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The Whole-Body Approach to Treating Allergies.

Introduction

Allergy response can be a wide range of symptoms: sneezing, congestion, rhinitis (runny nose), post-nasal drainage, watery/itchy eyes, itchy/sore throat, hives, headache, fatigue/malaise, coughing, wheezing, shortness of breath, atopic dermatitis (eczema), digestive issues, and more. For some people, allergies can occur seasonally, or for some unlucky sufferers, constant year-long allergies. Some people's allergies can seemingly appear to occur out of nowhere at a later stage in life or can persist since childhood. It is a major inconvenience when dealing with allergy symptoms. Allergic reactions can range from minor problems to life-threatening. Allergies are the sixth leading cause of chronic illness in the US with an annual cost in excess of $18 billion. More than 50 million Americans suffer from allergies each year. 30% of adults in the US and 40% of children in the US have allergies. (1) Worldwide, the rise in prevalence of allergic diseases has continued in the industrialized world for more than 50 years. (2) There is an increased use of alternative medicine by allergy sufferers due to assumption of fewer side effects, avoiding the use of drugs, and unsatisfactory results with conventional medicine. (3,4) This article will discuss using a personalized treatment approach while addressing the patient as a whole.

Looking for Underlying Causes

With allergies, there are numerous underlying causes to why a person develops symptoms. One can start with the most common approach through looking for environmental triggers like dust, pollen, dander, and foods.

Taking a step further is to look at food sensitivities or food intolerance. These are delayed hypersensitivities that can also present a burden on the patient and lead to the above symptoms. (5) Other underlying causes for allergies can be found within the gut. Elevated histamine is present in gastrointestinal conditions such as IBS and SIBO, which can exacerbate allergy response. (6,7) Also, exposure to parasites like giardia may lead to allergies, increases in food intolerance, and IBS symptoms. (8,9)

Other issues, such as mycotoxin exposure, can lead to allergy/asthma symptoms. Mold and mycotoxin exposure affect the immune system deeply and can be related to more complex illnesses beyond allergies. (10-12) Evaluating mold exposure may require a thorough workup and specialized treatments, but it is helpful to keep this as a possible consideration when dealing with chronic allergies.

Air pollution can exacerbate allergy/asthma symptoms. (13-16) Data suggests that living in an e-waste-exposed area may lead to increased levels of heavy metals and accelerated prevalence of respiratory symptoms and asthma. (17)

Taking a comprehensive environmental exposure intake is helpful, looking for previous and current exposures to potential allergens.

Treating the Whole Body

Before starting on specific symptom relief treatments, I try to address the whole body as a complete system. This process seems to give allergy sufferers great relief, as well as address any other concomitant symptoms. There still may be more specific individual components to address as the reasons for allergies are individualized.

I usually start my patients off with the bucket analogy when trying to address the total body burden. Keep in mind this is an overly simplistic view of the biochemistry and mechanisms but helps to paint the picture. The bucket analogy goes like this:
Imagine your body is like a bucket. Everything that we are exposed to
gets into the bucket: food, water, air, pollution, toxins, emotions,
infections, etc. As all these exposures enter your body and start to
fill up the bucket, your organs of detox and elimination have to go to
work to break them down and process them. Your liver/gallbadder is
responsible for the bulk of the initial processing and metabolism of
all of those exposures and the broken-down exposures go to your
bloodstream, then to your organs of elimination: lymph, lungs, skin,
colon, and kidneys.
Somewhere along the line, if your liver is overburdened or not
efficient, then those exposures can overfill the bucket and spill over
the brim, leading to an increase in allergy-related symptoms or other
symptoms. Alternatively, if the liver/gallbladder is functioning
satisfactorily, but the organs of elimination are compromised, then the
bucket will still overfill or not drain properly leading to the same
symptoms. If the system as a whole works well, then the bucket can
eliminate these exposures, which helps keep the bucket from filling up
too quickly. If the bucket never fills over the edge, you can tolerate
these exposures with little to no symptoms.


