Show 1403: Managing Year-Round Allergies with Medicines and Herbs

This week, our guests share their expertise on how to deal with sniffles and congestion, whether you are reacting to seasonal triggers or suffer from year-round allergies. Can you reduce the amount of allergen you are exposed to? Which medications could help, and what are the downsides? We’ll also discuss some herbs that can help ease uncomfortable symptoms.

Is Climate Change Making Allergies Worse?

We’ve been talking about the misery of allergies for decades, but it seems as though they are getting worse. Could there be a link to climate change?

Dr. David Peden says that is very likely. With climate change, plants start releasing their pollen earlier in the spring and continue later in the fall. Depending upon which pollens trigger a person’s allergic response, they could start suffering sooner or discover they are miserable later in the year.

Does the Indoor Environment Contribute to Year-Round Allergies?

Outdoor air carries pollen, but indoor air can also be full of allergens. Pet dander and dust mites are common culprits. What can you do to protect yourself from hazards inside?

Ventilation is key to getting enough clean air. One tool that can help assess the ventilation in your space is a carbon dioxide monitor. That’s not because you need to avoid carbon dioxide but rather because it tells you if the air around you is circulating or just sitting and accumulating contaminants. A good air filtration system is vital for controlling indoor allergens and managing year-round allergies.

Medications to Treat Year-round Allergies:

Antihistamines:

Some of the best-recognized medications for allergies are antihistamines. Diphenhydramine (Benadryl) has been around for many decades. Although it blocks histamine quite effectively, it has a significant downside for daytime use. People taking Benadryl during the day may feel too sleepy to function. In fact, OTC nighttime pain relievers such as Advil PM or Tylenol PM continue diphenhydramine to cause drowsiness. Short-term use could help you breathe at night during allergy season. We worry about long-term use for year-round allergies because it could affect cognitive function. Moreover, using any of the antihistamines, including cetirizine (Zyrtec) or fexofenadine (Allegra) continuously for an extended period my result in reduced effectiveness.

Decongestants:

Decongestants shrink the blood vessels that lead to swollen tissue in your nose. That can help you breathe much more easily, but of course there’s a catch: Decongestant nasal sprays are limited to about three days. If a person uses one for longer than that, their body may adapt, and stopping use could result in rebound congestion. Oral decongestants don’t usually create that problem, but they are much less likely to be helpful. Scientists know that one common ingredient, phenylephrine, is essentially ineffective.

Steroid Nasal Sprays:

Within the last decade, a number of steroid nasal sprays have become available over the counter. These can be very useful in alleviating congestion and other nasal symptoms. They are powerful anti-inflammatory compounds being delivered right where inflammation is causing the most trouble. None of these should be used indefinitely, however.

Allergy Shots:

There is still a role for allergy shots in desensitizing people to certain allergens. Although doctors recommend them more often for severe allergies such as bee sting that could result in anaphylaxis, they can also be used for seasonal allergies. People who have had a series of allergy shots also seem to be less susceptible to respiratory infections.

Nasal Lavage:

Lavage is a fancy word for “washing.” You can clean allergens out of your nasal passages with a neti pot or saline nasal spray. Dr. Peden suggests this can be quite helpful.

Natural Approaches for Alleviating Allergies:

As we have learned, many of the agents used to treat allergies can be helpful, but they have downsides. What natural products might be beneficial? Dr. Tieraona Low Dog suggests that the gut microbiome may play a role in the immune system reaction we call allergy. One way to address that might be with a probiotic. To find an appropriate choice, she recommends consulting usprobioticguide.com

Bitter Herbs:

Traditional healers around the world recognize the value of bitter herbs for a range of symptoms including congestion as well as digestive problems. The bitter taste receptors that are found throughout the body, including the lungs, prevent mast cell degranulation. One medication that The People’s Pharmacy often recommends for allergies also stabilizes mast cells so that they don’t release histamine or other inflammatory compounds. Cromolyn (NasalCrom) needs to be used preventively, before allergy season starts, to get the most benefit. Bitter herbs may sound exotic, but dandelion root is readily available. Another herb, Andrographis, is termed the king of bitters and can be useful for seasonal and year-round allergies as well as cold symptoms (PLoS One, Aug. 4, 2017). https://pubmed.ncbi.nlm.nih.gov/28783743/

Other Supplements:

Quercetin is a compound that is found in numerous plants, including many that we consume often, such as apples, garlic and tea. To use it for allergy symptoms, Dr. Low Dog often recommends a reliable extract (500 mg twice daily during allergy season). An herb that helps with symptoms of stuffiness, butterbur, requires careful shopping. If the toxic compounds (pyrrolizidine alkaloids) are not removed, there is a risk of liver damage. The brand name product Petadolex has been treated appropriately and is safe. Some people take 50 to 75 mg twice a day for symptoms (PLoS One, April 11, 2024). https://pubmed.ncbi.nlm.nih.gov/38603736/ Finally, an extract of stinging nettle (Urtica dioica) is also useful for calming symptoms of seasonal or year-round allergies.

This Week's Guests:

David B. Peden, MD, MS, FAAAAI, is the Andrews Distinguished Professor of Pediatrics and Senior Associate Dean for Translational Research at the University of North Carolina at Chapel Hill. He also serves as the Chief Research Officer & Director of the UNC Clinical Research Alliance. In addition, he is Medical Director of the Center for Environmental Medicine, Asthma and Lung Biology in the Division of Pediatric Allergy & Immunology at The School of Medicine of The University of North Carolina at Chapel Hill.

[caption id="attachment_106238" align="alignnone" width="300"] David B. Peden, MD, MS
Harry S. Andrews Distinguished Professor of Pediatrics
Senior Associate Dean for Translational Research
Chief, Division of Allergy, Immunology & Rheumatology, Department of Pediatrics
Director, Center for Environmental Medicine, Asthma & Lung Biology[/caption]

Tieraona Low Dog, MD, is a founding member of the American Board of Physician Specialties, American Board of Integrative Medicine and the Academy of Women’s Health. She was elected Chair of the US Pharmacopeia Dietary Supplements/Botanicals Expert Committee and was appointed to the Scientific Advisory Council for the National Center for Complementary and Alternative Medicine. Her books include: Healthy at Home: Get Well and Stay Well Without Prescriptions, Life Is Your Best Medicine, and Fortify Your Life: Your Guide to Vitamins, Minerals and More. Her website is:
https://www.drlowdog.com/books

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