Allergies

Allergy afflicts millions of people worldwide. If you sniffle in the summertime or sneeze when you clean house, you may be "allergic."

Many snifflers and sneezers go through life more or less contentedly without seeking a definitive diagnosis or medical treatment. Their symptoms just don't bother them much. But for many others, allergies seriously interfere with their ability to enjoy life and get their work done. These people usually want some kind of treatment, if only an over-the-counter remedy. For a few patients, allergy is a serious, even dangerous condition that requires expert medical attention and constant vigilance to prevent a life threatening allergic reaction.

As common as allergies are, however, they are not always easy to diagnose. The first step is to find out whether your symptoms are caused by an allergy or some other problem, such as a chronic respiratory or intestinal infection.

Most patients visit an allergy doctor with one or more of the following kinds of complaints:

• Nasal and respiratory symptoms of the sort usually associated with a head cold or hay fever - that is, runny nose, sneezing, watery eyes, sinus headaches (pain in the forehead).
• Wheezing (especially on exhaling), shortness of breath, chest tightness, difficulty in exhaling completely. These are typical symptoms of asthma, but may be caused by other conditions as well. Asthma is often but not always associated with allergy.
• Itchy hives or rashes, or other skin irritations. The patient may suspect a food allergy or skin sensitivity to some chemical substance, such as suntan lotion.
• Diarrhea, indigestion, nausea. Food allergies are often suspected by the patient.
• Headache, irritability, fatigue, malaise. The patient may feel that a food or something in the air at home or in the office is causing the problem.

It's ordinarily much easier to find the causes of the symptoms at the top of the list than of those toward the end. In fact, until recently, patients suffering from fatigue, headaches, or jumpiness probably would not have thought of coming to an allergist. In the past few years, however, there has been considerable speculation that a wide range of ills may be caused by allergy or allergy like sensitivities and intolerances.

Luckily, most allergy sufferers report symptoms and histories that fit a common pattern, and a doctor who asks the right questions can quickly make a pretty shrewd guess as to the identity of the guilty allergen or allergens. Normally, it does not take long to confirm the diagnosis and begin treatment.

The chances that you are allergic to something are increased if one or both of your parents are or were allergic. There are certain physical signs that indicate allergy; for example, swollen, darkened eyes (almost like black eyes) are likely to appear in allergies affecting the respiratory tract. Also, many patients have noticed a pattern to their symptoms that suggests an allergy is at work. This is often the case when the symptoms are seasonal, or are related to a particular locale, or are associated with eating certain foods. By trial and error, patients sometimes find that antihistamines (which block allergic reactions) are helpful when they feel sick. If antihistamines help, the ailment is probably caused by an allergy.

Allergic reactions are triggered by the immune system, the complex system that recognizes and combats outside substances or organisms that get into the body. An allergy is a mistake by the immune system. The system reacts vigorously, even violently, to some harmless substance. For example, a family gets a cat, and everyone is fine except for one daughter, who after a few weeks or months begins to sneeze and wheeze anytime she is around the cat. She, it turns out, is sensitive to cat dander. The dander from one cat is essentially harmless. Nevertheless, she gets sick because her body reacts to a few specks of dander as if this were an invasion of pneumonia bacteria or some other dangerous organism.

Allergic reactions, these mistakes by the immune system, appear to arise from the body's protective reaction against parasites. There are several similarities in the way that the body fights parasites and allergens. In both cases, the body produces a large amount of immunoglobulin E (IgE) antibodies. In other immune system reactions, different antibodies take the lead.

For a person living in an undeveloped country who is exposed to numerous parasites, the tendency to produce IgE is protective and valuable. For our young friend, who gets sick around cats, IgE production is a problem. The first stage of allergy development is called sensitization. In this stage, the person is free of symptoms. She is playing with the cat and feeling fine, but, unfortunately, cells in her immune system are engaged in a complex process that results in the production of numerous IgE antibody molecules. These antibodies attach themselves to mast cells, which come from bone marrow. Mast cells are found in connective tissue throughout the body, especially near the small blood vessels and near epithelial tissue (which is tissue that covers or lines, such as skin and the lining of the intestines). IgE antibodies also attach to basophils, a type of white blood cell that can exit the small blood vessels and congregate around invading molecules.

The antibodies remain attached to the mast cells and basophils, which now resemble mobile grenades, packed with ammunition (histamine and other allergy mediators). It requires only the trigger of a new invasion of the allergen, in this instance cat dander, to activate these grenades and set off all those miserable symptoms of cat allergy - burning eyes, sneezing, and so on. This is the second stage of the allergy process, and it is characterized by acute symptoms.

