When our bodies are under attack by pathogens or other foreign particles that are perceived to be harmful, an immune response is sparked to eliminate the invaders. Our immune systems have evolved a variety of tricks to help identify these attackers and then recruit special cells to the sites of attack that can destroy them and protect the body. One such protective response is the allergic response, though in these cases, the body is overreacting to the invasion of something harmless, sending the immune system into overdrive. Thus, allergies belong to a category of immune responses known as hypersensitivity.
Upon recognizing the allergen as an intruder, the body sends in immune cells called T helper cells. These T helper cells secrete signaling molecules that recruit other immune cells to help deal with the attacker, including B cells, which are stimulated to produce an antibody called IgE. The IgE antibodies made are specifically responsive to the allergen -- they recognize it and bind it. Once antibodies are bound to the allergen, they can stimulate the production of molecules called histamines. Histamines alter the cells in the capillaries to allow white blood cells and other immune cells through so that they may eliminate the attacker. This also causes the inflammation (redness and swelling) associated with this part of the immune response, which the root of many symptoms associated with allergies.
Because the IgE molecules specific to the antigen can continue to circulate in the body, this also gives the immune system a sort of memory for what it has been exposed to. This immunological memory is the basis of many vaccines, which provide a measured exposure of a potential attacker, so that the body can very quickly respond to it if it is encountered again in life. Allergens provoke an unusually strong response, however, and why this hypersensitivity occurs in some people and not others is unclear.
Symptoms of Allergies
Allergy symptoms vary depending on where the allergen enters the body and the strength of the allergic reaction that occurs. Symptoms may include:
- Sneezing, coughing, wheezing, and constriction of the airways, sometimes accompanied by asthma.
- Swelling and inflammation of the nasal tissues and sinuses.
- Blockage, feelings of fullness, or pain within the ears.
- Redness and itchiness of the eyes (conjunctivitis).
- Rashes, eczema, or hives appearing on the skin.
- Severe bloating, abdominal pain, diarrhea, or vomiting.
Risk Factors of Allergies
If allergies are mild, they may pose little other risk beyond annoyance for the sufferer. Chronic allergies, such as seasonal allergies, may keep a person's immune system in overdrive, however, which can be very exhausting and potentially make them more susceptible to other illnesses and infections. The immune system has limited resources, so if its response is diverted toward something inconsequential, like pollen, they may not be able to adequately fight off pathogens and other infections.
The chronic inflammation associated with allergies can be damaging to tissues, as well, increasing the possibilities of outside infection. Many chronic allergy sufferers also endure frequent sore throats, sinus infections, and skin problems.
If the allergic response very suddenly triggers a massive release of histamines into the body, the rapid permeabilization of all the blood vessels can cause a devastating drop in blood pressure and release fluids into the lungs, making it difficult to breathe. There can be swelling of the face, neck, and throat, additionally obstructing breathing, and a person may also have convulsions. This extreme hypersensitivity response, called anaphylaxis, is a whole-body allergic reaction that can be fatal if not treated immediately.
Causes of Allergies
Specifically, allergies are caused by the allergens the body encounters. Many allergens are airborne, inducing the allergic response as they come into contact with the eyes, noses, mouths, and lungs upon inhalation. Seasonal allergies are caused by pollen, and people may also develop allergies to dust, mold, insect stings, medications, and certain foods. Contact of an allergen with the skin can also potentially provoke an allergic response, as is the case with latex allergies.
In better developed areas, the body is exposed to more pollutants and industrial byproducts, which could possibly make the body more sensitive to allergens. Overall, however, epidemiological data suggests a much lower incidence of autoimmune and immunological disorders in the developing world. This has lead to the hygiene hypothesis, which instead suggests that challenges to a young child's immune system actually have long term benefits. By exposing the immune system to allergens and pathogens early in life, it is strengthened and also better tuned such that it will not over-respond, as in the case of the allergic response. Some proponents of this theory add that certain pathogens and parasites ingested as a part of less "clean" living conditions may also be a benefit, as they effectively reduce what might otherwise be an overzealous immune response.
Treatment of Allergies
Diagnosis of specific allergies is generally done using skin tests or blood tests. If possible, it is recommended that people with allergies make efforts to avoid their allergens. In cases where this is not possible (as with seasonal allergies), then there are many drugs available to help quell the overactive immune response. Antihistamines, for example, can disrupt the histamine response responsible for initiating many of the symptoms. Cortisone, hydrocortisone, dexamethasone, and epinephrine are also useful for suppressing the immune response during an allergic reaction. During an anaphylactic response, decongestants, anti-cholinergics, and mast cell stabilizers (which will decrease histamine release) may also be used to relieve the symptoms.
