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Allergies Understood Conventional and Complementary Approaches

by Dr Druba Basnyet and Jolanta Basnyet(more info)

listed in allergies, originally published in issue 56 - September 2000

We treat hay fever patients and conduct allergy tests in our clinic in Preston. We find that results are very rewarding and beneficial for the patients. Dr Basnyet also offers advice to parents regarding the children's homeopathic immunization process. The subject of allergies is still a controversial issue not only within the medical profession but also within complementary medicine itself.

Professor Maurice Lessof commented on allergies at the conference on Aspects of Allergy: "In allergy, more than any other field of medical practice, there has been a surge in the popularity of unorthodox approaches to diagnosis and treatment. Many patients explain that they have turned to the unorthodox because "the doctors said they could do no more." He continued to say: "Allergy has been a neglected subject in our undergraduate curriculum, and even postgraduate education has neglected it until now."

What is Allergy?

In the UK, allergic diseases affect over 15% of the population and pose considerable problems for both patient and doctor alike. In lay language, the term 'allergy' loosely describes a variety of reactions to stimuli of many types. Allergy should be defined as 'a state of abnormal immunological reactivity to a specific stimulus'.

Gell and Coombes classified four separate allergic reactions and this classification still holds good. The Type 1 or immediate type anaphylactic response is classically described as histamine mediated. Initiation of the Type 1 mechanism depends on the reaction of a specific antigen with sensitized mast cells. A typical example of this type of reaction is hay fever.

Hay fever (allergic rhinitis and/or allergic conjunctivitis) is a non-effective, inflammatory disease of the nasal airways and conjunctiva caused by acquired reactivity to an exogenous allergen, most commonly grass pollen. Symptoms may vary ranging from running eyes and nose, sneezing and sore lips and nose, red eyes, glandular swelling and skin reaction to itching and general soft tissue swelling. It was found that people with severe allergic reactions to animal fur, chemical sensitivity, dust and dust mites, food, insect stings, mould, and sensitivity to poison ivy, pollen and changes of temperatures are prone to displaying hay fever symptoms in the form of allergic rhinitis. Although generally seasonal, owing to its relation to airborne pollens, other patterns and aetiologies occur. Approximately 20% of the population suffer from non-infectious rhinitis, and about 50% of cases are allergic in origin. Hay fever can be a recurrent depressing condition, interfering with many aspects of the patients' lives; for example, students suffering from hay fever may attain lower academic performance during critical 'O' and 'A' level years, with lifelong consequences.

Pathogenesis of Hay Fever

The typical symptoms of hay fever are:

* vascular congestion
* increased capillary permeability
* hypersecretion
* stimulation of nerve endings.

Patients with hay fever synthesize excessive IgE when stimulated by common allergens, such as grass pollen. The immediate response in reaction to the sensitizer is the release of histamine from the mast cells. Mediators, such as prostaglandins and leukotrienes, are important in the later responses.

Blackley first established in 1873 that grass pollen is the cause of summer hay fever. Since then, many more pollens have been identified as being responsible for hay fever symptoms. The symptoms of allergic rhinitis may include: sneezing, nasal blockage, watery nasal discharge, itchy and watery eyes and pharyngeal itching. About one third of all patients suffering from hay fever are in the 12-19 age group. As the peak months for symptoms of hay fever are June and July; the severity of their symptoms and the side-effects of their prescribed treatments, particularly sedation, may often pose serious problems for students at examination time. Also, one would need to take into account factors which affect pollen levels such as weather conditions, species of grass predominant in the area, rate of air movement and temperature prevailing during April and May.

Hay fever may be the cause of urticaria, which is a common skin reaction affecting approximately 20% of the population at some stage in their lives. Approximately 50% of all patients with urticaria have chronic diopathic urticaria. This condition is treated using conventional medicine with antihistamines.

Allergic conditions are an important cause of morbidity in childhood and, together with asthma, account for about 33% of all chronic disease. The most commonly encountered allergic conditions are asthma, eczema, allergic rhinitis and food allergy.

