Dr Rupy: I want to talk you through five things that could potentially help relieve spring allergies. And the reason why is because there could be potential side effects with antihistamines, a group of medications that many people pop every single day from months on end to treat their symptoms. I used to be one of these people, I suffer from hay fever, I still do, but I've been able to mitigate it with a few simple hacks that I want to talk to you about as well. With more and more of us struggling with hay fever or seasonal allergies, we might want to look at some preventative measures to mitigate our use of these medications and only keep them for when we really need them, when your eyes are streaming and your eyes are itchy and you've got a blocked nose. Those are the times when you want to be reaching for your antihistamines, not every single day. And the reason why I say that is because there could be some side effects that are easy to forget about with such commonly used and commonly and easily accessible products. They can cause headaches, dizziness, agitation, dry mouth, blurred vision, difficulty passing urine, in particular with some of the, particularly with some of the older generations of medications, stomach upset, constipation. Now you might say that those side effects are quite minor, but we actually don't know the long-term effects of higher doses of these medications. And there was a prospective cohort study published in JAMA, the Journal of American Medical Association, and they showed that use of these anticholinergics, so this class of first-generation antihistamines like Benadryl, which is a trade name that you probably recognise, was actually associated with an increased risk for dementia. Now, it could be for a number of reasons, it could be because they block the effects of a neurotransmitter called acetylcholine, which is vital for memory and learning, but that study did actually make me pause and just think, these medications are just so ubiquitous and they're used so commonly, and I used to use them very often myself. Perhaps this is just something that we need to rein in a little bit, if not for the minor side effects, the potential larger side effects down the road. Generally, antihistamines are classified into two groups. There's first generation, which are older medications, and those are used for antihistamine effects but also sedative effects as well, because they cause drowsiness and we actually use them for that reason. And then there's second-generation non-sedating antihistamines. They don't tend to cause drowsiness, although in certain people, myself included, they still do, but they act on histamine receptors in the periphery and they're less likely to concentrate into the brain. So potentially there's less side effects with other medications and potentially dementia as well. So that was just looking at first-generation antihistamines, but still, it did make me pause a little bit. So, why are more people getting allergies? For some people, pollen isn't a big deal, whereas others develop hypersensitivity to pollen allergens, resulting in all those annoying, irritating symptoms. It's influenced by many different factors. One of which is the state of the immune system, another is genetics. There are also environmental factors such as cigarette smoke, air pollutants, chemicals, and obviously processing your diet as well. So whether you grew up in an urbanised environment or a farm environment, this can also have an effect on whether you are likely to have allergic rhinitis. More recently, more people who have never had seasonal allergies before or only experienced mild symptoms are now developing hay fever or seasonal allergies as well. And the reason why research suggests is climate change could potentially be having a role and air pollution as well. So there's an increased production and dispersion and the potency of pollen that is being distributed all over our towns and cities. There's also an increased duration of the pollen season. There's different pollen species not endemic to the area. There's also an effect on our immune system as well and our barrier function. So the worsening, the worse our immune system is because of gradual degradation of our gut microbes for example, the worsening symptoms of allergy as well. Now for the folks watching this on YouTube, I'm just going to pull up this diagram here that shows you what exactly happens when you are having hay fever symptoms. So when you inhale pollen, your tissues in your nasal cavities recognise the pollen and the IgE antibodies on the surface of mast cells, as you'll see in that diagram, triggers the release of inflammatory mediators. And these are called histamine, leukotrienes and prostaglandins. Now you probably recognise the word histamine because antihistamines are the class of medications that we use to blunt the effect of these inflammatory markers and reduce symptoms as well. These are the immediate symptoms and the causes of the symptoms: sneezing, runny nose, itchy eyes, redness, watering, all that annoying stuff as well. And then hours after the exposure, your immune cells such as basophils, neutrophils, T lymphocytes, monocytes, all these other sort of characters within your immune system, they release even more mediators. So this perpetuates this inflammatory response. It causes further swelling of your mucosal tissues and nasal congestion. And probably everyone who's, anyone who's had an allergic reaction or seasonal allergies, you've gone to the park, you have this reaction, and then you come home, you shut your windows, you clean your face and you're still having this reaction. You're like, what on earth is going on? It's because the secondary line of defence of your immune system is still reacting to the primary cause of the seasonal allergies that you've had. And this diagram that I've just pushed up in front of you guys on YouTube will explain that for you. So, prevention is better than cure. Generally, it's best to use protective tools and treatments. So let's dive into some of the evidence-based habits that you can try to ease your symptoms this season and beyond. Number one, rinse your sinuses. Now, a lot of human trials have found that nasal irrigation with salt water has improved symptoms of allergic rhinitis in adults and children. This was also included as part of a 2021 consensus on how to manage common sinus issues. Now the reason why it works is because it's literally washing