by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT
Seasonal allergies (also called allergic rhinitis), hay fever, or any other type of allergy can be deeply uncomfortable. Symptoms usually feel like the first signs of a cold; sneezing, runny nose, red, watery, puffy or itchy eyes, itchy nose, nasal irritability and congestion, itchy throat, hoarseness, shortness of breath or wheezing, coughing, skin rash and/or itchy ears. With hay fever, symptoms usually appear when a person encounters an allergen, such as pollen, dust or mold.
Allergies are increasingly common. From 1988 to 2006, the prevalence of self-reported physician-diagnosed seasonal pollen allergy (or hay fever) increased from 8.8% to 11.3% (1). Asthma prevalence in the US population in 2005–2006 was estimated to be 14.1% (1). Allergic rhinitis, commonly known as seasonal allergies or hay fever, has been associated with a lack of sleep, reduced productivity at work or school, emotional distress, and embarrassment (2).
Over the counter (OTC) non-prescription medications exist, with mixed results in terms of effectiveness. Current medications for allergies can have undesirable side effects such as dry mouth, drowsiness and sleeplessness (2), which may affect quality of life. It is far from ideal to be reliant on these OTC medications. Getting to the root cause of seasonal allergies and addressing that is preferable for many.
Seasonal allergy is typically triggered by airborne allergens: pollens, animal dander, dust mites or mold.
Causes of seasonal allergies:
Modern hygiene has been blamed for the increasing prevalence of allergies. The increasing incidence is thought to be related to a reduced microbial exposure (3). Children who have fewer exposures to allergens in early life, such as those in small families, are more likely to develop seasonal pollen allergy or eczema (1). Children in households with at least 2 dogs or cats are 70% less likely to test positive for allergies (1). In Europe and other modern societies, risk for allergy and asthma are lower for children on farms (1). Asthma prevalence increases with migration from a less to a more highly industrialized country (1).
Allergies are an immune system reaction to an allergen. The immune system reacts to a foreign substance such as pollen or pet dander, and creates antibodies which tag the foreign substance as if it is a harmful pathogen, even though it isn’t. When confronted with the allergen, the antibodies produced by the immune system will react and release certain substances such as histamine that will cause inflammation and allergy symptoms.
Inflammation is part of the allergic reaction. Histamine is stored in white blood cells of the immune system (in basophils and mast cells) and is a significant contributor to allergy symptoms, particularly in allergic rhinitis or seasonal allergies (4). Increases in both plasma and tissue levels of histamine have been observed in allergic reactions in the skin, nose and lungs (4).
Given that 70-80% of the immune system is based in the gut, allergies are, like many other conditions, closely related to gut health. This is one of the big root causes of allergies.
Gut issues that may be at the root of allergies include:
- Intestinal permeability (aka ‘leaky gut’)
- Small Intestine Bacterial Overgrowth (SIBO)
- Yeast overgrowth (like candida as one example)
- Dysbiosis (excessive bad bacteria that have been linked with immune issues and autoimmunity)
- Other gut infections like parasites, worms, or certain viruses
These gut issues can be problematic for the immune system and lead to the development of allergies. Gut function should be addressed when treating allergies and a good functional medicine doctor will screen for and treat gut issues for those with allergies as a complaint.
Multiple studies show that the health of the gut microbiota influences allergy reactions:
- One study states that altered gutmicrobiota is associated with several diseases, including allergic diseases (5)
- Another study found that American adults with allergies, especially to seasonal pollen, have low diversity in gut bacteria and an imbalance in the types of gut bacteria strains (1). This is indicative of a gut that is not optimally healthy. The source of the dysbiosis is unknown but the authors of the study suspect that Caesarean births may play a role in the cause of the dysbiosis (1).
- A study looked at people with a confirmed allergy to birch and gave them a probiotic combination of the strains acidophilusand B. lactis Bl-04 during peak birch allergy season (3). The results showed that the probiotics positively influenced markers of respiratory allergy, and showed a reduction in reported nasal symptoms (3).
