Sinusitis, Rhinitis and Post-nasal Drip

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Rhinosinusitis is the term generally used now for chronic conditions of sinus congestion, with or without post-nasal drip, which an increasing percentage of the U.S. population is now afflicted with. Rhino- is a term signifying the nose, although commonly we use the term nasal, and sinus refers to the labrynth of airways behind the nose, which is supposed to protect us from infection, clear debris from the air we breath, and normalize the temperature of that air. The sinus is a large open membrane to the outside world, and is thus able to be inhabited not only by a healthy symbiotic microbiota, but also by a number of pathogenic microorganisms, especially if we don't take care of its health. We are learning that, like our intestines, there is an evolved line of immune defenses that protect this membrane, including the healthy symbiotic flora and fauna that control the balance of microorganisms that help maintain our health and the health of our sinus membranes, and a balance of antibodies, needed to properly regulate response to allergens. Standard management of this problem involves chronic use of, and dependence on, anthihistamines, synthetic steroid hormones, and antibiotics, to control symptoms, each of which is proven to decrease the health of these sinus membranes rather than improve it. While this is a good marketing strategy for maintaining high sales of these pharmaceuticals, it is not a smart or ethical medical solution to your problem. The real solution involves patient understanding of their individual pathology and utilizing the measures to counter the causes and perpetuating factors of this rhinosinuvitis, which are varied and numerous.

In 2009, the David Geffen School of Medicine at UCLA, Los Angeles, California, released information that studies now suggest that up to 87 percent of patients with rhinitis (sinusitis) may have what is called mixed rhinitis, or a combination of both allergic and nonallergic rhinosinuvitis. This is the most prevalent health problem affecting Americans today, with up to 30 percent of adults and 40 percent of children afflicted with chronic sinus pathology. Associated health problems include fatigue, headache, sleep disturbance, cognitive impairment, and asthma. Numerous subtypes and underlying etiologies make the diagnosis and treatment of rhinosinusitis complicated, and many subtypes will not respond to the standard one-size-fits-all treatments. The high prevalence of a superantigen mechanism in chronic sinusitis explains many of the associated health problems with this seemingly localized pathology. Debate continues among respiratory experts on how to address this important health issue. Integrating Complementary Medicine into an individualized treatment protocol, as well as new diagnostic tests and guidelines to individualize the rhinitis diagnosis and better guide the holistic therapy is desperately needed.

Rhinosinusitis is generally divided into three types, 1) infective, 2) vasomotor, and 3) allergic. Infection by bacteria, viruses or fungi can be acute or chronic. Vasomotor is also called nonallergic rhinitis, and includes an array of underlying causes of the vasomotor dysfunction (dilation and constriction of the blood vessels), with autonomic nervous system dysfunction, hormonal problems, drug side effects, rebound nasal and sinus congestion brought on by chronic use of decongestants and antihistamines (rhinitis medicamentosa), membrane atrophy (perhaps also attributed to chronic overuse of medications), and gustatory rhinitis (triggered by certain foods or alcohol intake). Allergic rhinosinovitis is considered the most prevalent type, and a variety of triggers, or allergens, including pollen, mold, fungi, animal dander, dust mites, etc. may be triggering an excessive immune response with histamine swelling. Often, there is more than one allergen involved. Just as often, there is both an allergic and vasomotor rhinosinovitis occurring in chronic conditions. This is generally termed mixed rhinosinusitis. In addition, there may be a non-inflammatory vasomotor rhinitis, where triggers such as chemical perfumes, smells, smoke, environmental toxins, or even temperature changes, may trigger an episode of vasomotor rhinosinusitis. Added to this is the high potential that a superantigen response, usually associated with acute syndromes, is involved, bypassing the normal cascade of complement immune responses to perpetuate chronic low-grade systemic T-cell responses. If the patient can correctly identify the type or types of rhinosinusitis that they have, the overall therapeutic success can be greatly enhanced. Patients that understand, as well, the signs of rebound nasal and sinus congestion from chronic overuse of decongestant medications etc. can also achieve a sensible overall effective treatment protocol with the help of a Complementary Medicine physician. Simply relying on chronic use of antihistamine and steroidal medication to decrease symptoms instead of addressing the underlying health issues is not sensible.

