Integrative Therapies for Spring Allergies

Warmer weather, blossoming trees and budding flowers, the hopeful markers of spring, are also bearers of bad news for allergy sufferers. Integrative therapies with good scientific evidence for allergies are available.

 

A recent review conducted by researchers from the Department of Complementary Medicine, Peninsula Medical School, University of Exeter, England, evaluated the efficacy of herbal medicines for the treatment of allergic rhinitis. The authors reported that there is encouraging evidence suggesting that butterbur may be an effective herbal treatment for seasonal allergic rhinitis. There are also promising results generated for other herbal products, particularly Aller-7 (an Indian herbal combination), Tinospora cordifolia (Guduchi, an herbaceous vine of the family Menispermaceae indigenous to the tropical areas of India, Myanmar and Sri Lanka), Perilla frutescens (Green Shiso, an ornamental plant in the Lamiaceae family) and several Chinese herbal medicines.

 

The plants butterbur and bromelain, probiotics and nasal irrigation therapy have been found to have positive effects on allergy symptoms.

 

Butterbur is a perennial shrub found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests and adjacent to rivers or streams. The leaves of the plant are responsible for its botanical and common names. The common name is attributed to the large leaves that have been used to wrap butter during warm weather.

 

Butterbur has been traditionally used as an antispasmodic and analgesic (pain reliever), specifically for conditions afflicting the stomach, bile ducts and duodenum (part of the small intestine). Butterbur is believed to help strengthen digestion and improve obstructed bile flow. Butterbur has also been given for inflammation of the urinary tract and cramps. There is compelling initial evidence from human trials to suggest benefits in the prevention of migraine headache. Evidence in support of the use for allergic rhinitis prevention is also promising.

 

Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra®) and cetirizine (Zyrtec®), have reported similar efficacy. These results suggest benefits of butterbur for the prevention of allergic rhinitis. Additional study is warranted before a strong recommendation can be made.

 

Classified as an herb, bromelain is a sulfur-containing digestive enzyme that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus, family Bromeliaceae). When taken with meals, bromelain assists in the digestion of proteins; when taken on an empty stomach, it acts medicinally as an anti-inflammatory agent.

 

Bromelain was introduced in 1957 and has been used in many clinical trials. Its use in digestion, inflammation and sinusitis has been substantiated by clinical evidence.

 

It is proposed that bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation/swelling. Studies report mixed results, although overall bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a strong recommendation can be made.

 

Probiotics are beneficial bacteria (sometimes referred to as "friendly germs") that help to maintain the health of the intestinal tract and aid in digestion. They also help keep potentially harmful organisms in the gut (harmful bacteria and yeasts) under control. Most probiotics come from food sources, especially cultured milk products. They can be consumed as capsules, tablets, beverages, powders, yogurts and other foods.

 

Probiotics work by colonizing the small intestine and crowding out disease-causing organisms, thereby restoring proper balance to the intestinal flora. They compete with harmful organisms for nutrients and may also produce substances that inhibit growth of harmful organisms in the gut.

 

Probiotic bacteria have been found to stimulate the body's immune system. They may also aid in several gastrointestinal illnesses such as inflammatory bowel diseases, antibiotic-related diarrhea, Clostridium difficile toxin-induced colitis, infectious diarrhea, hepatic encephalopathy, irritable bowel syndrome and allergies.

 

The use of probiotic Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce the frequency of relapses and the need for antibiotic therapy. Only a small variety of probiotic combinations have been studied in the treatment of allergies, mostly with children, teenagers and young adults. Studies of inhalant allergy conditions, such as allergic rhinitis (nasal inflammation and discharge), during pollen season have had mixed results. Some studies have found no benefits, while others have found benefit from adding probiotics to fermented milk.

 

There is also evidence that yogurt may improve or prevent the recurrence of allergic rhinitis. Studies of allergic skin reactions in infants (allergic dermatitis, atopic eczema) suggest that supplementation, including for breastfeeding mothers, may reduce frequency, symptom levels and duration.

 

Yoga enthusiasts have used the technique of nasal irrigation for thousands of years to clear the sinus cavity and also to clear the mind. There is growing scientific evidence to support its practice since proponents believe that it is more natural, soothing, almost harmless and cheaper than many over-the-counter medications. It is also devoid of side effects, such as drowsiness and nausea, often associated with these medications.

