Friday, April 8, 2011

Allergy season starts again

Last year, a friend of mine wrote to me looking for advice about his seasonal allergies. As soon as spring started to take hold in Massachusetts, he’d be sneezing and stuffed up, and would remain so for months. For years, he’d been taking Claritin and Zyrtec but wanted to cut back on them, going instead for a more natural approach. I made some recommendations, and he was able to cut his usage back to about 25% of what it had been previously! He emailed me last week to let me know about his continued success, and is looking to see how much more he can do this year… Maybe even go off the meds altogether. We’ll see how it goes, but it got me to thinking that I probably ought to write about natural approaches to allergies.

The first line of defense when it comes to allergies for most naturopathic doctors are vitamin C. Simple and unassuming, sometimes overlooked, vitamin C packs a punch against seasonal allergies. The exact mechanism is as yet unknown, although it appears as though it helps to block histamine release, as well as improving the breakdown of histamine once it is released. Dosing with vitamin C is variable, but 1-2 grams per day is an average dose. During acute flares, some patients take higher dosages, but this should only be pursued while under the supervision of a doctor, as there can be some side effects – loose stool and abdominal cramping being the primary one.

Quercetin comes next on the list, and for similar reasons – it’s a mast cell stabilizer that prevents those cells from releasing of histamine. Dosage is lower than the vitamin C dosage, and quercetin doesn’t generally come with any abdominal symptoms. Try going for around 500-1000 mg per day. In my experience, this does not have as strong an immediate effect as vitamin C, but can bring great results if used for long-term maintenance and prevention of seasonal allergies. Quercetin is often available in products along with vitamin C, making it easy to get these nutrients together. The friend I mentioned above used what is often called a ‘QBC’ product, meaning that it contains quercetin, bromelain and vitamin C. Bromelain is used in these products because it is an anti-inflammatory enzyme – when taken on an empty stomach, it enters the bloodstream and helps break down inflammation-producing molecules.

There is some question about the exact mechanism by which quercetin acts in allergies, as it is absorbed poorly in the gut, but nonetheless, it’s used clinically with great success. In vitro research has clearly shown that it acts directly on mast cells with great efficacy, leading a teacher of mine to suggest that its actual mode of action is calming the immune response in the gut, thus indirectly calming the systemic immune system.

It seems that people can’t get enough of probiotics lately, and allergies are no exception. Several studies have emerged recently that indicate that various preparations of probiotics help to relieve allergy symptoms. The exact mechanism is as yet unclear, but it has been suggested that the positive effect may come from actually influencing the immune system to shift the type of immune cells it produces – a shift from Th2 cells to Th1 cells, a shift associated with a less allergic immune response.

One issue in the use of probiotics that hasn’t been fully answered is the question of what strains to use. Clinical trials of probiotics always use specific strains of probiotics, because such is the nature of clinical trials – in order to meet the standards of clinical trials and facilitate reproducibility, researchers need to note exactly what species and strain was used to generate the results. Unfortunately, this doesn’t always translate to what is available to consumers! Here’s the good news, however – other research states that non-allergic people have higher levels of beneficial bacteria in their digestive tracts across the board, not just one or two strains. This means that probiotics of various types may offer benefit to those with allergies, so as long as you are buying from a reputable brand, you are in the clear.

Fish oils are sometimes used by clinicians for allergies, and although the research isn’t as strong, the reasoning is straightforward. As I’ve stated in previous columns, unsaturated fats, like those found in fish oil, are used by the body to produce anti-inflammatory compounds. This is in contrast to saturated fats, which are used to produce inflammatory versions of those same compounds. The logic says that by reducing saturated fats and increasing unsaturated fats, you shift the body towards a non-inflammatory state. Fish oils are a good idea for almost everyone anyway, and while the research isn’t specifically there for allergies, I recommend this as a general health measure.

And finally, for those of you who thought you could get away this allergy season by just taking vitamins, here’s the part where I say you should eat veggies and exercise. So there it is. Eat veggies and exercise. End of story.

Actually, it’s not the end of the story, but everything I’ve already said will be repeated here in this section. Less fatty meat and more fish will shift your body towards a less inflammatory state. Yogurt, sauerkraut, and other fermented foods contain live probiotics that can help promote healthy gut flora. Remember that veggies are chock full of vitamin C and bioflavinoids (like quercetin), which help to block the release of histamine, and the other antioxidants and minerals may help out as well.

I also want to make sure that I recommend drinking plenty of water and exercising. Part of the problem with allergic symptoms is water balance. Some folks have thick mucus that blocks their nasal passages, others have profuse flowing snot – either way, it’s a question of balance. By consuming water regularly and sweating it out, you help train your body to regulate the flow of water, not to mention helping to keep a steady flow of inflammatory compounds out of the body. There is, of course, no research showing this to be true, but I but I think it’s sound judgment. Let’s be honest, drinking water and exercising are helpful anyway, so get out there and get moving!

Long as this list might seem, it can actually be broken down into a fairly straightforward regimen. Eating vegetables and drinking plenty of water is the basis for any healthy regimen, as is moderating the amount of saturated fat you eat, and increasing unsaturated fat. Beyond that, make sure you get enough vitamin C and bioflavinoids (like quercetin) – in high doses like the ones listed above, they can really shut down the allergic cascade. Finally, probiotics seem to help just about everything, and the research is clearly there on allergies, so make sure you get those little guys in every day. Most importantly, all of these recommendations help prevent allergies in different ways, which means they won’t interact with one another, and will have an additive effect by shutting down your allergies in multiple locations.

And remember: the earlier the better – the more you can do to get your allergies under control now, before they start, the better. An ounce of prevention is worth a pound of cure.