Incidence of rebound rhinosinusitis is, of course, controversial in the standard medical community, since it implies that standard therapy is problematic. Still, studies have conservatively estimated the incidence of rebound rhinosinovitis in chronic cases with frequent use of decongestants from 1-52 percent. All authorities agree that the problem is on the rise, though, and the health authorities in the U.S. have offered guidelines to medical doctors specifying that chronic continuous use of decongestants, antihistamines, and steroidal inhalers and nasal sprays should be discouraged, and alternatives should be explored. There is also a growing perception that there are more types of medication-induced rhinitis, and a meta-analysis in 2010 by the University of South Florida found that there were three types of medication induced rhinitis, inflammatory, neurogenic and idiopathic (unknown mechanisms). The information from these studies on the array of medications that may cause or contribute to vasomotor rhinosinusitis is still hard to come by, although drugs that affect the autonomic nervous system with side effects are also expected to have a vasoactive effect on the nose (PMID: 21511676). This indicates that a large array of current pharmaceuticals could be implicated. Another type of cause in recent years is the superantigen response, which is being heavily researched in relation to autoimmune and hypersensitivity disorders, and is being acknowledged as a cause of many cases of rhinosinusitis that are difficult to treat. Superantigens are a broad class of infectious agents, environmental toxins, food molecules and altered membrane molecules that have evolved a way to evade normal immune responses by directly coupling the MHC (major histocompatability complex) genetic expression with the T-cell receptors. A separate article on this website explores and explains the superantigen response, where external or internal antigens trigger a prolonged T-cell response even in the abscence of the antigen.

Demographic studies of rhinosinuvitis have shown that this disease is a significant problem worldwide, but with much geographic variance in incidence and type. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), conservatively states that over 35 million U.S. citizens are afflicted with a diagnosed rhinosinuvitis, which is about 10% of the population. It also admits that a large number of persons probably have not been diagnosed due to the poor treatment options and the lack of affordable healthcare. The desire to find a commonality to disease in standard medicine, in order to find the common pharmaceutical that would treat all cases, is unfortunately what determines the type of treatment approach that is approved in our standard medicine, especially in the United States, where profiteering businesses, such as insurance companies and pharmaceuticals, as well as the increased degree of hospitals and clinics owned by large corporations, actually determines the guidelines for what treatment is going to be paid for. The medical doctors go along with this system, apparently with little questioning, and there is no strong national healthcare system determining treatment guidelines that is oriented to public health over profit in the system. In a pathology like rhinosinuvitis, though, the one-size-fits-all approach has produced a type of treatment that perpetuates the pathology. When we prescribe the same pharmaceuticals to all patients, in rhinosinuvitis, which is a multifactorial syndrome of various diseases, pathogenic, allergenic, neurohormonal and immunulogical causes all contributing to the health problem, this means that we can only come up with a few medicines that decrease symptoms for almost all patients, rather than concentrating on a variety of curative measures to stop the disease in an individualized manner that addresses the various underlying causes and perpetuating factors. An educated public is starting to demand a more holistic, thorough, and individualized approach in healthcare, and this is where Integrative and Complementary Medicine comes into play for such complex diseases.

One example of the poor direction in standard medicine towards chronic rhinosinuvitis and recurrent upper respiratory tract infections is seen with recent studies of adenoid removal in children to prevent recurrence. A randomized clinical human trial study of the effectiveness of adenoidectomy to prevent recurrent upper respiratory tract infections and rhinosinuvitis by Dutch researchers in 2011, published in the British Medical Journal (BMJ 2011;343:d5154; MTA van den Ardweg et al), enrolled 111 children at 11 hospitals selected for adenoidectomy. The outcomes showed virtually no benefit during a 2 year follow-up between the children receiving this surgery and those that did not.