 

Nasal irrigation is used to clear the sinuses and can be performed by the patient at home or by a professional up to twice daily provided the mucous membranes are not irritated by the procedure.

 

The three forms of nasal irrigation therapies used in clinical trials have been saline lavage, which uses a warm liquid solution; humidified warm air lavage (hyperthermia); and large-particle nebulized aerosol therapy, which uses aerosolized saline solution. Occasionally, antibiotics are added to the solution.

 

Studies support the use of hypertonic saline for nasal irrigation. There is good evidence in support of nasal irrigation for allergic rhinitis and sinusitis. There is promising early evidence for using nasal irrigation in treating common colds, respiratory symptoms from occupational exposure and in post-operative care following sinus or nasal surgeries.

Comments

[GM]

While not completely benign, the nasal irrigation or nasal douching offers a reasonable first line of treatment for allergy sufferers. Recently, on the Oprah show, Dr. Oz happened to mention the neti pot specifically and started a national craze for the product. I work in a pharmacy and have been recommending any of the nasal irrigation products for some time now, and not just for allergies, but also for other nasal congestion ailments. If you don’t mind the discomfort of pouring water through your nasal passages, then these products are often better alternatives than antihistamines, which commonly cause drowsiness.

[Julie]

I'm wondering how you actually take butterbur and bromelain? Do you just pick up supplements from the store? Is there a particular standardization I should be looking for? Do you just take them orally? Thanks!

[Jose]

I've also heard that eating honey produced from local bees may help treat spring allergies. I think honey supposed to help sensitize the body because it contains tiny, manageable amounts of plant allergens. Has anyone else heard about this or tried it?

[susan allport]

Thought you'd be interested in this short omega-3 video: http://www.youtube.com/watch?v=eIgNpsbvcVM

[Kelsy]

Ugh, I am not looking forward to allergy season. I need medications for my allergies; natural therapies just aren't effective enough. However, sometimes I use a saline nasal spray along with my meds. It seems to help.

[CE]

How do probiotics actually help to relieve allergies? When probiotics are taken orally, they remain in the GI tract and are not absorbed. This localized action is how they are helpful in reducing all of the GI issues mentioned. Using this line of thinking, then do probiotics need to be applied nasally? Otherwise, how are the bacteria supposed to reach the affected area.

[Bill]

Prevention is really the best way to get rid of allergy symptoms. If you're allergic to pollen, it's best to remain indoors in the morning and evening because this is when the outdoor pollen counts are the highest. I usually sleep with my air conditioning on at night. It's also a good idea not to dry your clothes outside. I've also heard that a humidifier can help remove some allergens out of the air, but I haven't tried this before.

[Dotty]

Research shows that children who have been breastfed are less likely to develop allergies than children who received formulas. In addition, a mother who avoids cow's milk, eggs, nuts and peanuts while breastfeeding may help prevent allergy-related conditions, such as eczema, in some children.

There is evidence that infants who are exposed to airborne allergens, such as dust mites and animal dander, may be less likely to develop related allergies.

[Kyle]

I've also heard that cat's claw may help treat allergic respiratory conditions. Early studies have assessed the effects of cat's claw in patients with allergic respiratory diseases, and a 10-year follow-up revealed that some patients experienced improvements.

[Britt]

Bromelain is known to cause IgE-mediated reactions of both the late phase reaction of immediate type reaction and immediate type with predominantly respiratory symptoms. The mechanism of bromelain's putative immunomodulatory activity is poorly understood. Bromelain has been shown to increase CD2-mediated T cell activation, to enhance antigen-independent binding to monocytes and to increase interferon (IFN)-gamma-dependent, tumor necrosis factor (TNF)-alpha, interleukin(IL)-1 beta, and interleukin(IL)-6 production in peripheral blood monocytes. These effects are thought to be due to bromelain's proteolytic activity at cell surfaces, whereby it either removes surface molecules or reveals ones that already exist on cell membranes, thereby altering receptor-ligand interactions. Recent studies have reported that bromelain proteolytically blocks activation of extracellular regulated kinase (ERK)-2 in T cells, resulting in inhibition of T cell signal transduction

[Barney]

In response to the comment concerning bromelain, can bromelain extracts still be used if a person is allergic to pineapple? In the Natural Standard monograph for bromelain, a cross-sensitivity to papain, wheat flour, rye flour, grass pollen and birch pollen is listed. This is important to know due to the fact that many allergy sufferers would be looking to take a product like bromelain to treat their allergies to grass pollen.

