Allergic Rhinitis & The Gut..Is it time for Probiotics?
Despite summer being in full swing here in Ohio, there are a lot of people here and across the country are who are still suffering from seasonal allergies and what the medical community refers to as allergic rhinitis (AR). AR is one of the most common diseases that effects nearly 1 in every 6 Americans. AR is an inflammatory condition often leading to symptoms such as congestion, runny nose, sneezing, nasal itching, and watery/itching eyes.1
Some experience seasonal allergies that are temporary due to triggers being pollens that come and go depending on the season. Others experience year-round or perennial allergies due to dust mites and continued triggers. Some patients could experience what is referred to as episodic allergies from triggers they encounter outside of their typical environment such as family members’ pets.1
Guidelines recommend avoiding allergic triggers as a first step in treatment such as removal of pets, using air filtration systems, and bed covers (to avoid dust mites). 1 Nasal saline rinses can be very helpful to clear out the pollens from the nasal passage before sleeping, this is my favorite one that is easy to use! Washing your hair before sleeping can also help reduce the pollens that attach to our hair follicles. From a western medicine standpoint, during serious allergy flare ups, I need to use a topical nasal steroid such as fluticasone. 1 The great part is they are now available over the counter. This can help calm down the inflammation short term as you consider other ways to address allergies more naturally. Budesonide is the nasal steroid of choice for pregnant women, using the lowest effective dose and duration is recommended.2,3
An interesting discussion recently has been the connection between the gut and the lack of diverse healthy microbes to the development of allergies. Multiple studies indicate that the increased incidence of autoimmune and allergic diseases in developed countries may be associated with reduced diversity in bacteria exposure and changes of bacteria in various body tissue. AR and atopic eczema have been shown to be related to changes in gut microbial composition.4
“Leaky gut” is a term for an impaired intestinal barrier or an increase in gut permeability, which may also play a role in the development of asthma and allergies. The intestine should play a role as the gatekeeper of immunity and when this is broken the body can start to have a reaction to typical proteins called antigens it would not normally react to. This can include food reactions, or reactions in the nasal passageways or lungs. AR is considered by some to be an early form of an autoimmune disease.4
Thus an important part of treating seasonal allergies is making sure the gut is healthy, this is a whole post in itself that will be coming soon, but for now starting with a high quality probiotic and avoiding allergic triggers including foods that further trigger allergy symptoms is a start. For me I have a reaction to ragweed in the fall and I have found that sunflower seeds trigger my allergic rhinitis because they are similar plants. Paying attention to food triggers can be very helpful! In regards to probiotics, Vliagoftis et al performed a meta-analysis of 16 clinical trials on the treatment of AR and Asthma and found that 9 of 12 studies that elevated clinical outcomes of AR showed improvement due to the use of probiotics. They determined that probiotics may have a beneficial effect by reducing symptom severity and medication use. Most of these studies reported used some form of Lactobacillus species such as Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus rhamnosus, some included a combination with Bifidobacterium strains.5
My favorite probiotic for adults right now is OrthoBiotic from OrthoMolecular. This is a high quality mix of the strains discussed above. It also includes Saccharomyces boulardii which is a beneficial non-pathogenic yeast that works to balance intestinal flora. The only patients who should not take Saccharomyces would be those with compromised immune systems. Each OrthoBiotic capsule provides seven proven probiotic strains chosen for their ability to withstand the harsh gastrointestinal (GI) environment and adhere to the intestinal tract. The specific strains found in this product have be shown to increase Secretory IgA which provides enhanced gut Immunity.
Bifidobacterium lactis (B. lactis), one of the probiotics in the above formula, is predominantly found in the colon. A double-blind, randomized placebo-controlled trial on subjects receiving B. lactis or placebo for eight weeks found that B. lactis supported a balanced immune response in individuals hypersensitive to environmental allergens.6 Flora Boost can be a great option for toddlers and kiddos that don’t swallow pills yet.
Ther-Biotic Complete is another great probiotic I recommend by Klaire Labs. They also have a Women’s Formula as well that supports healthy colonization in the vaginal tract as well as provides the probiotic strains above shown to be beneficial in allergic conditions. Klaire Labs formulas do need to be refrigerated upon arrival.
ProBiota HistaminX contains probiotic species that excludes strains that are known to increase histamine in the gut and is a great option for those who may be sensitive to histamine.
You can find all of these high quality probiotics in my Supplement Store on FullScript.
Stayed tuned for my next post which will discuss my favorite supplements (Quercetin, Stinging Nettles) and nutrients (Vitamin C, Bromelain, N-Acetyl-L-Cysteine) and their useful role in supporting allergic conditions. And if you need recommendations for probiotics for babies, head over to this post.
- Seidman et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery 2015, Vol. 152(1S) S1–S43.
- Wallace DV, Dykewicz MS, Bernstein DI, et al, “The Diagnosis and Management of Rhinitis: An Updated Practice Parameter,”J Allergy Clin Immunol, 2008, 122(2 Suppl):1-84.[PubMed 18662584]
- NAEPP Working Group Report on “Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment,” National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 05-5236, March 2005. Available athttp://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf
- Hormannsperger G, et al. Gut matters: Microbe-host interactions in allergic diseases. J Allergy Clin Immunol 2012;129:1452-9.
- Vliagoftis et al. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol. 2008;101:570–579
- Singh A, Hacini-Rachinel F, Gosoniu ML, Bourdeau T, Holvoet S, Doucet-Ladeveze R, Beaumont M, Mercenier A, Nutten S. Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial. Eur J Clin Nut. 2013 Feb;67(2):161-7.