These children had all failed to be helped with standard pharmaceutical remedies, and had on average 8 upper respiratory tract infections per year with chronic rhinosinuvitis. Now, when we examine the strategy of adenoid removal more closely, we may see some alarming fallacies to this strategy. In 2006, nearly 130,000 children in the United States received an adenoidectomy, and the numbers are increasing since then. The adenoids are lymphatic tissues called tonsils situated just behind the sinus cavities. Historically, we see that in the mid-twentieth century that tonsillectomy was recommended for almost all children to prevent upper respiratory tract and throat infections. Most of us recall that this was stopped when numerous studies showed no benefit, and an increased risk of poor immune response in the future with the removal of these important immune glands, or lymphatic tonsils. The adenoids are part of this immune protection, and are situated above the palatine tonsils in the rear of the mouth. These lymphatic tonsils do swell with cellular debris that is being cleared when there is a local infection or inflammation. This is the purpose of our lymphatic system, and lymph nodes. The problem is not the evolved lymphatic tissues, but the problems with infected and inflamed tissues outside of these lymphatic tissues and nodes. Removal to the lymphatic tonsils obviously does not really address the problems of poor immune defenses and chronic infections and inflammations. While most parents would question a tonsillectomy for their children based on past medical knowledge of the proven inappropriateness, when calling the procedure an adenoidectomy, most parents would agree to the surgery.

So, instead of integrating Complementary Medicine into the treatment protocol, using safe and benign herbal and nutrient medicines, dietary regimens, and other treatment protocols, the persistence of a standard course of therapy that has shown much failure, and proof of a chronic risk and adverse effect, is pursued in these cases until the failure of standard treatment leads to the advice to remove the adenoid tonsils. This Dutch study, along with a number of prior studies in recent years (Clinical Otolaryngology: Jan 2009; M Fiellau-Nikolajsen et al), shows that the removal of the adenoid tonsils has no long-term benefit to decrease the incidence of recurrent upper respiratory tract infections and chronic rhinosinuvitis (or recurrent ear infections). The justification of adenoidectomy mirrors the justification of tonsillectomy in the past. Standard medical authorities state that these adenoids are not functional in most people after age three. This is exactly the justification used for tonsillectomy in the past, and was found to be untrue. Lymphoid tissues do have an important function in our bodies. They help defend us against infections and the spread of tumors. These lymphoid tissues consist of a web of white blood cells, mostly lymphocytes that contain programmed immune cells to protect us from common microbial infections. These secondary lymphoid tissues, like the adenoids, use an adaptive immune response. This means that our immune defenses in our sinuses depend on an adaptive immune response to microbial infections, allergens and antigens, but standard medicine has chosen to remove these tissues to try to prevent recurrent infections and chronic inflammation. So, we see a few strategies in standard medicine. First, we inhibit our natural histamine responses to tissue irritation, secondly, we supplant our natural cortisol responses with synthetic corticosteroids, thirdly, we repeat antibiotic regimens that at best only target specific types of bacterial infections, which are seldom the prime cause of these infections and inflammation, and create antibiotic-resistant strains of bacteria that are threatening, and fourth, we surgically remove the lymphatic tissues that make up our natural immune defenses. Why this is still considered a sound and logical strategy is remarkable.

The array of underlying causes for rhinosinuvitis

Within this large sector of the population afflicted with chronic rhinosinuvitis, the individual wonders what are the most prevalent types of this disease. A 2000 study published in Otolaryngologic Clinics of North America (Apr2000; vol33(2); 441-449) found that a survey of all eyes, ears, nose, and throat specialists in North America found that the diagnosis of allergic fungal rhinosinusitis was as high as 23% of cases (in Memphis, Tennessee) to 4% of cases in the northern United States. While this would imply that damp weather was responsible, an oversimplification fails to consider the rising incidence of immune reactivity to fungi, and its relation to the rising incidence of candida fungal overgrowth, or candidiasis, in the population.