The IgE antibodies are especially designed to recognize and attach to the specific allergen that led to their creation. Like all antibodies, IgE molecules are Y -shaped; their base attaches to the mast or basophil cells; their arms extend outward. When invading allergens attach to at least two IgE antibodies, the grenade is triggered, and a cascade of substances is released. These cause allergy symptoms. The most important of these substances is histamine, which dilates blood vessels, causing redness and, in extreme cases, shock; constricts the bronchial tubes, impairing breathing; irritates nerve endings, causing itching and pain; and stimulates the production of mucus in the respiratory system.

Incidentally, histamine is also toxic to parasitic worms, which may be some comfort to the rare allergy sufferer who worries about worms.

A third stage of allergy development, a delayed, sometimes prolonged period of immune activity, is called the late-phase reaction. In this stage, white cells called eosinophils play a role, and an elevated eosinophil count can help to diagnose the presence of allergy. Basophils, eosinophils, and other white blood cells may cause ongoing inflammation and may damage tissue in their vicinity.

An antigen is any foreign substance capable of causing an immune system reaction that produces antibodies. An allergen is a special kind of antigen that causes an allergic reaction. Common allergens include animal dander, pollen, bee venom, mold spores, and various foods and drugs, such as peanuts and penicillin.

Allergens are invaders. To affect their victims, they must find a way into the body. It is not easy to enter through the skin (including the lining of the eyes-the conjunctiva), which offers pretty good protection. Molecules of an allergen - say, cat dander - in contact with the skin usually have a limited, local effect, if any. You may get a rash and feel itchy. Various chemicals, however, can penetrate the skin and travel through the body. For example, an antibiotic cream used topically may sensitize you, causing the production of allergy antibodies. If you later take the drug orally, you may experience an allergic reaction in the form of a rash or fever or other symptoms.

The respiratory and alimentary tracts are much better ports of entry for allergens. Substances breathed in or swallowed may affect the-entire respiratory tract (from nose to lungs) or alimentary tract (from lips and mouth to intestines). Ragweed pollen, for example, breathed in through the nose of someone sensitive to it, causes hay fever or, if it reaches the lungs, may cause an asthma attack. Animal dander can also provoke asthma as well as hay fever-like complaints.

Allergen molecules can escape the systems by which they enter, traveling widely in the body via the bloodstream. Thus, an allergen in food may activate mast cells in the skin, causing hives or a rash. Moreover, the histamine and other chemicals produced in an allergic response can cause a general, widespread reaction.

In rare cases, an allergen can cause problems in remote organs, including the liver and kidneys. A patient at a large metropolitan hospital, who had been receiving penicillin for strep throat developed fever, a rash, and blood in the urine. This kidney failure was evidently associated with an allergic sensitivity to penicillin. The penicillin was stopped, and prednisone (a steroid drug used to reduce swelling and suppress the reaction of the immune system in allergy reactions) was administered. The kidneys returned to normal function.

Supplements and herbs

For seasonal allergies, take all supplements (below) from early spring through the first frost. In place of prescription or over-the-counter drugs, try quercetin. Whereas drugs simply block the effect of histamine, this flavonoid inhibits its release-without any side effects. Combining it with the herb nettle can combat sneezing, itching, and swollen nasal passages.

Vitamin A and vitamin C support the immune system; vitamin C, the main antioxidant in the cells of the respiratory passages, may also have anti-inflammatory and antihistamine effects. The B vitamin pantothenic acid may reduce nasal congestion. You may want to take these three nutrients during allergy season, even if you opt for traditional drugs for specific symptom relief.

And, for severe cases of hay fever, ephedra (ma huang) may be useful because it opens the respiratory passages. You can use ephedra with quercetin and nettle, but not with prescription or over-the-counter antihistamines or decongestants. Ephedra may cause insomnia. It should not be used by people with heart disease, hypertension, or diabetes.

Aromatherapy

Commonly used essential oils for allergies:

• Patchouli

Homeopathy

Remedies mentioned here, when they fit the individual, may gradually help a person overcome imbalances. A constitutional remedy, chosen by an experienced homeopath, is usually the best approach.

