The Encyclopedia of Natural Medicine, 3rd Ed.

Hay Fever

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• Watery nasal discharge, sneezing, itchy eyes and nose

• Usually associated with a particular season

Hay fever (also known as allergic rhinitis and pollinosis) is an allergic inflammation of the nasal airways and eyes. It occurs when an allergen, such as pollen or dust, is inhaled by an individual with a sensitized immune system. In sensitized people the allergen triggers the production of the allergic antibody immunoglobulin E (IgE), which binds to specialized white blood cells known as mast cells and basophils, causing them to release histamine and other mediators of the allergic reaction. These chemicals can cause itching, swelling, and mucus production. Symptoms vary in severity between individuals. Some may have symptoms limited to red, itchy eyes, while extremely sensitive individuals can experience hives or other rashes along with the typical hay fever symptoms. About 25% of the adult U.S. population will experience hay fever symptoms each year.

Causes

In the United States, allergy to ragweed pollen accounts for about 75% of cases of hay fever. Other significant pollens inducing hay fever include various grass and tree pollens. In northern latitudes in the United States birch is considered to be the most important allergenic tree pollen, with an estimated 15 to 20% of hay fever sufferers sensitive to birch pollen. If the hay fever develops in the spring, it is usually due to tree pollens. If it develops in the summer, grass and weed pollens are usually the culprits. Hay fever symptoms that persist year-round (perennial allergic rhinitis) may be due not to pollen but rather to some other allergen, such as a food or mold.

The reason ragweed is a major cause of hay fever is that it produces a huge amount of pollen. A single ragweed plant can produce up to 1 billion pollen grains and each grain can travel more than 100 miles from its source. Ragweed allergy generally surfaces between August and October in many parts of the country.

Allergy testing may identify specific allergens. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. An alternative to skin testing is the RAST blood test.

Therapeutic Considerations

The first step in the natural approach to hay fever is reducing exposure.

• Track the pollen count in your area and try to stay indoors when pollen counts are highest.

• At home and in the car, keep the windows closed and the air conditioner on. Air conditioners filter the air as well as cool it. Just make sure to change or clean the filters every three months or so.

• Shower before bed to remove pollen, especially from your face and hair.

• Try nasal irrigation. Get a neti pot and wash nasal passages with a saline solution twice per day.

• Equip your home with HEPA filters, which can be attached to central heating and air-conditioning systems.

If you suffer from perennial hay fever, removing dogs and cats and any surfaces where allergens can collect (carpets, rugs, upholstered furniture) is ideal. If this can’t be done entirely, make sure that the bedroom is as allergy-proof as possible. Encase the mattress in allergen-proof plastic; wash sheets, blankets, pillowcases, and mattress pads every week in hot water with additive- and fragrance-free detergent; consider using bedding material made with Ventflex, a special hypoallergenic synthetic material; and install an air purifier. Search the house for areas of constant moisture. Such moisture can result in the growth of a black mold that is highly sensitizing to some people.

Immunotherapy

A popular treatment for hay fever is immunotherapy. In the classic form of this therapy the patient receives a series of injections of the allergy-causing agent into the skin (subcutaneous immunotherapy) until the body no longer mounts an immune response. The injections are usually given for several months before the effectiveness of the treatment can be determined. Typically, at the end of three years, one-third of patients will be cured of their allergies, one-third will have a significant reduction in symptoms, and one-third will show little or no benefit. With subcutaneous immunotherapy there is a small but definite risk of inducing a systemic allergic reaction. This reaction occurs in less than 0.1% of those treated (1 in 1,000), but it may be life-threatening.