Several factors are associated with the development of allergy in any individual. These may include family history, high serum IgE levels at birth, early introduction of mixed feeding and calendar month of birth.

Inhalant Allergy

Allergy is an important cause of attacks in the majority of cases of inhalant allergy. The house-dust mite is the most common allergen in childhood and other allergens include grass pollens and animals.

Food Allergy

Although food allergy is responsible for a small proportion of all allergic conditions, it is of interest to the medical profession because, as a result of increased media coverage, many individuals are questioning the relevance of this condition to their symptoms. It should be remembered that true food allergy is a far less common condition than food intolerance, and that a confident diagnosis is exceedingly difficult due to a lack of objective tests. It is sometimes very difficult to adhere to the exclusion diet and desensitization may be of use in these cases. Again, homeopathic desensitization may be the best solution, followed by homeopathic treatment to strengthen the immune system and increase body resistance.

Rhinitis may take two forms, i.e. infectious (purulent) such as common cold, rhinosinusitis and polyps, or non-infectious (non-purulent) such as seasonal allergic, perennial allergic, perennial non-allergic, eosinophilic, non-eosinophilic and polyps. The types and numbers of pollens present in the atmosphere are dependent on several factors, and vary throughout the summer months. Tree pollens predominate in May, grass pollens during June and July and weed pollens in August. A range of factors, but particularly the weather, affect the pollen count. Others may be temperature, wind, type of vegetation in the area, and the level of response to these conditions by the immune system of the sufferer.

The four basic steps in the management of hay fever are:

* Control or removal of allergens and irritants, wherever possible. Avoidance of irritants, such as cigarette smoke, helps to reduce symptoms;
* Prescription of antihistamines. As histamine is a crucial mediator of the allergic response, particularly the immediate response, antihistamines form the mainstay of treatment in hay fever;
* Application of corticosteroid sprays which do not treat acute symptoms, but are effective prophylaxis;
* Immunotherapy or desensitization which involves regular injections of the allergens responsible for the patient's symptoms.

Medical Management of Hay Fever

The side-effects of taking corticosteroids – whether proved or disproved – may result in alopecia, bronchospasm, confusion, depression, dizziness, dry mouth, gastro-intestinal distress, liver dysfunctioning, musculoskeletal pain, photosensitivity reactions, skin rash, tremor, urinary frequency and visual disturbances.

Courses of desensitizing injections given to alleviate the symptoms are being managed very carefully due to the possibility of anaphylactic shock, a severe allergic reaction to protein in the injection.

In a recent review of intranasal azelastine published in 1998, it was concluded that it is as effective as standard doses of other antihistamine agents, including intranasal levocabastine and oral cetirizine, ebastine, loratadine and terfenadine, for reducing the overall symptoms of rhinitis. The relative efficacies of azelastine and intranasal corticosteroids (beclomethasone and budesonide) remain unclear. However, overall, the corticosteroids tended to improve rhinitis symptoms to a greater extent than the antihistamine. Azelastine was well tolerated in clinical trials and post-marketing surveys. The most frequently reported adverse events were bitter taste, application site irritation and rhinitis. The incidence of sedation did not differ significantly between azelastine and placebo recipients. Although the study indicated the advantage of reduced sedation of azelastine over other antihistamine agents, this needs to be confirmed.

Severe life-threatening problems and even death that may be the result of subcutaneous specific immunotherapy in pollen-sensitive children became the reason for looking for new ways of hyposensitization. In a study by Cserhati and Mezei which concentrated on the efficacy of local nasal immunotherapy in grass- and ragweed-allergic children suffering from seasonal atopic rhinitis, the results showed that after the second year of immunotherapy the need for steroid treatment was significantly lower in the immunotherapy group, however some patients suffered from mild sneezing and nasal discharge. Also, mizolastine – a new non-sedating antihistamine – was used in a study by Stern, Darnell and Tudor to delay the appearance of hay fever symptoms when given prior to the pollen season. Tolerability of medication was found to be satisfactory and comparable between groups. Mizolastine, as a result of this study, can be safely used to delay and to treat symptoms of seasonal allergic rhinitis. However the sedative effects of antihistamines were reviewed by Nolen in his paper. Sedating antihistamines cross the blood-brain barrier more quickly and easily than the non-sedating antihistamines. They produce more central nervous system (CNS) effects, exacerbating the decreases in decision-making, verbal learning and psychomotor skills already experienced by the patient with allergic rhinitis. The non-sedating agents do not readily cross the blood-brain barrier and, therefore, do not produce CNS side-effects with the resulting performance impairment. They are safer alternatives for patients with allergic rhinitis.

