ac Paul Reller L.Ac.

Sinusitis, Rhinitis and Post-nasal Drip

Paul Reller, L.Ac.

Understanding your pathology leads to effective ways of ending these problems rather than just managing symptoms

Rhinosinusitis is the term generally used now for chronic conditions of sinus congestion, with or without post-nasal drip, which an increasing percentage of the U.S. population is now afflicted with. Rhino- is a term signifying the nose, although commonly we use the term nasal, and sinus refers to the labrynth of airways behind the nose, which is supposed to protect us from infection, clear debris from the air we breath, and normalize the temperature of that air. The sinus is a large open membrane to the outside world, and is thus able to be inhabited by a number of pathogenic microorganisms, especially if we don't take care of its health. We are learning that, like out intestines, there is an evolved line of immune defenses that protect this membrane, including the healthy symbiotic flora and fauna that control the balance of microorganisms that help maintain our health and the health of our sinus membranes. Standard management of this problem involves chronic use of, and dependence on, anthihistamines, synthetic steroid hormones, and antibiotics, to control symptoms, each of which is proven to decrease the health of these sinus membranes rather than improve it. While this is a good marketing strategy for maintaining high sales of these pharmaceuticals, it is not a smart or ethical medical solution to your problem. The real solution involves patient understanding of their individual pathology and utilizing the measures to counter the causes and perpetuating factors of this rhinosinuvitis, which are varied and numerous.

Rhinosinusitis is generally divided into three types, 1) infective, 2) vasomotor, and 3) allergic. Infection by bacteria, viruses or fungi can be acute or chronic. Vasomotor is also called nonallergic rhinitis, and includes an array of underlying causes of the vasomotor dysfunction (dilation and constriction of the blood vessels), with autonomic nervous system dysfunction, hormonal problems, drug side effects, rebound nasal and sinus congestion brought on by chronic use of decongestants and antihistamines (rhinitis medicamentosa), membrane atrophy (perhaps also attributed to chronic overuse of medications), and gustatory rhinitis (triggered by certain foods or alcohol intake). Allergic rhinosinovitis is considered the most prevalent type, and a variety of triggers, or allergens, including pollen, mold, fungi, animal dander, dust mites, etc. may be triggering an excessive immune response with histamine swelling. Often, there is more than one allergen involved. Just as often, there is both an allergic and vasomotor rhinosinovitis occurring in chronic conditions. This is generally termed mixed rhinosinovitis. In addition, there may be a non-inflammatory vasomotor rhinitis, where triggers such as chemical perfumes, smells, smoke, environmental toxins, or even temperature changes, may trigger an episode of vasomotor rhinosinovitis. If the patient can correctly identify the type or types of rhinosinovitis that they have, the overall therapeutic success can be greatly enhanced. Patients that understand, as well, the signs of rebound nasal and sinus congestion from chronic overuse of decongestant medications etc. can also achieve a sensible overall effective treatment protocol with the help of a Complementary Medicine physician.

Incidence of rebound rhinosinovitis is, of course, controversial in the standard medical community, since it implies that standard therapy is problematic. Still, studies have conservatively estimated the incidence of rebound rhinosinovitis in chronic cases with frequent use of decongestants from 1-52%. All authorities agree that the problem is on the rise, though, and the health authorities in the U.S. have offered guidelines to medical doctors specifying that chronic continuous use of decongestants, antihistamines, and steroidal inhalers and nasal sprays should be discouraged, and alternatives should be explored. There is also a growing perception that there are more types of medication induced rhinitis, and a meta-analysis in 2010 by the University of South Florida found that there were three types of medication induced rhinitis, inflammatory, neurogenic and idiopathic (unknown mechanisms). The information from these studies on the array of medications that may cause or contribute to vasomotor rhinosinuvitis is still hard to come by. Another type of cause in recent years is the superantigen response, which is being heavily researched in relation to autoimmune and hypersensitivity disorders, and is being acknowledged as a cause of many cases of rhinosinuvitis that is difficult to treat. A separate article on this website explores and explains the superantigen response, where external or internal antigens trigger a prolonged T-cell response even in the abscence of the antigen.

Demographic studies of rhinosinuvitis have shown that this disease is a significant problem worldwide, but with much geographic variance in incidence and type. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), conservatively states that over 35 million U.S. citizens are afflicted with a diagnosed rhinosinuvitis, which is about 10% of the population. It also admits that a large number of persons probably have not been diagnosed due to the poor treatment options and the lack of affordable healthcare. The desire to find a commonality to disease in standard medicine, in order to find the common pharmaceutical that would treat all cases, is unfortunately what determines the type of treatment approach that is approved in our standard medicine, especially in the United States, where profiteering businesses, such as insurance companies and pharmaceuticals, as well as the increased degree of hospitals and clinics owned by large corporations, actually determines the guidelines for what treatment is going to be paid for. The medical doctors go along with this system, apparently with little questioning, and there is no strong national healthcare system determining treatment guidelines that is oriented to public health over profit in the system. In a pathology like rhinosinuvitis, though, the one-size-fits-all approach has produced a type of treatment that perpetuates the pathology. When we prescribe the same pharmaceuticals to all patients, in rhinosinuvitis, which is a multifactorial syndrome of various diseases, pathogenic, allergenic, neurohormonal and immunulogical causes all contributing to the health problem, this means that we can only come up with a few medicines that decrease symptoms for almost all patients, rather than concentrating on a variety of curative measures to stop the disease in an individualized manner that addresses the various underlying causes and perpetuating factors. An educated public is starting to demand a more holistic, thorough, and individualized approach in healthcare, and this is where Integrative and Complementary Medicine comes into play for such complex diseases.

One example of the poor direction in standard medicine towards chronic rhinosinuvitis and recurrent upper respiratory tract infections is seen with recent studies of adenoid removal in children to prevent recurrence. A randomized clinical human trial study of the effectiveness of adenoidectomy to prevent recurrent upper respiratory tract infections and rhinosinuvitis by Dutch researchers in 2011, published in the British Medical Journal (BMJ 2011;343:d5154; MTA van den Ardweg et al), enrolled 111 children at 11 hospitals selected for adenoidectomy. The outcomes showed virtually no benefit during a 2 year follow-up between the children receiving this surgery and those that did not. These children had all failed to be helped with standard pharmaceutical remedies, and had on average 8 upper respiratory tract infections per year with chronic rhinosinuvitis. Now, when we examine the strategy of adenoid removal more closely, we may see some alarming fallacies to this strategy. In 2006, nearly 130,000 children in the United States received an adenoidectomy, and the numbers are increasing since then. The adenoids are lymphatic tissues called tonsils situated just behind the sinus cavities. Historically, we see that in the mid-twentieth century that tonsillectomy was recommended for almost all children to prevent upper respiratory tract and throat infections. Most of us recall that this was stopped when numerous studies showed no benefit, and an increased risk of poor immune response in the future with the removal of these important immune glands, or lymphatic tonsils. The adenoids are part of this immune protection, and are situated above the palatine tonsils in the rear of the mouth. These lymphatic tonsils do swell with cellular debris that is being cleared when there is a local infection or inflammation. This is the purpose of our lymphatic system, and lymph nodes. The problem is not the evolved lymphatic tissues, but the problems with infected and inflamed tissues outside of these lymphatic tissues and nodes. Removal to the lymphatic tonsils obviously does not really address the problems of poor immune defenses and chronic infections and inflammations. While most parents would question a tonsillectomy for their children based on past medical knowledge of the proven inappropriateness, when calling the procedure an adenoidectomy, most parents would agree to the surgery.

