Hay Fever

Hayfever (pollinosis) is an acute type I hypersensitivity reaction stimulated by tree, grass or weed pollens, affecting the upper respiratory tract, ears, eyes, nose and throat. It very often accompanies sensitivities to a variety of other allergens such as house dust, animal and human dander, certain textiles like wool or cotton and certain foods. It is a hypersensitivity to these allergens that cause the inflammation of the nasal passages, accompanied by watery nasal discharge, itchy red eyes, itching of the soft palate and itching of the eustachian tube. In severe cases it can induce asthma and even anaphylaxis. (Berkow 1992, 326)

Mechanism of Hayfever

When an air-borne antigen like pollen is inhaled, it becomes trapped in the mucus of the upper respiratory tract, dependent upon the viscosity of the mucus. The pollen then triggers IgE-mediated mast cell degranulation, releasing a group of chemicals called vasoactive amines, the most prominent of which is histamine. Histamine promotes local inflammation and constriction of the bronchi, as well as increases the permeability of local blood capillaries enabling white blood cells to penetrate the tissues and destroy the local invaders (as well as some of the tissue itself). In allergic people this reaction stimulates a hyper-reaction in adjacent tissues, and within minutes, the affected person is sneezing and rubbing their eyes, blowing their nose and rubbing their ears. The hyper-reactive response causes damage to various tissues and comprise their function. Repeated attacks damage these tissues to such an extent that they become susceptible to viral, bacteria and fungal infections that add to the repetitive cycle of hyper-reaction. The endothelial tissues of the respiratory tract eventually undergo structural changes, and nasal polyps may form over time. If this situation becomes chronic vasomotor rhinitis, may develop. In this scenario, there are more or less continuous hayfever symptoms, but with less hyper-reaction now that the tissues have been compromised. In vasomotor rhinitis there may be a chronic bacterial or fungal infection of the upper respiratory tract, and an enhanced sensitivity to smells, colour, light and sound.

Medical treatment of Hayfever and Allergies

The cornerstone of the medical treatment of hayfever involves the use of various antihistamines, or H1 blockers. Side effects include sedation, nausea, blurred vision, nausea, headache, tinnitus, impotence, arthralgia, insomnia, fever, weight gain, increased incidence of viral infections, constipation, and dryness of the throat and respiratory tract, although the newer antihistamines such as loratadine, terfenadine, and astemizole are non-sedating. Antihistamines may also be combined with decongestants such as pseudoephedrine. Topical intranasal corticosteroids such as beclomethasone are another important component of pharmacologic management of allergic rhinitis, but may cause immunosuppression and thus increase the likelihood of upper respiratory tract infection. Paradoxically, such drugs may even exacerbate the allergic response. Allergen immunotherapy, or hyposensitization, is used in patients that do not respond well to pharmacotherapy, and is a series of injections of the diluted antigen in gradually increasing amounts. Nasal polyps are removed surgically. Additional measures are taken to limit environmental exposure to the offending allergen, which can often represent major changes in patient’s life, such as giving up a loved pet, or even moving to a new location. (Berkow 1992, 326-27)

Holistic treatment of Hayfever

According to Ayurvedic medicine, kapha is the primary pathogenic factor in hayfever. In normalcy, kapha attends to the structural functions of the body, lubricating, moisturizing, nourishing and providing support. The cold weather of winter, coupled with a nourishing diet, causes an increase in kapha. This natural increase of kapha undergoes vitiation as the heat of the sun in spring begins to increase. An analogy would be the snow that has accumulated in the mountains over winter beginning to melt and flood the streams and rivers with water. This flooding of kapha throughout the body, but primarily in the areas of the upper body, impairs digestive function and if left unattended, gives rise to such conditions as chronic respiratory tract infections or hayfever. The traditional practice in many cultures of a spring cleanse is very useful at this time, best implemented just before the season has changed from winter to spring.

There are treatments for hayfever in almost every culture, so a wide repertoire of possible therapies exist. The following is a protocol based on the combined usage of Chinese, Indian and Western herbs, as well as nutritional supplementation. While clinical results can be expected in a relatively short period of time, the overall length of treatment depends on the depth and duration of the condition. Partial relief comes within one week of treatment and most symptoms within a few weeks to a month. It may be that some portion of the treatment such as the dietary changes may need to be followed at the same time every year, or practiced more or less continuously. Vasomotor rhinitis may involve as long 6-12 months of continual treatment, as well as lifelong preventative measures.

