MORE THAN JUST A RUNNY NOSE: NASAL AND SINUS ALLERGIES
Grace worked as a buyer for a luxury retailer. She loved her job because she loved to shop, but it required frequent air travel, which was really hard on her sinuses. As a clothing buyer, she frequently entered showrooms filled with the latest fashions. She found that the air in many showrooms and clothing warehouses would irritate her nose and make her sneeze. The reason: new fabric is usually treated with formaldehyde, an irritating chemical that evaporates and fills the air in fabric shops, showrooms, warehouses, and clothing stores.
She came to see me because she was sick of being sick, and because she wanted to save her job, which was in jeopardy because she missed so much work due to illness.
Grace had suffered from nasal allergies since childhood and had first seen an allergist when she was ten years old. Skin tests done by the allergist showed allergic reactions to house dust, dust mites, and several types of mold. Allergy shots were not helpful.
As a teenager Grace began to experience frequent colds, which occasionally caused sinus infections. In college she underwent surgery, first to correct a deviated nasal septum, then to clean and drain her sinuses. Nasal polyps were found and removed at the time of surgery, and she was advised to use a steroid nasal spray every day to prevent them from returning.
Following surgery, Grace had some relief of her chronic nasal and sinus congestion and mucus drip, but she still caught every cold that came around and each cold led to a new sinus infection, which was treated with antibiotics and steroid pills.
When she first came to see me she had been ill for about four years with continuous nasal and sinus congestion despite daily use of antihistamines and nasal sprays. She was getting steadily worse and had reached the point where almost every airplane ride caused a sinus infection requiring antibiotic therapy. Her doctors recommended further surgery, but Grace doubted it would be of much help, because the first one had not prevented her health from deteriorating.
One doctor thought that her sinus problems were the result of acid reflux. This is a common problem that may affect up to 40 percent of people with chronic rhinosinusitis (CRS), the term for the combined nasal and sinus disorder that afflicted Grace.1 With acid reflux, as we saw in Chapter 9, your stomach’s contents travel backward up your esophagus and into your throat. The most common symptom of reflux is heartburn, but throat and nose irritation may occur and can contribute to the development of CRS.
The standard treatment of acid reflux is the use of drugs that suppress production of stomach acid, but as I noted in Chapter 9, there are many reasons to avoid the use of acid-suppressing drugs. In Grace’s case, they simply didn’t work. She had used them for two years without benefit.
In an effort to get relief, Grace had changed her diet, eliminating dairy foods like milk, yogurt, cheese, and ice cream and also gluten-containing foods like wheat, rye, and barley. Her daily congestion improved somewhat, but her energy plummeted and she continued to get sick every time she traveled.
When I first saw her, her nose and sinuses were clearly inflamed and she had a thick, yellow postnasal drip. I suspected that the extreme drop in energy she’d experienced on a gluten-free diet might have been due to the dramatic decrease in carbohydrate consumption when she eliminated wheat. Some of my patients feel more energetic on a low-carb diet, but some feel more fatigued. It’s an example of the differing ways in which diet change can affect different individuals that I described in Chapter 6.
I thought that Grace needed an additional change to her diet. She was about to leave on another trip, so Power Wash and Re-entry would have to wait until she returned. In the meantime, she needed immediate help. My solution had three components:
What Are Nasal and Sinus Allergies?
Nasal allergy, or allergic rhinitis, is the most common allergic illness in the United States, affecting almost 60 million people.2 Around the world, it affects a total of 500 million people.3 It can make you feel pretty miserable. Stuffed nose. Runny nose. Sneezing. In addition to its relentless symptoms, it causes a great deal of time lost from work or school and wreaks havoc with quality of life.4 It can easily ruin a night’s sleep, producing additional symptoms like fatigue, irritability, and depression and damaging memory and concentration.
Scientific research has identified a little-known but troubling fact: nasal allergy can impair reaction time and driving performance, increasing the risk of motor vehicle accidents. In a controlled experiment conducted in Holland, people with pollen allergies were tested on a closed driving course out of season before and after being exposed to the pollen to which they were allergic.5 The impairment produced by pollen exposure was equivalent to that seen at a blood alcohol level of 0.05 percent, the legal limit in many countries. Treatment of symptoms with antihistamines or nasal sprays partially—but not completely—blocked the impairment.