So, instead of integrating Complementary Medicine into the treatment protocol, using safe and benign herbal and nutrient medicines, dietary regimens, and other treatment protocols, the persistence of a standard course of therapy that has shown much failure, and proof of a chronic risk and adverse effect, is pursued in these cases until the failure of standard treatment leads to the advice to remove the adenoid tonsils. This Dutch study, along with a number of prior studies in recent years (Clinical Otolaryngology: Jan 2009; M Fiellau-Nikolajsen et al), shows that the removal of the adenoid tonsils has no long-term benefit to decrease the incidence of recurrent upper respiratory tract infections and chronic rhinosinuvitis (or recurrent ear infections). The justification of adenoidectomy mirrors the justification of tonsillectomy in the past. Standard medical authorities state that these adenoids are not functional in most people after age three. This is exactly the justification used for tonsillectomy in the past, and was found to be untrue. Lymphoid tissues do have an important function in our bodies. They help defend us against infections and the spread of tumors. These lymphoid tissues consist of a web of white blood cells, mostly lymphocytes that contain programmed immune cells to protect us from common microbial infections. These secondary lymphoid tissues, like the adenoids, use an adaptive immune response. This means that our immune defenses in our sinuses depend on an adaptive immune response to microbial infections, allergens and antigens, but standard medicine has chosen to remove these tissues to try to prevent recurrent infections and chronic inflammation. So, we see a few strategies in standard medicine. First, we inhibit our natural histamine responses to tissue irritation, secondly, we supplant our natural cortisol responses with synthetic corticosteroids, thirdly, we repeat antibiotic regimens that at best only target specific types of bacterial infections, which are seldom the prime cause of these infections and inflammation, and create antibiotic-resistant strains of bacteria that are threatening, and fourth, we surgically remove the lymphatic tissues that make up our natural immune defenses. Why this is still considered a sound and logical strategy is remarkable.

The array of underlying causes for rhinosinuvitis

Within this large sector of the population afflicted with chronic rhinosinuvitis, the individual wonders what are the most prevalent types of this disease. A 2000 study published in Otolaryngologic Clinics of North America (Apr2000; vol33(2); 441-449) found that a survey of all eyes, ears, nose, and throat specialists in North America found that the diagnosis of allergic fungal rhinosinusitis was as high as 23% of cases (in Memphis, Tennessee) to 4% of cases in the northern United States. While this would imply that damp weather was responsible, an oversimplification fails to consider the rising incidence of immune reactivity to fungi, and its relation to the rising incidence of candida fungal overgrowth, or candidiasis, in the population. If candida is assuming a fungal form and disseminating through your body, the immune allergic reactivity to common fungi is probably higher. The answer to this aspect of your rhinosinuvitis may be to move to a drier climate, or to to move out of a house or apartment where mold and fungi may be a problem, but even this may not completely solve the health problem if you fail to analyze and correct the candidiasis in your body (see my article on candidiasis on this website). If the chronic problem has now undermined your immune responses significantly, even correcting the candidiasis may not give you a fully significant cure. You may have to improve the healthy responses of your immune system. While one-fifth of the cases of rhinosinuvitis may be attributed mainly to a fungal allergy or hypersensitivity reaction, even in these patients there is surely a variety of allergens and antigens that stimulate the sinus inflammation once the sinus membranes are unhealthy. In addition, studies at such prestigious establishments as the Mayo Clinic have established that fungal growth is found in about 96% of patients with chronic sinusitis, even if it is not diagnosed as the principle cause of the disease. A debate has raged for years, consequently, over whether medical doctors should treat fungi or bacteria, and this is precisely the problem. We need to treat holistically.

A 2003 study of the pathogens in the sinus membranes of patients with chronic rhinosinuvitis, conducted at the Cornell University's Weill Medical College in New York, found that, at that time, 9.22 % of these patients were infected with a chronic methicillin-resistant Staphylococcus aureus infection in their sinus membranes, as just part of the low-grade microbial infection and allergen stimulation that perpetuated the sinusitis immune response. This indicates that our overuse of antibiotics is a major contibutor to chronic rhinosinuvitis. It does not mean that if you personally do not overuse antibiotics that this has nothing to do with you. Rather, it indicates that we are creating an environment that is more and more prone to challenges to our immune system. Common environmental immune challenges, which should not be a problem to the human organism, such as symbiotic bacteria, mold and fungi, viruses, pollens, dust mites, smoke, and particulate matter in the air we breath, are all now contributing to an exaggerated immune response that defines rhinosinuvitis. The answer to the problem is not to use more antibacterial chemicals, more antibiotics, and more antiseptic cleaners to insulate ourselves from bacteria, fungi, allergens, and the variety of microbes naturally occurring in the environment. The logical answer to the problem is to improve our immune defenses and to create a healthier environment. The first step to clearing rhinosinuvitis is to reestablish a normal symbiotic flora and fauna in sinus membranes, and then we may proceed to regain the healthy membrane tissues and localized immune responses that will stop immune hyperreactivity. To clear this pathogenic imbalance of bacteria, fungi and chronic viral infection, we need to use a broad spectrum agent. Antibiotics will target only a subset of the bacterial population. Herbs are endowed with such a capacity, as plants have evolved a number of chemicals that help them clear a variety of pathogenic bacteria, fungi and viruses. Herbal formulas are able to both clear a wide spectrum of pathogens while simultaneously promoting improved circulation and immune responses.

