The Allergic Patient

Overview: The Allergic Patient

• More than 20% of U.S. citizens—approximately 50 million people—are estimated to suffer from an allergic condition, and they spend $8 billion annually for prescription drugs to treat allergic symptoms.

• A nationwide survey found that more than half (54%) of all U.S. citizens test positive to one or more allergens.

• Although acute and chronic allergic diseases may not rank as a leading cause of mortality in the population, they do constitute a leading cause of work and school absenteeism, and they contribute to significant social and economic costs.

• This chapter considers general integrative approaches to the patient with atopy, or environmental allergies, whether seasonal or perennial.

• Separate chapters in this book deal with some of the more prominent allergic and allergy-related conditions (e.g., asthma, atopic dermatitis, food intolerance, and multiple chemical sensitivities).

• Some commonalities link these seemingly disparate disorders, however, and knowledge of these common principles may be helpful in devising treatment recommendations for patients with allergies.

Importants Points to Consider

• Immunoglobulin E acts as a bridge that cross- links a specific antigen on the surface of mast cells and basophils to release mediators that foster inflammatory activity.

• Quercitin is similar to cromolyn in its mechanism of action. Both are mast cell stabilizers.

• Some forms of magnesium supplementation have prominent laxative effects. The clinician must be wary of prescribing magnesium citrate, oxide, or hydroxide in a patient for whom diarrhea is a problem.

• Dr. Randy observes cases of septal perforation as a result of improper spraying of these products in the nares. Advise patients to aim the “nozzle” of the canister or bottle away from the nasal septum (i.e., toward the outside of the nostril).

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Prevention Prescription

• Use environmental modification, including reduction of dust mite allergen (mattress and pillow encasements, removal of carpeting as possible, replacement of curtains with shades), removal
  of allergenic pets from the home (or at least the bedroom), purchase of a high-efficiency particulate air (HEPA) filter, and planning of activities to avoid exposure to early morning peak pollen counts.

• Follow an antiinflammatory diet. Avoid processed foods, partially hydrogenated oils, white sugar, and flour. Replace vegetable oils with olive or canola oil for cooking. Avoid excessive amounts of saturated fat, such as those found in red meat, fried foods, and dairy products.

Therapeutic Review

The following is a summary of general therapeutic options for allergies (e.g., allergic rhinitis). If a patient presents with severe respiratory or anaphylactic symptoms, stabilizing pulmonary function or allergen exposure risk with potent conventional therapies is prudent before introducing supplements or botanical preparations. For the patient with mild to moderate allergy symptoms, however, this stepladder approach is appropriate.

Remove Environmental Triggers From the Home

• With perennial allergens (e.g., dust mites), washing bedclothes weekly in hot water, encasing mattresses and pillows in mite-impermeable covers, and removing carpeting from rooms (especially bedrooms) may be helpful. Regular vacuuming of carpeted areas by someone without allergies is also suggested.

• Pet-sensitive individuals are a special case. The ideal solution, removal of the pet from the household, is typically not an option with pet lovers. In this case, removing pet access to the bedroom is helpful.  

  
  

• A high-efficiency particulate air (HEPA) filter is useful for light, floating allergens, such as cat allergens; it is less effective with dog allergens.  

  
  

Avoid Peak Pollen Exposure Outdoors

• Outdoor pollens are ubiquitous; avoidance is nearly impossible. Pollen-sensitive patients can avoid significant exposure by limiting outdoor activities between 5 and 10 AM and on dry, windy days, when airborne pollen levels are highest.  

  
  

Nutrition

• Decrease dairy (milk protein) and total protein intake. Plant proteins may be preferable.

• Consume omega-3-rich fats found in cold-water fish, nuts, greens, and ground flaxseed. Consider the addition of pharmaceutical-grade (distilled) fish oil capsules or liquid supplements.  

  
  

• Increase water intake dramatically to maintain adequate hydration.  

  
  

• Increase intake of natural bioflavonoids and antioxidants by eating more organic fruits (especially berries) and vegetables.

Mind-Body Therapy Clinical hypnosis may markedly attenuate allergic reactivity.

• Consider a trial of homeopathy, which is particularly helpful in individuals with multiple chemical or drug sensitivities.

• This form of therapy is safe for adults and children.

Traditional Chinese Medicine

• Acupuncture therapy with or without Chinese herbal therapy can be used for allergic rhinitis. Most studies used artificially standardized regimens; individualized therapy may be more efficacious.

• Chinese herbal therapy and acupuncture can be helpful for asthma control.

Supplements

• Quercetin: 400 to 600 mg one to three times daily

• Magnesium glycinate: 400 mg daily

• Vitamin C: 250 mg twice daily

Botanicals

• Freeze-dried stinging nettles: 300 to 500 mg one to three times/day

• Butterbur (Petadolex): 50 to 100 mg twice daily

Pharmaceuticals

• Cromolyn sodium: nasal spray, one spray/nostril three to four times daily; nebulizer, 20 mg (one ampule) two to four times daily

• Second-generation antihistamines (oral)

  • Loratadine: 10 mg daily

  • Fexofenadine (Allegra): 180 mg daily or 60 mg twice daily

  • Cetirizine (Zyrtec): 5 to 10 mg daily

• Nasal antihistamines Azelastine (Astepro), olopatadine (Patanase): one to two sprays/nostril twice daily

• Nasal corticosteroids (may be added if other natural and pharmacologic interventions fail or if nasal congestion or recurrent sinusitis is a prominent problem)

• Fluticasone nasal (Flonase): two sprays/nostril daily

• Budesonide nasal (Rhinocort): one to four sprays/nostril daily

Immunotherapy

• This is typically reserved for those patients with more severe or refractory symptoms, life-threatening allergic reactivity, or coexisting conditions (e.g., asthma, sinusitis).  

• Consider sublingual immunotherapy before subcutaneous immunotherapy.  

Key Web Sources

• World Allergy Organization: http://www.worldallergy.org/index.php Allergychoices, Inc.: http://www.allergychoices.com/

• Allergy Control Products: http://www.allergycontrol.com/; and National Allergy: http://www.natlallergy.com/

• NeilMed Pharmaceuticals, Inc: www.neilmed.com