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Can dietary supplements supply allergy sufferers with what they really need: efficacy and speed?
It’s not your imagination: Allergies-to foods, to pollens, to pets, to just about anything-are on the rise. According to UCLA’s Food & Drug Allergy Care Center, the number of Americans with an allergic condition rests at roughly one in five-an estimated 50 million of us-making allergies the fifth leading chronic disease in the United States among all ages, and the third most common among kids under 18.
And as any allergy sufferer will attest, chronic allergies are a disease. Even if allergies don’t rise to the level of a potentially fatal anaphylaxis, the itching, burning, wheezing, and sneezing typical of an attack sap measurable quality of life. As Nichole De Block, marketing director, Nutraceuticals International Group (Bloomingdale, NJ), says, “Allergies are no joke. They can be very frightening for families and can almost control lives.”
Like any disease, allergies take a toll both on individuals and in terms of social and economic costs, which total $14.5 billion in the United States, according to the Asthma and Allergy Foundation of America (AAFA). Almost $12.3 billion of that goes directly to doctor’s visits ($1.3 billion) and medications ($7 billion for prescriptions; $4 billion for over-the-counter drugs). But there are indirect costs, too-namely, missed work or school days and a general loss of productivity-accounting for $2.2 billion.
Allergies do require a physician’s attention for their proper treatment. But that doesn’t mean that sufferers can’t find relief for symptoms in the supplements aisle, where a number of technologies with scientific backing are helping those of us with allergies breathe a little more easily.
Allergies on the Rise
The uptick in allergic incidents hasn’t escaped the notice of Suzanne E. McNeary, president and managing director, NutraGenesis LLC (Brattleboro, VT). “More Americans have been complaining about allergies,” she says, “and even those folks who have never had allergies are starting to complain.” She notes that the rates have been increasing since the 1980s, hitting males and females equally. “The majority of those allergy sufferers have indoor/outdoor allergies triggered by tree, grass, and weed pollens; mold spores; dust mites; cockroaches; and cat and dog dander,” she continues. Allergic rhinitis, or hay fever, afflicts the largest proportion of allergy sufferers.
Other “flavors” of allergic reaction are becoming more commonplace, as well. Steve Siegel, vice president, Ecuadorian Rainforest (Belleville, NJ), cites Centers for Disease Control and Prevention data stating that skin allergies hit a prevalence of 12.5% among children aged 17 and younger between 2001 and 2009. “Food allergies are also a concern,” he goes on. “Over 15 million Americans have some sort of food allergy.” Their impact on children is particularly striking, with the rate of childhood food allergies rising nearly 50% between 1997 and 2011.
Behind the Epidemic
To what do we owe this mass epidemic? We can always blame our parents. McNeary is quick to note that allergies can have a genetic component, “so if one parent has allergies, their children will have a one-in-three chance of developing allergies. If both parents have allergies, that number jumps to seven in 10.”
But Mom and Dad already take enough flack, so let’s turn to global climate change. As McNeary explains, “Trees and plants respond intensely to environments that are warming and where seasons start earlier or last longer. In this scenario, you see significant increases in pollen production, which leads to increases in the severity of allergic responses, as well as to a greater number of people experiencing allergy symptoms.”
Then there’s the much-discussed hygiene hypothesis, which posits that our excessively clean environments shelter our immune systems, depriving them of the germ exposure they need to deal with allergens in a more modulated fashion. Whether it’s the near-ubiquitous antibacterial hand sanitizer or insufficient playtime in the dirt, this “cleanliness factor,” as McNeary calls it, “has had an effect on the normal development of the immune system, and that change leads to an increase in allergies.” And, she adds, the theory enjoys “significant scientific support,” as the allergic response is “tied exclusively to the immune system and its response to an allergen.”
When Allergens Attack
Indeed, irritating though allergies and their symptoms may be, they are merely a byproduct of our ever-faithful immune systems’ attempts to keep us safe. Unfortunately, in the course of doing so, immunity can go a little overboard. So, as De Block explains, “When the immune system excessively fights against normally harmless substances-allergens like seasonal pollens, food, toiletries, dust, animals, et cetera-a typical allergic phenomenon occurs.”
How? The first time our immune systems encounter an allergen, scavenger cells called macrophages surround the allergen and break it into fragments that they hitch to their cell walls for a ride to specialized white blood cells called T lymphocytes. These T cells, which are also the ringleaders of the immune response, then secrete a signaling protein called interleukin-4 that wakes up yet another set of blood cells-this time, the B lymphocytes.