There is yet another reason why overuse of antibiotics is not recommended for patients with chronic rhinosinuvitis. Of the bacteria studied in these cases, the most prevalent type of bacterial overgrowth involve not only staphylococcus aureus, antibiotic-resistant staph, and coagulase-negative staph, but also gram-negative bacteria and anaerobic bacteria, for which our standard antibiotics do not effectively treat. Gram-negative bacteria have a double membrane which makes them naturally resistant of standard antibiotics. Common examples of gram-negative bacteria include e. coli, Neisseria, enterobacteria, Klebsiella, Salmonella, Shigella, Heliobacter, Campylobacter, Proteus, and Pseudomonas. It is not a coincidence that most of these are common to gastrointestinal infections. The health and healthy function of the gastrointestinal tract may be very important in the eventual clearing of chronic rhinosinuvitis. While standard antibiotics are ineffective against these gram-negative bacteria, many plant chemicals are proven effective. Your own immune system is also effective at controlling these more difficult chronic bacteria, as is the normal healthy balance of symbiotic flora and fauna in our bodies. Restoration of the immune system and the normal symbiotic flora and fauna, as well as restoration of the gastrointestinal tract and function may be integral to curing the patient with chronic rhinosinuvitis. Coagulase-negative staph are a type that does not produce a clotting enzyme, and are thus seen in many cases of low-grade infection and milder symptoms. Coagulase-negative staph are the most common bacterial infectious agent in nosocomial infection, or infections originating or taking place in a hospital or clinic. As far back as 1981, the U.S. CDC found that 194,000 patients per year in U.S. hospitals acquired a nosocomial systemic bacterial infection. At present, this figure has risen considerably, despite antiseptic precautions. Coagulase-negative bacteremia has spread to the general population, and standard antibiotics are inadequate to counter this problem. Once again, strengthening the proven mechanisms to counter these prevalent low-grade infections, our own immune responses and normal symbiotic flora and fauna, as well as the health of our sinus membranes, is the answer to this difficult problem.

When the sinus membranes are chronically inflamed they are more susceptible to an immune reaction to common allergens, seasonal viruses, environmental toxins, dust mites, and mold and fungi in the home. The chronically inflamed sinus membrane is more open to the environment and has a diminished capacity to affect the normal local immune response. If the patient does not improve the membrane health, decreasing exposure to all of these irritating pathogens and allergens, by itself, if possible, still will not be enough to stop the immune responses that cause the sneezing, congestion, headaches, and post-nasal drip. A step-by-step approach to regaining this sinus membrane health is necessary. In chronic conditions, though, there may be even more to the pathology than this. Chronic rhinosinuvitis may also be perpetuated by other chronic health issues which inhbibit tissue maintenance, immune function, and may stimulate a vasomotor response, which is a vascular and neural stimulation of blood vessel dilation and subsequent swelling and fluid drainage. Underlying health issues often need to be assessed and treated as well. The implications for not addressing chronic rhinosinuvitis, and the potential underlying health problems that perpetuate it, are now becoming clear. Research has shown a considerable increase in risk of various diseases associated with aging in the population afflicted with chronic rhinosinuvitis. Cardiovascular risk has been the most studied, but metabolic disease, and other problems are now clearly associated. The smart patient will get to work and solve this chronic health problem, not just quiet symptoms with standard medication. Complementary Medicine is ideally suited to provide the array of treatments and the time intensive care that is needed to guide this restoration of health.

Because the pathology of chronic sinusitis is so varied and complex, we still do not have a clear medical understanding that uniformly defines this condition for all patients. A 2009 article by research professors at the University of Connecticut School of Medicine and Albert Einstein College of Medicine (Seth Brown and Marvin Fried M.D.s et al), stated that the pathophysiology of chronic sinusitis is still poorly defined. Chronic rhinosinuvitis is thought to be a predominantly inflammatory disease, but a variety of cofactors that contribute include persistent low-grade infection, allergies, immune dysfunction, superantigens (see my article on superantigens on this website), intrinsic factors of the upper airway, colonizing fungi (re: candidiasis), and metabolic disorders (such as aspirin sensitivity). Altered acidity and lowered oxygen tension in the sinus tissues also may play a significant role. All of these conditions create a favorable condition of an imbalance of the normal bacterial symbiotic colonization. Chronic rhinosinuvitis contributes to increased risk for other facial and cranial infections (75% of all orbital infections are directly related to sinusitis), as well as cardiovascular problems. One scientific study found that 50% of chronic migraine patients had chronic sinusitis (this varies among geographies and patient subsets). Worsening of asthma and skin allergic conditions is also highly associated. Many studies show a clear association between gastrointestinal symptoms and chronic rhinosinuvitis as well.

So we see that a variety of pathogens, allergens and environmental toxins are irritating the sinus membranes in all cases of chronic rhinosinuvitis. We see that blocking the natural histamine responses, using synthetic topical steroids, and antibiotics, do not restore sinus health in any way, and in fact gradually erode the health of the sinus membranes further. And we see that a variety of other health problems may be perpetuating, causing, or worsening the rhinosinuvitis, and contributing to such related conditions as post-nasal drip, nasal polyps, tissue thickening, and autonomic vasomotor responses. We also see a number of common health problems associated with chronic rhinosinuvitis that is not resolved, but only managed with symptom relieving pharmaceuticals. While this is a list of things we need to understand and address, ignoring them may lead to serious consequences. The first step in resolving these chronic problems is to gain a better understanding and adopt a proactive approach, since the patient is always the primary treater of disease. The Licensed Acupunturist and herbalist is ideally suited to provide many of the treatment options available to you, and whether you utilize pharmaceuticals to quiet symptoms or not, this Complementary Medicine physician can provide care that will eventually help you to restore your health and end the problem.

Understanding post-nasal drip

There is a normally a constant flow of fluid through the sinus membranes, even when we do not notice it. We are normally unaware of this fluid flow because of the healthy system of drainage in the sinuses. The flow of fluid is part of the evolved protection against outside debris, pathogens, toxins and allergens that threaten our health. When this flow of fluid is increased, and the drainage is inhibited, we end up with post-nasal drip, which irritates the throat, and eventually may contribute to chronic cough, bronchitis and asthma. Much research has been conducted to understand this mechanism. A study in Japan in 2000, at the Mie University School of Medicine, found that in about 50% of cases of chronic sinusitis, there is a decrease in the ability of the sinus membranes to clear mucus due to thickened nasal secretions, or pituita, which causes a progressive dysfunction of the membrane cilia to transport the mucus (cilia are small hairs that move on the membrane to transport mucus). Now mucus is important in the sinus immune protection, because the thickened fluid that coats the sinus membrane both protects it and traps debris, allergens, pathogens and toxins, so that our immune responses may break these down and render them harmless. When the pituita, or thick mucus, is not transported well, it stagnates and increases in quantity. Finally, over time, this progressively worsening condition will result in postnasal drip. If the pituita is full of allergens, unwanted bacterial strains, viruses etc., these may drip onto bronchial membranes or into the larynx and pharynx, causing an immune reaction in these tissues as well. To correct the problem, we can't just attack the mucus, but instead, we must restore the health to the mechanism. A step-by-step approach is needed over time.

