Antihistamine Precautions: Alternatives for Navigating Spring Allergy Season

It is indeed allergy season! Read on for the most common questions followed by actions you can start taking today towards relief.

Q:  Many people are really struggling this spring with allergies.  Things like headache, constant congestion, and runny nose, and we know the issues are seasonal because the symptoms only appear during spring (mostly) and fall.  We already know over-the-counter antihistamine drugs have a lot of side effects such as drowsiness and listlessness (lethargy.)  Do you know of some natural solutions that really work?  There’s a lot of stuff on the internet, but we aren’t sure if any of them are effective.  Or is there a way to take the drugs without all the side effects?  

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A:   You are right about the side effects of typical anti-histamine medications.  These drugs often leave a person feeling drugged, sleepy, or foggy-brained.  They also can have other potent (but not often publicized) side effects such as dizziness, blurred vision, nausea, or making an enlarged prostate or a yeast infection worse. We encourage patients to avoid them whenever possible.  And yes, there are several natural choices that we have seen make major improvement.  Not only with seasonal allergy symptoms but also asthma and ongoing, chronic allergy.

The Physiology of Allergy

Our immune system can react with alarm to the protein in a particular type of pollen and develop antibodies to these “foreign invaders”. Think of antibodies as your body’s “Most Wanted” criminal list. Exposure to them then causes our mast cells to release histamine, triggering swelling of mucus membranes and the flow of mucus.  Despite the discomfort, our immune system really does have our best interests at heart ! Mucus can flush unwanted substances out of the body and protects delicate tissue. The problem is that our immune systems can get overwhelmed, especially if clients are (1) chronically stressed, (2) consume lots of sugar/sweeteners/chemicals,  and/or (3) are not well-rested (three factors which influence our immune system greatly).

The following conditions can put you at risk for Pollen Allergies
  • asthma
  • constipation
  • unmanaged stress
  • food allergies
  • poor nutrition
  • lack of exercise
  • sleep deficit
  • deviated septum
  • nasal polyps
  • recent trauma or illness
  • pregnancy

All these conditions are a signs of inflammation. Let’s use the glass of juice analogy.

The body is the glass. The juice is inflammation. A body battling asthma, eczema, constipation, food allergies is like an overflowing glass of juice. Aka, a body full of inflammation. Allergies to pollen cause more inflammation. Thus when the trees bloom, the glass spills over and horrid allergy symptoms commence.

However, when the above conditions are addressed and inflammation is lowered, the body will resemble a glass half full of juice. Therefore, this body will be able to handle pollen allergies much better with a lot less symptoms.

Natural Solutions for Allergies
Eat Lots of These Foods
  • fresh fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes, berries
  • fresh vegetables, organic when possible, here is the list of the dirty dozen
  • dairy substitutes: coconut milk, hemp milk, almond milk, rice milk
  • cooking oils: olive oil, coconut oil
  • leafy herbs
  • organic, free range eggs
  • gluten free grains: quinoa, rice, oats
  • freshly wild caught fish
  • freshly cooked organic poultry
  • herbal teas such as Green Tea

The above foods are low histamine foods which means they are least likely to irritate the immune system.  They are also power houses of Vitamins such as Vitamin C, Vitamin D, Magnesium, and Antioxidants such as Quercitin.

Dairy foods are mucus-producing in many people, hence a short term removal of these foods may provide some relief 

Reduce or Avoid These Foods

These foods prevent the immune system from working properly.  In order to avoid allergy symptoms, we need a strong immune system.  One that doesn’t over-react or under-react.

  • sugar
  • caffeine
  • bottled / store bought fruit juices (yes even organic)
  • food preservatives
  • decrease/avoid dairy and gluten (even non gmo, organic, grass fed, etc)Keep in mind too that dairy foods are mucus-producing in many people.  You might want to embark on a trial, full elimination of all dairy foods (e.g. milk, cream, cheese) to see how it affects you, at least until the worst of the allergy season has passed.
  • processed foods with ingredients that you can’t pronounce or have no idea what they mean
  • cured meats
  • wine, chocolate (wahhhh, we know!) and strawberries are all very high in histamine
Reduce your exposure to Pollen
  • Wear a protective mask when gardening or doing yard work.
  • Modify the indoor environment to keep out allergens. Use HEPA (high-efficiency particulate air) filters in air conditioners to better trap pollen spores. Change air condition filters often.
  • Check pollen counts before you travel. To find pollen counts, go to the National Allergy Bureau (www.aaaai.org/nab)
  • Protect your eyes. Wear sunglasses when outdoors to reduce the amount of pollen coming into the eyes,
  • Wash your hair and shower at the end of the day to wash out pollens. This will help avoid pollen transfer to the pillowcase and bedding.
  • Exercise in the morning or late in the day. Pollen counts typically are higher on a hot, windy, sunny day compared with a cool day without much wind.
  • Check the pets, they are known pollen carriers.
  • Leave your shoes at the door. Tracking in mud and pollen through the house will make symptoms worse. (This is my biggest challenge in my house, uhm uhm husband uhm)
Supplements

To access some of the items listed below click HERE.