• Arsenicum album
  This remedy is useful for people who are highly sensitive to many foods and substances, and respond to them by feeling restless, ill, and exhausted. Asthma and digestive disorders (such as vomiting and diarrhea) are common reactions. Burning sensations relieved by warmth, and thirst for frequent small sips of water can also suggest this remedy. A person who needs Arsenicum tends toward strong anxiety, and may have excessive concern over neatness, details, and order.
• Calcarea carbonica
  This remedy is often helpful to responsible, steady people who become fatigued and overwhelmed. Anxiety may develop, sometimes with fear of heights or claustrophobia. The person is typically chilly, with clammy hands and feet, and has low stamina. Digestive troubles with gas and heartburn are common, especially after eating wheat or dairy products. Swollen lymph nodes and tonsils, head sweats during sleep, shortness of breath from exertion, back pain, dizziness, nightmares, and strong cravings for sweets are often seen. Individuals who need this remedy are sometimes oversensitive to aspirin.
• Calcarea phosphorica
  Irritability, headaches, stomach and abdominal pains, and a craving for "junk food" are all indications for this remedy. Stiffness in the neck and back, leg cramps, and aggravation from cold are also likely. The person may seem dissatisfied, with a strong desire for travel or a change of circumstances and a tendency to complain when fatigue and health problems interfere. This remedy is often helpful to restless, whiny children who have growing pains, get headaches from school, and have picky appetites with many food problems.
• Carbo vegetabilis
  A person who reacts to foods or substances with weakness, faintness, chilliness, and indigestion may be helped by this remedy. Bloating, flatulence, and a frequent need to burp are often seen. Breathing may be difficult and, even when feeling very cold, the person has a strong desire for fresh and moving air. Feeling insecure because of weakness, the person may be cross and demanding toward family members. Problems typically are worse in the evening and from talking, eating, or lying down.
• Gelsemium
  Allergy reactions with flu-like symptoms-weakness, trembling, aching muscles, droopy-looking eyes, and chills along the spine-may indicate a need for this remedy. Headaches in the back of the head and involving the muscles of the neck are common. A person who needs this remedy may seem ill and weak, with a feeling of internal shakiness. Being under pressure to perform (exams, public speaking, etc.) or hearing distressing news can often make things worse both mentally and physically.
• Hepar sulphuris
  People who need this remedy are oversensitive to stimuli and substances of many kinds, and can be extremely irritable and touchy, often feeling worse from even slight exposure to cold or drafts. Skin problems, ear infections, or respiratory problems with yellow discharge and offensive sour or cheese-like odors often occur as results of allergy. Because these people feel so deeply vulnerable, they may develop a fear of going out in public. Discouragement about their health can lead to angry outbursts or despair.
• Lycopodium
  Food allergy problems with heartburn, gas, and rumbling in the abdomen may indicate a need for this remedy. The person may feel ravenous hunger yet quickly get bloated from eating a very small amount. Fatigue or drowsiness develop after eating, but the person also feels weak from missing meals. Problems are typically the worst in late afternoon and evening. The person may have a chronic worried look, a craving for sweets, a preference for warm drinks, and discomfort felt mostly on the right side of the body.
• Natrum carbonicum
  This remedy can be helpful to people who have trouble digesting and assimilating many foods and have to stay on restricted diets. Indigestion, heartburn, and ulcers can occur if offending foods are eaten. Milk or dairy products can lead to flatulence or sputtery diarrhea that leaves an empty feeling in the stomach. Cravings for potatoes and sweets are common; also milk, but it makes these people sick, so they usually learn to avoid it. They are sensitive to weather changes and temperatures, as well as foods, and (although they make an effort to be cheerful and considerate) often feel weak and want to be alone to rest.
• Natrum muriaticum
  A person who needs this remedy can react to allergens in many ways-with headaches, mouth sores, hay fever symptoms, respiratory problems, back pain, or fatigue. Headaches may tend to be worse in late morning and early afternoon, and asthma may be worse in the early evening. Staying in the sun too long can also lead to headache or weakness. These people usually seem reserved, disliking consolation when ill or upset, yet often have deep feelings. A craving for salt and very strong thirst may help to confirm the choice of this remedy.
• Nux moschata
  If a person reacts to chemical or allergen exposure with an overwhelming feeling of sleepiness-or seems dizzy, giddy, or absent-minded-this remedy should be considered. A very dry mouth, dry eyes, a feeling of weight in the chest, and numbness in the extremities are other indications. Joint pains that move from place to place and stubborn constipation are also possible.
• Nux vomica
  Irritability, cramping pains, and chilliness are typical when this remedy is needed. Oversensitivity to substances can lead to many ailments-headaches, runny nose, tight breathing, heartburn, stomach problems, constipation, back pain, and insomnia. People who need this remedy are often irritable, impatient, easily angered or frustrated, and have a lot of trouble relaxing. They tend to crave stimulants, alcohol, tobacco, sweets, and strong foods, and feel worse from having them. They are also very sensitive to odors, light, and noise
• Petroleum
  A person needing this remedy can be extremely sensitive to fumes from traffic or industry, reacting with headaches, chilliness, diarrhea, and nausea with an empty feeling inside. The person may feel confused, disoriented, or anxious when exposed to toxins. Individuals who need this remedy sometimes develop eczema with inflamed and cracking skin, especially on the palms and fingertips.
• Phosphorus
  People who need this remedy are usually excitable, imaginative, and sensitive to impressions, having strong anxieties and fears. They react to many foods and substances by becoming tired, "spaced-out," and dizzy, and may have headaches, nosebleeds, respiratory problems, nausea, or diarrhea. The person feels worse from missing meals and better from eating and sleeping well. A strong desire for ice cold drinks, ice cream, and refreshing things can help to confirm the choice of Phosphorus.
• Silicea
  This remedy can be helpful to individuals who have low stamina, are prone to fatigue, and are very sensitive to substances. Resistance to infection may be low and the person may have frequent colds, sore throats, and swollen lymph nodes. Fine hair and skin, weak or brittle nails, and offensive perspiration (especially on the feet) are often seen. People who need this remedy are usually nervous, shy, refined, and fragile, yet also capable and quietly stubborn internally. A strong desire for sweets, and a tendency to be energized by moderate exercise are other traits that fit this remedy.

