the cells that line our digestive system are held together by a brick and mortar system called the “tight junctions”.^[14,23] These tight junctions hold the cells close together (like a glue of sorts). In other words, the barrier in the gut is composed of:

• Bricks
• Which is made of intestinal cells
• Mortar
• Which consists of intercellular tight junctions
• Researchers at the University of Maryland School and Harvard Medical School recently identified a molecule called zonulin that can play a detrimental role in the "mortar" part.^[1,9]
• ^{Zonulin is a novel human protein analogue to the Vibrio cholerae derived Zonula occludens toxin}
• ^{Zonulin can induce tight junction disassembly and a subsequent increase in intestinal permeability in non-human primate intestinal epithelial.}
• ^{Zonulin expression was raised in intestinal tissues during the acute phase of coeliac disease, a clinical condition in which tight junctions are opened and permeability is increased.}

 (Source: [30])

Figure 1.  Prevention of gut-barrier dysfunction in arthritis ameliorates joint inflammation^[30]

Leaky Gut Syndrome

The lining of your intestines is a sensitive environment critical to your health. Sitting on top of this cell lining is a layer of mucus that is also an important part of the barrier.^[13] This barrier's job is to regulate everything that passes between your intestine and the rest of your body. Together with the immune cells located in your gut, the barrier helps control how your immune system reacts to anything foreign. When the barrier is weak or comprised, you have a condition called leaky gut symdrome.

Video 1.  Gut Dysbiosis - Starving Our Microbial Self (YouTube link)

Leaky Gut Syndrome and Autoimmune Disease^[2,9,10,12]

The latest research on leaky gut syndrome and autoimmune disease shows that almost everyone with an autoimmune disease has leaky gut syndrome.^[3,4]

Leaky gut allows anything that is inside your intestines to be "seen" by the immune system that is lying beneath your intestinal lining. When this exposure is chronic, meaning that it goes on and on for months, the immune reaction over time begins to malfunction, putting you at risk for an autoimmune disease.

This is what happens: When your intestinal barrier is weak or broken down, partially digested food or antigens from bacteria and yeast can seep into your body, bump into the lymphoid tissue and immune cells in your gut, and then also get into your bloodstream. Your immune cells react by making lots of T helper cells, which are directly in charge of revving up the killer cells and antibody-producing cells to attack anything they don't recognize as an invader. However, problems can occur when your body starts producing an abundance of T helper cells, especially if the T regulator cells don't do their job to turn this attack off.

Symptoms

People with leaky gut syndrome often have digestive symptoms such as constipation or gas and bloating after they eat. But it is also possible to have leaky gut syndrome and have absolutely no digestive symptoms at all. Instead you might feel your hands and feet swell up after you eat, your muscles are tight and stiff in the morning, and you have brain fog and difficulty thinking after eating certain foods. These symptoms are a result of what's called systemic inflammation,^[2,8] which simply means that there are irritating molecules running around your body after eat certain foods. Sometimes it is hard to know which food is the culprit because it seems like you react to so many.

Besides the conditions above, general symptoms of leaky gut are vast given the indirect impact of a leaky gut on the entire body’s health and capacity for handling stressors. Some of the most common include:^[5]

• Allergies and skin rashes
• Anxiety, fatigue, poor concentration, irritability, moodiness
• Headaches
• Impaired immune functions or frequent colds

What Causes Leaky Gut?

There are many things that can cause leaky gut. For example, the mortar in between the cells gets damaged by things like:^[2]

• Dysbiosis  by exposure to yeast candida, parasites, bad bacteria, or glyphosate (i.e., the active ingredient in Roundup)
• Bad bacteria can secrete enzymes that destroy the "mortar" between the cells
• In 2013, scientists show that gut dysbiosis, brought on by exposure to glyphosate, plays a crucial role in the development of celiac disease.^[20]
• Severe or chronic stress
• Acute emotional or physical trauma, such as surgery or food poisoning
• Alcoholism
• Certain medications
• Antibiotic use
• Non-steroidal anti-inflammatory drugs (NSAIDs), medications such as ibuprofen and other prescriptions.
• Viral infection
• Infections or exposures that were never resolved, such as traveler's diarrhea or a parasite
• Toxins
• Those secreted by the yeast candida:
• They can bind to part of the protective barrier, breaking it down
• They also can create pores across the membranes of the barrier
• Chemotherapy
• Vitamin D Deficiency
• Vitamin D deficiency may compromise the mucosal barrier, leading to increased susceptibility to mucosal damage and increased risk of IBD.^[23]

When leaky gut happens, you are also likely to develop food sensitivities. These food sensitivities can happen not only in childhood but later in life, too. It's true that some people can outgrow food allergies. However, symptoms of food allergies can return just as mysteriously as they disappeared.^[16] In [17], scientists have speculated on the effect of increased intestinal permeability on the onset of sensitization towards dietary antigens. So, it seems that the recurring of food sensitivities could be related to the permeability of intestinal barrier.