First step is helping the patients limit the outside things coming into this bucket, such as exposures of irritating foods, drinks, chemicals, emotions, and known allergens if possible. We start with avoidance. We educate patients about possible contaminant exposures through air pollution, food, and drinking water, such as chemicals in the tap water, contaminants in plastic water bottles, glyphosate, or other herbicides in produce. Glyphosate has been linked to issues of celiac sprue and gluten intolerance. (18) We encourage patients to drink adequate amounts of filtered water. Exposure of chemicals through the skin is also another issue that is addressed. A good resource to look into popular skincare products and their possible contaminants is www.ewg.org/skindeep/. We talk about the possible effects of emotions such as stress and trauma and other repressed feelings that could lead to chemical hormones in the body that also have to be dealt with too. Unresolved emotions can have larger implications for overall health that go beyond the scope of allergies. (19)

Secondly, we work on the diet. We recommend an allergy elimination diet, which limits the most common reactive foods: wheat, dairy, soy, corn, sugar, and eggs. In addition, we limit the intake of processed foods and beverages and encourage to source organic foods if possible. We recommend whole foods with a variety of vegetables, good quality fats and protein. A good source for learning about organic fruits and vegetables is www.ewg.org/foodnews/.

The third step we address is the patient's micronutrient status. There are various nutrients that are important for supporting the basic liver detox pathways. I generally try to start with a medical food or broad-spectrum multivitamin that contains nutrients that support these detox pathways. I look for products that have methylated B vitamins, supportive amino acids, and herbs that can encourage healthy liver function. In addition, we may add vitamin C (3,000-5,000 mg), magnesium (400-1,000 mg), fish oils (1-3g). (20)

Fourth, we focus on the other organs of detox and elimination.

For healthy gallbladder function, we may suggest gallbladder-supporting nutrients that include lipotropic agents, ox bile, taurine, beet extracts, or botanical choleretics. (21) Micronutrients from our second step also support this process.

For the blood and lymph, we encourage adequate exercise two to three times per week of at least 15 minutes. Simple things like jumping rope or using a rebounder can stimulate lymphatic movement. Additionally, hydrotherapy techniques such as alternating cold/hot water baths can help stimulate circulation. These same therapies help with skin and lung function.

For skin elimination, we suggest sweating through exercise, infrared sauna usage, dry brushing. Sweating is helpful for eliminating toxins, as the skin is the largest organ in the body. (22)

For lung function, practice deep breathing, or exercise, which can also help lower stress. (23) Look to getting a high-quality air filtration system for home and/or work use to minimize toxic air exposure.

For kidneys, the simple place to start is with adequate hydration. Aim to drink one-half of the body weight in ounces of filtered water to support adequate hydration. For example, if a patient weighs 160 pounds, they should aim for 80 ounces of water per day. There is some variability to this calculation, but it is a helpful rule of thumb.

For the Gl system, focus on proper elimination and microbiome balance. Ensure patients have a minimum of one bowel movement per day. Adequate hydration can help with constipation. (24) Address microbiome balance with prebiotic fiber, probiotics, or antimicrobials if necessary. By changing the diet and limiting processed foods, it can help favorably alter the microbiome. (25)

There are a lot of steps for optimizing the emptying of this "bucket," but what I've found most helpful for patients are the pre-packaged-detoxification programs by several nutraceutical companies. I typically use kits like Designs for Health 14-day Paleo-cleanse and Thome Mediclear 10-day program. They make it easier for the patient by supplying adequate amounts of micronutrients, herbs, and amino acids to support the majority of the biochemistry of detoxification. In addition, they serve as one-to-two meal replacements so patients will have less struggle with deciding which food options to choose from. Patients only need to focus on one major meal of the day, which will improve their compliance with the recommendations. There are similar programs and kits offered by other nutraceutical companies. The advantage to these programs is that they give patients a tangible and simplified process to start on while they get used to making the lifestyle changes.

Symptom-Relief Treatment Options

There are currently a wide range of treatment options available that I use in practice to help treat allergy symptoms. They range from temporary relief to more permanent lasting solutions. I will give examples of these options.

Nutrition. As mentioned above, start with foundational nutrition like a quality multivitamin.

Nettle leaf (Urtica dioica) has shown benefit for people suffering from allergic rhinitis. (26) Silymarin, a common herb used for liver support, has also shown benefit for alleviating the severity of allergic rhinitis symptoms. (27) Vitamins A, C, and E have shown some protective benefit on airway symptoms and may reduce wheezing symptoms. (28,) (29) Omega 3 oils from fatty fish show protection for childhood asthma risk and reducing atopic dermatitis. (30,31) There are supplements that have a combination of the above ingredients that we use in practice to give patients allergy symptom relief.