- One study found changes in the production of inflammatory immune cells were observed in patients treated with probiotics. These data show that probiotic supplements modulate immune responses in allergic rhinitis and have the potential to improve the severity of symptoms (6).
- Quality of life for seasonal allergy sufferers improved when given a combination probiotic (Lactobacillus gasseriKS-13, Bifidobacterium bifidumG9-1, and longum MM-2) for 8 weeks at a dose of 3 billion colony-forming units (or CFUs) during spring allergy season (2). The study subjects were healthy individuals with self-reported seasonal allergies (2).
In addition to addressing the root causes of allergies (typically related to the gut and immune system), there are other interventions beyond OTC medications that can help reduce symptoms, often with fewer side effects. We will first cover solutions that get to the root cause of allergies, and then look at remedies to help with acute symptoms during allergy season.
Solutions – getting to the root: What can you do to reduce or eliminate your seasonal allergies for good?
- Probiotics: Clearly there are multiple studies that show how probiotics can help prevent and alleviate seasonal allergy symptoms (2, 3, 5, 6). Probiotics boost the immune system and help to populate the gut with good bacteria. There are various strains that show up in research; most of them are strains of lactobacillus and/or bifidobacterium. A professional-grade multi-strain lacto/bifido blend probiotic of at least 15 billion CFU (preferably 25-100 billion for a time when working on a root causes of allergies) can be helpful. You can order professional grade probiotics here (we like Ortho Biotic 100 if you want to try a product with 100 billion CFU that is also multi-strain)
- Heal the gut: The health of the gut microbiome is now known to be associated with good health. Poor gut health is linked to so many conditions and diseases. Again, given that 70-80% of the immune system resides in the gut, this makes perfect sense. Find out if you have any gut infections or overgrowths (SIBO, parasites, candida, dysbiosis, leaky gut or others). A SIBO lactulose breath test (be sure it is 3 hour and measures hydrogen and methane) together with a stool test like the GI-MAP or a CDSA with Parasitology will help to rule out many gut conditions as well as show what strains of bacteria and how many are in your gut. Once armed with this information, you can implement targeted therapeutic approaches to improve your gut health. Working on gut health will improve your reaction to seasonal allergies. To work with a functional medicine doctor and get comprehensive testing for gut health, click here to book a free 15-minute discovery call to answer any questions and give you the opportunity to schedule with one of the functional medicine doctors in our clinic. We consult with clients world-wide.
- Nutrients for T-Regulatory Cell activation: T-Regulatory cells are involved in calming overactive immune responses by producing regulatory cytokines. Cytokines are usually inflammatory molecules, but certain cytokines like IL-10 can help prevent immune cells from attacking your own body (autoimmunity) or reacting to food or environmental triggers. These cells have receptors for Vitamin D and Vitamin A right on the cells themselves. A nutrient in cruciferous vegetables can also help T-reg cell production.
- Getting enough sunlight on unprotected skin (skin without sunscreen, but not enough sun to burn or even turn pink) for at least 5 days per week between 11am – 3pm can optimize vitamin D production for most people. For fair skinned individuals, this can be as little as 15 minutes 5 days per week.
- Eating at least 4oz of liver per week or taking 1 tsp Cod Liver Oil per day provides a good amount of pre-formed vitamin A. The nutrient in carrots is actually called beta-carotene and needs to be converted in the liver to retinol. Retinol is vitamin A. Some people have poor conversion of beta-carotene to retinol so we recommend getting some pre-formed retinol through diet.
- Eat about 3-5 cups (measure before cooking) of cruciferous vegetables (broccoli, kale, Brussels sprouts, cauliflower, bok choy, etc.). You can cook the cruciferous vegetables, as this makes them easier to digest. It can help to get more nutrients like sulforafane from cooked cruciferous vegetables like broccoli if you have a small amount raw crucifer like daikon radish, mustard, or arugula in the same meal. These provide the myrosinase enzyme that helps your body extract sulforafane. You do not have to have the raw crucifer in the same bite as the cooked cruciferous veggies, just in the same meal.