[Julie]

To answer Barney's question, I found this abstract very helpful:

The therapeutic efficiency and safety of the proteolytic enzyme bromelaine obtained from pineapple (Bromelain-POS, Ursapharm GmbH, Saarbrücken, Germany) was evaluated in children under the age of 11 years diagnosed with acute sinusitis. Data from 116 patients from 19 centres located across Germany were analysed in a pharmacoepidemiological cohort study. Patient cohorts were either treated with Bromelain-POS (N = 62), in combination with Bromelain-POS and standard therapies (N = 34), or with standard therapies (N = 20). The primary parameter measuring effectiveness of the different treatment groups was the duration of symptoms. The shortest mean period of symptoms was observed in patients treated with Bromelain-POS alone (6.66 days), followed by the standard therapy (7.95 days) and those treated with a combination of Bromelain-POS and the standard therapy (9.06 days). Patients of the Bromelain-POS monotherapy group showed a statistically significant faster recovery from symptoms (p = 0.005) compared to the other treatment groups. One 10-year-old male patient, with a known pineapple allergy, showed a self-limiting mild allergic reaction. No other unwanted side-effects were reported. This trial documents that the proteolytic pineapple enzyme Bromelain-POS is widely used in the treatment of young children diagnosed with acute sinusitis in Germany and that the use of proteolytic enzymes can benefit such patients. PMID: 15796206

It looks like people allergic to pineapple may have a reaction to bromelain; however, the only reaction discussed in the current literature was described as a "self-limiting mild allergic reaction."

[Andrew]

Has anyone tried allergy shots before? I think they're only for people with severe or long-term allergies, but it focuses on treating the immune system, rather than just the symptoms.

The therapy works like a vaccine. A diluted extract of the allergen that the patient is allergic to is injected into the patient. The patient responds to the treatment by developing an immunity, or tolerance, to the allergen. As a result of these immune changes, immunotherapy can lead to decreased, minimal or no allergy symptoms when the patient is exposed to the particular allergen again.

[Mike]

A high-efficiency particulate arresting (HEPA) filter can help remove allergens from the air at home or in the office.

A HEPA filter can remove more than 99% of indoor airborne particles that are 0.3 micrometers wide. This includes allergens, such as dust mites, pollen, animal dander and mold, as well as bacteria. Even though particles of this size, also called the most penetrating particle size (MPPS), are the most difficult to filter, a HEPA filter can remove almost all of them from the air. The HEPA is able to filter particles that are larger and smaller than 0.3 micrometers with even greater efficiency.

[Dave]

Butterbur, to me, seems to have conflicting mechanisms of action for the treatment of allergic rhinitis or sinusitis. On one hand, butterbur may down-regulate leukotriene synthesis which may indeed help with allergic rhinitis. However, butterbur’s vasodilatory properties may worsen symptoms of sinusitis (i.e. nasal congestion). Butterbur’s comparison in trials to both fexofenadine (Allegra®) and cetirizine (Zyrtec®) make me wonder if it contains an anti-histaminic properties as well.

[LM]

Seasonal allergies are a major concern among many this time of year. Natural remedies, such as changes in diet and exercise, are alternatives to medication therapy. Although results of alternative treatments, such as eating yogurt or practicing yoga, for relieving symptoms of spring allergies are not groundbreaking, these changes are safe and provide overall health benefits. These changes, along with herbal supplements, may even be more cost effective for consumers compared to more costly drug therapies.

[Larry]

I think allergies shots are great and the way to go if I were an allergy sufferer. The principals are just like what they have been doing for years with antibiotics. If someone is allergic to a substance you can often acclimate, or get them used to it, by small exposures that won’t trigger a full-scale immune response. I would much rather try to get rid of my allergies than have to treat them every year.

[laura]

Neti pots work, but for convenience and ease of use, I am a nasopure fan. No bending and twisting. It helps keep my nose open during allergy season. I think nasal washing is the best defense against allergens.