The protocol for hayfever is as follows.

1.Inhibit the inflammatory response. Allergic responses represent what Priest and Priest called a negative state, “…a forced reaction to the progressive encroachment of obstructive conditions and the pathological deterioration of the vital force in the affected tissues (Priest and Priest 3, 1982). In contrast, positive states to obstructive conditions are represented by a non-specific enhancement of bodily defenses and immunity, and the successful resolution of the condition. Even though acute symptoms are by nature positive, they need to be directed to the source of the injury. In hayfever the origin of the dysfunctional response is the preexisting weakness and derangement of the mucosa: pollen and other “allergens” are simply catalysts. Inhibiting the inflammatory response is key in hayfever if for no other reason to maintain the integrity of the tissues.

  • antiinflammatory botanicals: Feverfew (Tanacetum parthenium), Nettles (Urtica dioica), Tansy(Chrysanthemum vulgare), Oregon Grape (Mahonia repens), Huang Qin (Scutellaria baicalensis), Forsythia(Forsythia suspensa), Katuka (Picrorrhiza kuroa), Turmeric (Curcuma longa), Neem (Azadirachta indica), Cayenne (Capsicum frutescens) spp.), Schizandra (Schizandra sinensis), Goldenrod (Solidago virgaurea), Bilberry (Vaccinium myrtillus), Hawthorn (Crataegus oxycantha), Amalaki (Emblica officinalis), Ginkgo (Ginkgo biloba)
  • Omega 3 fatty acids (GLA, EPA, DHA), to down-regulate inflammatory eicosanoid  synthesis: 3-5 g/day (best to get in food, rather than supplements)
  • Pantothenic acid (vitamin B5): supports adrenal function, antihistamine: up to 100-400 mg/day, with a B-complex
  • Pyridoxine and pyridoxal-5-phosphate (vitamin B6), antihistamine: 100 mg/day, with a B-complex
  • Methylsulfonylmethionine (MSM), antiinflammatory in mucous membranes; 3-5 g/day

2.Enhance digestion. Eliminate dietary articles such as dairy and flour that promote thick mucoid accumulations and promote damage to the gut wall.  Digestive sensitivities in are large part responsible for the underlying mucosal dysfunction.

  • Bitters, cholagogues, dipanam: Barberry (Berberis vulgaris), Gentian (Gentiana spp), Centuary (Centaurium umbellatum), Buckbean(Menyanthes trifoliata), Goldenseal (Hydrastis canadensis), Katuka (Picrorrhiza kurroa), Bhunimba(Andrographis paniculata)
  • Carminatives, pachana, herbs that remove food stagnation and dispel wing-dampness: Calamus (Acorus calamus), Caraway (Carum carvi), Fennel (Foeniculum vulgare), Mints (Mentha spp), Dong Gui (Angelica sinensis), Anise (Pimpinella anisum), Cardamom (Elettaria cardamomum), Chen Pi (Citrus reticulata), Shan Zha (Crataegus pinnatifida), Ginger (Zingiber officinalis), Cardamom (Elettaria cardamomum), Pippali (Piper longum), Hingu (Ferula foetida), Cang Er Zhi (Xanthium sibiricum)
  • Spleen Qi restoratives: Astragalus (Astragalus membranaceus), Dan Shen (Codonopsis pilosula), Ginseng (Panax spp)
  • Aperients: Triphala, Turkey Rhubarb (Rheum palmatum), Chandraprabha (Operculina turpethum), Buckthorn (Rhamnus cathartica)
  • Digestive enzymes, full spectrum (i.e. HCl, pancreatic enzymes, ox bile): 2-3 caps with meals
  • Avoid overeating, do not eat within three hours of bedtime
  • Avoid alcohol
  • Avoid deep-fried foods, e.g. French fries, potato chips, etc.
  • Avoid all grass-based foods (e.g. wheat, rye, barley, oats, spelt and kamut) and dairy (butter/ghee is OK) to reduce allergic threshold

