Autoimmune Allergy Spectrum Disorder
As NDs, we are the best physicians at taking care of disease utilizing natural substances, but we also need to be the best at diagnosing the true cause of the dis-ease. We are getting better all the time. I hope you find a piece of this article that can aid you in treating the allergy and autoimmune disorder complex.
Unless my patients are born with allergies or autoimmune problems, I treat these disorders as a reaction by the body to some other influence that needs to be corrected. I also see the autoimmune disorder or reaction as a continuum in the course of an untreated allergy symptom complex. This article will focus on inhalant allergy symptoms, while the second article in this series will address ingestion and topical allergy symptoms, and the last article will address autoimmune disorders.
Understanding the Process
We all have been tricked by this disorder, haven’t we? We learn how to stop the inflammatory processes using all the latest naturopathic armaments of botanical extracts, high-tech fractions of vitamins, amino acid blends, micro-minerals and bottles of liquid super foods. Many of these nutraceuticals are of the highest quality and definitely have a place in our medicinaries. Before we apply them like pharmacological agents, though, we need to take a step back and analyze exactly what processes are going awry and how to permanently correct them, if possible. So yes, when we substitute naturopathic formulations our patients think we are great because they don’t need steroids or anti-histamines, but how many are truly able to exist without any type of allergy medicine? To understand how to reverse the process, we need to understand the process itself and what the body’s intent is in initiating this process.
What is an “allergy,” or its big brother, “autoimmune dysfunction”? I view autoimmune disorders as a continuum of the allergic process. Basically, there are only three ways that allergies can enter the body and are initiated: inhalation, ingestion and surface contact. I must state here that all symptoms we associate with allergy and autoimmune disorders must also be screened for poisoning, toxicity or genotype. If any of these problems is suspected by examination, history or a lack of efficacy in therapeutic trials, then additional tests must be performed.
My preference is to first run a six-hour urine, heavy-metal toxicity test with DMSA challenge to detect mineral toxicity. I also run a liver and kidney function profile with a large meal, and a caffeine challenge. This can highlight potential organ problems that would go unnoticed during a fast and are responsible for many of the signs and symptoms of allergy. A genotype diet can often be effective if indicated.
A very thorough history of a patient’s environment can sometimes turn up toxic problems that would otherwise go unnoticed and be treated as allergies. I live in a rural area where, much to my chagrin, a lot of chemical sprays are used by orchard growers. I can’t tell you how many times I have received phone calls like this: “Dr. Schwartz, can I please come in today? My allergies are acting up and I have a migraine.” In actuality, the patient has just been exposed to orchard spray. Most people do not understand that they cannot be allergic to a poison; they are just suffering toxicity from it. We need to look at where people work, what clothes they wear, food they eat, type of housing they live in, area they live in, etc. The list is too extensive for this article, but suffice it to say the importance of toxicity cannot be stressed enough. Other problems that mask themselves as allergy include, but are not limited to, Lyme and other tick-borne disease, TMJ dysfunction, chronic nasal staph infection, eye infections and disorders, and really any disease that affects the head and neck, especially the cervical lymph nodes.
As an aside, has anyone else noticed that what people say they are allergic to changes over the course of time or location? The reason I mention this is because I am not a proponent of allergy testing per se. I find if I key in on the process and not the trigger that I get faster and more complete results without the additional cost of any number of specific allergy tests.
Inhalant Allergy Symptoms
So what are the processes that I have eluded to? Let’s first look at inhalant allergy symptoms, which are by far the most reported. We all know that from our nose down through our lungs, we have a coating of mucous tissue richly supplied with immunoglobulin-A (IgA). This IgA basically binds to foreign substances, making the complex larger than could otherwise be absorbed by the body and thus filtering out potential problems. If the patient affected by “allergies” is suffering from a chronic sinus infection (which most are), then a lot of the normal production of IgA is used up on bacteria and their byproducts, rendering the body less capable of filtering out normal products carried in air. Before we follow this process further, note that a lot of patients do not understand that they have an active, low-grade sinus infection; but with a good exam and history, it will become apparent. Chronic pressure or headaches in the sinus areas, post-nasal drip, eye pressure, excessive mucous drainage, history of multiple sinus infections, facial rashes, lymph node swelling, excessive fluid in the ears and the like are all symptoms of sinus problems.
To follow the process further, if the IgA that is needed is not present or is bound to other substances, then a potential allergen will eventually work its way into the tissue, causing the second line of defense to be triggered. Immunoglobulin-E (IgE) resides in the subcutaneous tissues and reacts to foreign substances in the following manner: It binds to the foreign substance, making it a larger particle and slowing its migration to the inner core. In addition, it releases a chemotactic substance that draws macrophages and mast cells to it. When the macrophages phagocytize the substance, it is carried to the lymph system, which is one reason allergic patients usually present with enlarged or engorged lymph nodes in the cervical region. When the mast and basophil cells migrate to an area of increased IgE and degranulate, they cause a release of histamine and leukotrienes. These typically are the cause of symptoms related to allergy, such as tissue swelling, itchy eyes, airway constriction and the like. It is a type of downward spiral: As more IgE is mediated, the more mast, macrophage and basophil cell migration happens, with the resultant severity of symptoms ever increasing, making life unpleasant for the patient.
