This article was originally written by Dr Tawnya Ward for the trade journal "Vital Link" - published by the Canadian Association of Naturopathic Doctors. It is geared as a summary more for physicians in the natural treatment and naturopathic treatment of asthma. The links to environmental medicine and to the patient page on asthma can provide a less technical summary.
Effect of Inhalant Allergies and Chemical Sensitivities on Asthma
Tawnya Ward, ND
Allergies and chemical sensitivities can alter the function of every cell of the body. This article will focus on the effect of allergies and chemical sensitivities on the respiratory tract. The most common allergic lower respiratory tract condition is asthma. In my experience, most cases of asthma, even those reliant on daily inhalant steroids and semi-annual prednisone tapers at presentation, can be brought under control with the aggressive naturopathic treatment and environmental controls. Chemical sensitivities can affect asthma and other allergic conditions, both through exaggerated IgE immune reactivity and alteration of the autonomic nervous system response.
The ground regulating system, an Environmental Medicine concept studied extensively by Environmental Medicine doctors, such as William Rea, M.D.1 (American Environmental Health Foundation), is synonymous with the more common naturopathic terms of the terrain or milieu. Dr. Rea’s texts entitled ‘Chemical Sensitivity’ Volumes 1 to 4 are highly recommended for anyone interested in the field of Environmental Medicine. Although some of the terminology may be different, the general principles are remarkably similar. Excessive chemical, heavy metal and toxin exposure, in conjunction with nutritional and enzymatic deficiencies can result in alterations in the normal cellular functioning and communication, manifesting in a myriad of chemical sensitivity symptoms. An increased allergy response is a common symptom of patients with chemical sensitivity, which can result in exacerbation of respiratory tract immune mediated disorders such as asthma. Chemical sensitivities can also alter the neurological innervation of the pulmonary and cardiovascular system, aggravating respiratory diseases.
Bronchial asthma is characterized by the triad of airway hyper-responsiveness, reversible airflow limitation, and chronic submucosal airway inflammation. Acute exacerbations lead to widespread narrowing of the airways which results in dyspnea, cough and wheezing, of short-lived duration. Asthma can be divided into allergic asthma, characterized by a history of allergic diseases (e.g. rhinitis, urticaria, and eczema), elevated IgE titers, and wheal and flare reactions to intradermal injection of inhalant allergens, and idiosyncratic asthma, occurring in the absence of allergic family history, negative skin tests and normal IgE antibody titers. Both allergic and idiosyncratic asthma have underlying hyper-reactivity of the tracheobronchial tree. Viral infections can further increase airway reactivity.
Mast cells, neutrophils, eosinophils, and lymphocytes all appear to be locally increased in asthmatic patient’s airways. Activation of these cells and the release of potent inflammatory mediators results in mucus secretion obstructing the airways. Mediators involved include histamine, bradykinin, leukotrienes C, D and E, platelet activating factor, and prostaglandins E2, F2alpha and D2, producing an intense, immediate inflammatory reaction of bronchoconstriction, vascular congestion and edema.5
Allergies, Sensitivities, Intolerances and Toxicities
There is a great deal of confusion in the medical community in reference to the difference between allergies, sensitivities, intolerances and toxicities. An allergy is an adverse reaction involving an IgE mediated antibody immune mechanism (Gel-Coombs Types I, II, and II). A hypersensitivity is an adverse reaction involving a Gell-Coombs Type IV, non-IgE-mediated reaction, and all other immune system mediated reactions. Intolerances involve an adverse reaction occurring in individuals susceptible to dysfunctioning of specific non-immune, metabolic mechanisms (overstressed enzyme systems, nutritional deficiencies, etc). Toxicities involve adverse reactions mediated by poisoning of any biological mechanism in otherwise normal individuals .
Most cases of asthma and allergic rhinitis are triggered by highly specific IgE-mediated allergic responses . The most common asthmatic inhalant allergens are cat saliva, dust mites, pollens, molds, and tobacco smoke. Underlying conditions can heighten the production of IgE antibody against these inhalants. Exacerbating factors may be a dysregulation of gastrointestinal flora, mercury polarizing the immune response toward antibody production and autoimmune tendencies, elevated mold spore exposure, mold toxins wreaking havoc on the immune and/or neurological system (e.g. Stachybotyrus spp, especially when stressed by dry conditions), allergenic food consumption multiple times every day (e.g. corn, dairy, wheat, egg, soy) and/or increasing toxic load resulting in chemical sensitivities. Chemical sensitivities, when not properly addressed, have the potential to result in an upregulation of immune chemical messengers causing a general increased production of IgE antibodies against foods, drugs, inhalants, and chemicals to which the immune system was previously tolerant (spread phenomenon).