Please speak with your functional medicine practitioner about what is appropriate for you. Some supplements can interfere with certain medications and/or other supplements.

  • Nasal Saline rinse twice daily, will wash pollen out of nose, reduce symptoms, and decrease medication use by 62% (article). An effective way is to rinse your nose after coming in from outside to immediately get the pollen out.
  • Vitamin D (preferably D3 with K2) Vitamin D, a critical vitamin for immune system function is found in Eggs, Salmon, Cod Liver Oil, Tuna, Sardines.  Emerging evidence shows Vitamin D to increase the effectiveness of nasal corticosteroids in those suffering from Allergic Rhinitis (allergic runny nose) (article)
  • Quercetin (pronounced kwehr’-suh-tin). It is best used as a long term remedy starting about 4-6 weeks before allergy season.  (article) A natural extract from plant foods like onions, apples, berries, buckwheat, and citrus fruit, quercetin is technically a flavonol.  These polyphenols help to determine a plant’s color – in this case, a bright yellow. Quercetin is a natural anti-histamine without the side effects of many medications!  Quercetin actually calms the immune system to reduce or prevent histamine release. Several patients over the years with chronic seasonal allergies or asthma have found great relief.  As an aside, quercetin is also being researched for circulation and cardiovascular health too, as it’s been shown to increase blood flow via artery dilation, promoting the release of nitric oxide. This action creates greater tissue oxygenation, nutrient flow, and waste removal.  For this reason, it may also improve symptoms of fatigue and malaise due to poor circulation or in those with anemia or mild hypertension.  Be cautious using quercetin, however, for those already taking blood thinners (e.g. Coumadin, Plavix, or daily aspirin). In a supplement, quercetin is often combined with bromelain, an extract from pineapples that is a potent anti-inflammatory that also calms the immune system and increases the effectiveness of quercetin.  For seasonal allergies, we recommend clients start using quercetin right away to build up levels in their body and continue throughout the full allergy season.  Consider starting with 1000 mg, taken twice daily on an empty stomach. Allergic reactions to quercetin are virtually unheard of;  we believe this is a safe supplement to explore.

Quercetin actually calms the immune system to reduce or prevent histamine release

But quercetin has also been heavily studied in recent years because of its ability to heal intestinal permeability.  This is especially helpful for those who may be prone to allergies/sensitivities in part because of the ongoing immune insults that having a leaky gut allows.  This makes Quercetin a perfect two-solutions-in-one remedy!

  • Stinging nettle leaf (very important:  leaf, not root) has been shown to have effective ‘antihistamine’  action because it makes histamine receptors less sensitive.  Because of this mode of action, we tend to use stinging nettle as a synergistic, additive pairing with an antihistamine like quercetin (vs. an agent on its own).  This can be a powerful combination for more entrenched cases which don’t find sufficient relief via quercetin alone.
  • Another excellent choice is the herb Butterbur.   This one has actually been formally studied and found to be just as effective as Zyrtec at treating seasonal allergy symptoms.  Unlike quercetin, butterbur is helpful because it is an anti-spasmodic remedy.  Phytochemicals in butterbur relax swollen nasal membranes and alleviate muscle spasms in the respiratory system.  When our immune system reacts to a perceived “foreign invader” (like an allergen), our cells produce  inflammatory signaling molecules called leukotrienes (which usually happens in concert with the production of histamine, as mentioned above).  Leukotrienes trigger spasms in the trachea which can help us to cough – to expel undesirable substances.  Overproduction of leukotrienes, however, causes major inflammation in the respiratory system in the case of asthma and allergy.  Butterbur simply interferes with the production of leukotrienes.   Short-term use (3-4 mos) is generally regarded as quite safe; long-term use has not been studied.   Note that butterbur is not suitable for pregnant or breast-feeding women (or for very young children less than six years of age).   A typical therapeutic dose of butterbur extract is about 200mg/day (divided into an AM and PM dose for greater absorption).  Mild headache or stomach ache may be side effects of butterbur and can be best avoided by taking it on a full stomach.  Before you ask:  yes, in very tough cases, it would be quite syergistic to pair these three agents together.
  • Vitamin C, an antihistamine, is one of the most important antioxidants and immune enhancing nutrients to an allergy sufferer.  Found in Red Peppers, Oranges, Kiwi, Melons.  The effect of Vitamin C is enhanced when taken with Quercetin (article)
  • Local Raw Honey, in those older then 12months old, has shown promise in the prevention of Seasonal Allergies (article).  Honey ingestion is thought to help via Oral Sensitization.  In other words, eating the allergen regularly can help the body recognize the specific allergen as a non threat.  It is important to buy the honey locally, because pollen from Brazil won’t help much in New Jersey.  The only exception is Manuka Honey from New Zealand due to it’s antibacterial, antimicrobial, and immune system boosting properties.  Furthermore, make sure it’s raw. Processing destroys most of the nutrients.
  • Last but not least, Omega-3’s found in Salmon, Free Range Eggs, Free Range Grass Fed Meats, Avocado, Olive Oil, Nuts.  It has been shown to boost the immune system (article)