Nasal and sinus inflammation are not the only conditions causing postnasal drip, though. Numerous studies show that in many cases, acid reflux into the larynx and pharynx is also contributing to this dysfunction. Tissue changes in these upper airways can also contribute to the condition. Tissue hypertrophy, or thickening, can be caused by a variety of conditions. Hormonal changes can greatly affect tissue maintenance, and chronic use of synthetic hormones, as in contraception and menopausal hormone replacement is linked to postnasal drip in many studies. Adverse hormonal balance in pregnancy is also shown to cause or worsen postnasal drip. Cysts and polyps may also change the tissues in the upper airways, as well as thyroid growths, tonsil stones, tissue calcification, or scarring from trauma or severe infection. Upper airway acid reflux, or extraesophageal reflux disease (EERD) is becoming more common. Heartburn is seen in less than 50% of cases studied, and a high percentage of cases are found to involve not excess stomach acidity, by gastric hypofunction and problems with gastric emptying, as well as chronic asthma. In asthmatic patients, the daily us of inhalers, with a combination of steroids, antihistamines and antileukotrienes, is shown to potentially worsen the upper airway acid reflux and gastric hypofunction.

Sometimes, the early stages of postnasal drip are not obvious to the patient. Signs include increased swallowing, spitting of mucus, an irritating tickle in the throat, increased clearing of the throat or an altered voice, the feeling of obstruction in the back of the throat, shortness of breath, chronic episodes of sore throat, tonsil irritation (tonsil stones, or calcifications), increased snoring, a chronic mild cough, and changes to the appearance of the mucosa in the back of the mouth and throat. Often, by the time the patient becomes fully irritated and aware of the postnasal drip, the situation is chronic and advanced, making it more difficult to treat.

Understanding vasomotor rhinosinovitis.

Vasomotor is a term that signifies that a neurohormonal stimulation is causing a motor dysfunction of vasodilation or vasoconstriction which may cause tissue swelling, congestion, drainage, and potentially bleeding. It is generally referred to a non-allergic rhinitis. Studies have found that about one fourth of the adolescent and adult population of patients have vasomotor, or non-allergic rhinisinuvitis, although some European studies have found that about 40% of patients had vasomotor rhinosinuvitis, generally with a more severe presentation. Women were found to have vasomotor rhinosinuvitis twice as often as men, with symptoms that were more persistent, usually non-seasonal, and involved congestion and drainage that were usually without sneezing and itchy eyes. Patients with vasomotor rhinosinuvitis usually had used antihistamines within the last 4 weeks prior to episodes, and were less likely to have concurrent food allergies, or prevalence of asthma.

Currently, there are no approved standard pharmaceuticals for chronic vasomotor rhinosinuvitis, although corticosteroids, antihistamines and decongestants are routinely prescribed. Anticholinergics are also being explored, although each of these medications comes with risk of side effects and problems with chronic use. Clearly, the patient that wants to address this problem effectively will seek a better treatment protocol. This involves assessing and treating the underlying conditions as well as decreasing symptoms. As stated, the most common underlying causes are autonomic dysfunction, hormonal imbalances, neurohormonal problems, drug side effects, and rebound vasomotor effects from chronic use of decongestants. These need to be assessed with a careful history, and the patient and physician need to spend some time going over the treatment options for each individual case.

A number of scientific studies in recent years have demonstrated the efficacy of acupuncture, herbal medicine, and nutrient medicine with vasomotor rhinitis. Some of these studies are cited below in additional information. A combination of these therapies will be more effective, and a course of therapy that addresses the patient holistically will also be more effective in the long run. Complementary Medicine is thus ideal to treat this problem, and the Licensed Acupuncturist and herbalis is an ideal choice.

Understanding Allergies: Do We Manage or Cure?

As we take a hard look at allergies in the United States we can clearly see that there is an oversimplification of this increasingly prevalent and important problem. The medical community on the whole, and the public, still views the subject of allergies as primarily limited to the common hayfever and allergic rhinitis, and groups such as the Mayo Clinic still stress that allergies affect about 10-16% of the population and are well controlled by steroid and antihistamine medications. This is a small piece of the big picture, and most studies confirm a steady increase in allergic diseases over the last 30 years, mostly in developed industrialized countries. The alarming prevalence of serious food allergies, and episodic allergic reactions such as angioedema, are a cause of great concern. At least 12 million Americans have food allergies and severe episodes account for more than 30,000 emergency room visits each year. Even more prevalent are the allergies to dust mites, pet dander, molds and fungi that are ubiquitous in our homes. The underlying connection between the variety of serious and not-so-serious allergic reactions is the function of the immune system and the health of your reactions to allergens.

Clinically, one sees a greater and greater percentage of patients aware of allergies today, as well as a growing body of scientific study pointing to a more serious and complex problem. As you look more closely at the subject of allergies on the Mayo Clinic website, you see that there are more and more types of allergic reactions that are presenting serious, prevalent, and growing health problems. Are we taking the subject of allergies too lightly? Are we looking inside of ourselves to see what is wrong or are we blaming the environment and failing to see what we need to do to shore up our defenses? An interesting study in Japan in 2010 found that patients with allergies had a much improved immune response to their allergies when they took regular walks in nature, such as parks and forests (see the link to a NY Times article on this study below in information resources). It seems that plant chemicals, such as phytoncides, an airborne chemical emitted from plants to protect them from pathogenic antigens and insects, also works on the human physiology. This is why herbal chemicals are effective in the treating of allergic pathologies. While we develop allergies that cause unwanted symptoms, simply blaming and avoiding nature, rather than utilizing nature to restore our immune defenses, is not a productive attitude.

One of the most significant new health threats with chronic allergies is the fact that these chronically inflamed membranes leave a patient more vulnerable to community infections, drug resistant staph and other bacterial infections, as well as more serious viral infections such as avian flu etc., which are becoming more prevalent in the U.S. For many individuals, the chronic immune stress in allergies and frequent infections contributes to much more serious and chronic syndromes, such as autoimmune disorders, neuroendocrine disorders, etc. which depend upon optimum health and function of the immune system. Working to improve immune function and membrane health, rather than just relying on prescription medications to relieve symptoms, will provide your body with protection that may prevent a host of serious pathologies. Complementary Medicine will help you to achieve these goals.