Our Integrative Approach
We know that allergies can make you feel miserable, particularly if the allergens are difficult to avoid, leaving you in a chronic state of discomfort. We will help you identify the allergens through blood testing and as appropriate, help devise a treatment plan specific to your allergen profile.
As part of your treatment, we may prescribe natural supplements that will support a healthy immune response and respiratory health. Herbal supplements containing quercetin, bromelain and stinging nettles improve respiratory health by relieving allergy symptoms in the lungs, sinus, and nasal passages. The anti-inflammatory activities of omega-6 fatty acid may help calm the immune response and reduce allergy symptoms.
A complete evaluation and comprehensive review is completed for each patient. Our doctors and professionals will evaluate your results and will spend one on one time with you to interpret and explain your results. Together we will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle. Our team at The Center for Natural & Integrative Medicine will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way. We work in conjunction with your existing doctors to ensure the best possible care.
Our immune systems are designed to protect us from pathogens and other foreign particles that may do us harm. Upon sensing an intrusion, the body sends specialized cells that can fight and kill the offending particle by inducing the inflammation response. Normally, the immune response is appropriate to the level of threat.
The allergic response, however, is an overreaction by the immune system, normally in response to something that is not particularly harmful, such as dust or pollen. People can also develop allergies to particular foods, which can cause a severe allergic reaction upon ingestion. The incidence of food allergies has increased dramatically over the years, and it is estimated that up to 20% of the population have adverse reactions to foods. Our hyperactive immune system is mistakenly identifying foods and environmental proteins as foreign invaders such as bacteria, fungus and viruses.
Risk Factors of Food Allergies
Food allergies in children can impact their growth and development if the sources are not identified and eliminated quickly. Mild food allergies in adults may be reasonably tolerated, the symptoms perhaps confused with food poisoning or illness-related gastrointestinal distress. Clearly, if a person is sensitive enough to the food that anaphylactic shock is a probability, special care must be taken to avoid eating, touching, or smelling the food, as anaphylaxis may be fatal.
The Consequences of Food Allergies
An allergic reaction to food can occur within seconds of consuming the food or may take an hour to develop. Symptoms include:
- Swelling of the lips, tongue, face, and the eyelids. The swelling of the tongue in the mouth may make it difficult to swallow or breath.
- Itchiness of the mouth, throat, skin, and eyes.
- Nasal congestion, scratchy throat, and wheezing.
- Abdominal pain, stomach cramps, diarrhea, nausea, and vomiting.
In the case of a severe food allergy that induces anaphylactic shock, a person may experience:
- Sudden drop in blood pressure.
- Respiratory distress and heart palpitations.
- Drowsiness, dizziness, or loss of consciousness
Increased total antigenic load related to food and environmental sensitivities has been associated with a wide range of medical conditions affecting virtually every part of the body. Even mood and behavior, including hyperactivity disorders in children, are profoundly influenced by food allergies. Symptoms can range from mildly uncomfortable to severe and may include:
- Ear infections
Over 90% of the food allergies in the United States are caused by the same eight food types. These include:
- Dairy. This allergy renders a person unable to consume milk or dairy products, as the proteins in cow milk provoke an immune response.
- Eggs. Most people with egg allergies are responding to proteins in the egg white, however some also develop reactions against yolk proteins. Some people with egg allergies also go on to develop allergies to chicken and other poultry.
- Peanuts. It is estimated that peanut allergies contribute to more food-related deaths than any other. Most airlines no longer serve peanuts as an in flight snack because peanut oil or dust can induce an allergic response in a person that is highly sensitive to them.
- Tree nuts. Tree nut allergies are more common in children, but do occur in adults, as well. They are distinguished from peanut allergies since peanuts are considered legumes, while tree nuts are considered fruits.
- Seafood. Both fish and fish products, such as imitation crab meat (which does contain fish!), can aggravate allergies. Sauces that contain anchovies (such as caesar salad dressing and Worcestershire) should also be avoided.
- Shellfish. Some people have seafood allergies that are more specific to lobster, shrimp, and other crustaceans.
- Soy. In addition to being a component of many Asian dishes (as soy sauce or tofu, for example), soy is a common component of fast food. Soy meat and soy flour are often used in hamburgers and buns. Soy protein is also found in many sauces (in hydrolyzed vegetable protein), canned broths, bouillon cubes, and food flavorings.
- Wheat. There are many potentially allergenic components in wheat. Given the dominance of wheat products in our diets, this is can be one of the more difficult food allergies to deal with.