Adapted From the School of Applied Functional Medicine’s Clinical database and our colleague Dr. Ana Maria Temple

Carpal Tunnel Syndrome

 

One of the most common causes of hand and wrist pain is a condition called Carpal Tunnel Syndrome. This condition is usually the result of the median nerve getting trapped and compressed in the carpal tunnel as it courses towards the hand.

The carpal tunnel is a tunnel in which the bottom and sides of the tunnel are formed by the carpal or wrist bones and the top is formed by the transverse carpal ligament. This ligament or fibrous band connects the top two carpal bones. Inside the carpal tunnel is the median nerve as well as 9 of the flexor tendons for the fingers and thumb. The purpose of the carpal ligament is to stabilize the carpal bones and anchor some of the tendons for the hand muscles (finger flexors) to enable them to work correctly.

Carpal tunnel syndrome occurs due to compression of the median nerve running through this tunnel. The compression can be due to swelling of the tendons, inflammation of the tendons, overall fluid retention in the body (due to pregnancy, allergies, or other inflammatory conditions) and over-use injuries (such as typing).

Carpal tunnel syndrome can be classified as mild, moderate or severe.

Mild carpal tunnel presents as primarily sensory symptoms with numbness and tingling of the fingers and hand. As the median nerve gets more compressed the symptoms of carpal tunnel syndrome becomes more severe and the motor component of the nerve gets involved. When this happens, weakness and atrophy (muscle wasting) can be seen.

Common Symptoms of Carpal Tunnel Syndrome:

Mild:

  • Numbness, tingling or aching of the thumb, 2nd, 3rd, and part of the 4th fingers
  • Nighttime hand/wrist pain and numbness
  • Difficulty typing, or with fine finger movement involving the first 3-4 fingers
  • Numbness and tingling which worsens when the wrist/hand is bend at a right angle (either flexed forward or extended backwards)
  • Electric shock sensations radiating into the hand
  • Pain that radiates from the wrist upward towards the elbow

Moderate to Severe: (in addition to above symptoms)

  • Weakness in hand grip
  • Dropping objects from the hand
  • Muscle wasting in the palm of the hand, especially at the base of the thumb

For mild symptoms the use of a wrist splint at night will be helpful. These splints can be purchased over-the-counter at a pharmacy or medical supply store. The splint should have Velcro or adjustable type straps and should have some sort of support or rigid material on the underside of your wrist and palm, that will prevent your wrist from bending forward too much. The splint should be worn at night to prevent inadvertent wrist bending, and can be worn during the day if symptoms are continuously present.

Certain exercises may exacerbate carpal tunnel syndrome such as push-ups, planks, and low jacks. Any exercise which puts pressure through the wrist while it is at a 90 degree angle from the arm can further compress the median nerve in the carpal tunnel. Helpful exercise modifications include doing push-ups on your fists and keeping your wrists straight, or doing the push-up on an incline (with your head higher than your feet) so you are putting less weight through your wrists.

In addition, activity modification may be indicated if the above interventions are not helpful. If cleared by your doctor, adding a small amount of Vitamin B6 (<200mg/day) is beneficial for improvement of nerve function. Vitamin B6 acts a a diuretic (decreases swelling), helps the body to make neurotransmitters and helps with the function of the immune system.

Foods which contain B6 include:

  • Wild caught tuna
  • Bananas
  • Salmon
  • Grass-fed beef
  • Chicken breast
  • Spinach

If dietary, activity, and exercise modification are not successful in treating your carpal tunnel syndrome in conjunction with the use of a wrist splint and occasional anti-inflammatory medications, it is important to be evaluated by a health care professional. In addition, if your symptoms progress, are not localized to your first three fingers, or are associated with any other symptoms, make sure to get checked to rule out other causes of hand/finger numbness.

If conservative treatments fail, other interventions such as physical therapy, corticosteroid injections, prolotherapy, platelet rich plasma injections, or surgical release may be indicated.