Allergic Rhinitis - Curcumin and Probiotics Can Help

Melissa Descoteaux
ND
https://www.melissadescoteauxnd.com
14 June 2018

Language English

www.melissadescoteauxnd.com/

Allergic rhinitis (AR)—known for causing watery eyes, sneezing, runny nose, itchy eyes, and nasal congestion—is becoming more common in developed countries. In Canada, up to 44% of individuals claim to have experienced AR symptoms, while 20% have been diagnosed by their medical doctors.^{[ 1 ]} For some, it happens mostly during spring or fall, termed “seasonal allergies,” and for others, it is present all year round, aka “perennial allergies.” Other symptoms of allergic rhinitis include fatigue, poor concentration, and reduced productivity, all of which are more systemic and can significantly affect quality of life.

AR symptoms are due to an inflammatory response of the nasal mucosa as well as mucous membranes of the ears, sinuses, or pharynx. They are triggered by exposure to various environmental allergens. These allergens may be indoor—such as dust mites, pet dander, or mold—or outdoor—such as pollen from grass, weeds, trees, or other outdoor molds.^{[ 2 ]} Many turn to over-the-counter (OTC) medications—such as decongestants, antihistamines, or intranasal corticosteroids—to manage their symptoms, with roughly 60% feeling their symptoms are somewhat controlled during the worst months of the year.^{[ 1 ]} Naturopathic medicine may provide alternative or complementary treatments to OTC medications to help reduce AR symptoms and improve quality of life. Wouldn’t we all love to stop and smell the roses during the spring?

Immune Response to Allergens

Our immune system has evolved to protect us against viruses, bacteria, fungi, and parasites. However, if it behaves abnormally and responds to benign triggers such as airborne pollen, it causes an unwanted immune response. There are two main arms of the immune system. The innate immune system is front-line defense and acts rapidly against infections; it is not antigen-specific and does not have immunological memory of previous infections. The other arm of the immune system is the adaptive immune response. It is slower to respond, sometimes taking up to days, but exhibits immunological memory and is antigen-specific, meaning the immune response may strengthen with each exposure to antigens.^{[ 3 ]}

The inflammation of mucus membranes in AR is the result of an adaptive immune response, more specifically an immunoglobulin E (IgE)–mediated immune response. IgE is an antibody produced by the immune system which binds to the surface of mast cells. When IgE comes into contact with allergenic proteins, aka antigens, mast cells are triggered and release inflammatory mediators such has histamine. This increases the permeability of blood vessels, which allows white blood cells and some proteins to reach the specific area, causing inflammation of local tissue such as mucous membranes of the nose, ears, and eyes.

Diagnosis

The two most-common methods of identifying allergic antigens are the skin-prick/scratch test and a blood test called fluorescence enzyme immunoassay (FEIA). The skin-prick test measures the immediate IgE reaction to a variety of allergens. The procedure involves inserting an extract of the allergen under the skin surface, usually of the forearm. A positive result is noted by the formation of a hive due to local histamine release of mast cells. On the other hand, the FEIA is a blood test that indirectly measures serum levels of IgE associated with certain antigens. It is not as sensitive or specific as the skin test, but can be useful in determining specific allergens.^{[ 2 ]}

Interventions
Avoidance

Once specific allergens have been identified, the main way to prevent allergic symptoms is avoidance. Regarding outdoor allergens, this means avoiding outdoor exposure during times of the year when specific pollens are highest. For example, tree pollen is usually highest in the spring, grass pollen in early summer, and weed pollen in late August into September.^{[ 2 ]}Also, making sure windows and doors are closed, using the recirculating mode of air conditioners, and taking a shower after being outside can help remove excess pollen form your skin and hair. These are the best ways to help prevent allergic symptoms from outdoor allergens. For indoor allergens, washing linens at least twice a month in hot water, and using hypoallergenic mattress and pillow covers can help reduce exposure to dust mites.^{[ 4 ]}^{[ 5 ]} In addition, dust mites thrive when humidity is more than 50%, so a dehumidifier may be useful.^{[ 6 ]} Lowering indoor humidity may also prevent the formation of mold, which is another common indoor allergen. It is best to avoid carpet altogether, especially if pets are present. Regarding animal allergies, avoidance is best, but for those who do have an allergy to animals and are exposed, HEPA air filters can be useful especially for cat dander. Furthermore, it is important to not only avoid indoor and outdoor allergens, but also respiratory irritants such as cigarette smoke and perfumes, as well as rapid changes in temperature and air pollution, which increase local inflammation and can aggravate allergic symptoms.