away the allergens and mucus as well as reducing the inflammation and swelling as well. So you're having that exposure, instead of it sort of hanging around in your nasal passages, you're literally using salt water and it pushes it out of you. It's still actually uncertain if adding nasal saline, so this is a particular concentration of salts in the water that you use, to pharmaceutical treatment further improves symptoms over the drugs alone, but it's one of those old wives' tales and one of the traditional remedies for seasonal allergies that has stood the test of time. And there is some evidence for it as well. Now, if putting a neti pot, I think they call it a neti pot or like a some sort of like mini pourer through your nasal cavities and out the other side, it's a bit intense for a lot of people. If you don't like that, then a sort of like light version is a steam inhalation for five minutes daily. This has also been found to improve nasal obstruction in small studies, so you can try that if you're a little bit squeamish about putting nasal saline through your your cavities as well. You can also add a nasal rinse to your daily routine as well. You need just a spray or an irrigation device and you just spray it up there and it just sort of allow the products to come out. It's a little bit gruesome to think about, but you can do it in the privacy of your own bathroom as well. You can purchase it as part of a kit. There's lots of things online, but honestly just go for the cheap stuff. The more expensive ones with added sort of phytonutrients and stuff, there's no evidence for that that I've seen. It's just simple saline or water will absolutely do fine. Number two, make sure you are taking your vitamin D3. Research links vitamin D to allergic rhinitis. There was a randomised control trial that found that vitamin D supplementation for 30 days reduced nasal symptoms in 50 patients, so a relatively small study with allergic rhinitis. There was also a systematic review that was also found to alleviate symptoms in children with allergic rhinitis. Plus, low serum vitamin D levels have also been linked to the risk of allergic disorders more generally as well. So there does appear to be some association with vitamin D and allergy disorders. You may as well give yourself the benefit of the doubt and take your vitamin D supplementation every day to reduce the chances of seasonal allergies as well. The reason why it could potentially help is by regulating the immune cells and influencing the allergy-related inflammatory response. The other tip that I have is to get your vitamin D from supplements with vitamin K2. Always make sure you're getting your vitamin K, vitamin D3 with vitamin K2. You want to make sure that you have that combined, that that combination because vitamin D3 can release more calcium into your system and that can get deposited in places that you don't want, like your arteries. So make sure that you're getting your vitamin D3 with K2 as well. A lot of pharmaceutical and supplement manufacturers are getting a little bit more attuned to this and actually producing combination products as well. So you're getting the hit from both sides. In terms of the dose, it really depends on what your vitamin D level is, but a minimum of 1,000 IU of vitamin D3 is what I would go for. Some people benefit from more. I personally take 3,000 IU, but that's because I need more vitamin D3 in supplemental form to push my levels higher. And I've experienced that by doing supplementation and then checking my levels after 90 days and then rechecking after a higher dose and that's my sweet spot for me. Also, don't forget to get some sun exposure and getting foods like fatty fish, trout, salmon, tuna, mackerel. These are all sources of vitamin D3, but the best way to get it is from supplements unfortunately. It's one of the things that I think is worth investing in. Number three, eat probiotic-rich foods. There was a small, funded trial, so this is something that you just need to discount. It's a funded trial where they gave people probiotics for 10 to 12 weeks and they improved their hay fever symptoms, runny nose, itchy eyes. You can also get probiotics from food, guys. So adding probiotics to your meals, using yoghurts or kefirs, sauerkrauts, pickles, miso, tempeh, kimchi, sourdough bread, these are all ways in which you can get not just live microbes, but also the dead microbes that still might have that immune-enhancing effect as well. It can help by potentially modulating the gut microbiota and improving your response to an allergen by reducing the inflammatory cascade afterwards. So eating probiotic-rich foods might be something that could help, but just remember there weren't that many good quality trials looking at probiotics, but definitely getting probiotics in your daily diet is something that you should be doing anyway. If not for the immune benefits, certainly for your gut health benefits. Number four, use anti-inflammatory spices. And my top two are ginger and turmeric. Now, it stands to reason that because seasonal allergies are essentially an inflammatory cascade, it's an inflammation-fuelled response to an allergen, that something that dampens inflammation, like spices for example, could mitigate against symptoms. And this was shown in a couple of trials involving patients with allergic rhinitis. Both ginger and curcumin extracts, so curcumin being the main component in turmeric, improved nasal symptoms and quality of life. Ginger and curcumin extracts were both in 500 milligrams per day doses, and it was as effective as an antihistamine medicine with fewer side effects. So to dive into this RCT, randomised control trial, they were randomised to either ginger extract, so this is the ginger RCT, the ginger extract at 500 milligrams, they were, 40 people were given that, and then the other antihistamine in question was loratadine, which is a later generation antihistamine, so it's non-drowsy. It was given in a double-blind controlled manner for three and six weeks, and they found that they reduced the, they reduced the symptoms of allergic rhinitis with fewer side effects. That's a really good win. So maybe before you reach for an antihistamine, you might want to reach for a ginger supplementation, as long as you don't have allergies to ginger. It could be something that you want to try before antihistamines. Less side effects and very, very available as well. How might it work? Well, I've just explained