Local nasal immunotherapy (LNIT) is an effective and safe alternative to conventional subcutaneous immunotherapy. In one of the studies, 20 grass pollen-sensitized patients suffering from seasonal allergic rhinitis were studied in a randomized, double-blind, placebo-controlled trial. This study indicated that LNIT, when administered at steady dosages, may be proposed as a treatment for grass pollen seasonal allergic rhinitis as it appears to be effective and well tolerated.

Management of Hay Fever by Alternative Medicine

The basic steps in the management of hay fever in the field of alternative medicine are:

* Control or removal of allergens and irritants, wherever possible; and avoidance of irritants, to help reduce symptoms;
* Allergy testing for other sensitizers such as food and drink items ingested by hay fever sufferers;
* Avoidance of food and drink sensitizers and environmental pollutants;
* Introduction of hay fever desensitization process.

Hay Fever Desensitization by Homeopathic Remedies

Our method of homeopathic desensitization to pollen and grasses for patients who suffer from hay fever is different from our methods regarding other desensitization procedures, e.g. food allergies or environmental pollutants.

Treatment for hay fever may be carried out over a period of two years, but patients usually experience considerable improvement immediately upon introduction of homeopathic desensitization. This improvement is sustained during the first year of this procedure. They are usually symptom-free the following year.

Hay fever desensitization using the homeopathic process of desensitization takes place in three stages.

Stage I

Ideally the treatment should begin at the end of February/ beginning of March. This takes the form of by introduction of pollen prevalent in the spring and early summer. The homeopathic desensitizer will bear a label with Stage I on it.

Stage II

The next step is the introduction of main types of pollen present during June and July, and the remedy will bear a label with Stage II on it. This remedy would be introduced in May and early June.

Stage III

The third stage of hay fever desensitization – Stage III on the label – primarily consists of mixed grasses present during the August and September hay-gathering season. The Stage III homeopathic desensitizer would be introduced by the end of July in order to prevent severe reaction the same year.

More than often, the patients are symptom-free during the first year, but in chronic cases and in cases of extreme severity of allergic reaction, we strongly recommend that the above procedure is repeated the following year.

During the hay season, the overall body sensitivity is increased considerably hence the immune system may react to food additives such as antioxidants, colours, emulsifiers and stabilisers, preservatives and sweeteners. There is every likelihood that hayfever sufferers will be sensitive to substances, foods, chemicals, etc. other than grasses and pollens, and for this reason we always advise patients to have a full allergy test because other sensitivities may be contributing to the hay fever symptoms.

Homeopathic desensitizers may be combined and prescribed as mixed grasses, mixed pollens or a combination of the two. The mixed grasses and mixed pollens desensitizing homeopathic remedy includes, among others: bent, broom, coltsfoot, crested dogstail, meadow foxtail, rye grass, timothy, sweet vernal, alder, ash, beech, willow, heather, nettle, mugwort, birch and plantain.

Clinical Studies

In the world of science, sublingual-swallow immunotherapy was recently recognized in the WHO Position Paper as a "viable alternative to parenteral injection therapy to treat allergic diseases" in adults. A double-blind placebo-controlled design study was carried out to assess the clinical efficacy and safety profile of sublingual-swallow immunotherapy with high-dose allergen in children with allergies. In conclusion, it was stated that the immunotherapy was well tolerated in children with allergic rhinoconjunctivitis. The study provided a clinical benefit and a decreased specific reactivity to the allergen. The safety profile of this treatment, which constitutes an important issue, indicated good tolerance and compliance.