B lymphocytes secrete allergen-specific antibodies called immunoglobulin E (IgE) that then venture off to attach to even more immune cells, among which are mast cells. Mast cells hold onto the antibodies for future reference, in effect, so that the next time we come into contact with the allergen, the immune system is primed, sensitized, and ready to fight. And sure enough, minutes after that next encounter, IgE antibodies will recognize the offending allergen, bind it, and cause granules within the mast cells to burst and release mediator chemicals contained within.
And this is where the allergic agony comes in. Among those mediators is histamine, which stimulates mucus production, as well as inflammation and swelling. Prostaglandins-also released during this “degranulation” stage-constrict airways and make breathing difficult. And mast cells send out chemical signals that recruit basophils, eosinophils, and other cells to affected tissues to help beat down the allergen through the inflammatory response. All of which will be familiar to anyone who’s ever had an allergy attack.
The upside is that our bodies have a strategy for vanquishing foreign invaders; the downside is that they nearly vanquish us along with it. Which is why pharmaceutical developers have come up with entire classes of products, both over-the-counter (OTC) and prescription, to ease any blowback from the allergic response.
Drugs include everything from antihistamines and decongestants to shots, nasal sprays, and mast cell inhibitors-all of which have their merits and drawbacks. Given consumers’ weariness over some of the drawbacks, including high price tags and side effects that can rival the allergy symptoms themselves, many now seek “safe, effective, and natural dietary supplement ingredients clinically studied to promote respiratory health and normal breathing,” even in the face of allergies, says Paul Dijkstra, CEO, InterHealth Nutraceuticals (Benicia, CA).
Such supplements are building stronger track records by the day. Notably, products that address respiratory symptoms enjoy the most support-more so, for example, than remedies targeting food or skin allergies. “Some supplements should be considered to ease allergy-related seasonal irritants and to help boost your immune system,” De Block says. “Supplements are natural and do not have the typical side effects [of] immune-stimulating drugs.”
De Block’s observation raises an interesting question: With immunity playing such a foundational role in allergic reactions, does it stand to reason that immune-boosting supplements-of which there are legion-might keep allergies at bay, or vice versa? “Yes and no,” McNeary says. “While the allergic response is tied directly to the immune cascade, a supplement that relieves allergy symptoms may or may not have any direct benefit for immune support.”
And makers of immune-health supplements aren’t always eager to “cross-promote” their products for allergy relief. David Walsh, senior vice president, marketing and communications, healthcare group, Biothera (Eagan, MN), makes clear that his company “is dedicated to supporting and strengthening the immune systems of people of all ages so they can enjoy better health.” That being the case, allergies, he says, “are not a focus of ours because in the United States, allergies are considered a disease, and DSHEA”-the Dietary Supplement Health and Education Act of 1994-“prohibits disease claims.”
Nevertheless, the company has long received feedback from consumers who believe that its immune-health ingredient Wellmune “has helped alleviate their allergy symptoms,” says Walsh. Curious to see if the science supports these testimonials, Biothera conducted a placebo-controlled, double-blind study of the ingredient-a proprietary baker’s yeast beta-glucan that wakes up immune cells without overstimulating them-in 48 ragweed sufferers exposed to high pollen counts. The study,1 first published online in 2012 in Food Science & Nutrition, found statistically significant reductions in overall symptoms, symptom severity, and key nasal and visual symptoms, while also improving scores on an objective Quality of Life Index.
The results, which were consistent with those of earlier studies supporting the ingredient’s immune benefits, are nothing to sneeze at (ahem!). And, Walsh adds, they “may have commercial application outside of the United States in markets with different regulatory climates.” But, for now, his company remains focused on clinical and biomarker research that advances its technology’s “unique ability to activate key immune cells that help keep the body healthy.” And they’ll leave the task of tackling allergies to others.
Different Formulas and Strategies
It’s a task that industry appears eager to take on, The supplement ingredients proffered in the fight run the gamut. According to Dijkstra, “A healthy immune system is important to overall good health, but different formulas work to help protect or strengthen the immune system in different ways.” His company’s Aller-7, which he describes as “a natural, patented, proprietary blend of seven standardized herbal extracts,” helps build a healthy immune system that doesn’t overreact to allergens and thereby trigger respiratory problems, he says.
A three-year clinical trial involving 545 subjects and 14 clinical centers demonstrated that over a 12-week period, 94% of the subjects taking the ingredient in an open-label arm and 92% of those in a double-blind, placebo-controlled group reported respiratory symptom improvement ranging from 40%–100%.