Conclusions

Maintaining a strong barrier is the best way to keep your immune system healthy, which means that it knows when to turn on and off, knows the difference between self and not self and has tolerance of the good bacteria lining the digestive tract.

Photo Credit

• Arthur John Elsley
• Figure 1 in [20]

References

1. A. Fasano. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol 2012 Feb; 42(1):71-78.
2. The Immune System Recovery Plan by Susan Blum, M.D. M.P.H.
3. Linda Chia-Hui Yu et al. Host-microbial interactions and regulation of intestinal epithelial barrier function: from physiology to pathology. World J Gastrointest Pathophysiol 2012 Feb 15; 3(1):27-43.
4. Katherine R. Groschwitz and Simon P. Hogan. Intestinal barrier function: molecular regulation and disease pathogenesis. J Allergy Clin Immunol 2009; 124:3-20.
5. Leaky Gut (Core One Health)
6. Fasano A, Not T., Wang W. et al. Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease. Lancet. 2000;355:1518–1519.
7. David Seaman: Inflammation From Our Diet Is Killing Us Slowly
8. Body mass index and musculoskeletal pain: is there a connection?
9. New Research Shows Poorly Understood “Leaky Gut Syndrome” Is Real, May Be the Cause of Several Diseases
• In the 1980s, the UCLA researchers found that leaky gut preceded inflammation, implying that the leakiness plays a key role in Crohn's disease development.
• Harvard celiac researcher, Alessio Fasano, MD found that our bodies make a protein (with the nifty name, “Zonulin”) that essentially unzips the tight junctions that seal the intestinal lining.
10. Researchers Find Increased Zonulin Levels Among Celiac Disease Patients
11. Dr. M's Seven-X Plan for Digestive Health: Acid Reflux, Ulcers, Hiatal Hernia, Probiotics, Leaky Gut, Gluten-free Gastroparesis, Constipation, Colitis, Irritable Bowel, Gas, Colon Cleanse/Detox & more
12. Ulcerative colitis flare-ups: 5 tips to manage them
• Ulcerative colitis, like its sister condition Crohn's disease, is treated as an autoimmune disease.
13. Mucus is Retained in Cystic Fibrosis Patients’ Cells, Leads to Potentially Deadly Infections
• This is what happens when your mucus malfunctions:
• Cystic fibrosis is that mucus lining the lungs, pancreas and other organs is too sticky, which makes it difficult for the organs to work properly and, in the lungs, attracts bacteria and viruses resulting in chronic infections.
14. Physiology Of The Small Intestine
15. Sarah Ballantyne on The Paleo Approach and the Autoimmune Protocol
• Leaky gut could be influencing the immune response
• Eating to promote intestinal health is the same as eating to support immune health
16. Can you outgrow your allergies?
17. Gut permeability and food allergies
18. The Epithelial Gatekeeper Against Food Allergy (good)
• Intestinal epithelial barriers play a crucial role in the maintenance of gut homeostasis by limiting penetration of luminal bacteria and dietary allergens, yet allowing antigen sampling via the follicle-associated epithelium for generation of tolerance.
19. Early Studies Linking Gut Bacteria to Atherosclerosis, Offer Tantalizing Glimpse at New Drug Target
20. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance (31 citations)
21. Immune homeostasis, dysbiosis and therapeutic modulation of the gut microbiota
22. Increased Intestinal Permeability Correlates with Sigmoid Mucosa alpha-Synuclein Staining and Endotoxin Exposure Markers in Early Parkinson's Disease
23. Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier
24. Macdonald TT, Monteleone G. Immunity, inflammation, and allergy in the gut. Science. 2005 Mar 25;307(5717):1920-5.
• The Gut Epithelial Barrier – The primary cellular barrier of the bug in preventing antigens encountering the immune system is the single layer of gut epithelium
25. D M Saulnier, S Kolida, G R Gibson. Microbiology of the human intestinal tract and approaches for its dietary modulation. Curr Pharm Des. 2009;15(13):1403-14.
26. Broccoli improved digestive issues similar to symptoms of leaky gut and colitis in animals
• Same for other vegetables, like brussels sprouts and cauliflower 
27. Gut microbes could help trigger multiple sclerosis
28. Putting a stop to leaky gut (Harvard Medical School)
29. The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics
30. Intestinal barrier dysfunction plays an integral role in arthritis pathology and can be targeted to ameliorate disease
31. Extra Virgin Olive Oil Reduces Gut Permeability and Metabolic Endotoxemia in Diabetic Patients
• Addition of Extra virgin olive oil to a Mediterranean diet or chocolate improves gut permeability and low-grade endotoxemia.