Spring has sprung, the daffodils are blooming and many of us are hoping for a beautiful summer. But for numerous people, the season of sneezing, runny noses and itchy eyes is just around the corner.
A staggering 44% of British adults now suffer from at least one allergy and the number of sufferers is on the rise, growing by around two million between 2008 and 2009 alone. Almost half (48%) of sufferers have more than one allergy.(1)
Seasonal allergic rhinitis (hay fever) is the most common form of non-infectious rhinitis, affecting between 10% and 30% of all adults and as many as 40% of children.(2)
An allergy is the immune system’s response to normally harmless substances, such as pollens, foods, and house dust mite. Whilst in most people these substances pose no problem, in allergic individuals the immune system identifies them as a ’threat’ and produces an inappropriate response.
There are many types of allergies. Some allergies are seasonal, and others are year-round. In this blog we are going to concentrate on seasonal respiratory allergies. Pollen is one of the most common triggers of seasonal allergies. Many people know pollen allergy as “hay fever,” but the medical term is “seasonal allergic rhinitis.”
What is Hay Fever?
Hay fever is a common allergic reaction which occurs at particular times of the year. It is known as seasonal allergic rhinitis, sharing symptoms with perennial (year-round) allergic rhinitis, but occurring as a reaction to pollen from grass, trees and weeds during the early spring and summer months. While hay fever frequently begins at a young age, it can affect both adults and children. Sometimes seasonal allergy symptoms fade over the years, only to reoccur later in life. For some, moving to a new location with different types of flora can alleviate symptoms or even eliminate them.
The same pollen and allergens that trigger seasonal allergy symptoms can cause asthma attacks, resulting in wheezing, shortness of breath, chest tightness and difficulty breathing. This condition is referred to as allergy-induced asthma or allergic asthma.(3)
What Causes Hay Fever?
It is caused when the body makes antibodies (IgE) to certain substances, such as pollen, which are known as allergens.
Grass pollen is the most common allergen (May to July), but tree (February to June) and weed (June to September) pollens can also cause the allergic reaction we know as hay fever.
What are the symptoms?
- Itchy eyes/throat
- Sneezing, blocked/runny nose
- Watering, red eyes (allergic conjunctivitis)
- Headaches, blocked sinuses
- Shortness of breath
- The sensation of mucus running down the back of the throat, which can also be a symptom, and is called ‘post-nasal drip’.
Symptoms will vary depending on the pollen count.
Avoidance of the allergic triggers and the use of antihistamines. Often symptoms are managed by:
- Monitoring pollen forecasts daily and staying indoors with the windows closed when the count is high (generally on warmer, dry days). Rain washes pollen from the air so counts are normally lower on cooler, wet days
- Avoiding drying washing on a clothes-line outside when pollen counts are high
- Taking antihistamines, which are probably the best-known type of allergy medication, and most are readily available from a pharmacy without prescription
However, antihistamine medication isn’t for everyone. Remember, they don’t cure the allergies — they just treat the symptoms. In fact, many antihistamines are not recommended for people with high blood pressure, heart disease, kidney or liver disease, glaucoma, thyroid problems, or women who are pregnant or breastfeeding.
Theories as to why hay fever is on the rise
Allergies are considered as disorders of the immune system. The body over-reacts to harmless substances and produces antibodies to attack the substance. A person can be particularly susceptible to a weakened immune system after a physical trauma or surgery, underlying illnesses, or during times of emotional and physical stress.(4)
Prolonged sleep restriction and the accompanying stress response invoke a persistent unspecific production of pro-inflammatory cytokines (chronic low-grade inflammation) and also produce immunodeficiency, which both have detrimental effects on health.(5)
The Hygiene Hypothesis
The modern hygiene hypothesis suggests that increased risk of allergies is due to our insistence on cleanliness and lack of exposure to a wide range of microbes in the developed world, which deprives our bodies of immune stimulation, disrupting normal immune development.
The original hypothesis dates back to 1989 when David Strachan proposed that lower incidence of infection in early childhood could be an explanation for the rapid 20th century rise in allergic diseases such as asthma and hay fever. He reported that over the past century declining family size, improvements in household amenities, and higher standards of personal cleanliness have reduced the opportunity for cross infection in young families. This may have resulted in more widespread clinical expression of atopic disease, emerging earlier in wealthier people, as seems to have occurred for hay fever.(6)
Changes in microbiome
Another factor is the relationship between gut health and allergy symptoms. This is something many would not consider; however, it is recognised that the gastrointestinal system plays a central role in immune system homeostasis. The crucial position of the gastrointestinal system is testified by the huge number of immune cells that reside within it.