Curcumin

Curcumin is the active ingredient in turmeric, a perennial tuber native to Southeast Asia. It has strong anti-inflammatory effects, comparable to those of hydrocortisone.^{[ 7: 371–372 ]} In mice, it has shown benefit in decreasing rhinitis symptoms by decreasing immune mediators such as IgE which also plays a role in human allergic rhinitis. As a result, one study explored the effect of curcumin supplementation to alleviate sneezing, runny nose, and nasal congestion in adults. The study included 241 participants with perennial (aka all-year-long) AR who had positive skin-prick test results to multiple allergens. All participants had experienced symptoms for a minimum of two years, and they were not on any other pharmacological treatments during the study. Half of them received 500 mg of curcumin orally per day, and the other half received placebo treatment. After two months, nasal symptoms (sneezing, runny and itchy nose, obstruction) had significantly decreased in the curcumin group, with no change seen in the placebo group. Symptoms were measured by participants filling out a symptoms-rating scale before and after treatment. Nasal congestion also improved in the curcumin group and not in the placebo group. In addition, those receiving curcumin had decreased levels of IL‑4, which mediates the production of IgE and is known to be elevated in individuals with AR symptoms.^{[ 8 ]}

Probiotics

Probiotics refer to live microorganisms that, when introduced to the digestive system, may improve digestion as well as overall health by modulating the immune system. As a result, probiotics may play a role in reducing allergic symptoms. In fact, the effect of the human microbiome on the immune system has been well-studied. Although the evidence for probiotics as a treatment for AR is conflicting, it does show some benefit. A study demonstrated an improvement in quality of life regarding seasonal allergy symptoms. For the randomized control trial, 173 adults were divided into two groups: The treatment group received one capsule of probiotics containing 1.5 billion CFU two times daily, from March to May (eight weeks), during spring allergy season; the placebo group received the same treatment, with a capsule containing no probiotics. At the end of the eight-week period, the probiotic group reported an improvement in quality of life based on a questionnaire; however, no change in immune markers was seen.^{[ 9 ]} This means there was a benefit with probiotic treatment, but the mechanism is unknown. Another study also found improvement in quality of life for individuals with persistent AR symptoms. The difference in this study was that all participants were also given loratadine, an antihistamine used to treat AR symptoms. The treatment group received one probiotic capsule of 2 billion CFU daily for five weeks during grass-allergy season. Although no changes in rhinitis symptoms (nasal obstruction, sneezing, itchy nose) were seen between groups, itchy eyes did improve.^{[ 10 ]} In a third study, 27 adults with known grass allergy were given a specific strain of probiotic, Bidifidobacterium lactis NCC2818, 4 billion CFU, daily for eight weeks or placebo. After five weeks of treatment, nasal symptoms were significantly lower in the probiotic group compared to the placebo group. Furthermore, immune markers, usually high with allergic symptoms, were lower in the treatment group, which demonstrates a possible immune-regulatory effect of probiotic supplementation dependant on strain.^{[ 11 ]}

Conclusion

Allergic rhinitis can be triggered by several environmental allergens. The main way to prevent symptoms is to avoid exposure to specific allergens; however, general avoidance without knowing the exact allergens is not recommended. To identify allergens, a skin-prick test should be performed by an allergist. If symptoms do arise, OTC medications may be used to control symptoms, but the use of natural interventions—such as curcumin and probiotics—may also help reduce nasal and eye symptoms as well as improve quality of life during allergy season. Larger studies are needed to confirm the efficiency of these supplements, in addition to appropriate dosage and duration of treatment for the prevention of AR symptoms.