In a similar experiment conducted at the Veterans Affairs Medical Center in Washington, D.C., pollen exposure had a major adverse impact on vigilance and response times and decreased the efficiency of working memory and the speed of reasoning and computation.6 The effect was comparable to taking a sedative drug. But this was not a drug effect. It was a direct effect of the allergy itself. From the perspective of public health and safety, nasal allergy is a serious disease that needs to be taken seriously.
Having allergic rhinitis increases your susceptibility to asthma, colds, and sinusitis, the medical research observes.7 Proper treatment of allergic rhinitis has also been found to improve school performance.8 However, research has shown that treatment of allergic rhinitis is often inadequate.9
The usual treatments for allergic rhinitis are antihistamines taken either as pills or as nasal sprays, steroid nasal sprays, and drugs like monteleukast that block the activity of allergic mediators called leukotrienes. All these drugs work best when used continuously and daily, but side effects like fatigue, nosebleeds, and excessive dryness can limit their usefulness.
Nasal Allergies and the Common Cold
The interaction between allergic rhinitis and rhinovirus, the group of viruses that cause the common cold, creates a vicious cycle. Rhinovirus enters your cells by attaching to a molecule called ICAM-1, which is a mediator of inflammation. Having nasal allergies increases the levels of ICAM-1 in the cells that line your nose, increasing the opportunity for rhinovirus to cause infection.
Rhinovirus infection then further increases the levels of ICAM-1, which aggravates nasal allergies.10 Laboratory research has shown that zinc, an essential mineral often lacking in modern diets, can bind to ICAM-1 and prevent rhinovirus from attaching to it.11 This effect of zinc probably explains the benefits of zinc treatment in decreasing severity and duration of the common cold, which has been demonstrated in numerous controlled clinical trials.12 Maintaining optimal zinc status is one component of the Allergy Solution program that can help build your antiviral defenses.
Types of Rhinitis and Sinusitis
Allergic rhinitis predisposes you to developing allergic sinusitis. The combined disorder, chronic rhinosinusitis (CRS), affects 12.5 percent of the U.S. population.13 In addition to nasal symptoms, CRS causes postnasal drip, sore throat, cough, facial pain, headache, and fatigue. Like simple rhinitis, CRS may interfere with sleep and mental concentration and plays a major role in causing or aggravating asthma.14
There are two major types of allergic rhinitis and two major types of CRS. Allergic rhinitis may be seasonal (SAR) or year-round (perennial rhinitis); CRS may occur with or without nasal polyps, which are soft, painless growths in the lining of the nose. Understanding these distinctions may help you in applying the Allergy Solution program to heal your own allergies. Nasal polyps, for example, are strongly associated with food allergy, and dietary treatment may greatly enhance the effect of conventional treatment.
Seasonal rhinitis is usually triggered by pollens or outdoor mold spores. If you suffer from SAR, the timing and severity of your symptoms will depend upon what’s in the air. Unfortunately, the pollen count is going up almost every year, a result of the increased carbon dioxide content of the earth’s atmosphere due to industrial emissions.
Perennial rhinitis is triggered by allergens to which you are continuously exposed, like food, dust, pet dander, or indoor mold, and may also be caused by allergic reactions to bacterial or fungal microbes growing in your nose or sinuses.
Air pollution aggravates all types of allergic rhinitis and sinusitis by irritating the lining of the respiratory tract.
Out-of-Control Ragweed Now Growing in Your City?
In many action films the future is a barren wasteland where few green plants grow. But what if the real future looks different, with nature somehow hijacked by greenhouse gases and plants growing in unnatural ways?
That scenario is previewing in a city near you. Ragweed plants are growing more quickly, flowering sooner, and getting bigger. The reason? Higher temperatures and higher levels of carbon dioxide in the city than in the countryside. It turns out that more pollution and higher temperatures create a greenhouse effect that makes ragweed thrive. But more ragweed spells big trouble for millions of allergy sufferers, because ragweed is the main allergen triggering seasonal allergic rhinitis.
