Allergies and Naturopathic Treatment with a Focus on Modulating Cytokines
With the start of allergy season, many patients are interested in alternatives to the daily routine of popping an over-the-counter antihistamine. Generally, patients have had to try a variety of types of these antihistamines to find one that works well for their symptoms. Some have gone the route of using intra-nasal steroids as a way to control allergic rhinitis. These patients end up in the office usually because of a disdain for the daily use of a synthetic drug, and are interested in natural alternatives.
There are definitely natural alternatives that have similar mechanisms of action as the over-the-counter drugs. For example, quercetin has been widely used because of its known action in stabilization of the mast cell membrane, and subsequently lessens the release of histamine.1 This effect of quercetin can be enhanced by the use of a variety of herbal teas, including the commonly used herbs chamomile, saffron, anise, fennel, caraway, licorice, cardomom and black seed.2 Often times, I have found in clinical practice that the use of quercetin alone is usually insufficient. The addition of high doses of oral vitamin C can be used to enhance its effectiveness; most of my allergic patients benefit from bowel tolerance doses of vitamin c, according to Robert Cathcart MD's guidelines at www.orthomed.com/titrate.html. In cases where allergic patients are not finding symptomatic relief after approximately 5-10 days, a more in-depth approach to balancing the immune system is used where we evaluate triggers that may promote a Th2 dominant phenotype, toxins that predispose to an excess over-stimulation of the immune system, and finally the use of oxidative therapies to encourage a more balanced immune response.
A general understanding of allergy, though a gross over-simplification, is that there is a cytokine imbalance in the immune system that general leads to a Th2-phenotypic dominance.3 This Th2 dominance is thus responsible for over-active B-cells and their subsequent production of an excess of immunoglobulin E. It is the immunoglobulin E that triggers the allergic symptoms with the activation of cells such as the mast cells. The Th1-Th2 balance theory is useful in clinical practice, but has its limitations, including that many cytokines do not fall neatly into one category versus the other.4
The first part of my approach to difficult allergic patients is to ascertain whether or not food sensitivities may be promoting the allergic phenotype. I choose foods to evaluate first because of the control the patient has in choosing his or her exposure - for example it is much easier for the patient to avoid casein as opposed to staying away from environmental allergens such as grass. The identification and elimination of food sensitivies helps many of my patients with their environmental and seasonal allergies, although the mechanism is not completely understood. One theory involves the limiting of Th2 cytokines. For example, if the patient has an IgG or IgE protein directed against casein, every time the casein is ingested in significant and frequent enough quantities it will elicit a release of cytokines such as IL-4 or IL-5.5 These cytokines can then increase Th2 cell activity in general, leading to the increased activity of more immunoglobulin including those that cause the seasonal allergic symptoms.6
Case Study 1: A 4 year old male presented to my clinic with his parents complaining of severe mucus build up in the nasal passages, with concurrent chest congestion. The symptoms had been present at a very early age, and a sweat-chloride test had previously come back negative. Symptoms were almost always worse seasonally. Being such a young patient, simple oral supplements were difficult to use and thus not attempted. Instead, a blood draw and concurrent elimination-challenge diet was done to identify food triggers. On the elimination diet, after roughly 7 days mucus production had lessened significantly. After 14 days, there was no evidence of any mucus nasally, whereas previously I could not even examine the color of the nasal mucosa. When the blood tests came back, foods not tested positive were reintroduced without incident, and positive foods were continually avoided. Note that elimination-challenge testing of food sensitivities is the gold standard, and there may be more variation with blood tests.7
The second component of my treatment program involves detoxification of organic and heavy metal toxins. While I recommend a combination of intense exercise to promote sweating, usually a compromise is made whereby alternating hot and cold showers (similar to constitutional hydrotherapy) is done. Provoked testing for an increased body burden of toxic metals is done using oral DMSA, oral DMPS, and IV CaEDTA. The heavy metal lead has been shown to have a very distinct effect of polarizing towards an excessive Th2 response8,9 although this has been in mice. Clinically I see my patients having improvements in allergic symptoms if lead is detoxified.
