With spring on the horizon, people all over the country are beginning to feel the effects of allergies. Over 50 million people in the United States, including up to 30% of adults and 40% of children, suffer from allergic rhinitis, more commonly known as hay fever (1). With more than 13.4 million visits to physician offices, hospital outpatient departments and emergency departments stemming from allergic rhinitis yearly, several drugs are on the market to try to minimize the effects of allergies, but several natural options may be worthy of your attention.

Before discussing some of the natural options for allergies available, it’s important to go into some of the mechanisms that trigger them in the first place. Allergic rhinitis has two variations: seasonal or perennial, each stemming from immune system overreactions to different sources. Seasonal allergies cause symptoms upon exposure to things like pollen from trees, grasses or weeds, as well as mold spores. The culprits behind perennial allergies tend to be house dust mites, animal dander or cockroaches (1).

When someone breathes in an allergen, the immune system releases substances known as immunoglobin-Es (IgEs) into the nasal passages, along with inflammatory chemicals such as histamines. This commonly leads to itchy and congested noses, eyes and sinuses. Allergic rhinitis has a wide range of symptoms, including runny nose, fatigue, dry cough and post-nasal drip. Scientists still have yet to figure out why the immune system overreacts to these allergens (2). Conventional over-the-counter options for allergy care generally center around using antihistamines to counter the initial overreaction and reduce symptoms.

Stinging Nettle
Stinging nettle (urtica diotica) has seen use for a variety of different conditions, with different parts of the plant playing different roles. Its roots have traditionally been used to help with urination problems in men stemming from enlarged prostate, but it is the above-ground portion that may have some benefits for allergy sufferers. While none of the products mentioned here can be said to treat any disease or condition, it is believed that some preparations of stinging nettle can function in similar ways to traditional antihistamines.

In one randomized, double-blind study, patients were supplemented with a daily 300-mg dose of a freeze-dried stinging nettle preparation over a week-long period. Results were gauged by daily symptom diaries along with responses in a follow-up visit at the end of the study period. Out of the 69 people who initially completed the study, 58% rated it effective and 48% found it equally or more effective than medicine they had previously taken (3). One possible reason stinging nettle could have these effects is—ironically enough—due to the fact that it contains histamine. While this may sound confusing, histamine can also act as an autacoid that helps modulate immune response. Subcutaneous and intravenous injections of histamine have been used by physicians to treat a wide variety of conditions stemming from allergies, such as migraines and allergic arthritis. Another study specifically focused on the mechanics behind stinging nettle noted several cases of inhibited pro-inflammatory pathways commonly associated with allergic rhinitis following the administration of stinging nettle (4).

Butterbur
Butterbur (Petasites hybridus) has been traditionally used as an anti-spasmodic and poultice for wounds, but is seeing different applications today. Scientific trials have shown potential value for butterbur in helping deal with migraine headaches in addition to allergic rhinitis. It is important to mention that in its raw state, butterbur contains liver-toxic and possibly carcinogenic components called pyrrolizidine alkaloids, but all supplemental preparations utilize an extract with the alkaloids removed (5).

In one double-blind, placebo-controlled study designed to test both objective and subjective responses to butterbur, 16 patients with perennial allergic rhinitis were given either 50 mg of butterbur, 180 mg of the antihistamine fexofenadine or a placebo twice daily over the course of a week. At the end of the study period, the peak nasal inspiratory flow as well as the presence of nasal symptoms were recorded and compared to baseline. The study results showed a similar level of improvement in both the butterbur and fexofenadine groups, suggesting that butterbur could potentially be valuable for sufferers of allergic rhinitis (6).

Another larger study also yielded positive results. This randomized, double-blind, placebo-controlled test had 186 participants, all with intermittent allergic rhinitis. The participants were then split into three groups; a placebo group, a low-dose group given 8 mg of butterbur extract twice a day, and a high-dose group given 24 mg daily. The study took place over a two-week period, with self-assessment of symptom severity using a visual scale taken at baseline and conclusion of the study. The study’s results showed not only an overall reduction in symptoms with the butterbur groups over placebo, but also a higher reduction in the high-dose group over the low-dose group. The study authors noted that this showed a dose-dependent effectiveness for butterbur in treating allergic rhinitis, and concluded that it “should be considered for treating intermittent allergic rhinitis in patients in whom antihistamines are not indicated or when sedation is to be avoided.” Neither of the two studies found any adverse effects in participants (7).