With public attention and concern about allergies and related health problems there has, of course, developed a new health industry around allergy testing and treatment. With this new attention to allergies has grown the oversimplification of diagnosis, as well as the oversimplification of treatment. The diagnosis of food allergies from standard testing is problematic, and this will be explained later in the article, and many patients without a serious allergic reaction to foods are diagnosed with multiple food allergies with these tests. All foods and external chemicals produce some antibody immune reaction in the human, and judging which of these are serious allergens is not entirely clear from tests that measure antibodies. They do point to potential allergic reactions when the body is producing higher than normal antibodies. The sensible thing for the patient to do is to objectively analyze whether these potential food allergens do produce the symptoms, by noting symptoms after eating the foods. With serious allergic reactions, there are clinics that challenge the patient with the food allergens while monitoring them in a safe clinical environment. For most patients, who have not had serious reactions, this is prohibitively expensive, though. Often, for the patient analyzing mild potential allergic symptoms, a diary is useful, noting each day the foods consumed, and the relationship to symptoms, such as digestive upset, skin reactivitiy, etc.

The subject of superantigens (explored on a different article on this website) also complicates the subject, with the potential that food molecules could induce a state of sensitivity and/or exagerrated immune responsiveness after a latent period of days to weeks, and stimulate a broad unwanted immune response that lasts well after the food is not consumed. Superantigens are now asociated with a variety of diseases, and appear to be the link between the prevalence of chronic allergic respiratory diseases and skin allergies producing eczematous reactions. This mechanism, of course, makes the analysis of food allergies more complicated. The patient must realize that foods are not the problem, though, but rather the dysfunction acquired in the individual immune system, and that a thorough holistic approach may be needed to restore a healthy immune response, and get past these potential allergies. The patient who simply starts being fearful of many foods may wind up with health problems related to poor nutrition.

Allergic reactions point to a more systemic problem in your overall health and the health of the community. Overcoming allergic reactions depends on a holistic look at all of the potential insufficiencies in your health that allows immune missense to occur. We cannot entirely eliminate allergens from our environment, so we must take the steps to insure that our immune response to allergens is healthy.

The most alarming aspect of allergic immune dysfunction that can be seen clinically has to do with the percentage of children now affected by allergies. Health problems that we overlook may be passed onto our children. Recent research into inheritable traits has proven that common health problems may be acquired and passed on in one generation, and that these traits may be cleared from inheritance in subsequent generations if addressed (see the Feb.19 issue of the British journal Nature on acquired trait inheritance). P. Brock Williams announced at the 2005 American Academy of Allergy, Asthma and Immunology that his objective measurement of increases in IgE antibody levels in asthmatic parents and their children confirms this acquired immune trait, and in fact shows that offspring had dramatically higher numbers of allergen-specific IgE than their parents with allergies.

The International Study of Asthma and Allergies in Childhood (ISAAC) shows that our community immune health is declining steadily. One of the most striking relationships in this study is the MacDonald's index: the more MacDonalds outlets you have in a country, the higher is the prevalence of allergy and allergic asthmatic symptoms. Clearly this shows a complex relationship to the overall health of the community and not just the changing environment.

The most striking thing one notices when looking at the research into allergies is the lack of specific reasons or patterns. Different types of allergic diseases have increased dramatically in different areas while other have stayed steady. Objective evidence has also been non-specific, with different types of T-cell responses seen and increases in IgG more than IgE responses noted. This also confirms that we should be looking at overall immune health and problems that affect our immune health rather than looking for the magic bullet.

Complementary and Integrative Medicine, acupuncture, herbal medicine and nutraceutical prescription can effectively manage symptoms, but also offers the patient with allergic disease the opportunity to correct the underlying mechanisms and perhaps cure the problem, or at least see the symptoms better controlled by your own immune responses.

Examining the Risk vs Benefit of Standard Medication

There are a few reasons why patients currently choose to incorporate Complementary and Integrative Medicine into their treatment of allergies. One, they want to decrease their use of prescription medications due to side effects or warnings of risk with chronic use; two, they want to lessen the side effects and risks; and three, they want to not only control symptoms but to actually get healthier, and to improve the health of the systems contributing to immune missense. Currently, standard allopathic medicine alone offers no evidence of significant benefit in many types of chronic allergy, yet produces risk with chronic use that engenders much concern from the medical community, and has prompted numerous warnings from the FDA and other health regulatory commissions. Because of this, more and more medical doctors are starting to incorporate Complementary Medicine into their practice. Thoughtful patients will turn to the physicians that specialize in these therapies to improve the results of a multidisciplinary treatment stategy. The best outcome is to overcome allergies and to escape the need for future therapy at all, especially allopathic medications that come with risk when taken chronically. This requires a more thorough and comprehensive treatment protocol in most cases.

There are still only 3 types of standard medication to treat allergies. Antihistamines, Decongestants and Anti-inflammatories, although in allergic asthma and other serious allergic reactions Bronchodilators, such as Anitcholinergic agents, Beta-adrenergic agonists, Theophylline, and Anti-IgE antibody meds are used. Many current allergy medications combine these various types of drugs. The problems with this approach is that it not only presents serious negative consequences of long term chronic use, but also overlooks key features of various allergic mechanisms, and fails to address underlying non-inflammatory parameters and contributing health problems. Evidence also points to damage to the membranes and natural immune responses by continous use of these drugs and authorities now recommend a treatment protocol that at least alternates these types of drugs each month or so if the patient uses them daily.

“A modern treatment of chronic rhinosinovitis syndrome should adapt its schemes to evidence-based medicine. Unfortunately, basic evidence on drug efficacy in CRS is still missing. As mentioned by the EPOS expert panel, validated trials are lacking even for the most prescribed medications against CRS such as antibiotics. Finally, as for all treatment for chronic diseases, an adequate management of CRS should include a regular evaluation of efficacy (and a) multidisciplinary approach.”

- (an NIH PubMed citing of a paper published in Therapeutic Clinical Risk Management 2007 March; 3(1) by the Dept of Otorhinolaryngology, Univ of Ghent and Univ Catholique de Louvain, Belgium)

Antihistamines: while short term use of antihistamine presents little threat of risk other than drowsiness, hypotension or interaction with other drugs that may potentiate depression or anxiety, the FDA has issued serious warnings concerning long term chronic use. In 1992, the FDA warned that nonsedating antihistamines, astemizole (Hismanal) and Seldane, could cause cardiac arrhythmias if accumulation of blood levels increased above therapeutic indications. Some of these antihistamines had to be taken off the market due to the serious risk due to the problem with accumulation to toxic dose, yet are we concerned with mildly toxic blood levels with chronic use?

Concurrent use of the antibiotic erythromycin, ketoconazole, itraconazole and other drugs have been shown to cause great increases in blood level accumulation of antihistamine. Keep in mind also that antihistamines are now added to a variety of common over-the-counter products, including sleeping aids, allergy remedies, cold and flu meds, etc., and are added to a number of pain medications, usually denoted by the PM version of the drug. Also, antihistamines have been documented to excrete in breast milk and nursing mothers have been cautioned, especially if levels rise. Many antihistamines are broken down mostly in the liver and poor liver function or competition in catabolism could decrease an individuals rate of drug breakdown. Risk of toxic blood levels seems to be largely ignored.