Indeed, gut-associated lymphoid tissue (GALT) is the prominent part of mucosal-associated lymphoid tissue (MALT) and represents almost 70% of the entire immune system; moreover, about 80% of plasma cells (mainly immunoglobulin A (IgA)-bearing cells) reside in GALT.(7) In addition, early-life environmental influences that are known to disrupt the microbiota, such as antibiotic use,(8) caesarean birth,(9) and formula feeding,(10) are all associated with increased susceptibility to asthma and allergies later in life.
The histamine connection
Histamine is considered an important compound in the body. It acts as a neurotransmitter and regulates production of stomach acid, blood vessel permeability, and contraction of skeletal muscle. It is also a major component of the immune response and thus a key mediator in allergic reactions. A certain amount of histamine is required for proper physiological function; however, some people have a condition called histamine intolerance in which they produce excess histamine and/or have a deficiency in diamine oxidase (DAO), the enzyme that breaks it down. When this occurs, histamine can then be absorbed and be transported to various sites of the body, exacerbating allergic symptoms.
There are many possible causes of histamine intolerance including high consumption of histamine-rich foods, genetic factors when certain sequence variants (polymorphisms) in the DAO gene lead to a significantly reduced DAO enzyme activity, intestinal permeability and SIBO (small intestine bacteria overgrowth). So fundamentally a disturbance in the gut biome plays a significant role in creating histamine intolerance.
Taking probiotics that contain histamine-degrading strains such as Bifidobacterium infantis, Bifidobacterium longum and Lactobacillus rhamnosus is recommended for those with histamine intolerance.
It is not surprising, therefore, that there appears to be a link between the severity of allergies and the health of the gut and its corresponding immune system and therefore, restoring a healthy balance of gut flora is the best long-term solution to resolving a histamine issue.
Histamine N-methyltransferase (HNMT) is an enzyme expressed in the central nervous system that specifically metabolises histamine. HNMT plays an important role in regulating histamine as it breaks down histamine at an intracellular level. It inactivates histamine by transferring a methyl group from S-adenosyl-L-methionine to histamine.
HNMT is expressed in many human tissues, with the highest levels found in the liver and kidneys, but also in the bronchi and trachea. HNMT is a key enzyme concentrated in the liver which is responsible for degrading histamines generated as a result of the functions of the body and in particular mast-cells. It plays an important role in degrading histamine and in regulating the airway response to histamine.(11) Thus there is a link between histamine breakdown and methylation; poor methylation may contribute to allergies.
Recent studies have revealed that vitamin D has important functions in the immune system and might influence the course of immune-mediated disorders. Lower vitamin D levels have been associated with more allergic disease and elevated serum IgE.(12)
In addition, magnesium is another nutrient to be considered. Vitamin D cannot be metabolised without sufficient magnesium levels.(13) Magnesium consumption from natural foods has decreased in the past few decades, owing to industrialised agriculture and changes in dietary habits. Magnesium status is low in populations who consume processed foods that are high in refined grains, fat and sugar. In addition, high consumption of coffee, fizzy drinks, salt, alcohol, stress and vigorous exercise can also lower magnesium levels.
Bromelain – a digestive enzyme from pineapple fruit, has been shown to relieve hay fever or sinusitis in a number of human clinical studies by working as a natural antihistamine, anti-inflammatory and decongestant.(14) Clinical studies in the 1960s found that bromelain reduced sinusitis and hay fever symptoms.(15-17) Bromelain also helps to aid absorption of quercetin.
Garlic – contains quercetin. Quercetin is a bioflavonoid which is a natural antihistamine and is a potent antioxidant that promotes a healthy inflammatory response. A number of studies have shown that quercetin regulates histamine production.(18)
Vitamin C – is a powerful promoter of a strong immune system, calms allergic reactions and is also anti-inflammatory. In one study, the lowest intakes of vitamin C were associated with more than fivefold increased risks of bronchial reactivity.(19)
Spirulina – Spirulina is a nutrient-rich, blue-green algae that has been associated with a wide range of interesting health benefits. A small number of studies have revealed very convincing anti-histamine effects of spirulina and have found that regular consumption of spirulina significantly reduces allergic rhinitis symptoms such as nasal discharge, sneezing, nasal congestion and itching.(20,21)
Additionally, spirulina has been found to inhibit the production of Interleukin-4. Interleukin-4 is a cytokine that promotes the production of Immunoglobulin E (IgE), an antibody that can trigger an allergic reaction such as seasonal allergic rhinitis caused by pollen (i.e. hay fever) or perennial allergic rhinitis which is caused by airborne allergens other than pollen.(22)
Research comparing the gut microbiotas of allergic and non-allergic children found that children with allergies tended to have an increased abundance of Staphylococcus, Clostridium, and Escherichia species, while numbers of Lactobacillus and Bifidobacteria were significantly reduced compared to healthy children.(23,24) This data demonstrates that differences in the indigenous intestinal flora might affect the development and priming of the immune system in early childhood.