Scientists at the U.S. Department of Agriculture sought to discover the impact of global climate change on ragweed pollen. Unable to travel into the future, they instead went to the inner city of Baltimore, where pollution had already generated elevated carbon dioxide levels and higher temperatures, just like global warming will produce worldwide. They planted ragweed seeds in aluminum bins, using the same soil, and placed the bins in the city, a nearby suburb, and a country field 40 miles away. Urban ragweed grew to be twice the size of rural ragweed and released five times as many pollen grains.15
Allergic Fungal Sinusitis
Fungi are plantlike organisms that lack chlorophyll and feed on organic matter. They include yeasts, molds, mildew, rusts, and mushrooms. A form of sinus allergy called allergic fungal sinusitis (AFS) occurs when common environmental fungi growing in the nose and sinus tract provoke allergic reactions. The chronic sinusitis resulting from AFS resists conventional treatments, which are aimed largely at bacterial sinusitis. AFS tends to occur in young adults and causes thick, highly viscous nasal secretions. People with AFS may have several types of allergic reactions to fungi. Type 1, 3, and 4 allergic reactions have been found in people with AFS.16
The biggest mystery of AFS is why fungal colonization of the nose and sinuses stimulates a severe inflammatory response in people with AFS and no response in people without chronic sinusitis. Medical research sought answers:
In addition, an Atlanta physician observed that the degree of nasal inflammation among patients with chronic sinusitis correlated directly with the level of mold in their homes.19 This suggests that exposure to environmental mold may impact how allergic you are to the fungi that normally grow in your nasal passages.
AFS is a complex and difficult disorder that should be treated by a physician with experience in that condition. You can support proper medical treatment by controlling environmental mold exposure (see Chapter 5), maintaining a healthy level of vitamin D, and using the Immune Balance Diet to enhance T-reg function.
Diet, Environment, and Nasal Allergy
The role of environmental allergens in producing allergic rhinitis is well recognized. However, the role of food in either provoking or soothing nasal allergy is underappreciated. In perennial rhinitis, food alone may be the trigger. In SAR, specific foods have been shown to aggravate the allergic reactions to specific pollens. This aggravation is called cross-reactivity. It’s especially strong for ragweed and birch pollens (see “The Pollen-Food Connection,” below). In my clinical practice, I’ve found that people who are allergic to environmental mold are often sensitive to mold in food and can improve their symptoms by avoiding dietary mold and yeast. This was the case for Kate, whose story I told in Chapter 4.
Chronic Sinusitis and Food Allergy: The Staph Connection
Several studies from Europe have demonstrated a very high frequency of food allergies in people who have CRS with nasal polyps. In one study, 81 percent of people with nasal polyps had positive allergic skin tests to specific foods.20 In another study, food allergy occurred in 70 percent of people with nasal polyps and was twice as common as inhalant allergy.21
Researchers have linked this phenomenon to the heavy growth of staphylococcal bacteria (staph) in the noses and sinuses of people who develop nasal polyps. Staph bacteria produce toxins called superantigens that are swallowed when mucus drips into your throat. These toxins travel along the intestinal tract, where they induce allergic reactions to food that you’ve eaten.22 Staph toxins stimulate inflammatory reactions and inactivate T-reg cells or even change their functions, making them promote rather than reduce inflammation.23 The standard medical treatment for nasal polyps is a steroid nasal spray, which causes polyps to shrink. Having allergies, however, causes people with nasal polyps to respond less well to steroid sprays than do people with nasal polyps who do not have allergies.24 This is surprising, because symptoms of allergic diseases are usually well controlled by steroids. Staph may be the reason. Staph toxins induce resistance to the effects of steroids25 and at the same time induce food allergy, both of which are critical components of chronic sinusitis for many people.
Nutritional research has observed that dietary flavonoids are able to bind to and inactivate staph toxins,26 and this is one of the many mechanisms by which the Immune Balance Diet helps in the fight against CRS.
Antibacterial Soap Linked to Staph
Environmental toxins can increase the growth of staph in your nose. Triclosan is an unregulated synthetic chemical increasingly used over the past 40 years as an antibacterial ingredient in soaps, gels, and toothpaste. It’s also applied to clothing, kitchen counters, and medical equipment as a disinfectant. Once in contact with your skin or mouth, triclosan is absorbed into your body.
Researchers at the University of Michigan found triclosan in the nasal secretions of almost half the people they tested. Higher levels of triclosan were associated with greater colonization by the most dangerous species of staph. Looking further, the researchers found that triclosan increased the ability of staph to attach itself to human cells and exposure to triclosan made laboratory animals more susceptible to staph infection.27
Triclosan also pollutes the outdoor environment. Triclosan contamination of streams increases with urbanization and can dramatically alter the ecology of fresh water, reducing the diversity of normal bacteria and increasing the abundance of potentially toxic cyanobacteria, a major ecological and human health problem worldwide.28
The triclosan story demonstrates a fundamental theme of The Allergy Solution: environmental toxins can alter the microbial ecology of your body, creating changes that increase your susceptibility to allergy. Read labels and avoid products made with triclosan. Steering clear of toxins is good for you and good for the planet.