A good patient history can help to differentiate between the common inhalant allergens. Pollen allergies are worse outside (better inside), on dry windy days (better after rain) and in the summer. Mold allergies are worse in warm humid weather (better in cold weather, especially after snow), on hot windy days, after rain, after freshly cut grass, in damp environments, during the evening hours, around indoor potted plants, stables or barns. Dust mite allergy symptoms are often worse indoors (better outdoors), in the winter, after cleaning, 30 minutes after going to bed and on waking. Food allergies often develop after meals, in the middle of the afternoon (~4:30 PM) or early in the morning (3:30-4 AM awaking patient). Alcohol can increase food allergen absorption, making the patient react more strongly to a reactive food consumed in conjunction with alcohol.
Chemical and inhalant exposures can sensitize the airways and lead to bronchoconstriction and increased asthmatic tendencies. Exacerbating inhalants include, metal salts (platinum, chrome, and nickel), wood and vegetable dusts (e.g. oak, cedar, grain, flour, castor bean, coffee bean, etc), pharmaceuticals (e.g. antibiotics, piperazine, and cimetidine), chemicals and plastics (e.g. toluene diisocyanate, phthalic acid anhydride, trimellic anhydride, persulfates, ethylenediamine, p-phenylenediamine, and various dyes), biologic enzymes (e.g. laundry detergents and pancreatic enzymes); and animal and insect dusts, serums and secretions . Reduction of occupational exposure such as wearing a properly fitting mask designed for the offending inhalant can help prevent respiratory sensitization.
Cross Reactive Inhalant and Food Allergens
A number of foods can cross react with inhalant allergens. Examples of cross reactive inhalants and foods include cedar pollen and cherries, bell pepper, apple and tomato ; birch pollen (Bet v 1 epitope) and apples, stone fruits, celery, carrot, nuts and soybeans ; birch (Bet v 6 epitope) and apple, peach, orange, lycee fruit, strawberry, persimmon, zucchini and carrot10; birch-pollen and kiwi ; latex and banana . Generally, most foods that cross-react with pollen allergens lose their allergenicity when cooked. It should be noted that both cooked celery and hazelnuts still pose a high allergenic risk for sensitized individuals10. Corn sensitive patients may react to beef, chicken and turkey raised on corn based feed. In such cases, bison and fowl raised on non-corn feed may be preferable.
Fungal Hypersensitivity Reactions
Fungal organisms can result in hypersensitivity reactions, such as Candida (gastrointestinal) and Aspergillus spp. (sinuses, lungs). IgE antibody titers or skin testing can assess the resulting level of allergy. Sinus and chest x-rays and a sputum sample can assess for aspergillosis in patients with highly positive IgE titers or highly positive aspergillus skin test results. Antifungal medication or supplements should be given reduce or eliminate colonization, and resulting exacerbation of allergies. Ozone can be injected near the sinus cavities (through gums superior to upper teeth) to help clear fungal sinusitis. Fungal infections left untreated can result in hypersensitivity reactions and spread phenomenon, resulting in increased IgE production to multiple allergens.
Lab tests appropriate for allergic patients in addition to a full baseline workup include ESR, hs-CRP, stool microbiology, chelation challenge (assess for heavy metal body burden), and allergy testing (serum IgE, IgG4 or total IgG and/or serial dilution end-point titration for inhalant allergies or provocation neutralization for food allergies). It should be noted that provocation neutralization food allergy testing is contraindicated in patients with any history of asthma. Training courses in provocation neutralization food allergy testing and serial dilution end point titration are available through the American Academy of Environmental Medicine. If warranted, a blood mercury (for acute exposure), ANA, AM cortisol, DHEA-S and environmental air testing (mold plates, pollen counts) should be done.
As naturopathic doctors, many of us test serum total IgG or IgG4 levels to various potential food allergens. It should be noted that although IgG/IgG4 can cause delayed type sensitivities to foods, in the context of a moderate to high IgE production to that same food, the IgG antibodies will block the immediate onset IgE reactions more dangerous reactions, characterized by edema, erythema, heat and pain. It can be advantageous to have a moderate level of IgG antibodies to the foods and inhalants pre-sensitized for IgE reactivity. Conventional 'allergy shots' (Subcutaneous Immunotherapy [SCIT]) work on this pathway to build a more calm immune response, thus shifting away from IgE reactivity.
Sublingual Immunotherapy (SLIT) uses small amounts of the antigen, which is taken sublingually on an increasing dose regime. The sublingual mucosa is unique in that there are no IgE mast cells (little to no potential for severe allergic reactions), and a high density of T-regulatory cells (previous known as TH0 cells). The T-regulatory cells bind their corresponding antigen, resulting in the down regulation of antigen-specific daughter B-cells and decreased IgE antibody production. Additionally, the stimulation of T-reg cells changes the terrain resulting in a down regulating non-specific IgE antibody production.
