By Dr. Carla Cashin, ND
This is the time of year for hay fever, or in medical terms, allergic rhinitis. Symptoms of itchy eyes, ears, nose, and throat, sneezing, runny nose, and nasal congestion can be very uncomfortable and unrelenting for those who experience hay fever. For many, hay fever is a seasonal condition starting as early as February and ending as late as October, while for others it lasts all year round. Common hay fever triggers include pollen (tree, grass, and ragweed), animal dander, mold, and dust mites. Can those suffering from hay fever find any reprieve? Furthermore, can hay fever be eliminated altogether? Naturopathic medicine offers a unique approach to hay fever management and possibly even a cure.
What are conventional treatments for hay fever?
Conventional treatments for hay fever include a combination of medications such as antihistamines, stimulants, and intranasal corticosteroids. The first generation antihistamines such as Benadryl (diphenhydramine) have been replaced with newer generation antihistamines such as Claritin (loratadine) and Aerius (desloratadine) to prevent the unwanted symptom of drowsiness. This class of drug can be useful in mild hay fever if taken prophylactically as it blocks histamine, the chemical responsible for inflammation of mucous membranes. In adults, stimulants such as pseudoephedrine are used to address nasal congestion. Pseudoephedrine has significant side effects and the potential for abuse, and it is not approved for use in children
The cornerstone of conventional treatment of hay fever is intranasal corticosteroids such as Nasonex (mometasone furoate monohydrate) and Flonase (fluticasone proprionate). Intranasal corticosteroids shut down the inflammatory response and are demonstrated in clinical studies to be more effective than antihistamines in alleviating symptoms in cases of moderate to severe hay fever. While these medications can be prescribed by your ND and definitely have their place in the management of hay fever, they do not address the underlying cause of hay fever – immune dysregulation – and lead to relapse of symptoms once discontinued.
Do any conventional treatments treat the root cause?
Perhaps the most interesting conventional approach to hay fever is immunotherapy. This therapy provided by allergists involves an injection of a small, diluted amount of an allergen, for example, tree pollen. The theory behind this therapy is that it retrains the immune system to become more tolerant of a particular allergen. Studies show that with 3 to 5 years of immunotherapy, hay fever symptoms can be dramatically reduced or eliminated altogether. This type of therapy makes a lot of sense as it addresses the root cause of hay fever – inappropriate immune response. Increasing in popularity is sublingual immunotherapy, which involves taking drops under the tongue daily instead of regular injections. In fact, the World Health Organization (WHO) has endorsed sublingual immunotherapy as a viable alternative to injection immunotherapy. Naturopathic physicians can prescribe sublingual immunotherapy.
What else can naturopathic physicians do to address allergies such as hay fever?
From a naturopathic perspective, treatment focuses not only on symptomatic relief but also addressing immune imbalances contributing to the disease process. For symptomatic relief, natural antihistamines such as Quercetin, Bromelain, Vitamin C and Bioflavonoids, or free-dried Nettle are used. As well, herbs such as Eyebright (Euphrasia officinalis) and Goldenseal (Hydrastis canadensis) can alleviate eye inflammation and nasal congestion. To address immune imbalances, immune herbs and probiotics are implemented.
What’s the scoop on Echinacea?
My favorite immune herb is Echinacea. This is a very well known herbal medicine but unfortunately it is commonly misunderstood and mismanufactured. Echinacea is best known for its role in acute cold and flu prevention and treatment. Many herbalists believe it is to be used only for short term use and avoided in conditions such as allergies, autoimmune disease, and cancer because it was previously understood to be an immune stimulant. However recent research suggests it has an immune modulation action instead and can be safely used in such conditions (Phytotherapist Perspective, 2004). The other concern with Echinacea is that it is poorly manufactured by most companies. The active ingredients (alkylamides) of Echinacea are most concentrated in the roots and are greatest in the species Echinacea angustifolia yet some products are made from the leaf or species such as Echinacea purpura or Echinacea pallida. High quality Echinacea products should make your tongue tingle, since the active ingredients promote salivation.
What other herbs support immune balance and inflammation in hay fever?
Other herbs that have a role in modulating the immune system with respect to hay fever include Albizia (Albizia lebbek) and Licorice (Glycyrrhiza glabra). A randomized controlled clinical trial compared oral use of Albizia to corticosteroid eye drops for relief of itchy eyes associated with hay fever (J Res Educ Indian Med, 1992). The corticosteroid eye drops relieved symptoms sooner but all patients experienced a relapse of symptoms once discontinuing the medication. In contrast, those using oral Albizia found symptom relief took longer but only a quarter of patients experienced a relapse of symptoms. This study suggests a role for Albizia in hay fever management. Licorice has a similar action to corticosteroids but is associated with fewer side effects, making it a possible alternative to corticosteroid use.
I’ve heard so much about probiotics, is it true that they can help my hay fever?
Probiotics are one of the most frequently prescribed supplements in my practice. This is because they have such an important role in gut heath but also in supporting our immune system. Research shows that they can reduce incidence and duration of cold and flu in children (Pediatrics, 2008). As well, supplementation with probiotics during pregnancy has been shown to prevent allergy, asthma, and eczema in infants and children (Lancet 2001, 2003). In addition, several clinical studies have shown that probiotic supplementation can reduce symptom severity and medication use in people with hay fever (Ann. Allergy Asthma Immunol., 2008). Though it is still not fully understood how probiotics influence our immune system, many clinical studies demonstrate a benefit for several immune related conditions.
How can I learn more about naturopathic medicine for management of hay fever and other allergies?
Contact Coco Chiropractic Wellness to book an initial visit to start treatment or a free ten minute consultation to learn more with Dr. Carla Cashin, ND.
Bone, K. and Berris Burgoyne. Echinacea: modern research confirms traditional use. Phytotherapist Perspective 2004 38.
Kalliomaki, M. et al. Probiotics and prevention of atopic disease: 4 year follow-up of a randomised placebo-controlled trial. Lancet 2003 361: 1869-71.
Kalliomaki, M. et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 2001 357: 1076-79.
Mukhopadhyay B et al. J Res Educ Indian Med 1992 11: 17
Ouwehand, G. and D, Carcano. Probiotics reduce incidence and duration of respiratory tract infection symptoms in 3- to 5-year-old children. Pediatrics 2008 121.