Chronic use of antihistamines are documented to cause weight gain and insomnia, as well as other common health problems that are typically ignored by the prescribing physicians. Insomnia is often improved at first by the taking of antihistamines, many of which affect the CNS sleep centers and cause drowsiness, but chronic use typically results in a disruption of healthy sleep regulation. Natural allergic responses are sometimes diminished with chronic antihistamine use and patients will become more prone to frequent viral, fungal and bacterial infections.

The reasons that antihistamines may cause increased CNS depression when combined with alcohol or other anti-depressants and anti-anxiety drugs is alarming to some. This serious threat is why second and third generation of antihistamines were developed to decrease risk, and are called nonsedating. First generation antihistamines easily crossed the blood brain barrier and affect the central nervous system (CNS). The first generation antihistamines are also lipophylic and are metabolized by the liver P450 oxidative enzymes, thus competing for enzyme breakdown with antidepressants, anti-arrhythmics, beta blocking blood pressure medications, and antipsychotic medications used for common depression and anxiety. Second generation non-sedating antihistamines, while not directly crossing the blood brain barrier to effect the CNS, were the first drugs studied in relation to drug interactions with P450 enzyme competition, and still contain this threat of altering blood levels of both the antihistamine and these other drugs. Third generation non-sedating antihistamines do not cause these interactions, but studies show that clinical response varies widely among and within patients (Armstrong and Cozza M.D. analysis published in Psychosomatics 2003; 44:430-34). This study also asserts that Claritin/Altavert safety profile has been the subject of much professional debate, and drug interactions and competition is still problematic with certain patients, especially concerning patients taking concurrent anti-histamine antacid medications and cardiovascular drugs.

Histamines are important chemicals in the area of proper stomach function also, and inhibition has shown potential nutrient depletion of B12, calcium, folic acid, iron, zinc and vitamin D. The FDA has issued warnings that caution should be used in prescribing these drugs to patients with peptic ulcers or small bowel obstructions, as well as those with prostrate hypertrophy, glaucoma and bladder obstruction. Certain antihistamines come with precautions that caution should be observed in use with patients with history of bronchial asthma, hyperthyroidism, cardiovascular disease and hyptertension.

Coupled with these extensive problems of risk with antihistamines are the consequences of long term corticosteroid use (see article on this website) and the damage done to sinus membranes from chronic use of decongestants. Common prescriber warnings state that there are potential side effects with decongestants of nervousness, sleeplessness, increased blood pressure, racing heart, and rebound rhinitis, where more than three days use in a row of nasal decongestant spray may cause the congestion to become more severe which will lead to increased use of the decongestant and dependency on the medication.

The key question in evaluating long-term risk versus benefit is not whether we may be one of the unlucky few who face serious consequences, but rather, if these medications can cause such significant harm, what are they doing to my general health. As far as benefit concerns, are these drug regimens correcting the immune membrane health and addressing key health factors that contribute to the problem? Are they possibly perpetuating the health problem while controlling symptoms?

New Recommendations for Treatment Strategy for Chronic Rhinosinovitis Syndrome (CRS), commonly called Hayfever, Rhinitis or Sinovitis:

The NIH has published recent extensive analysis of rhinosinovitis syndromes and recommended a change in treatment guidlines. These recommendations are that instead of just focusing on reducing mucosal inflammation, swelling, infection and aeration of the membranes, that modern treatment should, “First of all...consider the patient in totality: from etiology (indlcuding contributing health problems) when possible, to (differences in individual) clinical features. When considering patients with CRS, comorbidities (associated health problems)... must not be underestimated...A modern treatment of CRS should adapt its schemes to evidence-based medicine. Unfortunately, basic evidence on drug efficacy in CRS is still missing. As mentioned by the EPOS expert panel, validated trials are lacking even for the most prescribed medications against CRS such as antibiotics...A multidisciplinary approach and follow-up is mandatory as diseases such as cystic fibrosis can generate sinus diseases.”

Understanding the Mechanisms of Allergic Reactions

One theory in allergic immune missense is that the immune system makes mistakes when it is overtaxed. The cytotoxic immune system is a very complex interaction of chemical mediators in our body because it has to respond to millions of potential threats from viruses, fungi, mold, mildew, pollen, toxic chemicals, etc. As our environment gets more complex and less healthy, and as our community becomes more global, the stress on the cytotoxic immune system increases exponentially. When our general health suffers, this immune system is struggling even more, as the body is less capable of producing the right metabolic chemicals to supply the needs of the immune complex. As the cytotoxic immune complex recognizes allergens, the cytokines, or protein messengers, activate the T-cell and B-cell responses. When the B-cell responses are triggered too easily, unwanted inflammatory responses cause allergy symptoms. By creating a healthier immune system, there is a chance that this immune memory response can be modified.

B-cells are immune blood cells that are able to use a 'memory' mechanism to produce specific protein antibodies to the allergens. The whole process of activating B-cells to produce the antibodies involves both the protein complement system and the T-cells though. The B-cell binds to the allergen or antigen and combines this with a protein marker that is then recognized by a T-cell, which carries a matching receptor to this marker. This activates the T-cell, which releaeses complement protein cytokines, or interleukins, that transform the B-cell into an antibody-secreting blood cell.

B-cells are produced and processed in the bone marrow and liver, with billions of types of antibodies produced. Problems with the metabolic function of the liver and marrow may thus produce specific problems with the allergic responses. Increasing the healthy functions of the liver and marrow may be just as important as avoidance of the allergens in correcting the allergic reaction. Some of our complex B-cell memory was obtained from the colostrums of our mother’s first breast milk. One theory states that problems with this memory B-cell system may contribute much to certain allergic states. Bovine colostrums have proven to be beneficial in some instances to correct this problem.

A complete process of trying to stop the allergic memory of overreaction must involve therapy aimed at improving the healthy function of all of these aspects of the immune response. The allopathic approach, which still tries to target a single problem in a part of the cooperating immune system, will not achieve this goal, and hence, modern pharmaceutical research has been stymied. The patient that chooses a holistic approach to improve the whole health of the system has a great chance to stop this allergic missense.

This holistic process involves identification of the right allergens, decrease in exposure to these allergens as you work to improve the health of the immune system, stimulation and restoration of the immune memory, stimulation of more healthy B-cells and T-cells, stimulation of healthy complement proteins and inflammatory mediators by improving liver health, and improving the health of the membranes, where ill health and inflammatory processes may be altering the healthy function of these antibodies and complement proteins. Testing may be the first step in correctly identifying allergens. Other methods may be to keep a diary of symptom onset and compare this to exposure. Some patients have utilized physicians using muscle testing reactions.