Quick relief. A newer supplement product containing an enzyme known as diamine oxidase (DAO) has been shown to give rapid symptom relief for allergic reactions. DAO helps to break down histamine in the body. Elevated histamine can lead to gastrointestinal upset, migraine, irritation of nasal mucosa, itching, or other forms of allergy. DAO, along with other enzymes, has the potential to break down and excrete histamine quickly thus helping to reduce the symptoms of allergy and food intolerance. (32,33) The only downside is that currently the products on the market are relatively expensive when compared to other supplements. This should be used as temporary support while helping to address the underlying causes.

Nasal sinus relief. Nasal symptoms seem to be the most common presentation of allergies. Chronic runny nose or recurrent sinus infections are common conditions we see. Simple solutions, such as saline nasal rinse, can be helpful for chronic rhinosinusitis. (34) For tougher cases, addressing the underlying causes is helpful at eliminating chronic rhinitis. Some of the underlying causes could be naso-sinus fungal, polymicrobial, or multidrug resistant bacteria biofilm. This could be caused by mold exposure through water-damaged buildings or frequent use of antibiotics. (35)' (36) Either way there are helpful agents that can be used for treatment and improvement of symptoms. Colloidal silver nasal spray has been shown to be effective against the biofilm activity and may be more superior than oral antibiotics. (36) Other agents such as N-acetyl cysteine and EDTA may assist in the biofilm disruption and enhance the effect of antifungal and antimicrobials. (37)

Treating the gut. Healthy microbiome balance is important. Proper prebiotics and probiotics have an effect on allergy development. (38) Specific probiotics like Saccharomyces cerevisiae and Lactobacillus rhamnosus have shown to reduce allergic rhinitis and nasal congestion and reduce food allergy. (39,40) Spore forming bacilli of the Bacillus species are showing promise for the treatment of gut dysbiosis, diarrhea, IBS, obesity, type 2 diabetes, cardiovascular conditions, and more. (41) In our practice, we use the product Mega Sporebiotic, which has shown benefit in patients dealing with inflammation and allergy symptoms.

Parasitic infection. An often-overlooked source of underlying allergy symptoms are parasitic infections. Various protozoa and parasites such as Plasmodium falciparum, Dientamoeba fragilis, Blastocysts, Cryptosporidium spp., Entamoeba histolytica, Entamoeba dispar, and Giardia intestinalis can lead to symptoms of asthma, atopic dermatitis, food allergy/intolerance, mast cell activation, anaphylaxis, and other inflammatory conditions. (42-45) One of the most effective treatments for parasites I have seen in my practice is the use of nitazoxanide (Alinia). It has been shown effective for a wide variety of parasites, helminths, in addition to H. pylori, Campylobacter jejuni, and potentially Clostridium difficile, Rotavirus and other viruses. (46-48) It has an extremely low side effect profile. For those without infections, the medication effects are comparable to placebo. I use a higher than normal prescribed dose of 1 g BID for up to 15 days. Patients generally tolerate the treatment well. There are times when I need to start at a smaller dose 250 mg BID for the first few days depending on the initial effects of the drug. Common adverse effects are temporary increase in gastrointestinal effects, primarily diarrhea or abdominal discomfort. Rarer effects are temporary yellowing of the skin and eyes that clear up when discontinuing the medication. I have had success in clearing chronic eczema cases in which the previously mentioned treatments have failed.

Allergy Tolerance. One last treatment option I use in my practice has shown rapid and effective resolution of chronic and acute allergy symptoms, especially hay fever. Low dose allergy therapy (LDA) has been discussed in previous articles. (49) For patients dealing with simpler cases of seasonal allergies, one to two treatments of LDA were able to get a virtual elimination or significant reduction in their allergy symptoms. I typically use this therapy as a supportive treatment for building allergy tolerance. I have seen patients have significant reduction in food intolerances following this therapy. It is typically recommended for patients to have the LDA treatment once every two months for six to eight treatments.

Summary

Allergies can be treated effectively by addressing the whole person and their individual underlying conditions. Most patients can benefit with general detoxification support to help lower their total body burden. However, personalized treatment approaches can yield far superior results to eliminate allergy symptoms.

References

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(10.) Carey SA et al. Satratoxin-G from the black mold Stachybotrys chartarum induces rhinitis and apoptosis of olfactory sensory neurons in the nasal airways of rhesus monkeys. Toxicol Pathol. 2012 Aug;40(6):887-898.