What else you can do

• Stay indoors with the windows closed when pollen counts are high. Use an air-conditioner even in the car and clean the filter regularly.
• Eliminate carpets and use furniture slipcovers that can be washed. Encase mattresses and pillows in allergy-proof covers and wash bedding weekly in very hot water. Dust mites collect in these areas.
• Clean damp areas to prevent the growth of mold.

How much to take

Quercetin

500 mg twice a day.
Use 20 minutes before meals; often sold with vitamin C.

Nettle

250 mg 3 times a day on an empty stomach.
Standardized to contain at least 1% plant silica.

Vitamin A

10,000 IU a day.
Women who are pregnant or considering pregnancy should not exceed 5,000 IU a day.

Vitamin C

1,000 mg 3 times a day.
Reduce dose if diarrhea develops.

Pantothenic acid

500 mg 3 times a day.
Take with meals.

Ephedra

130 mg standardized extract 3 times a day.
Don't use if you have high blood pressure, heart disease, or anxiety or take an MAO inhibitor. Don't take for more than 7days.

For kids

See age-appropriate dosages of herbal remedies

• Astragalus (Astragalus membranaceous) is a Chinese herb that helps to strengthen the overall constitution. Give your child one dose daily for one month before the hay fever season.
  Note: This herb should not be given if a fever or any other signs of infection are present.
• If your child suffers from chronic allergies, give him one dose of an Echinacea and goldenseal herbal combination formula, two to three times daily, for five to seven days to strengthen his immune system.
  Note: You should not give your child Echinacea on a daily basis for more than ten days at a time, or it will lose its effectiveness.
• Prepare a fenugreek and thyme tea. These herbs act as a mild decongestant to relieve nasal and sinus congestion. Give your child one dose of tea, twice daily, as needed.
• Garlic has antibacterial properties that are beneficial in healing a chronic runny nose. Choose an odorless form, and give your child one capsule, twice daily. It can be taken in whole capsule form, or you can open a capsule and dissolve the liquid in warm water or soup.
• Licorice root has a strengthening effect on the adrenal glands. Give your child one dose daily for two weeks before the hay fever season. Licorice and astragalus can easily be combined.
  Note: This herb should not be given to a child with high blood pressure.
• Ma huang is the original source of the decongestant pseudo ephedrine (better known as Sudafed), and it is effective in relieving nasal congestion. Give your child one dose in tea form, twice a day, for up to three days.
  Note: This herb can stimulate the nervous system, causing an increased heart rate and agitation. Do not give it to a child under thirteen, and do not give it after 3:00 P.M.
• Minor bupleurum helps to strengthen the immune system. For chronic allergies, give your child one dose, twice daily, for two weeks out of every month. Continue this regimen for three months.
  Note: Minor bupleurum should not be given to a child with a fever or any other sign of an acute infection.
• Nettle can be very helpful for drying out the sinuses. It can be highly effective for chronic allergies (allergic rhinitis), especially when taken in freeze-dried form. Give your child one dose, three times daily, for three to four days. Note: Some children experience stomach upset as a result of taking nettle. If this happens, stop giving the herb. This herb should not be given to a child under four.

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