In recent years, sublingual (under the tongue) immunotherapy has shown efficacy at least on a par with allergy shots. Drops of liquid containing minute quantities of the offending pollen(s) are placed under the tongue. Sublingual immunotherapy can be more convenient than traditional subcutaneous immunotherapy—there is no need to come in for shots—and it takes less time. Permanent results are often seen within weeks or months.1,2 We recommend physician supervision with the initial use of sublingual immunotherapy; although it is much safer than subcutaneous immunotherapy, allergic reactions may still occur, and though they are usually restricted to the upper airway and gastrointestinal tract, rare anaphylactic episodes (but no deaths) have been reported.1,2

Quercetin

Quercetin consistently demonstrates the greatest activity among the flavonoids studied in experimental models, particularly in test tube studies. In these studies, quercetin has been shown to exert significant antiallergy effects. In particular, it prevents the release of histamine from mast cells and basophils. Unfortunately, regular quercetin is not very well absorbed.3,4 Recently, a highly bioavailable enzymatically modified form of isoquercitrin (EMIQ) has been developed. This form has shown significant effects in improving some of symptoms of hay fever in double-blind clinical studies. In one of these studies, 20 subjects with hay fever took two capsules per day of 100 mg EMIQ or a placebo for eight weeks during the pollen season.5 During the entire study period, total ocular score and ocular itching score were significantly lower for the EMIQ group than for the placebo group. In another study, 24 subjects with hay fever took 100 mg EMIQ or a placebo for eight weeks, starting four weeks prior to the onset of pollen release.6 During the entire study period, ocular symptom scores for the EMIQ group were significantly lower than those of the placebo group. When limited to the pollen release period, ocular symptom scores and ocular congestion scores for the EMIQ group were significantly lower than those for the placebo group, while other scores for the EMIQ group, such as ocular itching scores, lacrimation scores, and ocular congestion scores, all tended to be lower. However, no significant differences were found in nasal symptoms between the two groups. These results indicate that EMIQ is useful in reducing ocular symptoms of hay fever, especially ocular congestion.

Apple Polyphenols

Two double-blind studies showed apple polyphenols to reduce hay fever symptoms. The first study was conducted on patients with allergy to cedar pollen.7 The results showed that the sneezing score was significantly lower for the AP group than for the placebo group during the early and main periods of pollen dispersion. The second study was of patients with persistent allergic rhinitis due to house dust mites.8 Patients were treated with a low dose of apple polyphenols (50 mg per day), or with a high dose of apple polyphenols (250 mg per day); controls received none. Significant improvements were observed in sneezing attacks and nasal discharge in the high-dose group and in sneezing attacks in the low-dose group. There was also a significant improvement observed in swelling of the nasal passages in the treated groups. Similar results may be achieved with other polyphenol-rich extracts such as grape seed, pine bark, or green tea extract.

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QUICK REVIEW

• Hay fever (seasonal allergic rhinitis) is an allergic reaction of the nasal passages and airways to windborne pollens that shares many features with asthma.

• In the United States allergy to ragweed pollen accounts for about 75% of the cases of hay fever.

• The first step in the natural approach to hay fever is to reduce exposure.

• In recent years, sublingual immunotherapy has shown efficacy at least on a par with allergy shots.

• A highly bioavailable enzymatically modified form of isoquercitrin (EMIQ) has shown significant effects in improving some of symptoms of hay fever in double-blind clinical studies.

• Two double-blind studies showed apple polyphenols to reduce hay fever symptoms.

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TREATMENT SUMMARY

If a specific allergen can be identified, immunotherapy (preferably sublingual) may offer the best long-term solution. Otherwise, allergen avoidance and supporting the body’s antiallergy mechanisms appear to offer some benefit.

Diet

Eliminate all food allergens and food additives to reduce the allergic threshold. If you have multiple food allergies, utilize a four-day rotation diet, as described in the chapter “Food Allergy.” Otherwise, follow the general guidelines detailed in the chapter “A Health-Promoting Diet.”

Nutritional Supplements

• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”

• Vitamin D3: 2,000 to 4,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)

• Fish oils: 1,000 mg EPA + DHA per day

• EMIQ: 100 mg twice per day

• One of the following:

  images Apple polyphenols extract: 100 to 250 mg twice per day

  images Grape seed or pine bark extract (>95% procyanidolic oligomers): 150 to 300 mg per day

  images Green tea extract (90% polyphenols): 150 to 300 mg per day