After what seemed like a never-ending winter of rain and snow, at last spring has come to Southern Vancouver Island. Now airborne pollens are on the rise, and so are allergies. If you are part of the 20-25% of Canadians that have hay fever then you may not enjoy the warmer weather as much as other people.
If you suffer from a runny nose between March and September, you’ll likely wonder if you’ve caught a cold or have allergies. One way to tell the difference is if there is an itchy component to it. If you have itchy eyes, nose, and throat, have sneezing with a clear nasal discharge, a dry cough, and/or have nasal stuffiness that seem to come at the same time each year, it is likely you have seasonal allergic rhinitis, otherwise known as “hay fever.” If there is no itchiness, your body feels achy, you have a yellow nasal discharge, and your throat is sore, it is likely you have caught a cold or have sinusitis. The timing of your symptoms will give clues as to what you are reacting to but if you want to know specifically, skin and blood tests are recommended.
In the springtime, common early allergens include pollen from alder, maple, pine, and broom. As the year progresses and the weather warms up, you may find yourself reacting to pollen from grasses and weeds. When my car windshield is covered in a fine yellow powder, I know the pollen count is indeed high, and will likely be answering questions about allergies.
People most often get hay fever for the first time as children or adults, but it can happen at any age. Symptoms, which can vary throughout a person’s life, occur when your body overreacts to certain foreign substances called allergens. The interaction between your immune system and the allergen causes your body to release histamine, the substance that causes most allergy symptoms. Why do some people react when others don’t? That is a question that so far remains unanswered. There seems to be a genetic component. Anecdotally people tell me their symptoms are worse when they are stressed out, or hve eaten something they are allergic to. Some scientists also believe that some of us have immune systems that have little to do, so when a foreign substance comes along, the resulting attack is much greater than would normally be anticipated. People with asthma and atopic dermatitis also tend to have allergies, and/or food insensitivities.
Some people, however, can suffer continuously as they are allergic to household and environmental substances (pet dander, dust mites, moulds, etc) present throughout the year.
Recommendations for reducing your pollen load include minimizing outdoor activity, such as lawn mowing in the early morning or evening, avoid going outside during or after a thunderstorm, keeping windows closed, planning holidays outside of your pollen season, showering after going outside, and not drying laundry outdoors. A HEPA air purifier further reduces exposure.
Conventional medical treatment offers a variety of medications that can help with seasonal allergy symptoms. Over-the-counter antihistamines are most frequently recommended. As a pharmacist I like to suggest the non-sedating agents (cetirizine, desloratidine, etc) that are taken once a day. Older antihistamines chlorpheniramine and diphenhydramine work very well, but can cause sedation, dry eyes and mouth, as well as headache. They can worsen emphysema, bronchitis, glaucoma, high blood pressure, heart disease, seizures, thyroid problems, an enlarged prostate, and need to be given several times a day. I’ve noticed that many people will successfully take a certain antihistamine for a certain time, only to find out it is no longer effective. Switching to a different antihistamine in that case, will often bring relief.
Decongestants, that work by narrowing blood vessels, are generally not recommended, though they can be used for a few days to relieve a blocked nose when used carefully—decongestants are stimulants that can increase blood pressure, cause restlessness, increase anxiety, aggravate insomnia, and negatively impact diabetes, narrow angle glaucoma, heart disease, hyperthyroidism and an enlarged prostate. Inhaled nasal decongestants have fewer side effects but can cause rebound congestion leading to dependence if used for more than 3 days in a row. Regular use of decongestant eye-drops to clear red eyes can also cause chronic red eyes after 3 days.
Inhaled corticosteroids (fluticasone, mometasone, etc) are second line in the treatment of allergic rhinitis. Available as both over-the-counter and prescription, they often need to be used for a few days before they reach maximum benefit. They can work wonderfully at reducing nasal symptoms particularly when there is nasal congestion. These medications work by decreasing inflammation but can also impair local immunity. It is thus important to rinse your mouth and gargle with water after using them to avoid getting a candida (thrush) infection in your mouth or throat. Because some people have nosebleeds and have even perforated their nostrils with use, it is suggested to insert the applicator gently so that it points toward the outside of each nostril. To avoid coughing, avoid sniffing the medicine into your lungs. The correct dosage must be followed to avoid serious side effects. Other reactions, such as vision changes, facial swelling, are not very common. Some people will require a combination of inhaled corticosteroid and oral or inhaled antihistamine to have adequate symptom control.
Leukotriene receptor antagonists (montelukast) are used for severe symptoms in asthmatic patients that don’t respond to the above therapy(s). They may be associated with serious allergic reactions and neuropsychiatric manifestations, as well as headache and gastrointestinal upset.