References :

1.Keith, P.K., et al. “The burden of allergic rhinitis (AR) in Canada: Perspectives of physicians and patients.” Allergy, Asthma, and Clinical Immunology, Vol. 8, No. 1 (2012): 7.
2.Sheikh, J. “Allergic rhinitis.” Medscape. · https://emedicine.medscape.com/article/134825 · Updated 2018‑05‑18.
3.Holgate, S.T., et al., eds. Allergy 4th Edition. Edinburgh: Elsevier Limited, 2012, 432 p., ISBN 978‑0‑7234‑3658‑4.
4.McDonald, L.G., and E. Tovey. “The role of water temperature and laundry procedures in reducing house dust mites populations and allergen content of bedding.” The Journal of Allergy and Clinical Immunology, Vol. 90, No. 4, Pt. 1 (1992): 599–608.
5.Morgan, W.J., et al. “Results of a home-based environmental intervention among urban children with asthma.” The New England Journal of Medicine, Vol. 351, No. 11 (2004): 1068–1080.
6.Korsgaard, J. “House-dust mites and absolute indoor humidity.” Allergy, Vol. 38, No. 2 (1983): 85–92.
7.Godfrey, A., et al. Naturopathic botanical medicine, Vol. 1: Botanical medicine monographs. Toronto: CCNM Press, 2010, 568 p., ISBN 978‑1‑8970‑2526‑0.
8.Wu, S., and D. Xiao. “Effect of curcumin on nasal symptoms and airflow in patients with perennial allergic rhinitis.” Annals of Allergy, Asthma & Immunology, Vol. 117, No. 6 (2016): 697–702.
9.Dennis-Wall, J.C., et al. “Probiotics (Lactobacillus gasseri KS‑13, Bifidobacterium bifidum G9‑1, and Bifidobacterium longum MM‑2) improve rhinoconjunctivitis-specific quality of life in individuals with seasonal allergies: A double-blind, placebo-controlled, randomized trial.” The American Journal of Clinical Nutrition, Vol. 105, No. 3 (2017): 758–767.
10.Costa, D.J., et al. “Efficacy and safety of the probiotic Lactobacillus paracasei LP‑33 in allergic rhinitis: A double-blind, randomized, placebo-controlled trial (GA2LEN Study).” European Journal of Clinical Nutrition, Vol. 68, No. 5 (2014): 602–607.
11.Singh, A., et al. “Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: An exploratory, randomized, placebo-controlled clinical trail.” European Journal of Clinical Nutrition, Vol. 67, No. 2 (2013): 161–167.