The suggested mechanism of action seems to involve both free-radical neutralization and stabilization of mast cells, which, Dijkstra says, “promote respiratory health.” Another benefit is that the ingredient “works to help promote a healthy immune system before respiratory issues become a problem.” After all, he says, “It’s important to maintain overall health, particularly a healthy immune system, to address the root cause of allergies.”
Cracking into Egg-Based Options
Also acting on the immune system is NutraGenesis’s AllerGuard Express, the active ingredient of which is a glycoprotein derived from certified-organic quail eggs of the species Coturnix japonica. According to McNeary, the natural egg powder “utilizes a completely novel mechanism of action that helps reduce the physiological cascade of events that leads to a full-blown allergic response after exposure to an assortment of outdoor and indoor allergens.”
Research shows that the glycoprotein bioactives in AllerGuard Express inhibit tryptase enzymes, blocking their binding-and the binding of other trypsin inhibitor homologs-to a type of receptor known as protease-activated receptor 2 (PAR2). When tryptases introduced via allergens or released as part of the allergic response bind to these PAR2 receptors on immune cells and neurons, “a wide range of allergy symptoms” result, McNeary says. So by cutting off the enzymes’ receptor access, the glycoproteins “reduce or prevent amplification of the allergic response.”
Because tryptase inhibition occurs primarily after the allergic response begins, this action of the ingredient is considered a downstream mechanism, McNeary explains. “But tryptase inhibitors also act upstream of histamine in the allergic reaction cascade,” she continues. Research shows that tryptase inhibitors like her company’s help prevent the release of histamine from mast cells, thus promoting respiratory wellness via that mechanism, as well.
McNeary says that the tag-team action represents “a more comprehensive approach to respiratory wellness than what is offered by current natural and OTC products.” And a recently completed randomized, double-blind, placebo-controlled human clinical trial2 conducted by an independent domestic contract research organization has confirmed the ingredient’s efficacy and rapidity of action.
In the study, 43 healthy subjects braved exposure to a standardized quantity and array of common indoor and outdoor allergens, after which they immediately consumed two tablets of either the quail-egg powder or a placebo. They then underwent evaluation over a two-hour period for Peak Nasal Inspiratory Flow (PNIF) and subjective symptom severity-stuffy, runny, and itchy nose; itchy, watery eyes. The data showed that subjects experienced significant objective improvement as measured in the PNIF scores, as well as subjective improvement in symptom discomfort-and they experienced it as soon as 15 minutes after consumption of the supplement tablets.
“As any allergy sufferer will tell you,” McNeary says, “when they’re in the throes of allergy symptoms, they want something that’s going to work quickly. A product that has a load period of, say, weeks or months is simply not going to cut it with the consumer.” A supplement that gets going within minutes supplies what McNeary calls the “missing piece” in typical approaches to allergy relief: efficacy and speed.
Relief without Drowsiness
In addition to speed of results, consumers want minimization of side effects, and one much-maligned side effect of standard OTC antihistamines is drowsiness. The botanical butterbur (Petasites hybridus) has shown itself in clinical trials to alleviate allergies similarly to antihistamines, but “without the antihistamine side effects,” Siegel says, “making it an effective natural option for allergies.”
To wit, researchers studied3 the efficacy and tolerability of both butterbur and the antihistamine cetirizine in a randomized, double-blind, parallel-group comparison involving 125 participants over a two-week period. “They concluded that butterbur was just as effective as other antihistamines for allergy symptoms,” Siegel says. The difference, though, was that two-thirds of the subjects in the cetirizine group reported drowsiness and fatigue despite the fact that the drug is marketed as not producing sedative effects. Meanwhile, the butterbur not only relieved allergy symptoms comparably, but did so without making subjects sleepy.
Siegel notes that laboratory analyses point to petasines as the active compounds in butterbur. “Petasines are able to inhibit the synthesis of leukotrienes, chemicals in the body that may be causing inflammation tied to allergies,” he says. Even better: they occur naturally in the herb, and “that’s a big deal for an allergy sufferer who wants to find a natural solution to an allergy problem,” he says.
In fact, a “natural” approach to everything-allergies included-is “a growing concern for consumers,” says Siegel, who notes that the natural foods market is worth nearly $40 billion and “expected to go up.” That bodes well for allergy-alleviating supplements; after all, Siegel says, “To get consumers to trust your product, especially for those looking for alternatives from conventional medicine, it is best that products be unadulterated and as natural as possible.” But all the natural bona fides in the world aren’t enough to sell consumers on a supplement that doesn’t ameliorate their symptoms-which is why the mounting body of science behind these ingredients is so encouraging.
Photo © iStockphoto.com/Matt_Brown