3. Tone and restore the respiratory mucosa and lungs:

  • Respiratory tonics and mucolytics: Bayberry (Myrica cerifera), Goldenseal(Hydrastis canadensis), Horseradish (Armoracia rusticana),Witch Hazel (Hamamelis virginiana), Mullein (Verbascum thapsus), Goldenrod (Solidago virgaurea), Eyebright (Euphrasia officinalis), Ginger (Zingiber officinale),Cang Er Zhi (Xanthium sibiricum), Hou Po (Magnolia officinalis), Ma Huang (Ephedra sinica), Pippali (Piper longum), Cardamom (Elettaria cardamomum), Elecampane(Inula helenium), Vasaka (Adatodha vasica)
  • Demulcents and vulneraries: Licorice (Glycyrrhiza glabra), St John’s Wort (Hypericum perforatum), Comfrey (Symphytum officinale),Plantain (Plantago spp), Marshmallow (Althaea officinalis), Chickweed (Stellaria media), Mai Men Dong (Ophiopogon japonicus) Shi Di Huang (Rehmannia glutinosa),Shi Hu (Dendrobium nobile)
  • Vitamin A, trophorestorative in mucous membranes: 20,000-30,000 daily
  • Vitamin C:antioxidant, relieves bronchospasm and inflammation,trophorestorative: 3-5 g/day
  • Vitamin E: antioxidant, prevents scarring: 800 IU/day
  • Bioflavonoids:capillary trophorestorative, antihistamine: 3-5 g daily

4.Modulate the immune response, and support the nervous and endocrinal system. In physiomedical terms this is redirecting the activities of the vital state from a negative state to a tolerant state. Immunomodulation is always undertaken while removing the cause, i.e. digestive impairment. In Chinese and Ayurvedic medicine it is important to note that many herbs with immunomodulating and adrenal restorative properties such as fu zheng and rasayanam are best used after the obstruction is removed. Thus a period of cleansing prior to immunomodulation/trophorestoration is typically under taken after the first two components of the protocol has been implemented.

  • Immunomodulants, adrenal restoratives, rasayana, fu zheng: Reishi (Ganoderma lucidum), Huang Qi (Astragalus membranaceus), Ashvagandha (Withania somnifera), Amalaki(Emblica officinalis), Gokshura (Tribulus terrestris), Siberian Ginseng (Eleuthrococcus senticosis),Jujube date (Zizyphus jujuba), Saw Palmetto (Serenoa serrulata), Shatavari (Asparagus racemosa), Ginseng (Panax spp), Schizandra(Schizandra sinensis), Shilajit,Licorice (Glycyrrhiza glabra), Dang Gui (Angelica sinensis), Gou Qi Zi (Lycium barbarum), American Ginseng (Panax quinquafolium)
  • Parasympathomimetics, medhya, herbs to quiet the heart: Vervain (Verbena officinalis), Milky Oats (Avena sativa), Ashvagandha (Withania somnifera), Valerian (Valeriana officinalis), Brahmi (Bacopa monniera),Skullcap (Scutellaria lateriflora), Motherwort (Leonorus cardiaca), Catnip(Nepeta cataria), Jatamamsi(Nardostachys jatamansi), Gotu Kola (Centella asiatica), He Shou Wu (Polygonum multiflorum), Passionflower (Passiflora incarnata), Damiana (Turnera diffusa), Kava (Piper methysticum)
  • Zinc, immunomodulant activities: 50 mg daily
  • Magnesium, relieves bronchospasm: 800-1000 mg per day

5. Formulations.

  • Trikatu, 2-3 g taken with honey, tid
  • Pe Min Kan Wan, 3-5 pills each thrice daily.

6. Lifestyle measures. For daily use in the diet, useful spices and condiments include cumin seed, five spice powder, rosemary, basil, turmeric, garlic, shallots, ginger, apple cider vinegar, tamari and miso. Herbal teas, especially nettle, horsetail, red clover and mint are all useful. Juicing can be a very effective short-term technique to relieve symptoms, especially celery, but also cucumber, parsley, carrots and beet, with a little ginger root. The traditional practice in many cultures of a spring cleanse is very useful at this time, best implemented just before the season has changed from winter to spring. Ayurvedic medicine recommends a course of vamana (vomiting) therapy, followed by the application of nasal medications (nasya, neti), the consumption of simple and easily digestible foods, vigorous exercise, sauna and dry massage. A course of kaphareducing herbs would add to the effectiveness of a cleanse, as would a period of vegetable juice fasting. Exercise (vyayama) in Ayurveda is important too, and some form that causes one to sweat (“to one half one’s capacity”) should be practiced daily to clear the lymphatic system.