SEASONAL ALLERGIES

WHAT ARE SEASONAL ALLERGIES?

Although seasonal allergies (SA) is commonly referred to as hay fever, the term is inappropriate because SA symptoms are neither produced by hay nor associated with fever (1).  Seasonal allergies are actually symptoms that are caused by allergens entering the body through the eyes, nose or throat, settling on the nasal mucous membranes and causing a hypersensitivity reaction (1).   This reaction is because the immune system considers allergens to be invasive, causing the body to produce and release chemicals, including histamine, to defend it (2).

Symptoms are identifiable because of how quickly they start and stop based on allergen exposure (3).  The onset of symptoms is dependent on geographical location and are triggered by seasons that have high allergen counts (3,4).  For example, people usually experience symptoms during seasons when trees, grasses, flowers, and weeds release pollen (5,6).   Pollen, which is the most common allergen, is the male reproductive organ of flowering plants. The proteins that cover pollen grains assist in plant reproduction, but it also triggers allergic reactions in sensitized people (7).  Other common allergens include molds, house dust mites, and pet/animal dander (3,5,8).

SA can be difficult to treat because even though the symptoms repeat themselves because they can be caused by multiple types of allergens and vary in intensity from mild to severe (9). Therefore, familiarity with the pollinating season of the major trees, grasses, and weeds of your geographical location makes symptoms easier to detect and diagnose (3).

RISK FACTORS OF SEASONAL ALLERGIES

• Frequent exposure to allergens
• Eczema
• Having a blood relative with allergies or asthma
• Having other allergies or asthma

SYMPTOMS OF SEASONAL ALLERGIES

• Sneezing
• Coughing
• Runny nose
• Nasal congestion/stuffiness
• Itchy nose and throat
• Red eyes
• Itchy, watery eyes
• Skin irritation
• Fatigue and sleepiness (1,3,10,11,12,13)

SEASONAL ALLERGIES FACTS AND STATISTICS

• SA affects an estimated 10–30% of the global population and is rising due to climate change (10).
• Seasonal allergies affect up to 14% of the North American adult population and generally occur during its Spring season (March – June) (10,15).
• SA is very common in Australia and New Zealand, affecting up to 40% of the population. Its prevalence has doubled over the past 25 years (14).  In Australia alone, pollen from ryegrass is the most common allergen. It affects 56.3% of the Australian population (6).
• SA usually appears early in life. On average, at about the age of 10 (4,9).
• Contrary to popular belief, SA is not just a nuisance but a serious, clinical health problem that costs the United States health care $6 billion annually. It also causes absenteeism and poor performance for adults at work and children in school (4).

MEDICAL TREATMENT OF SEASONAL ALLERGIES

Although there is no cure for SA, there are many ways to prevent or treat its symptoms (14).  Be sure to speak with your doctor about symptoms. If symptoms cannot be managed with medicine, your doctor might refer you to an allergist or immunologist.

Common medicines to treat SA include:

• Antihistamines
• Decongestants
• Nasal filters
• Cromolyn sodium
• Topical synthetic corticosteroids (1,9,16)

Another possible treatment is immunotherapy.  Allergen immunotherapy is the process of continually administering allergen extracts, in increasing doses, to patients of a period of years. The objective of immunotherapy is to desensitize individuals to the specific allergens and can be administered as an injection, as tablets, as a spray or drops under the tongue (17).  Although it is not a cure, it provides substantial relief of symptoms and is equally safe and beneficial for most patients (4).  It may also be able to remain effective for at least three years after the discontinuation (8).

NATURAL WAYS TO SUPPORT HEALTHY AIRWAYS

Practices to Help Support Healthy Airways:

• Exposure prevention (4)
• Acupuncture (18,19)

Natural Supplements that Support Healthy Airways:

• Butterbur (Petasites hybridus) (1,11)
• Nigella sativa(Black Cumin) (20)
• Stinging Nettle (21,22)
• Tinospora cordifolia (23)
• Phleum pratense (24,25,26)
• Lactobacillus (27,28)