- Short chain fatty acids can also help produce T-reg cells. These are made by gut bacteria (yes, back to the gut again). The gut bacteria convert fiber into these short chain fatty acids and so having some prebiotic fibers by eating things like lentils, potatoes that have been cooked then cooled 24 hours (eat them cool or room temp to keep the starch resistant so it will feed the bacteria), green bananas, green plantains, onions that are raw or partly cooked but still crunchy, leeks, and dandelion greens.
- Glutathione can also support T-cells. Taking between 200-1000mg per day may be helpful.
- Keep a diary. In order to identify what causes or worsens your allergic symptoms, track your activities and what you eat, when symptoms occur, and what seems to help. This may help you identify triggers for your allergies. Reducing exposure to allergens when possible can prevent symptoms.
Supplements that are useful in lessening allergy symptoms are:
- Quercetin: Quercetin is a flavonoid found in onions, broccoli, apples, some herbs, tea and wine. Use caution with wine and alcohol though as it can worsen histamine and allergies. Quercetin is a strong antioxidant and has anti-inflammatory and anti-allergic properties. It inhibits histamine and other inflammatory immune cells, which cause allergy symptoms (7). It is effective in the treatment of hay fever (7).
- Nettle: Nettle, or stinging nettle, is a plant that has medicinal properties. It is anti-inflammatory. It specifically has been found to reduce inflammatory events that cause allergy symptoms (8). It inhibits histamine, certain enzymes involved in inflammation and other inflammatory substances that cause hay fever symptoms (8).
- Bromelain: Bromelain is an enzyme found in pineapples. It is also available as a supplement. It is anti-inflammatory and anti-allergic. In one study, it prevented allergic sensitization (9).It has an inhibitory mechanism on allergic responses and can help in the treatment of allergies and asthma (9).
- Vitamin C: Vitamin C is an antioxidant which helps in the reduction of oxidative stress and inflammation. This can be beneficial in people with allergic diseases (10). This study observed that the use of high-dose vitamin C in daily practice in the treatment of allergic diseases reduces allergy-related symptoms (10). Furthermore, it was found that patients with allergic diseases had a vitamin C deficiency (10). Another study found that Vitamin C prevents the secretion of histamine by white blood cells and increase its detoxification (11). Histamine levels were found to increase exponentially as ascorbic acid levels in the plasma decreased (11).
- N-acetylcysteine or NAC: NAC is an anti-inflammatory substance that can also break up and help to dissolve mucous (11). It reduces the thickness of mucous which helps it to be expelled from the body and from nasal passages (11).
- Histamine supplements often combine many of these together for relief from symptoms of allergies. We like Hista-Eze by Designs for Health as a good option. You can purchase this at our online store here.
What diet should you follow to better manage allergy symptoms?
Research looking into what diet should be followed to avoid or reduce allergic diseases has found that a healthy diet rich in antioxidants and omega-3 fatty acids consumed by the mother during pregnancy and by the child during childhood may significantly decrease the prevalence and incidence of allergic diseases (asthma, allergic rhinitis, atopic dermatitis) even in children with a hereditary predisposition (12).
We recommend a gut-friendly, anti-inflammatory diet like the Mediterranean diet, which includes:
- Unprocessed, whole foods
- Lots of vegetables and fruit, which provide antioxidants and contribute to a healthy gut
- Focus especially on brightly colored fruits and vegetables (for antioxidants) as well as cruciferous vegetables (for compounds like sulforafane)
- Fish contains omega 3 fats which have an anti-inflammatory effect (1-2 pounds of cold-water fatty fish per week or some high-quality cod liver oil to get pre-formed Vitamin A + EPA and DHA from fish oil, especially if you aren’t eating a lot of fish and/or liver)
- Unprocessed meats
- Extra virgin olive oil
- Raw nuts and seeds, legumes, garlic and onion are other beneficial foods in the Mediterranean diet
- Sugar/ processed foods/ fast food/ soda and other sugary drinks
- Gluten can damage the lining of the gut and can contribute to gut issues like leaky gut. Minimizing or avoiding gluten is helpful in many cases of people suffering with allergies.