Probiotics
While many may think digestive health when they hear probiotics, these beneficial bacterial strains may have potential for allergy sufferers as well. The most common probiotic strains used in allergy studies are Lactobacillus acidophilus and Bifidobacterium longum, although several others have also been tested, as well as combinations of strains in some of the most recent studies (8). While several studies show possible relationships between probiotics and allergic rhinitis, results tend to differ from one study to another.

In one study, 425 participants with grass pollen allergies were given either the probiotic Lactobacillus paracasei or a placebo along with the oral antihistamine loratadine over a five-week period, with nasal and ocular symptom scores taken at baseline and at the conclusion of the study. Curiously, while there was no difference in nasal symptoms between the two groups, there was a significant improvement with the ocular symptoms of allergic rhinitis and the researchers suggested that these findings showed probiotics could be a viable add-on therapy for allergy sufferers (9). Another study where Lactobacillus acidophilus L-92 was tested with people with dust mite allergies yielded more rounded results. This double-blind, placebo-controlled study tested 49 patients with perennial allergic rhinitis, who were supplemented with fermented milk containing the probiotic strain daily over an eight-week period. During the study period, each patients had multiple blood tests and nasal cavity examinations.

The probiotics group experienced an overall improvement in symptoms over placebo, both in clinical examinations and in subjective symptom diaries taken by the patients. Both ocular and nasal symptom improvements were recorded, but curiously, the blood samples taken showed little difference, including levels of IgEs. The study authors believed that while probiotics may be valuable for alleviating symptoms of allergic rhinitis, the mechanisms behind this are unknown (10). Due to the variance of results and the amount of strains being tested, it may take some time before an ideal probiotic solution is identified.

Spirulina
A blue–green algae, spirulina’s high levels of nutritional content have led to its popularity as a dietary supplement for quite some time, with it serving as a strong source of protein, vitamins, minerals and antioxidants. Some studies suggest that this multifaceted supplement may play a variety of roles, including overall immune support and supporting liver strength in addition to helping with allergies (11). Research is also ongoing regarding spirulina’s potential applications for inflammation and viral infections.

While research regarding spirulina and allergies is preliminary, many of the findings to date have been positive. One double-blind, placebo-controlled study tested the effects of spirulina on 150 patients aged 19-45 with a clinical history of allergic rhinitis as well as presently exhibiting symptoms of allergic rhinitis at the time of the study. The spirulina group took five tablets daily, totaling 2,000 mg of spirulina, over a six-month period, with physical and symptom tests taken at baseline and at the end of the study period. The patients also graded their own symptoms on a weekly basis using a four-point scale. The study found significant improvement in symptoms, including nasal discharge, sneezing, nasal congestion and itching (12).

The exact way that spirulina garners these types of results are unknown, but several studies present strong potential reasons. One study specifically focused on the immune modulator properties of spirulina, testing the production of three cytokines critical in regulating IgE-mediated allergy. This randomized, double-blinded, placebo-controlled study took place over 12 weeks, with both 1,000 mg and 2,000 mg daily doses tested along with placebo. At the conclusion of the study, while the 2,000-mg group only saw reduction in IL-4, (i.e. one of the three cytokines), it was by a significant amount, and the authors concluded that the results “indicate that spirulina can modulate the T-helper (Th) cells profile in patients with allergic rhinitis by suppressing the differentiation of Th2 cells mediated, in part, by inhibiting the production of IL-4.” They went on to say that this fact demonstrates a protective effect from spirulina regarding allergic rhinitis (13). Other theories exist, though. Some preliminary animal and in vitro studies suggest that spirulina may actually play a role in stopping the release of histamines, but more data are needed (11).

Quercetin
Another multipurpose supplement that may find yet another use with allergies is the flavonoid quercetin. Found in several fresh fruits and vegetables, quercetin’s high antioxidant content and anti-inflammatory properties have led to studies testing it for a variety of conditions from high cholesterol to rheumatoid arthritis, both in supplemental form as well as in foods. One Japanese study of mast cells from nasal mucosa of individuals with perennial allergic rhinitis supplemented with quercetin showed significant inhibition of antigen-stimulated histamine release, almost twice as much as a similar dosage of sodium cromoglycate (14). In a study of mice administered quercetin to try to test its effects on allergic asthma, several chemicals associated with allergic diseases were suppressed compared to a control group, something the study authors attributed to anti-inflammatory properties (15). In addition to inhibiting histamine release, it is also believed that quercetin can help lower some of the swelling that occurs when allergens come in contact with the body, particularly in the lungs, nasal passages, and eyes (16).