If candida is assuming a fungal form and disseminating through your body, the immune allergic reactivity to common fungi is probably higher. The answer to this aspect of your rhinosinuvitis may be to move to a drier climate, or to to move out of a house or apartment where mold and fungi may be a problem, but even this may not completely solve the health problem if you fail to analyze and correct the candidiasis in your body (see my article on candidiasis on this website). If the chronic problem has now undermined your immune responses significantly, even correcting the candidiasis may not give you a fully significant cure. You may have to improve the healthy responses of your immune system. While one-fifth of the cases of rhinosinuvitis may be attributed mainly to a fungal allergy or hypersensitivity reaction, even in these patients there is surely a variety of allergens and antigens that stimulate the sinus inflammation once the sinus membranes are unhealthy. In addition, studies at such prestigious establishments as the Mayo Clinic have established that fungal growth is found in about 96% of patients with chronic sinusitis, even if it is not diagnosed as the principle cause of the disease. Since use of a corticosteroid increases the risk of a fungal infection, perhaps the widespread chronic use of steroid nasal sprays has become a significant contributor to the problem. A debate has raged for years, as well, over whether medical doctors should treat fungi or bacteria, and this is precisely the problem. We need to treat holistically.

A 2003 study of the pathogens in the sinus membranes of patients with chronic rhinosinuvitis, conducted at the Cornell University's Weill Medical College in New York, found that, at that time, 9.22 % of these patients were infected with a chronic methicillin-resistant Staphylococcus aureus infection in their sinus membranes, as just part of the low-grade microbial infection and allergen stimulation that perpetuated the sinusitis immune response. This indicates that our overuse of antibiotics is a major contributor to chronic rhinosinuvitis.

It does not mean that if you personally do not overuse antibiotics that this has nothing to do with you. Rather, it indicates that we are creating an environment that is more and more prone to challenges to our immune system. Common environmental immune challenges, which should not be a problem to the human organism, such as symbiotic bacteria, mold and fungi, viruses, pollens, dust mites, smoke, and particulate matter in the air we breath, are all now contributing to an exaggerated immune response that defines rhinosinuvitis. The answer to the problem is not to use more antibacterial chemicals, more antibiotics, and more antiseptic cleaners to insulate ourselves from bacteria, fungi, allergens, and the variety of microbes naturally occurring in the environment. The logical answer to the problem is to improve our immune defenses and to create a healthier environment. The first step to clearing rhinosinuvitis is to reestablish a normal symbiotic flora and fauna in sinus membranes, and then we may proceed to regain the healthy membrane tissues and localized immune responses that will stop immune hyperreactivity. To clear this pathogenic imbalance of bacteria, fungi and chronic viral infection, we need to use a broad spectrum agent. Antibiotics will target only a subset of the bacterial population. Herbs are endowed with such a capacity, as plants have evolved a number of chemicals that help them clear a variety of pathogenic bacteria, fungi and viruses. Herbal formulas are able to both clear a wide spectrum of pathogens while simultaneously promoting improved circulation and immune responses.