- Dairy foods as dairy products can increase mucous production. If you tolerate dairy (no digestive or skin symptoms that you know of) then having full-fat grass-fed dairy is fine when you are not having an excess of mucous.
- Conventional meat can contain inflammatory fats that will contribute to inflammation. Organic, pastured grass-fed meats are preferred.
- Alcohol can contain and promote the release of histamine, especially wine and champagne. All alcohol can also worsen many gut conditions. Avoiding alcohol can help reduce allergies.
- Any foods which you know you are sensitive to as these will increase inflammation as well
Specific foods that can help with allergies:
- Local Raw Honey: Eating raw honey made locally can help reduce allergies and symptoms. The honey contains beneficial bacteria and trace amounts of local pollen, which, when introduced in small amounts, can sensitize the immune system so that it can better tolerate the local pollens. A study using birch pollen honey found a 60% reduction in symptoms in allergic people who ate local birch pollen honey during the birch pollen season (13). You can also buy local bee pollen and have 1tsp per day for several months to help build tolerance to local allergens.
- Fermented Foods: Fermented foods support good gut health. They contain probiotics and can help to rebalance and maintain healthy gut flora. This includes foods like sauerkraut, kefir, kombucha, yogurt and kimchi. However, fermented foods also contain histamine. If you are already overburdened by histamine from active allergies, such as during allergy season, you may want to avoid fermented foods and take probiotic supplements instead. Fermented foods when not in allergy season, if you tolerate them without histamine reaction, can be a great aid for improving gut health.
- Ginger: A study on mice with allergic rhinitis found that ginger in the diet decreased the severity of sneezing and nasal rubbing in the mice (14). The anti-inflammatory effects of ginger can help to prevent and improve allergy symptoms (14). Making tea from or juicing fresh ginger and drinking regularly can help. Mix with a small amount of raw local honey and some lemon for a great-tasting, allergy-fighting drink.
Other helpful tips to minimize allergy symptoms:
- Avoid known triggers: If you are allergic to pollen, stay inside with windows and doors closed when the pollen count is high. If you are allergic to dust mites, dust and vacuum and wash bedding often. You can also get an air filter for your home. A high-quality filter works much better than cheap options due to filtering finer particulate and moving more air. We recommend IQAir. You can use our affiliate code to get 5% off: IQ50470
- Try nasal irrigation:Allergy symptoms improve with regular nasal irrigation, using a neti pot and a saline solution (or filtered water with a small amount of sea salt) (15). Nasal irrigation rinses out the sinuses with a salt and water solution. It helps to flush out thickened mucus and irritants from the nose. One study found that it improved nasal symptoms by 28%, led to quicker mucous clearance from the nose by 31%, caused a 62% reduction in allergy medicine use and improved quality of life by 28% (15).
- Household airborne allergy symptoms.Reduce your exposure to dust mites or pet dander by frequently washing bedding and stuffed toys in hot water, maintaining low humidity, regularly using a vacuum with a fine filter such as a high-efficiency particulate air (HEPA) filter and replacing carpeting with hard flooring.
- Hua X, Goedert JJ, Pu A, Yu G, Shi J. 2015. Allergy associations with the adult fecal microbiota: Analysis of the American Gut Project. 2015 Nov 27;3:172-179. doi: 10.1016/j.ebiom.2015.11.038.