Due to a lack of human trials, quercetin’s exact allergy-fighting capacity cannot be entirely determined. With this said, increasing intake of quercetin-rich foods such as citrus fruits, apples and teas can support your overall health due to the high volume of antioxidant nutrients they contain. For those interested in supplemental quercetin, it is recommended to also use bromelain, an enzyme commonly found in pineapple that also has anti-inflammatory properties. Several quercetin supplemental products on the market already come with bromelain included (17). Tell to shoppers to always consult a doctor before using herbs or dietary supplements to address allergies. WF

See www.wholefoodsmagazine.com/supplements for additional coverage of the supplements category.

References
1. American College of Allergy, Asthma, and Immunology. “Allergy Facts,” http://acaai.org/news/facts-statistics/allergies, accessed 1/12/15.
2. University of Maryland Medical Center, “Allergic Rhinitis,” http://umm.edu/health/medical/altmed/condition/allergic-rhinitis, accessed 1/12/15.
3. P. Mittman, “Randomized, double blind study of freeze dried urtica dioica in the treatment of allergic rhinitis,” Planta Med. 56, 44-47 (1990).
4. B. Roschek, Jr., et al., “Nettle Extract (Urtica dioica) Affects Key Receptors and Enzymes Associated with Allergic Rhinitis,” Phytother. Res. 23 (7), 920–926 (2009).
5. NYU Langone Medical Center, “Butterbur,” www.med.nyu.edu/content?ChunkIID=21626#ref14, accessed 1/16/15.
6. D.K.C. Lee et al., “A Placebo-Controlled Evaluation of Butterbur and Fexofenadine on Objective and Subjective Outcomes in Perennial Allergic Rhinitis,” Clinical and Experimental Allergy, 34 (4), 646–649 (2004).
7. A. Schapowal, “Butterbur Ze339 for the Treatment of Intermittent Allergic Rhinitis: Dose-Dependent Efficacy in a Prospective, Randomized, Double-blind, Placebo-Controlled Study,” Arch. Otolaryngol. Head and Neck Surgery, 130 (12), 1381–1386 (2004).
8. G. Yang, Z.Q. Liu and P.-C. Yang, “Treatment of Allergic Rhinitis with Probiotics: An Alternative Approach. North American Journal of Medical Sciences,” 5 (8), 465–468 (2013).
9. D J Costa et al., “Efficacy and Safety of The Probiotic Lactobacillus Paracasei LP-33 In Allergic Rhinitis: A Double-Blind, Randomized, Placebo-Controlled Trial,” Eur. J. Clin. Nutr. 68, 602–607 (2014).
10. Y. Ishida et.al., “Clinical Effects of Lactobacillus Acidophilus Strain L-92 on Perennial Allergic Rhinitis: A Double-Blind, Placebo-Controlled Study,” J. Dairy Sci. 88 (2) 527–533 (2005).
11. University of Maryland Medical Center, “Spirulina,” http://umm.edu/health/medical/altmed/supplement/spirulina, accessed 1/16/15.
12. C. Cingi et al., “The Effects of Spirulina Allergic Rhinitis,” Eur. Arch. Oto-Rhino-Laryngol. 265 (10), 1219–1223 (2008).
13. T.K. Mao et al., “Effects of a Spirulina-Based Dietary Supplement on Cytokine Production from Allergic Rhinitis Patients,” J. Med. Food, 8 (1), 27–30 (2005).
14. H. Otsuka et al., “Histochemical and Functional Characteristics of Metachromic Cells in the Nasal Epithelium In Allergic Rhinitis: Studies of Nasal Scrapings and Their Dispersed Cells,” J. Allergy Clinical Immunol. 96, 528–536 (1995).
15. A.P. Rogerio et al. “Anti-Inflammatory Activity of Quercetin and Isoquercitrin in Experimental Murine Allergic Asthma,” Inflammatory Res. 56 (10), 402–408 (2007).
16. R. Firshein, “Quercetin: The End Of Allergies,” www.health-prism.com/experts-columns_the-end-of-allergies.html, accessed 1/19/2015.
17. University of Maryland Medical Center, “Quercetin,” http://umm.edu/health/medical/altmed/supplement/quercetin, accessed 1/19/2015.
 

Published in WholeFoods Magazine, March 2015