Treatment Options For Alleviating Seasonal Allergies

Do you dread the coming of spring or fall because it means suffering through unpleasant symptoms of uncontrollable sneezing, runny nose, and itchy eyes? What follows are summaries of how conventional medicine and naturopathic medicine approach the treatment of allergies.

The Allopathic Approach

The conventional approach to managing the symptoms of allergies is medications. The four steps of the immune response are the following:

   • Exposure to allergen leads to histamine release;

   • histamine release leads to dilation of blood vessels and spasm of the airway muscles;

   • dilation of blood vessels leads to mucus production, swelling, and sensation of “itching”;

   • spasm of the muscles that encircle the airway can lead to wheezing and shortness of breath.

Allergen—Histamine Release—Dilation

The most well-known medications are the class of “antihistamines.” These medications work by stabilizing, and preventing, granules of the molecule histamine from being released by immune cells. When histamine is released, it causes a dilation of the smallest arteries and spasm of airway muscles. These two effects are what cause all of the annoying symptoms associated with allergies.

First-generation antihistamines (over-the-counter)—Benedryl, Chlortrimaton, Dramamine, Dimetapp; also Tavist, Allerhist, Drixoral—frequently create mouth dryness and drowsiness as side effects.

Second-generation, “non-sedating,” antihistamines include over-the-counter Claritin OTC as well as prescription Clarinex, Allegra, Zyrtec, and Astelin nasal spray. In general, this group of antihistamines is more expensive, has a slower onset of action, is longer acting, and induces less sleepiness. Different people respond differently to these medications and sometimes it takes a bit of experimenting to determine the medication that works best with your body. There have been no studies that suggest long-term down-sides to their use. Astelin, while applied locally, can cause headaches and can leave a bitter taste in your mouth. However, if you do not get these side effects, it is my opinion that applying medication locally is far better than taking it orally, and hence systemically.

The second category of allergy medications is decongestants. These work by constricting blood vessels that have dilated in response to histamine release. Clearly, if you can avoid the release of histamine, you do not need this category of medication as it works downstream from the initial problem.

Decongestants are available by prescription and over-the-counter. They are sold in different forms including pills, liquids, sprays, and drops. There are only two types of medication under the category of decongestants: psuedoephedrine (aka Sudafed) and phenylephrine (aka Entex). These drugs can cause side effects that are the opposite of those caused by antihistamines. Decongestants are, in essence, stimulants, which can cause your heart to race as well as insomnia. They can also cause what is known as the rebound effect: after three to four days of using decongestants, your symptoms could rebound, becoming worse than they were initially.

A third allergy medication category is steroids—which are always acquired by prescription. Steroids affect the entire immune system’s response to an allergen. They are powerful medications that are best used topically in small doses prior to a known exposure. Steroids can be taken via nasal sprays, inhalers, and pills.

Another drug I see commonly used is Afrin. This is a potent local vasoconstrictor with amazing and immediate results. I only advocate the use of this if you’re flying and need some nasal clearance during take-off and landing. This medication is over-the-counter and extremely addicting. Do not use this drug for more than two consecutive days or you’re hooked due to the severe rebound effect.

Dr. Jordan Shlain is the founder and medical director of Current Health Medical Group (CurrentHealth.com). Dr. Shlain is an assistant clinical professor at the UCSF Medical Center and a medical economics lecturer at UC Berkeley.

The Naturopathic Approach

An allergy occurs when the immune system inappropriately mounts an immune response to something it thinks is a “foreign invader.” In the case of seasonal allergies, that foreign invader (or allergen) is usually tree or grass pollens inhaled in the ambient air. The resulting immune response causes the classic symptoms of sneezing, runny nose, watery eyes, and itching. A comprehensive treatment of allergies requires both symptom management (as discussed by Dr. Shlain) and exploration of underlying causative factors.

Getting At The Root Cause

One of the basic tenets of naturopathic medicine is “tolle causam,” which means that the naturopathic doctor seeks to identify and remove the underlying cause of an illness. Allergies, like most medical conditions, are often a complex interplay of multiple factors. The goal is to take the time needed to understand what specific factors are contributing to each case, so that a strategic and individualized plan can be constructed to effect a lasting resolution. In this paradigm of personalized medicine, no two treatment plans are the same.

The first question to ask is, “Why is your immune system reacting inappropriately in the first place?” There are a number of potential factors that can predispose your immune system to develop allergies. Some of these include genetics, environmental exposures during development, hormonal changes, microflora imbalances, or excessive inflammation in the digestive tract, certain vitamin deficiencies, and poor liver function. A thorough review of your medical history and current health status can help elucidate which factors are important for you.

Another important consideration in treating seasonal allergies is to evaluate what is contributing to your “total allergen load.” Total allergen load simply refers to all the substances your immune system is recognizing as foreign and mounting an allergic response to. Each person has a threshold of total allergens he or she can be exposed to before actually feeling symptoms. If you can reduce the cumulative load of allergens you are exposed to to below your threshold, then you can prevent symptoms from manifesting. Clinically this can be accomplished by performing blood or skin tests to screen for the most common environmental (pollens, dusts, animal dander, molds) and food allergies. By eliminating your exposure to the allergens you have control over, it may be possible to prevent your immune system from being pushed over it’s symptom threshold when seasonal pollen counts are highest. Identifying the specific allergens you are reacting to also allows for targeted “desensitization” therapies.      

Desensitization refers to a number of techniques designed to desensitize or retrain your immune system so that it doesn’t react inappropriately when it is exposed to a specific allergen. One low-force technique is to use homeopathic medicine, which is based on the principle that giving a minute dose of a remedy that mimics the issue at hand can bring about a long-term cure. This can be applied to allergies by giving a diluted dose of a specific allergen to help “reset” the immune system so it stops reacting inappropriately.

There are a number of contributing factors to be considered with respect to seasonal allergies. By addressing the underlying cause of your allergies, it can be possible to minimize or alleviate the need for medications to control the symptoms.

Dr. Jacob Leone is the Director of Naturopathic Medicine at Current Health Medical Group (currenthealth.md). Dr. Leone has been involved in several clinical research studies, investigating such diverse topics as mental health, HIV, hepatitis C, and diabetes.