What is the body really trying to do? Yes – just stop the foreign substance from eventually migrating to the blood, where the most severe form of reaction can occur, the triggering of immunoglobulin-G (IgG). This is when potentially life-threatening body changes may occur, such as anaphylactic reactions, severe airway constriction, extreme blood pressure decreases and the like. But to get back to what was going on earlier … If we just use pharmacological or naturopathic substances to stop the body’s reaction, I feel we have failed our patients. It is our duty to both (as my Chinese colleagues would say) “treat the root and the branch” – that is, treat the symptoms but also the cause. This way, the patient will get immediate relief and long-term resolution of the problem.
Additionally, the adrenal hormones, particularly cortisol, tend to get depleted during the chronic phase of any allergic reaction. The adrenal gland is highly involved in the repair and damping down of tissue that is inflamed and/or damaged. Eventually it loses its ability to produce adequate amounts of needed hormone. That is when we start to see patients complaining of fatigue, sleeplessness, slower healing of damaged tissues and chronic infections. If the process is not addressed, then disorders such as chronic fatigue syndrome, fibromyalgia, autoimmune disorders, hypothyroidism, adult growth hormone deficiency and other disorders will arise and further complicate the ability of the practitioner to treat the patient, and of the patient to respond to treatment.
When first treating allergy, much of the therapeutic regime should be focused on the ability we have with natural medications and our understanding of how to treat without suppressing the symptoms so patients can resume normal life functions. But it quickly should shift to reversing the allergic process and resolving the cause. Of course, if there is an acute infection with the allergy, that too must be addressed. One can do that with a quick course of antibiotic, usually cephalexin 500-1000mg qid x seven days; or azithromycin, starting with 500mg day one and dropping to 250mg days two through five. These are adult dosages. If antibiotics are not needed but a slighter infection is detected, various reliable TCM formulas can be used in the ears, nose and throat. If there is extreme cervical lymph node swelling, I use 5gtt of phytolacca tincture bid/tid PO. In any case of acute infection I defer to the individual practitioner’s preference of treatment.
The substances I use vary with each patient, but a sample formulary to choose from would definitely include:
- Boswellia serrata standardized to contain 90% acetyl 11-keto beta boswellic acid (AKBA) 1 tid
- Quercetin 1,500mg tid
- Freeze-dried Urtica dioica, 2 tablets tid
- Methylsulfonylmethane (MSM) .5 tsp bid.
If adrenal deficiency is suspected, then I would add natural cortisol – 3mg twice a day and 2mg at early evening.
One of the main treatments I always advocate is use of a nasal lavage:
Add 1Tbsp sea or kosher salt to 1 pint of distilled water. The patient should use it twice a day in the following manner: Standing erect (usually looking into a mirror), the patient should start with a 1/2tsp of solution held close to one nostril. He or she should inhale deeply, with the opposite nostril held closed. If a slight pressure is felt above the eye, the technique was adequate. Repeat on the opposite side.
Have the patient slowly work up to 1Tbsp of solution per nostril. If the patient is unable to obtain the pressure sensation above the eye (similar in feeling to diving in water the wrong way), then the assumption is that the sinus is closed, and a further therapy is indicated. This is when I have the patient come back to my office to initiate a bilateral nasal specific (BNS) series. I repeat this technique every week, using a stronger technique each time until the nasal lavage is successful. Of course, I do not initiate the BNS until I am sure all acute infections are gone. The patient should repeat the nasal lavage every day until no symptoms of allergy are noted – even without medications – and then for an additional month.
Sometimes I employ a cold laser above the sinuses and at the cervical lymph nodes for quicker drainage and increased circulation. I also employ, if needed, a trusty TCM formula that has always helped allergic symptoms and is given as a traditional Chinese tea.
Whatever the combination of therapies utilized, if one keeps in mind that there is usually a low-grade, chronic infective process going on, and therapy is directed at its resolution, then barring other problems mentioned all symptoms of inhalant allergy usually resolve without return.
Robert Schwartz, ND, LAc graduated from NCNM and Oregon College of Oriental Medicine and has a private practice in the Columbia River Gorge in Oregon. He served as president of the Oregon Acupuncture Association from 1987-1992, and was hired by the People’s Republic of China to teach acupuncture in Beijing and Harbin in 1991. He can be reached at firstname.lastname@example.org.