Gluten and Its Impact on Chronic Disease
27 Jan 21
Emerging health implications of gluten sensitivity reach far beyond the borders of the gastrointestinal tract. The gluten-sensitive spectrum includes different forms of manifestations: allergic (wheat allergy), autoimmune celiac disease (CD), dermatitis herpetiformis, gluten ataxia, and immune-mediated (nonceliac gluten sensitivity).
Probiotics. Part 2/2
29 Apr 22
Probiotics have extensive potential for therapeutic use, and we continue to discover their specific actions. The previous article looked at classification and the role of probiotics with regards to immune function and digestion, including autoimmunity, atopic skin reactions, and respiratory conditions.
Sleep and the Immune System - Naturopathic Perspectives
17 Dec 19
Hitting the hay, sawing logs, catching ZZZs— these are terms we use to describe sleep, but what is happening is more like a well-timed orchestra performance. Areas of the brain work in concert; some turn on and some turn off, directed by cues from light and chemical messengers called neurotransmitters. However, recent research suggests that sleep is not a process confined to the brain but that can receive input from the entire body, most prominently through the immune system.
Fever and Thermal Therapy - Why Heat Is a Good Thing
13 Apr 20
Have you met the people that tell you, quite proudly, they never, ever, ever get sick? Do you find yourself feeling just a wee bit jealous? Well, feel jealous no more! Exercising our immune system with a good fever may feel yucky, but it is great for all kinds of reasons.
The Gut Microbiome and Health - Naturopathic Perspectives
09 Mar 20
The human gastrointestinal tract (GIT) alone contains 1014 microorganisms including bacteria, viruses, and fungi. That’s approximately 100 times more microbial cells than human cells, which shows how much of an impact they can have on human health.
Celiac Disease and Gluten Sensitivity - Should we be worried?
02 Jul 14
Consumption of wheat has increased dramatically over the last decades. Wheat was once thought to be an important part of a healthy diet, but now is seen as a potential health threat for many individuals. Gluten is a food component found in wheat, rye, barley, and cereals. More specifically, it is a protein complex that is formed by gliadin and glutenin, typically used in processed foods as a stabilizing agent. Celiac disease (CD) is a complex chronic immune-mediated disorder whose gastrointestinal symptoms are triggered by eating gluten.
Parkinson’s Disease Associated Sleep Disorders - Novel Treatments
13 Apr 17
Parkinson’s disease (PD) is one of the most common neurodegenerative disorders, affecting 1–2% of the population over the age of 65.
Food Sensitivities - What You Need to Know
06 Oct 16
Did you know many people are sensitive to foods without even knowing it? Food sensitivities can manifest in the body in a variety of different ways, such that two unique individuals will not necessarily experience the exact same symptoms.
Histamine Intolerance - Naturopathic Perspectives
03 May 17
Histamine is an organic compound that is involved in many processes in the body. It can be produced within the human body or ingested in foods. In humans, histamine is synthesized in several cells, including mast cells, basophils, platelets, histaminergic neurons, and enterochromaffin cells.
Bleeding Gums?
13 Feb 16
Noticing blood while brushing or flossing can be alarming and shouldn’t be ignored! The importance of oral health is a concept introduced to most Canadians at a very young age, and with good reason. The Ontario Dental Hygienist’s Association reports that the link between oral infections and other diseases in the body is becoming well-documented and accepted within the health-care community. Periodontal disease is one of the most common human diseases
Psoriasis - Naturopathic Therapies
02 Sep 15
Psoriasis is a chronic skin condition that may have varying levels of symptom intensity. It causes skin cells to grow very quickly, which results in thick silvery or red patches of skin ^[1]. Usually, skin cells grow and turn over once a month and new skin grows to replace the old skin.
Benefits of Acupuncture for Cancer Patients
17 Jun 16
The use of complementary medicine for the treatment of cancer and its side effects has skyrocketed in recent years. Complementary therapies refer to ones that are nonpharmaceutical in nature, and that have the potential to not only enhance quality of life, but also to reduce side effects of conventional therapy.
Ashwagandha / Withania somnifera
09 Jul 15
W. somnifera, also known as Ashwagandha, is an important herb that has been used for over 3000 years. The important constituents of the root are steroidal alkaloids and steroidal lactones referred to as withanolides. It is used for anxiety, inflammation, Parkinson’s disease, cognitive and neurological disorders, and as a supportive adjunct for people undergoing radiation and chemotherapy.
Gut Health
07 May 15
The immune system is able to discriminate self from non-self antigens, substances that trigger the immune system, which protects the host from infections and cancer. Autoimmune diseases are characterized by deregulated immune responses. Autoimmune diseases affect 5-8% of the population in the United States and can affect almost every site in the body
Rheumatoid Arthritis - Naturopathic Perspectives
11 Oct 18
A fairly common chronic condition that afflicts people is rheumatoid arthritis (RA); a form of chronic joint inflammation that can have major impact on quality of life. The exact cause of rheumatoid arthritis is unknown, but it has a significant autoimmune component. This is how it differs starkly from the much more common osteoarthritis, which is more of a “wear-and-tear” form of arthritis that results from mechanical use of joints over a long and active life. Rheumatoid arthritis not only affects the joints, but also presents with systemic inflammatory symptoms.
Diverticular Disease - Acute and Preventative Management
18 Jan 19
A large portion of people who see naturopathic doctors come with a chief concern of digestive issues. After months of scopes and bloodwork, they are often left without answers from their medical doctor and seek a new perspective. Other times, their diagnostic imaging tests reveal something significant, yet the medical system is still at a loss for treatment options.
Acute Inflammation in Physical Activity and Recovery
22 Dec 16
Acute inflammation is something we want to get rid of so we can return to play and feel more comfortable. But inflammation has a purpose and a place in the short-term.
Chronic Pain : The Gut-Joint Axis
28 Feb 19
Chronic pain is a significant health issue, and it is estimated that one-half of those suffering with chronic pain have been suffering for longer than 10 years.^[1] An estimated 54.4 million North Americans have been diagnosed with various arthritic disorders,[2] conditions that are typically treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
Meditation
08 Jan 15
If you have taken an active interest in your own health-care treatment, then you have likely heard about the benefits of meditation and mindfulness. But do you really know why regular meditation is so beneficial? Common self-reported benefits include reduced levels of anxiety, depression and pain; data which have been reinforced through many clinical trials.
Colorectal Cancer And Mistletoe
10 Apr 16
In 2015, 1 in 14 men and 1 in 16 women were diagnosed with colorectal cancer. It is the second most likely cause of death from cancers for males, with a 1 in 29 chance of dying from it, and the third most common cause of death for females with cancer.