(11.) Nagayoshi M et al. Inhalation of Stachybotrys chartarum evokes pulmonary arterial remodeling in mice, attenuated by Rho-kinase inhibitor. Mycopathologia. 2011 Jul;172(1):5-15.

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(30.) Hodge L, et al. Consumption of oily fish and childhood asthma risk. Med J Aust. 1996;164:137-140.

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(32.) Jumarie C, et al. Diamine Oxidase from White Pea {Lathyrus sativus) Combined with Catalase Protects the Human Intestinal Caco-2 Cell Line from Histamine Damage. AppI Biochem Biotechnol. 2017;182(3):1171-1181.

(33.) Manzotti G, et al. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol. 2015;29(1):105-11.

(34.) Pham V, Sykes K, Wei J. Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis. Laryngoscope. 2013;124(4):1000-7.

(35.) Brewer JH, Thrasher JD, Hooper D. Chronic illness associated with mold and mycotoxins: is naso-sinus fungal biofilm the culprit? Toxins (Basel). 2013;6(1):66-80.

(36.) Ooi ML, et al. Topical Colloidal Silver for the Treatment of Recalcitrant Chronic Rhinosinusitis. Front Microbiol. 2018;9:720.

(37.) Venkatesh M, et al. Novel synergisitic antibiofilm combinations for salvage of infected catheters. J Med Microbiol. 2009;58:936-944.

(38.) Thorburn AN, et al. Evidence that asthma is a developmental origin disease influenced by maternal diet and bacterial metabolites. Nat Commun. 2015;6:1-13.

(39.) Moyad MA, et al. Immunogenic yeast-based fermentation product reduces allergic rhinitis-induced nasal congestion: a randomized, double-blind, placebo-controlled trial. Adv Ther. 2009;26(8):795-804.

(40.) Pascal M, et al. Microbiome and Allergic Diseases. Front Immunol. 2018;9:1584.

(41.) Elshaghabee FMF, et al. Bacillus As Potential Probiotics: Status, Concerns, and Future Perspectives. Front Microbiol. 2017;8:1490.

(42.) Herrant M, et al. Asthma and atopic dermatitis are associated with increased risk of clinical Plasmodium falciparum malaria. BMJ Open. 2013;3(7):e002835.

(43.) Mukai K, et al. IgE and mast cells in host defense against parasites and venoms. Semin Immunopathol. 2016;38(5):581-603.

(44.) Krogsgaard LR, et al. Characteristics of the bacterial microbiome in association with common intestinal parasites in irritable bowel syndrome. Clin Transi Gastroenterol. 2018;9(6):161.

(45.) Hegewald J, et al. Cellular cytokine and chemokine responses to parasite antigens and fungus and mite allergens in children co-infected with helminthes and protozoa parasites. J Inflamm (Lond). 2015;12:5.

(46.) Hoffman PS, et ai. Antiparasitic drug nitazoxanide inhibits the pyruvate oxidoreductases of Helicobacter pylori, selected anaerobic bacteria and parasites, and Campylobacter jejuni. Antimicrob Agents Chemother. 2006;51(3);868-76.

(47.) La Frazia S, et al. Thiazolides, a new class of antiviral agents effective against rotavirus infection, target viral morphogenesis, inhibiting viroplasm formation. J Virol. 2013;87(20):11096-106.

(48.) White CA, Jr. Nitazoxanide: a new broad spectrum antiparasitic agent. Expert Rev. Anti Infect. Ther.2004;2(1):43-49.

(49.) Schrader WA. Low Dose Allergen Immunotherapy (LDA): The Allergy Treatment of the Future--Here Now. Townsend Letter. April 2012.

Financial Disclosures:

I have not been paid nor have any financial interest in the products and services mentioned in the article.

by Clement Lee, NMD

Clement Lee, NMD, received a BS in biological sciences from University of California, Irvine, and Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine. Dr. Lee is the founder of Optimal Health & Wellness in Pasadena, California, a clinic that uses cutting edge integrative and holistic therapies to support patients with chronic illness and others to gain general wellness, or optimal health. Dr. Lee has extensive training on regenerative medicine and injection therapies, anti-aging, IV therapies, environmental medicine, and functional medicine. Dr. Lee sees patients dealing with wide variety of gastrointestinal issues, allergies, chronic infections, autoimmunity, chronic pain and injuries, disease of aging, and more. More information on Dr. Lee's practice can be found at www.opthealthwellness.com.
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