Another clinical study (Weiser et al, 1999) investigating the efficacy and tolerance of a homeopathic nasal spray in cases of hay fever (seasonal allergic rhinitis) in comparison with the conventional intranasal cromolyn sodium therapy was conducted recently. The homeopathic remedy consisted of a fixed combination of Luffa operculata, Galphimia glauca, histamine, and sulphur. The results of the study demonstrated the quick and lasting effect of the treatment. This effect was independent of the medication applied and produced a nearly complete remission of the hay fever symptoms. Adverse systemic effects did not occur. This study proved that, for the treatment of hay fever, the homeopathic nasal spray is as efficient and well tolerated as the conventional therapy with cromolyn sodium.

Homeopathic hay fever treatment studies are often referred to as the placebo effect. There have been only a limited number of studies conducted in this area of treatment so far, but the results are encouraging.

With the increase in the number of hay fever affected people, the medical profession tries desperately to find the most effective and safe ways of combating the problem and the pharmaceutical industry follows suit. However, even the limited number of studies in the field of application of homeopathic treatment to counteract or to prevent hay fever symptoms compare very favourably with the body of research on the application of corticosteroids and antihistamines. Homeopathic management of hay fever symptoms generates positive and long-lasting effects. The preventative form of application of homeopathic remedies can stimulate the immune system. This, in effect, usually decreases the level of reactivity and also the severity of the accompanying symptoms.

Anecdotal Evidence

We have a very high rate of success in treating hay fever and other allergies in our clinic in Preston. Many successful cases are filed away in our portfolios. Although they form 'anecdotal' evidence, they await scientific justification for the need to use homeopathy in the treatment of hay fever symptoms. We hold many testimonials on our files and we have also included them on our website. Patients refer their friends and other family members to the clinic and introduce them to this simple procedure. Due to the popularity and high effectiveness of the hay fever homeopathic desensitization we now offer this remedy by mail order.

References

Weiser M, Gegenheimer LH and Klein P. A Randomized Equivalence Trial Comparing the Efficacy and Safety of Luffa Comp.-Heel Nasal Spray in the Treatment of Seasonal Allergic Rhinitis. Forsch – Komplementarmedizine 6(3): 142-8. June 1999.
Bertoni M, Cosmi F, Bianchi I and Di-Berardino L. Clinical Efficacy and Tolerability of a Steady Dosage Schedule of Local Nasal Immunotherapy. Results of Preseasonal Treatment in Grass Pollen Rhinitis. Annual – Allergy – Asthma – Immunology 82(1): 47-51. January 1999.
McNeely W and Wiseman LR. Intranasal Azelastine. A Review of Its Efficacy in the Management of Allergic Rhinitis. Drugs 56(1): 91-114. July 1998.
Cserhati E and Mezei G. Nasal Immunology in Pollen-sensitive Children. Allergy 52(33 Suppl): 40-4. 1997.
Nolen TM. Sedative Effects of Antihistamines: Safety, Performance, Learning, and Quality of Life. Clinical Therapy 19(1): 39-55. January-February 1997.

Further Information

Further information can be obtained from the Natural Health Centre, 78 Meadow Street in Preston, Lancashire. All enquiries are welcome. Tel/Fax: 01772 825177; e-mail: jolanta@jolanta.co.uk; Website: www.jolanta.co.uk. Happy surfing!

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About Dr Druba Basnyet and Jolanta Basnyet

Jolanta Basnyet BSc, BA(Hons), ITEC, MIFA, MAR, C>C practises aromatherapy, reflexology, osteopathy and remedial tactile treatments at the Natural Health Centre in Preston with her medically qualified husband, Dr Basnyet MD, DFFP, MBMAS, MFHom (Ass), who supports the multi-disciplinary character of the clinic in his capacity as an acupuncturist and a homeopath. The clinic has been in existence for many years and is renowned for its long-standing reputation in the Preston area of Lancashire.

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