Case study 2: A middle-aged female flight attendant presented with chief complaints of severe fatigue and daily allergic rhinitis. Her history includes being hospitalized on more than one occasion for observation after accidental exhaust inhalation. While it is may be doubtful if lead exposure occurred in her occupation, the fact that her system was exposed to increased organic toxins made me evaluate her for a significant increase in body burden of metal toxins. We found a very high lead level (roughly twice to three times what I routinely see in my patients). With CaEDTA IV pushes, her energy returned first, followed by a significant decrease in allergic symptoms.
My third branch of treatment for allergic patients is the one that I have found most useful in the majority of patients. This involves the use of the oxidative therapies. Particularly, ultraviolet blood irradiation, ozone therapy by major autohemotherapy, and occasionally intravenous hydrogen peroxide according to the International Oxidative Medicine Association guidelines are the therapies that are most useful.
Ozone therapy by major autohemotherapy is perhaps the most well-studied of these oxidative treatments when it comes to understanding the cytokines that are released during treatment. In particular, Bocci has done a great review article10 in which he describes the biological effects, including cytokine release, that occur during this useful treatment. In practice, major autohemotherapy is performed twice a week for 3 weeks and then the effect evaluated. If positive, the treatment is tapered off to once a week to once every two weeks for 4 treatments, and then as needed or once every 1-2 months. During the tapering period, aerobic exercise is prescribed in incrementally increasing durations and intensity. The reason for this is that at intense aerobic exercise, as much as 5% of the oxygen consumed will not be completely reduced to water, and will contribute to direct oxidative stimulation of the cells. I have found that if exercise is included in the routine after the initial ozone therapy, the improvements that we see in allergic (and other symptoms) is maintained for longer and more likely to become permanent. Usually patients will begin to see improvements in their allergic symptoms early in the therapy, but it is important to continue therapy at the prescribed course.
Case study 3: A 53 year old male patient presented to me because of fatigue, difficulty concentrating, sensation of congestion in both ears, and a persistent sense of a dull headache. Conventional work-ups had been normal. Whenever the patient moved his jaw, such as to chew, he would hear popping with-in his ears. A food allergy test was done (patient was unwilling to do an elimination-challenge diet) and dairy and egg products were avoided. Once weekly IV hydrogen peroxide was given according to IOMA protocols. After the first few treatments, congestion in his ears had significantly decreased, but the most noticeable improvement was in his ability to think clearly and concentrate. His energy had improved, and no longer was there a low-grade congestion in his ears. After the ten treatments were done (a different protocol was used compared to the above described), exercise was increased. 3 months later he returned to inform me he was still doing much better but the low-grade congestion had returned. Further questioning revealed exercise had not been done as frequently as prescribed. The patient is now doing well on once-monthly ozone treatments. He only has minor aggravations during the fall season, not coming close to the intensity of his presenting symptoms.
Allergies and other conditions of the immune system can be treated very successfully with naturopathic medicine. Our biological approach to optimizing function, as opposed to simply suppressing symptoms, makes our medicine much more effective at effecting cure than a simple antihistamine or steroid approach to allergy. While the majority of allergic patients can benefit from minor health-promoting lifestyle changes, quercetin, herbal medicines, and oral vitamin C, some patients require more help to re-establish good immune function. The approach described above is one that I have had good success with clinically, and should be considered by those willing to become experienced in chelation and the oxidative therapies.
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Br J Pharmacol. 2005 Aug;145(7):934-44.
2.Haggag EG, Abou-Moustafa MA, Boucher W, Theoharides TC. The effect of a herbal water-extract on histamine release from mast cells and on allergic asthma.
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J Allergy Clin Immunol. 1996 Jul;98(1):73-81.
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Below background levels of blood lead impact cytokine levels in male and female mice.
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9. : Gao D, Kasten-Jolly J, Lawrence DA. Related Articles, Links
The paradoxical effects of lead in interferon-gamma knockout BALB/c mice.
Toxicol Sci. 2006 Feb;89(2):444-53. Epub 2005 Nov 9.
10. Bocci V. Ozone as Janus: this controversial gas can be either toxic or medically useful. Mediators of Inflammation, 2004 Feb;13(1), 3-11.