Yeast and Mold in Foods
Yeasts and molds are common food additives, used to preserve food, to induce fermentation, and to enhance flavor. They also occur naturally in some foods. Beer, for example, is produced by the addition of brewer’s yeast to a mash of malted barley. Wine is created when crushed grapes are fermented by yeasts that naturally live on their skin. Mold is likely to be found growing on any food that is fermented, aged, or spoiled.
With all of this fermenting of yeast and growth of mold, it is no wonder that such a profusion of allergens confronts us. Indeed, scientific studies have identified more than 150 human allergens in various yeasts and molds.29 Researchers at the world-renowned National Jewish Hospital in Denver have demonstrated that people allergic to inhaled molds commonly show allergic reactions to oral challenge with mold extracts.30 I often recommend that people who are allergic to airborne molds try eliminating food sources of yeast and mold to test their reactivity.
Here are some typical foods and beverages that often contain yeast or mold. Please note that mold and yeast can be found in a wide range of foods and beverages.
The Pollen-Food Connection
People with pollen allergy may experience allergic symptoms when they eat food that contains proteins similar to those found in the pollen to which they are allergic. This cross-reactivity has been most widely studied with ragweed, grass, and birch pollens. I was able to help Vivian, whom you met in the Introduction, control her acute mystery illness by using the birch pollen–food connection.
Ragweed, Grass, and Pan-Allergies
Ragweed pollen is the major trigger for late-summer hay fever throughout much of the United States. Scientists estimate that a single ragweed plant can release one billion grains of pollen over the course of a single ragweed season. The grains are so light that they float easily on gentle breezes and can travel incredible distances. Ragweed pollen has been detected as far as 400 miles out to sea and as high as 2 miles up in the atmosphere.31 People with ragweed allergy are often sensitive to melons or bananas and may develop symptoms that range from an itchy mouth or swollen lips to aggravation of hay fever.
The cross-reactive allergens between ragweed and food appear to be proteins called pan-allergens, which are found in many plants and pollens, including ragweed and grass pollen. Pan-allergens are the allergic triggers for about a third of all pollen allergies and are the likely triggers if a person with pollen allergy is also allergic to melon, watermelon, bananas, citrus fruits, tomatoes, or latex.
Pan-allergens may also provoke symptoms outside the respiratory tract, including hives, diarrhea, abdominal cramps, anaphylaxis, and itching or swelling of the throat or lips, which is called oral allergy syndrome.32 Sometimes pan-allergens require an additional factor, such as exercise or the use of painkillers (aspirin, ibuprofen, or naproxen), to provoke symptoms.
If you have late-summer rhinitis due to ragweed pollen (hay fever), or late-spring rhinitis due to grass pollen (spring fever), your symptoms may be aggravated by eating foods containing pan-allergens, especially during the allergy season.
Birch Trees
Birch pollinates in the early spring and may cause sneezing, coughing, and itchy eyes. Researchers in northern Europe, where birch trees abound, have determined that almost three-quarters of people with birch pollen allergy are allergic to plants that contain proteins similar to the main birch pollen allergens, which are called Bet v 1 and Bet v 6.
Apples, celery, carrots, hazelnuts, soybeans, peaches and other stone fruits, oranges, lychee fruit, strawberries, persimmons, and zucchini may all cross-react with birch pollen and can cause allergic symptoms in people with birch pollen allergy, especially in springtime.
In a study at Germany’s Paul Ehrlich Institute, about 70 percent of patients allergic to birch pollen were found to experience symptoms when exposed to birch pollen–related foods.33 And although pollen-related food allergens are often destroyed by cooking, recent studies have shown that hazelnuts and celery may provoke symptoms even after being thoroughly cooked.34
In a creative clinical experiment done in Finland, people with birch pollen allergy ate birch pollen in honey daily from November through March. During the subsequent birch pollen season in April and May, they reported a 60 percent reduction in symptoms of allergy, had twice as many days with no symptoms, and decreased their use of antihistamines by 50 percent, compared with a control group.35 The mechanism for the protective effects of oral birch pollen was presumed to be the phenomenon called oral tolerance, which I discussed in Chapter 3.