Immunotherapy can be administered by your doctor or specialist to desensitize your body to the allergens identified.
Traditional Chinese Medicine, (TCM) offers an alternative to drugs, with fewer side effects. When herbs are purchased through companies with stringent testing for contaminants and toxins and are prescribed by a trained herbalist, they are quite safe as long as they are taken at the correct dose. Side effects, when they occur are generally upset stomach that can be easily remedied, or a possible allergic reaction.
Like conventional medicine, TCM can treat symptoms (“the branch”) but more importantly can address the reasons why symptoms occur (“the root”).
If your symptoms make you miserable, we treat “the branch”. Once you get some relief, we treat both the branch and the root. During your off season(s) we work at building up your constitution (“root”) so that you will be less likely to have symptoms when your allergen is in the air. This means TCM actually works toward healing the patient.
Each person walking into my clinic could potentially have a different treatment based upon what they present. This is difficult for a typical North American to wrap their head around, as we are so symptom oriented, and are used to a one-size-fits-all kind of medicine. To help you out with this idea, I’ll present a small case study:
MA, a 35 year-old woman visits the office with itchy eyes, sneezing, a clear running nose, and an itchy throat, typical for this time of year. She easily catches colds and has had seasonal allergies for over a decade. I check her pulses and see they are superficial yet soft underneath. Her tongue is slightly swollen in the front and there are tooth prints on the sides. I hear her deeply clearing her throat. After asking her a number of questions I diagnose her with “Wind-Cold” (“branch”) with a deficiency the Spleen and Stomach (“root”), whose role is to govern digestion and absorb nutrients from food. The functioning of her lungs is also weak (“root”), impairing her Wei, or defensive Qi. I check her medications, concomitant diseases, and ascertain she is not pregnant.
My treatment is first aimed at treating her symptoms—by clearing Wind and Cold. In the office I give her acupuncture, including points such as Yin Xiang (Welcome Fragrance), Feng Chi (Wind Pool), and Bi Tong (Nose Passage). For herbs I prescribe 2 weeks of a formula containing Xin Yi Hua (Flos Magnoliae), Bai Zhi (Radix Angelicae dahuricae), Cang Er Zi (dry fried Fructus Xanthii)—herbs that work very well at clearing Wind from the nose and alleviating allergy symptoms. I ask that she use a Neti pot twice a day to rinse out her sinuses and drink plenty of water to promote nasal drainage. She should reduce or eliminate dairy foods as they increase mucous production, as do fried or greasy foods. Shellfish should be avoided as it promotes Wind. Regular Qi Gong is recommended as it works on the meridians to release blockages and move Qi throughout the body. I encourage her to continue her stress reduction techniques.
After a 3 treatments, I see MA’s symptoms are no longer interfering with her life. I then shift my acupuncture and herb treatment toward tonifying her digestive and immune systems. I change my acupuncture prescription to contain points such as Zu San Li (Leg-three mile), San Yin Jiao (Triple Yin Junction), and Fei Shu (Lung’s Hollow). These tonify the Spleen, Stomach, and Lungs, thus treating the root. The herbal prescription, at this point, would be built around Yu Ping Feng San (Jade Windscreen Formula). It contains Huang Qi (Astragalus), a very strong Qi and immune tonic, thus addressing the root. Future treatments will focus on this strategy so that she will no longer overreact to allergens the next season. I caution her to avoid cold foods as they damage digestion—these include physically cold foods out of the fridge or freezer, as well as cold producing foods from a TCM perspective, such as tofu, tomato, celery, cucumber, and oranges. When eating a cold food, it is suggested to either drink a tea containing 20 Gou Qi Zi (Goji berries). Warming foods are encouraged, such as ginger, root vegetables, and squash, especially in congees, soups or stews. Qi Gong and stress reduction techniques are to continue.
In reality, there are many variations of the above case study, but I think you get the general idea. I will often add a liver cleansing aspect to my treatments to boost overall response.
In summary, you are now aware of how conventional medicine treats symptoms of allergic rhinitis and how TCM differs by treating the both the cause of distress as well as the manifestations. Conventional medicine treats allergic rhinitis mainly by using antihistamines and nasal corticosteroids. TCM looks at your entire body, and prescribes an acupuncture, diet, herb, and Qi Gong prescription tailor made for you. TCM will help rid you of symptoms and help build your constitution naturally so that you are less likely to experience those symptoms the following allergy season. No matter what system you choose, it is very important that you check with your trained practitioner, doctor or pharmacist to see if the treatment is safe in children, pregnancy, breast-feeding, with your medications, or any concomitant diseases.
The above article has been adapted from the May 2017 Rural Observer publication “Spring is in the Air”