REFERENCES

1. Schapowal A, Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ. 2002;324(7330):144-146.
2. Lichtenstein LM, Gillespie E. The effects of the H1 and H2 antihistamines on "allergic" histamine release and its inhibition by histamine. J Pharmacol Exp Ther. 1975;192(2):441-450.
3. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001;108(1 Suppl):S2-8.
4. Adkinson NF. Immunotherapy for Allergic Rhinitis. N Engl J Med. 1999;341(7):522-524. doi:10.1056/NEJM199908123410710
5. Knapp HR. Reduced Allergen-Induced Nasal Congestion and Leukotriene Synthesis with an Orally Active 5-Lipoxygenase Inhibitor. N Engl J Med. 1990;323(25):1745-1748. doi:10.1056/NEJM199012203232506
6. Park HJ, Lee J-H, Park KH, et al. A Six-Year Study on the Changes in Airborne Pollen Counts and Skin Positivity Rates in Korea: 2008-2013. Yonsei Med J. 2016;57(3):714-720. doi:10.3349/ymj.2016.57.3.714
7. Schmidt CW. Pollen Overload: Seasonal Allergies in a Changing Climate. Environ Health Perspect. 2016;124(1). doi:10.1289/ehp.124-A70
8. Durham SR, Walker SM, Varga E-M, et al. Long-Term Clinical Efficacy of Grass-Pollen Immunotherapy. N Engl J Med. 1999;341(7):468-475. doi:10.1056/NEJM199908123410702
9. Berman BA. Allergic rhinitis: mechanisms and management. J Allergy Clin Immunol. 1988;81(5 Pt 2):980-984.
10. Schmidt CW. Pollen Overload: Seasonal Allergies in a Changing Climate. Environ Health Perspect. 2016;124(1). doi:10.1289/ehp.124-A70
11. Käufeler R, Polasek W, Brattström A, Koetter U. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv Ther. 23(2):373-384.
12. Tamm S, Cervenka S, Forsberg A, et al. Evidence of fatigue, disordered sleep and peripheral inflammation, but not increased brain TSPO expression, in seasonal allergy: A [11C]PBR28 PET study. Brain Behav Immun. 2018;68:146-157. doi:10.1016/J.BBI.2017.10.013
13. Leung A, Hon K. Seasonal Allergic Rhinitis. Recent Pat Inflamm Allergy Drug Discov. 2008;2(3):175-185. doi:10.2174/187221308786241965
14. Allergy and Immune Diseases in Australia (AIDA) Report 2013 ASCIA Allergy and Immune Diseases in Australia (AIDA) Report. https://www.allergy.org.au/images/stories/reports/ASCIA_AIDA_Report_2013.pdf. Accessed July 12, 2018.
15. Wallace D V, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM. Pharmacologic Treatment of Seasonal Allergic Rhinitis: Synopsis of Guidance From the 2017 Joint Task Force on Practice Parameters. Ann Intern Med. 2017;167(12):876-881. doi:10.7326/M17-2203
16. Kenney P, Hilberg O, Laursen AC, Peel RG, Sigsgaard T. Preventive effect of nasal filters on allergic rhinitis: A randomized, double-blind, placebo-controlled crossover park study. J Allergy Clin Immunol. 2015;136(6):1566-1572.e5. doi:10.1016/j.jaci.2015.05.015
17. Allergen immunotherapy. https://www.allergy.org.au/images/pcc/ASCIA_PCC_Allergen_immunotherapy_2016.pdf. Accessed July 12, 2018.
18. Roberts J, Huissoon A, Dretzke J, Wang D, Hyde C. A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis. BMC Complement Altern Med. 2008;8(1):13. doi:10.1186/1472-6882-8-13
19. Lee MS, Pittler MH, Shin B-C, Kim J-I, Ernst E. Acupuncture for allergic rhinitis: a systematic review. Ann Allergy, Asthma Immunol. 2009;102(4):269-279. doi:10.1016/S1081-1206(10)60330-4
20. Nikakhlagh S, Rahim F, Aryani FHN, Syahpoush A, Brougerdnya MG, Saki N. Herbal treatment of allergic rhinitis: the use of Nigella sativa. Am J Otolaryngol. 2011;32(5):402-407. doi:10.1016/j.amjoto.2010.07.019
21. Helms S, Miller A. Natural treatment of chronic rhinosinusitis. Altern Med Rev. 2006;11(3):196-207.
22. Mittman P. Randomized, Double-Blind Study of Freeze-Dried Urtica dioica in the Treatment of Allergic Rhinitis. Planta Med. 1990;56(01):44-47. doi:10.1055/s-2006-960881
23. Badar VA, Thawani VR, Wakode PT, et al. Efficacy of Tinospora cordifolia in allergic rhinitis. J Ethnopharmacol. 2005;96(3):445-449. doi:10.1016/j.jep.2004.09.034
24. Rak S, Yang WH, Pedersen MR, Durham SR. Once-daily sublingual allergen-specific immunotherapy improves quality of life in patients with grass pollen-induced allergic rhinoconjunctivitis: A double-blind, randomised study. Qual Life Res. 2007;16(2):191-201. doi:10.1007/s11136-006-9110-3
25. Malling HJ, Lund L, Ipsen H, Poulsen L. Safety and immunological changes during sublingual immunotherapy with standardized quality grass allergen tablets. J Investig Allergol Clin Immunol. 2006;16(3):162-168.
26. Dahl R, Stender A, Rak S. Specific immunotherapy with SQ standardized grass allergen tablets in asthmatics with rhinoconjunctivitis. Allergy. 2006;61(2):185-190. doi:10.1111/j.1398-9995.2005.00949.x
27. Costa DJ, Marteau P, Amouyal M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomized, placebo-controlled trial (GA2LEN Study). Eur J Clin Nutr. 2014;68(5):602-607. doi:10.1038/ejcn.2014.13
28. Lue K-H, Sun H-L, Lu K-H, et al. A trial of adding Lactobacillus johnsonii EM1 to levocetirizine for treatment of perennial allergic rhinitis in children aged 7–12years. Int J Pediatr Otorhinolaryngol. 2012;76(7):994-1001. doi:10.1016/j.ijporl.2012.03.018