Air Pollution and the Pollen-Food Connection
Most of the allergens responsible for the pollen-food syndrome are defense proteins made by plants to protect themselves. Science has uncovered a troubling fact: environmental stresses like air pollution or climate change can stimulate the expression of these proteins, making both pollens and foods more likely to provoke allergic reactions.36 Research indicates that increasing global air pollution and climate change are not only increasing the amount of pollen to which we’re exposed, but making the pollen grains themselves more allergenic.
Probiotics for Nasal Allergies
Probiotics are cultures of living bacteria with possible health benefits. Most probiotic cultures contain species of Lactobacillus or Bifidobacterium or combinations of different species. Several have been shown to help people with nasal allergies by relieving symptoms and by improving immune balance, according to double-blind, placebo-controlled clinical trials.37
The species with the best track record for allergic rhinitis is Lactobacillus paracasei. Different strains of Lactobacillus paracasei have been used with those suffering from seasonal or perennial rhinitis. All seem to produce similar effects and may improve symptoms and quality of life; they may also stimulate the immune system in ways that counteract Type 1 allergy. In a head-to-head contest with a mixture of Bifidobacterium lactis and Lactobacillus acidophilus, L. paracasei came out on top.38 Here’s the science on probiotics for allergic rhinitis:
Other probiotics shown to help relieve symptoms of nasal allergies in controlled clinical trials include:
This fascinating research indicates that probiotics of Lactobacillus bacteria or Bifidobacteria may improve symptoms of allergic rhinitis. They seem to work by shifting immune balance in a direction that resists allergic responses. Lactobacilli may be more potent in this effect than Bifidobacteria. The benefits of probiotics for nasal allergies may take between three and eight weeks to become evident and may last for many weeks after the probiotics are stopped.
Products containing multiple types of bacteria may not be better than those with just one species. The bacteria may not even need to be living to have an effect. My clinical experience has taught me over and over again that no single probiotic is best for everyone. If your main symptom of allergy is rhinitis, there are many types of probiotics from which you can choose.
In addition, probiotics have been shown to help reduce the incidence and the duration of colds.50 Reducing the incidence of colds is important for reducing nasal allergy, because the severity of both depends on the inflammatory mediator ICAM-1, as mentioned earlier in this chapter. Colds are also a major factor in the development of CRS.
Grace Finds Balance
So what happened to Grace, whom you met at the beginning of this chapter? She made it through her trip without getting sick. When she returned, we had to work on keeping her well. There was a lot more to do:
For many people, balancing life is the final part of the Allergy Solution program, as it was for Grace. In order to control her life she needed to break out of the vicious cycle of illness that resulted from her allergies and escalated her allergies. By establishing control in one vital area, improving her health through her own efforts, she gained the confidence that allowed her to make other changes. She even wound up changing her job to become a designer instead of a buyer. Paradoxically, she’d come to me to keep from losing her job because she was sick all the time. Once she became healthy, she decided to leave her job for one she liked more.
The Allergy Solution Program for Nasal and Sinus Allergies
Nasal and sinus allergies are never just problems involving your nose and sinuses, but involve your entire body. They are systemic ailments that require systemic solutions. That being said, there are some local treatments that can provide relief, especially if nasal staph or fungi are helping to create the T-reg dysfunction that underlies allergy.
Here are some steps that may help improve the health of your nose, sinuses, and upper respiratory tract:
Conclusion
This chapter looked at the most common allergy in the United States, allergic rhinitis, with symptoms such as congestion, a runny or stuffed nose, and frequent interference with sleep. Quality of life suffers, and irritability and fatigue often occur.
I told you about research done in the United States and Europe that showed a direct impairment of mental focus and performance resulting from nasal allergies. I reviewed the types of sinusitis and the critical role of nutrition and environment in this condition. I explored how what you eat can increase symptoms of pollen allergy, and how pollution and climate change can worsen allergy symptoms by increasing the amount of pollen produced by plants such as ragweed and by making the pollen more allergenic. I reviewed the research on supplements that may help, including a tour of the fascinating strains of probiotics that have been shown to relieve symptoms of allergic rhinitis.
We met Grace, the world-traveling buyer for a luxury retailer. She was constantly in contact with clothing and the formaldehyde it often contains, which exacerbated her nasal allergies. By reducing her exposure to mold, adjusting her diet, and healing her digestion, we were able to get her on the road to recovery.
For your own journey to recovery, I highly recommend you go over the material in this chapter with your doctor, to collaborate with her or him on your care.