Some common food chemicals can also induce allergic responses, such as sulfites, which are commonly used as preservatives in wine, dried fruits, and dried potato products. Food colorings, such as tartrazine (aka Yellow 5), can also aggravate allergies in some people, leading them to avoid food colorings completely. Monosodium glutamate (MSG) is a food additive used to intensify flavor in a variety of soups and sauces that some people also have reactions to. Salicylates found in instant coffee, beer, soy sauce, tomato paste or sauce, honey, and aspirin may also be food allergens in some people.
Our Integrative Approach
At The Center for Natural & Integrative Medicine we offer food allergy testing using specialized blood lab testing for up to 300 foods, vegetables, spices, dyes, inhalants, and pollutants. Classical skin testing for allergies such as skin-scratch testing, only measures IgE-mediated reactions and provides no information concerning delayed IgG hypersensitivity reactions. Assessment of relative IgG antibody levels to a multitude of foods using sensitive Enzyme-Linked Immunosorbent Assay (ELISA) technology identifies those foods against which the patient is producing antibodies. Measuring both relative IgE and IgG antibody levels provides an invaluable starting point for dietary intervention. . This test helps to identify those with true immune-mediated allergies versus food intolerance. It measures IgG antibody levels and IgE.
The key differences between IgE and IgG mediated allergies are summarized below:
IgE Mediated Allergies
IgG Mediated Allergies
The results of the test come with a detailed explanation and a suggested avoidance, elimination and subsequent slow reintroduction of foods. We help with menu and food planning. Delayed food sensitivity or intolerances can lead to fatigue, fibromyalgia, brain fog, unexplained aches and pains among other symptoms.
What is Sublingual Immunotherapy? (SLIT)
Sublingual immunotherapy, or SLIT, is a form of immunotherapy that involves putting drops of allergen extracts under the tongue. Many people refer to this process as “allergy drops,” and it is an alternative treatment for allergy shots. This form of immunotherapy has been used for years in Europe, and recently has had increased interest in the United States.
SLIT is usually delivered by placing drops of allergen extract under the tongue, and then swallowed. Generally, SLIT is administered daily, or multiple times per week, over a period of months. Most patients are able to self-administer SLIT at home. Studies have looked at giving SLIT before a pollen season, during a pollen season, both, or year-round. By repeatedly exposing the immune system to the allergens at low levels, the goal is to help desensitize the immune system, eventually reducing or eliminating the allergic reaction all together. This is a long term commitment on the part of the patient, though it has proven to be a successful in reducing hypersensitivity.
How Does SLIT Work?
The immune system of the gastrointestinal tract tends to "tolerate" foreign substances, meaning that it does not respond in an over-active way to swallowed material. This makes sense; otherwise the body would over-react to anything swallowed, including food. When SLIT is administered into the gastrointestinal tract, the immune system tolerates the allergen, instead of the over-reactivity of the immune system, as with allergic disease. This results in less allergy symptoms when the body is exposed to the allergy source, such as airborne pollen, pet dander or food.
What is the Safety of SLIT?
Over the past 10 years, the safety of SLIT has been well documented. Serious and fatal reactions to SLIT have not been reported to date. Mild side effects, such as an itchy mouth, occur in the majority of people, and moderate side effects have been documented (1 in about every 12,000 doses), including:
- lip, mouth and tongue irritation
- eye itching, redness and swelling
- nausea, vomiting, abdominal cramping and diarrhea
- sneezing, nasal itching and congestion
- asthma symptoms
- urticaria and angioedema
Because of the safety of SLIT, people generally treat themselves at home, and are followed in the office at close intervals to monitor response to treatment.
Who Could (or Should) Receive SLIT?
People with documented allergic disease (allergic rhinitis, allergic conjunctivitis and/or allergic asthma) by allergy testing may be considered for SLIT. Suspected food allergies may be tested and treated using SLIT. Young children have been shown to tolerate and benefit from SLIT, as have older adults. Pregnant women, as is considered the general rule of thumb for allergy shots, can continue SLIT during pregnancy, but should not start the therapy while pregnant. People with severe asthma may need to be monitored more closely on SLIT, since asthma symptoms can worsen with SLIT.
A complete evaluation and comprehensive review is completed for each patient. Our doctors and professionals will evaluate your results and will spend one on one time with you to interpret and explain your results. Together we will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and can be integrated into your lifestyle. Our team at The Center for Natural & Integrative Medicine will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way. We work in conjunction with your existing doctors to ensure the best possible care.