Treatments for asthma can include an individualized combination of major and minor autohemotherapy (blood ozone treatments), chelation (mercury is often an exacerbating factor in allergic and autoimmune diseases), desensitization of inhalant allergies, far-infrared sauna treatments to reduce total body toxin load, intravenous (IV) magnesium to promote airway relaxation, Myer’s injections to support the adrenals and buffer antibody response (high cortisol suppresses both humeral and cell-mediated immunity; low cortisol promotes elevated antibody production) and IV vitamin C (15 or more grams) treatments to help clear chemicals liberated by sauna treatments. Higher doses of IV vitamin C are used if infection is suspected (25 to 75 grams). Major (IV) and minor (intramuscular) autohemotherapy (no risk of vein irritation) give outstanding results in asthmatic and allergic patients (ultraviolet blood irradiation is better for acute infection).
For Naturopathic Doctors not able to use oxidative treatments such as major autohemotherapy (‘ozone therapy’), photoluminescence (UV blood irradiation [UBI]) or IV peroxide (never oral; lack of gastric catalase can promote stomach cancer), higher dose IV vitamin C treatments (25-75g) can give a similar oxidative push. Intravenous vitamin C (>17 g) promotes the transient formation of hydrogen peroxide in the tissues, giving an effect similar to intravenous peroxide (0.03% peroxide). Although we do not often use IV peroxide because of the risk of vein irritation (phlebitis), high dose IV vitamin C (25-75g) can give a similar clinical effect with far less (if any) vein irritation. In practice, I use MAH, UBI and occasionally IV peroxide to treat asthma. Since IV peroxide can be used to treat asthma, in theory high dose IV vitamin C may work as well. Additionally, IV vitamin C can help clear allergy-antibody complexes and chemicals, further aiding allergies and asthma. It should be noted that patients to receive oxidative treatments should be screened for G6PD deficiency and IV vitamin C treatments should be gradually increased to oxidative levels (e.g. 15-25g increments). Urine analysis for hemoglobin and CBC post-treatment can screen for evidence of hemolysis (exceedingly rare).
Oral supplementation often includes high potency EPA fish oil, probiotics, and high potency vitamin/mineral replacement, and trisalts powder (calcium carbonate, sodium bicarbonate and potassium bicarbonate). Patients with concomitant chemical sensitivities receive far infra-red sauna treatments, IV vitamin C, oral high magnesium and multi-mineral rehydration drink, fish oils, hydrotherapy, and breathed oxygen therapy (2 hours per day for 15-30 days). The sauna should be constructed from hypoallergenic wood such as hemlock, using no toxic glues and no plywood inserts. Cedars can off-gas terpenes, to which patients can become sensitive.
Environmental controls can decrease the level of asthma reactivity to inhalant allergens and decrease the sensitization process. For pollen allergies, it is best to wear a hat, glasses, mask, and long sleeves when working outside (especially in the garden); remove clothing as soon as come indoors, shower and shampoo hair to remove pollen; keep indoor windows closed; have a Hepa filter on high at all times, air conditioning, and avoid window fans. Environmental controls for dust mite allergies include, good ventilation, keep the bedroom cool and humidity below 50% (dust mites thrive in a warm humid environment), mattress & pillow covers, wash bedding weekly in hot water, dry in high heat, tumble pillows in drier on high for 1 hour to kill mites (detergents do not affect mites, very high temperature kill mites), sun exposure for area rugs, damp cloth to dust, clean ceiling fans, no stuffed animals in the bedroom, hard floors (cleaned weekly), and removal of upholstered furniture. For mold allergies, have a dehumidifier always running, sump pump or French drains and no carpet in basement, examine shower curtain and bathroom tiles for mold, ventilate bathroom after bathing; repair leaks quickly, remove wet carpets, ventilate the kitchen, clean visible mold from ceiling and walls, and have patients wear a mask while cleaning basement and attic. For cat allergies it is best to remove the pet, or if the patient then suggests removing the Naturopath, consider no pets in the bed, or better yet no pets in the bedroom. Regular washing of the cat can reduce allergen exposure although this should not be the only measure. It should be noted that cat allergen can be found in houses without cats, and may be higher in some classrooms than in some homes with a cat . Cat allergen is sticky and can persist for months after cat removal. Even a small amount of cat allergen can trigger asthma attack in cat sensitive individuals.
Proper environmental controls and aggressive Naturopathic treatments can, in most cases, bring asthma and other allergic conditions under control. Screening for and normalizing underlying immune altering conditions (GI dysbiosis, fungal infections, mercury, etc) nutrient and enzymatic deficiencies, and concomitant chemical sensitivities are important to ensure favourable and long lasting results.
About the Author
Tawnya Ward received her ND from the Canadian College of Naturopathic Medicine and a BSc in biology from Dalhousie University. She has been trained by the American College for Advancement in Medicine (ACAM/ISCT) for chelation therapy and by International Oxidative Medicine Association for ozone, ultraviolet and peroxide therapies. She has been trained in bio-identical hormones and anti-aging by the International Hormone Society. She has been trained by the American Academy of Environmental Medicine, a specialist organization for allergy, detoxification, and environmental sensitivity. She is licensed through CNPBC in chelation therapy, oxidative medicine, and acupuncture. Dr. Ward runs her practice at the Pangaea Clinic of Naturopathic Medicine in Richmond, BC.