- Dennis-Wall JC, Culpepper T, Nieves C Jr, Rowe CC, Burns AM, Rusch CT, Federico A, Ukhanova M, Waugh S, Mai V, Christman MC, Langkamp-Henken B. 2017. Probiotics (Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9-1, and Bifidobacterium longum MM-2) improve rhinoconjunctivitis-specific quality of life in individuals with seasonal allergies: a double-blind, placebo-controlled, randomized trial. Am J Clin Nutr. 2017 Mar;105(3):758-767. doi: 10.3945/ajcn.116.140012.
- Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. 2009. Specific probiotics alleviate allergic rhinitis during the birch pollen season. World J Gastroenterol. 2009 Jul 14;15(26):3261-8.
- White MV. 1990. The role of histamine in allergic diseases. J Allergy Clin Immunol. 1990 Oct;86(4 Pt 2):599-605.
- Harata G, Kumar H, He F, Miyazawa K, Yoda K, Kawase M, Kubota A, Hiramatsu M, Rautava S, Salminen S. 2017. Probiotics modulate gut microbiota and health status in Japanese cedar pollinosis patients during the pollen season. Eur J Nutr. 2017 Oct;56(7):2245-2253. doi: 10.1007/s00394-016-1264-3.
- Ivory K, Chambers SJ, Pin C, Prieto E, Arqués JL, Nicoletti C. 2008. Oral delivery of Lactobacillus casei Shirota modifies allergen-induced immune responses in allergic rhinitis. Clin Exp Allergy. 2008 Aug;38(8):1282-9. doi: 10.1111/j.1365-2222.2008.03025.x.
- Mlcek J, Jurikova T, Skrovankova S, Sochor J. 2016. Quercetin and Its Anti-Allergic Immune Response. Molecules. 2016 May 12;21(5). pii: E623. doi: 10.3390/molecules21050623.
- Roschek B Jr, Fink RC, McMichael M, Alberte RS. 2009. Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Phytother Res. 2009 Jul;23(7):920-6. doi: 10.1002/ptr.2763.
- Secor ER,Szczepanek SM, Castater CA, Adami AJ, Matson AP, Rafti ET, Guernsey L, Natarajan P, McNamara JT, Schramm CM, Thrall RS, Silbartt LK. 2013. Bromelain Inhibits Allergic Sensitization and Murine Asthma via Modulation of Dendritic Cells. Evid Based Complement Alternat Med. 2013; 2013: 702196. doi: 1155/2013/702196.
- Vollbracht C, Raithel M, Krick B, et al. 2018. Intravenous vitamin C in the treatment of allergies: an interim subgroup analysis of a long-term observational study. J of Intl Med Res. June 27, 2018. org/10.1177/0300060518777044
- Thornhill SM, Kelly AM. 2000. Natural Treatment of Perennial Allergic Rhinitis. Altern. Med. Review. Volume 5, Number 5.
- Saadeh D, Salameh P, Baldi I, Raherison C. 2013. Diet and Allergic Diseases among Population Aged 0 to 18 Years: Myth or Reality?. Nutrients. 2013 Sep; 5(9): 3399–3423. doi: 10.3390/nu5093399
- Saarinen K, Jantunen J, Haahtela T. 2011. Birch Pollen Honey for Birch Pollen Allergy – A Randomized Controlled Pilot Study. Int Arch Allergy Immunol 2011;155:160–166. doi:0.1159/000319821.
- Kawamoto Y, Ueno Y, Nakahashi E, Obayashi M, Sugihara K, Qiao S, Iida M, Kumasaka MY, Yajima I, Goto Y, Ohgami N, Kato M, Takeda K. 2016. Prevention of allergic rhinitis by ginger and the molecular basis of immunosuppression by 6-gingerol through T cell inactivation. J Nutr Biochem. 2016 Jan;27:112-22. doi: 10.1016/j.jnutbio.2015.08.025.
- Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R. 2012. Nasal irrigation as an adjunctive treatment in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy. 2012 Sep-Oct; 26(5): e119–e125. doi: 2500/ajra.2012.26.3787.