that it's anti-inflammatory, but it might also be anti-allergic as well. If you remember from my podcast looking at ginger and other anti-inflammatory spices, ginger has shogaols in, they're a major compound within ginger extract, and they've exhibited very high anti-allergic activity. They also show high anti-inflammatory activities by reducing TNF-alpha release, which is an inflammatory protein as part of your immune system. It's very normal, but it can be exacerbated, it can be in excessive amounts when you are struggling with seasonal allergies as well. Curcumin on the other hand, I'll pull up a nice diagram of where curcumin has its effects. It can directly suppress the activation of mast cells and the secretion of pro-inflammatory mediators and allergic reactions as well. There's a nice little diagram where it looks at all the different touch points that curcumin could be having an effect on, including the APC or antigen-presenting cells, beta cells, IgE production, mast cells, there's a whole bunch of areas where curcumin could be having an effect as well. So turmeric supplements might be something that you want to try. The way I like to get it in every single day, rather than spending a lot of money on supplements, they are quite expensive these days, is try ginger teas. You can use fresh ginger, dry ginger, you're getting a different concentration of those phytonutrients like shogaols and gingerols. You're getting, you can get turmeric teas, add it to your meals, try and get as many anti-inflammatory spices into your diet as well. And if you want to know the other spices, I've done a whole podcast episode on that. You can find it on YouTube. Just look up anti-inflammatory spices, Doctor's Kitchen, you will find it. Clove and cinnamon are up there. There are a lot of other ways in which you can get anti-inflammatory spices that I will, I'll hold out on because you might as well watch the video. I go into a lot more detail there as well. The fifth one, eat lots of fruits and vegetables. I know it sounds obvious, but there was promising evidence that finds that compounds in fruits and vegetables may decrease nasal symptoms and improve the quality of life in allergic patients. The ones that they have examined in a big trial were apple polyphenols, tomato extracts, chlorophyll, which is what makes green plants green, vitamin C, vitamin E. The reasons why it might work, well in preclinical studies for example, apple polyphenols show anti-allergic effects, particularly through their ability to inhibit the release of histamine from mast cells and basophils as well. So others might work in a similar way. I'm personally a fan of getting your polyphenols that you find in apple and tomatoes and all the rest of it from the whole foods themselves, rather than getting it from purified extracts of those products because A, you're missing out on all the other cumulative benefits of the apples and tomatoes in terms of the fibre, the other phytonutrients that are probably adding weight to the anti-inflammatory effect of the diet as well. And it's obviously a lot cheaper to get the raw whole food product rather than a purified supplemental form. And the other thing is diversity in general when it comes to your meals is definitely the right strategy to rely on. Citrus fruits, tomatoes, apples, green and red peppers, kiwi, broccoli, strawberries, brussels sprouts, higher diversity is associated with reduced risk of allergic rhinitis. That's been shown in cross-sectional studies as well. And regular consumption of processed foods, i.e. the opposite of diversity and the opposite of high fibre, is associated with an increased risk of hay fever in other cross-sectional studies as well. So there's lots of evidence pointing in the direction of more diversity as much as possible, and you don't need to rely on expensive purified supplements, but they definitely add to the weight of why I'm so bullish on diversity as a good strategy. One thing you're probably wondering about is what about nettle? And researchers think nettle might have an anti-allergic effect because of its ability to reduce the amount of histamine in the body in response to an allergen. A lot of doctors actually recommend taking freeze-dried preparations of stinging nettles well before hay fever season starts. And anecdotally, a lot of people have tried that as well. I actually used to believe that nettle tea might have a beneficial effect in the same way turmeric and ginger extracts might do. But honestly, I really wanted to believe nettle did have an effect, but we only found one small randomised control trial that assigned 40 patients to take nettle, also known as Urtica dioica, 150 milligrams. So maybe it was a dose issue, but 150 milligrams seemed like a decent dose to me, versus placebo. They took it for 30 days, and both groups showed improvement in the severity of clinical symptoms, but there was no difference between the placebo. So this basically shows that it was no better than placebo. So I can't really sit here and say, you know what, take a nettle extract because there's just not enough evidence. If you wanted the same effect, just take a placebo, although you know it's a placebo, so it probably wouldn't have the same effect. So we need larger, longer-term studies on nettle for me to actually be able to recommend it for the treatment of allergic rhinitis. But we are keeping an eye on the research. The studies that we looked at today were generally small and limited, so I'm in a bit of a tight spot when it comes to recommending specific things, but I'm hoping more robust trials will come out in the next few years to solidify the dietary and lifestyle recommendations for improving allergic rhinitis. But for now, I would try the anti-inflammatory spices, definitely get diversity into your diet, vitamin D3 and K2, making sure you're trying probiotics, and maybe a nasal rinse as well. Those are probably my best strategies, and that will at least mitigate the reliance, reduce the reliance on things like antihistamines that certainly have their own side effect profile that for me just wasn't worth the trade-off. But if you think I've missed something, let me know in the comments on YouTube. That's where you're going to find me these days if you're listening to this on the podcast. I will respond and I will look into whatever suggestions that you have for antihistamine-like effects of plants, supplements, and other extracts that are of interest.