Testing

Testing for allergies usually involves testing either reactivity or antibody levels that are somewhat specific for the allergen. Both of these testing methods do fall short in assuring complete objectivity. Skin reactivity may gauge the immune reactivity of an area of skin but this may be different than the reactivity by antibodies or other immune complex in the membranes or in the lining of the gastrointestinal tract. Blood tests may find high IgE antibody levels to specific antigens, but for the individual these may or may not indicate a real allergic response, as the body creates antibodies for all foreign molecules, and some of these tests are affected by medications such as antihistamines.

Analysis is sometimes subjective. Tests often indicate allergic reaction to a substance that the patient isn't bothered by, and often tests show little evidence of allergic reactivity while the patient still has episodes of allergic symptoms. Nevertheless, tests are a good addition to the accumulation of objective evidence that can be assembled to find a comprehensive treatment plan. Other methods of objective assessment include keeping a diary of exposure and reaction, keeping in mind that some symptoms may not occur immediaately after exposure and so need a pattern analysis, and use of muscle testing, which is a reactivity of the strength of contraction with exposure, and is subtle.

The reasons for this accumulation of objective evidence is not merely to avoid the allergen for the rest of your life. Often times, even partial avoidance of the allergens during a period of increasing the healthy response of the immune system may help tremendously to change the pattern of hyperreactivity. In other cases, the persistence or duration of exposure may be a key factor in the allergic response. Studies indicate that certain populations may have high percentages of allergy to certain allergens simply because exposure lasts for months instead of weeks. Often, the patient reports that their specific allergy resolved when they moved to a new geographical place, even though both places obviously contain the allergen. Changes in allergic reactivity are commonly reported over time, and this indicates that the body does have the capacity to resolve specific allergies. Knowledge of the specific allergens may be very important to this process of cure.

Atopic allergen reactivity may be tested by blood samples or skin tests. ImmunoCAP is a blood test that measures allergen-specific IgE and is not affected by antihistamine use, with claims of more accuracy and objectivity. RAST, or radioallergosorbant test, has been shown to be less sensitive than skin tests.

Food allergies may be identified with the ELISA (enzyme-linked immunoSorbent assay), which detects antibodies or antigens, from the blood. Great Smokies Laboratory has performed these tests along with tests of stool samples for analysis of the bacteria, fungi etc. in the intestines. The ELISPOT (enzyme-linked immunosorbent spot) test is a modified version of the ELISA that is very sensitive. IgG antibody assessment (ELISA/EIA) has been used to identify food allergens that contribute to irritable bowel syndrome, with mild improvement from eliminating these foods from the diet. Once again, relying on just one focus, and not treating with a thorough, holistic approach, is often a recipe for failure. Attention to potential allergies should be part of a broader treatment protocol.

Reliability of the labs is a problem shown in testing and review, and the patient is advised to request that a reliable lab be used. Ultimately, these lab tests show possible ranges of allergic responses and the patient must still go through a series of elimination diets and see if possible results support the lab findings. As always, the cure is often more complicated than we would like it to be. Often, diagnosis of food allergies is best left to the naturopathic doctor.

Other testing facilities that are recommended by experts include: Geneva Diagnostic Laboratory or Asheville, NC: 800-522-4762; and ImmunoScience Inc. of Las Vegas, NV: 925-460-811.

Nutrient medicine

A 2007 systematic meta-review of scientific evidence of efficacy of Complementary Medicine in the treatment of rhinitis by the University Hospital Aintree Department of Otolaryngology in Liverpool, UK, cited below, found that few nutritional supplements and herbs had been cited in standard medical databases related to randomized, placebo-controlled human clinical trials for the treatment of chronic rhinosinuvitis. Nevertheless, there was proven efficacy with human trials with the use of spirulina, an algae supplement. Studies showed that 12 weeks of spirulina supplementation increased mucosal immunity and relieved symptoms. This review of scientific studies and human clinical trials also showed that the use of bromelain (an enzyme found in pineapple and various Chinese herbs) proved effective to speed recovery when used as an adjunct to standard therapy.

Herbal products

As stated, the National Institutes of Health in 2007 published a meta-review of scientific evidence of efficacy of standard medicine to treat chronic rhinosinuvitis (CRS) conducted by the University of Ghent and the Universitie Catholique de Louvain, Belgium, who found that basic evidence of drug efficacy was still missing. An EPOS expert panel found that validated trials are lacking for even the most prescribed medications to treat CRS. We have seen limited funding in the West for clinical trials to evaluate herbal medicines to treat CRS, but have observed a long history of clinical success around the world. More and more scientific study is proceeding to human clinical trials with placebo control and blinding to prove efficacy with both herbal medicine and acupuncture, though, and some of this evidence is cited below. A variety of herbal products are effective if they are of high quality and prescribed properly. Herbal medicines are able to control inflammatory mechanisms, increase vascular and neural vasomotor responses, promote healing of tissues, act as broad spectrum antibiotic, antiviral and antifungal agents, support healthy immune responses, both specific local and systemic, and address potential contributing health problems such as fibrosis, sublinical hypothyroidism, acid reflux and other esophageal reflux syndromes, and asthmatic mechanisms. In addition, herbal products may help alleviate some of the risk of damage to the membranes and overall health from chronic use of drugs. Some of the common herbal pill formulas in my clinical practice are listed below. Other tinctures and raw herb formulas are used as more specific and stronger phytomedication when needed.

  • Allergen: a general herbal formula to alleviate symptoms and help the immune system is very effective in many cases, especially with nasal and eye symptoms
  • Advanced Defense: a formula to stimulate better immune responses
  • Colostroplex: bovine colustrum supplement may help with food allergy problems especially
  • Ecliptex: a liver tonic with milk thistle is often useful to improve B-cell response
  • Astra C: a simple immune tonic with 3 forms of Vitamin C to improve the health of the mucosa to correct localized immune dysfunctions in nasal allergies and asthma
  • Cangerzi Tang plus: a symptom relieving formula for nasal/sinus allergies
  • Xanthium relieve surface: a simple formula to relieve skin symptoms or head congestion symptoms related to allergies

Information Resources

Treatment with Complementary and Alternative Medicine for allergies in Europe is proving very successful and well utilized. Some of the data on the practice and research support is listed below with links to published data.