Intestinal microbiota regulates the immune system, in particular to rebalance the T helper cells (TH1/Th2) ratio. In a well-functioning immune system, both groups of these T helper cells work together to keep the system balanced.
Many studies have demonstrated that the administration of probiotics is able to prevent the onset of allergic sensitisations and improve the symptoms of hay fever.(25-28)
Other vitamins and minerals
The DAO enzyme is dependent on vitamins B6 and B12, iron, copper, magnesium, zinc and vitamin C. Copper and vitamin C are crucial components of the DAO enzyme and B6 is a key cofactor that enables DAO to degrade histamine. Magnesium is important with regard to histamine metabolism and DAO activity has been found to decrease in conjunction with magnesium deficiency.(29) Zinc inhibits the release of histamine from mast cells.(30)
Not to be overlooked, is the possibility that methylation may need supporting in order to support the HNMT histamine degradation pathway. In the first instance, a good all round multi containing active folate (methylfolate), B12 (methylcobalamin) and B6 (P5P) is recommended. An anti-inflammatory diet, stress reduction, and avoidance of heavy metals will also support methylation. Some people may benefit from additional methylation support if an appropriate multi and dietary/lifestyle changes are not sufficient.
Strategies to reduce symptoms
A low-histamine, anti-inflammatory diet can often reduce the severity of allergy symptoms.
Foods high in histamine include: fermented foods, aged cheese, citrus fruits, fish, shellfish, avocados, spinach, cocoa, leftover meat or fish, fermented alcohol like wine, champagne, and beer.
Foods low in histamine include: freshly cooked meat, poultry (frozen or fresh), freshly caught fish, eggs, rice, quinoa, fresh fruits, fresh vegetables (except tomatoes, spinach, avocado and aubergine), olive oil, coconut oil, leafy herbs and herbal teas.
Certain foods can make symptoms much worse, so knowing those triggers is an important part of an overall plan. Recommendations are to include lots of anti-inflammatory, immune supporting foods such as:
- Blueberries, blackberries, purple grapes, blackcurrants, raspberries – these contain anthocyanins which are considered powerful antioxidants and possess anti-inflammatory properties. They also contain high quantities of vitamin C and quercetin, making them an excellent anti-inflammatory agent.
- Garlic and onions: garlic is a great source of quercetin. It can also help to boost the immune system and is a good source of vitamin C and potassium. Onions are another source of quercetin. Onions also contain high amounts of vitamin C and biotin.
- Ginger is known to slow down histamine production by reducing IgE levels.
- Omega-3 rich foods are known to have anti-inflammatory properties. Sources include wild salmon, mackerel, sardines, herring, walnuts, chia seeds and flaxseeds.
- An allergy is the response of the body’s immune system to normally harmless substances, such as pollens, foods, and house dust mite. Many people know pollen allergy as “hay fever,” but the medical term is “seasonal allergic rhinitis.”
- As well as triggering hay fever symptoms, allergens can cause asthma attacks in susceptible individuals.
- Grass pollen is the most common allergen (May to July), but tree (February to June) and weed (June to September) pollens can also cause the allergic reaction.
- Theories of why hay fever is on the rise include increased stress, sleep deprivation, the hygiene hypothesis, changes in microbiome (gut issues), histamine intolerance and nutrient deficiencies.
- Nutrient support – bromelain, vitamin C, garlic, spirulina, probiotics, vitamin B6, B12, folate (e.g. methylfolate rather than folic acid), iron, copper, magnesium and zinc.
- A low-histamine, anti-inflammatory diet can often reduce the severity of allergy symptoms.
- Foods high in histamine include fermented foods, aged cheese, citrus fruits, fish, shellfish, avocados, spinach, cocoa, leftover meat or fish, fermented alcohol like wine, champagne, and beer.
- Foods low in histamine include freshly cooked meat, poultry (frozen or fresh), freshly caught fish, eggs, rice, quinoa, fresh fruits, fresh vegetables (except tomatoes, spinach, avocado and aubergine), olive oil, coconut oil, leafy herbs and herbal teas.
If you have any questions regarding the topics that have been raised, or any other health matters, please do contact me (Jackie) by email at any time (email@example.com)
Jackie Tarling and the Cytoplan Editorial Team
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Last updated on 12th July 2018 by cytoffice