  1. A 2010 analysis of nasal congestion, or rhinosinusitis, from Weill Cornell Medical College in New York, outlines the complex array of types of this disease, its associations with such problems as sleep apnea, its impact on work productivity, and the &6 billion in annual healthcare costs that it creates: http://www.ncbi.nlm.nih.gov/pubmed/20463822
  2. Antibiotic resistant bacteria are now found in about 10% of all cases of rhinosinusitis studied, indicating that the standard protocol for treating sinus infections and flare-ups of chronic sinus congestion have probably contributed greatly to the rising incidence of chronic rhinosinusitis: http://www3.interscience.wiley.com/journal/121609485/abstract?CRETRY=1&SRETRY=0
  3. The U.S. Agency for Healthcare Research and Quality (AHRQ) provides current research for standard diagnosis and treatment of acute bacterial rhinosinuvitis, revealing that more than 10% of the population is affected with these acute infections, and that a variety of factors cause of predispose the patient to acute infections, including viral illness, immune hyperreactivity to fungi, allergic disorders, anatomic abnormalities, systemic diseases, noxious chemicals and environmental toxins, and trauma. The array of diseases that could contribute are many, including endocrine, or hormonal disorders, metabolic diseases, and more, many of which are subclinical and undiagnosed: http://www.ahrq.gov/clinic/epcsums/sinussum.htm
  4. Current use of Complementary and Alternative Medicine by medical doctors in Europe as far back as 2002 proves that this treatment protocol works for a growing body of patients: http://www.ncbi.nlm.nih.gov/pubmed/12121187
  5. A study of rebound rhinitis (rhinitis medicamentosa induced by chronic overuse of prescription drugs), in 2009, at a hospital in Greece, showed that diagnosed incidence of this problem increased dramatically after heavy advertising for these pharmaceutical products. One can surmise that the situation must be worse in the U.S.: http://www.ncbi.nlm.nih.gov/pubmed/19902852
  6. A 2010 meta-analysis of medication induced rhinitis, or rhinosinuvitis, found that a variety of medications were potentially linked to this disease, with 3 categories: inflammatory dysfunction, neurogenic, and idiopathic (unknown mechanisms of cause): http://www.ncbi.nlm.nih.gov/pubmed/20210811
  7. This video from Vanderbilt medical college show that many cases of post nasal drip are caused by upper airway acid reflux from gastric hypofunction and problems with the esophageal gastric sphincter. Unfortunately, the standard cure has not evolved past use of blockers of stomach acids, despite the acknowledgement that these patients usually do not have an excess of stomach acids: http://www.youtube.com/watch?v=m4OccOuAnuU
  8. This video from the Mayo Clinic shows how mold and fungi in the air will create a hyperactive immune response when fungal antigens stimulate excess T-cell responses with eosinophils, and how normal healthy immune responses will not produce these symptoms causing responses: http://www.youtube.com/watch?v=H1FIBSXz7fc
  9. By 2004 studies showed that 30% of all patients with in Europe chose to treat with Complementary and Alternative Medicine, with a great percentage choosing acupuncture and herbal medicine: http://www.ncbi.nlm.nih.gov/pubmed/15330007
  10. A German study at the Medical University of Lubeck found that patients who chose Complementary and Alternative Medicine to treat allergies were motivated by concern for Quality of Life and desire to take control of their health: http://www.ncbi.nlm.nih.gov/pubmed/14642985
  11. A Japanese study in 2010 found that when patients spent time in nature, such as parks and forests, that their immune system functioned better due to inhaling phytochemicals that plants create to protect them from the harmful effects of antigens, allergens and insects: http://www.nytimes.com/2010/07/06/health/06real.html?_r=1
  12. A 2008 meta-analysis of the effectiveness of acupuncture in the treatment of allergies in Germany, tested with double-blinded placebo trials, demonstrate the proven benifits: http://www.ncbi.nlm.nih.gov/pubmed/19055209
  13. A 2006 meta-analysis in Australia of current clinical trials and evidence supporting the use of acupuncture and herbal medicine in the treatment of allergic rhinitis: http://www.ncbi.nlm.nih.gov/pubmed/16670510
  14. A 2009 study of acupuncture to treat vasomotor, or non-allergic rhinitis, found in a pilot study that acupuncture, even in the constraints of a limited set treatment, was significantly effective in a double-blind placebo controlled study to treat vasomotor rhinitis. This study was also conducted at the University of Munich, in Germany: http://www.ncbi.nlm.nih.gov/pubmed/19388861
  15. A 2010 study at Kyung Hee University, South Korea, found that a Chinese herb Corydalis hereocarpa, with the active chemical Libanoridin, effectively inhibits allergic inflammatory response by the inflammatory mediators found to be excessive in the allergic responses, IL-1beta, IL-6, IL-8 and TNF-alpha: http://www.ncbi.nlm.nih.gov/pubmed/20100031
  16. A 2007 study at the Chosun University Medical School in Gwangju, South Korea, found that Quercetin, an antioxidant chemical found in a number of Chinese herbs, including Sang ji sheng (Loranthus parasiticus), Fan shi liu (Psidium guajava fruit), Di er cao (Hypericum, or St. John's wort), and Man shan hong (Rhododendrum dahuricum), and available in a purified extract, effectively treats allergic inflammatory responses by decreasing the inflammatory mediators IL-6, IL-8, TNF-alpha, and attenuating NF-kappaB and p38 chemokines: http://www.ncbi.nlm.nih.gov/pubmed/17588137
  17. A 2007 study at Kyung Hee University in Seoul, South Korea, also found that green tea, with the active chemical epigollocatechin, was an effective addition to an allergy regimen, inhbiting the production of the inflammatory mediators that drive allergic responses, IL-6, IL-8, and TNF-alpha, through inhibition of intracellular calcium ion triggering: http://www.ncbi.nlm.nih.gov/pubmed/17135765
  18. A 2010 study at the Tunghai University in Taiwan found that the Chinese herb Anoetochilus formosanus effectively modulates inflammatory allergic responses by modulating immune cytokines in allergic asthma, reducing IgE responses, and airway hyperresponsiveness: http://www.ncbi.nlm.nih.gov/pubmed/20092984
  19. A 2001 study in Germany showed that Siberian ginseng, or Eleutherococcus senticosus, extract effectively inhibited the replication of human rhinovirus and respiratory syncytial virus, making this Chinese herb an effective addition to treatmento protocol: http://www.ncbi.nlm.nih.gov/pubmed/11397509?dopt=Abstract
  20. A 2007 meta-analysis of Western human clinical trials of herbal and nutrient medicines to treat chronic rhinosinuvitis by the University Hospital Aintree in Liverpool, UK, found that evidence was confirmed for the use of spirulina supplement for 12 weeks to decrease symptoms and improve mucosal immunity. Bromelain also showed efficacy in promoting a faster recovery for acute sinusitis when added to the treatment protocol: http://www.ncbi.nlm.nih.gov/pubmed/17125579

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.