There is yet another reason why overuse of antibiotics is not recommended for patients with chronic rhinosinuvitis. Of the bacteria studied in these cases, the most prevalent type of bacterial overgrowth involve not only staphylococcus aureus, antibiotic-resistant staph, and coagulase-negative staph, but also gram-negative bacteria and anaerobic bacteria, for which our standard antibiotics do not effectively treat. Gram-negative bacteria have a double membrane which makes them naturally resistant of standard antibiotics. Common examples of gram-negative bacteria include e. coli, Neisseria, enterobacteria, Klebsiella, Salmonella, Shigella, Heliobacter, Campylobacter, Proteus, and Pseudomonas. It is not a coincidence that most of these are common to gastrointestinal infections. The health and healthy function of the gastrointestinal tract may be very important in the eventual clearing of chronic rhinosinuvitis, and indeed, studies have proven that probiotic regimens do improve most cases of chronic rhinosinuvitis. While standard antibiotics are ineffective against these gram-negative bacteria, many plant chemicals, or herbal medicines, are proven effective. Your own immune system is also effective at controlling these more difficult chronic bacteria, as is the normal healthy balance of symbiotic flora and fauna in our bodies. Restoration of the immune system and the normal symbiotic flora and fauna, as well as restoration of the gastrointestinal tract and function may be integral to curing the patient with chronic rhinosinuvitis. Coagulase-negative staph are a type that does not produce a clotting enzyme, and are thus seen in many cases of low-grade infection and milder symptoms. Coagulase-negative staph are the most common bacterial infectious agent in nosocomial infection, or infections originating or taking place in a hospital or clinic. As far back as 1981, the U.S. CDC found that 194,000 patients per year in U.S. hospitals acquired a nosocomial systemic bacterial infection. At present, this figure has risen considerably, despite antiseptic precautions. Coagulase-negative bacteremia has spread to the general population, and standard antibiotics are inadequate to counter this problem. Once again, strengthening the proven mechanisms to counter these prevalent low-grade infections, our own immune responses and normal symbiotic flora and fauna, as well as the health of our sinus membranes, is the answer to this difficult problem.

When the sinus membranes are chronically inflamed they are more susceptible to an immune reaction to common allergens, seasonal viruses, environmental toxins, dust mites, and mold and fungi in the home. The chronically inflamed sinus membrane is more open to the environment and has a diminished capacity to affect the normal local immune response. If the patient does not improve the membrane health, decreasing exposure to all of these irritating pathogens and allergens, by itself, if possible, still will not be enough to stop the immune responses that cause the sneezing, congestion, headaches, and post-nasal drip. A step-by-step approach to regaining this sinus membrane health is necessary. In chronic conditions, though, there may be even more to the pathology than this. Chronic rhinosinuvitis may also be perpetuated by other chronic health issues which inhbibit tissue maintenance, immune function, and may stimulate a vasomotor response, which is a vascular and neural stimulation of blood vessel dilation and subsequent swelling and fluid drainage. Underlying health issues often need to be assessed and treated as well. The implications for not addressing chronic rhinosinuvitis, and the potential underlying health problems that perpetuate it, are now becoming clear. Research has shown a considerable increase in risk of various diseases associated with aging in the population afflicted with chronic rhinosinuvitis. Cardiovascular risk has been the most studied, but metabolic disease, and other problems are now clearly associated. The smart patient will get to work and solve this chronic health problem, not just quiet symptoms with standard medication. Complementary Medicine is ideally suited to provide the array of treatments and the time intensive care that is needed to guide this restoration of health.

Because the pathology of chronic sinusitis is so varied and complex, we still do not have a clear medical understanding that uniformly defines this condition for all patients. A 2009 article by research professors at the University of Connecticut School of Medicine and Albert Einstein College of Medicine (Seth Brown and Marvin Fried M.D.s et al), stated that the pathophysiology of chronic sinusitis is still poorly defined. Chronic rhinosinuvitis is thought to be a predominantly inflammatory disease, but a variety of cofactors that contribute include persistent low-grade infection, allergies, immune dysfunction, superantigens (see my article on superantigens on this website), intrinsic factors of the upper airway, colonizing fungi (re: candidiasis), and metabolic disorders (such as aspirin sensitivity). Altered acidity and lowered oxygen tension in the sinus tissues also may play a significant role. All of these conditions create a favorable condition for an imbalance of the normal bacterial symbiotic colonization in the sinus membranes. Chronic rhinosinuvitis contributes to increased risk for other facial and cranial infections (75% of all orbital infections are directly related to sinusitis), as well as cardiovascular problems. One scientific study found that 50 percent of chronic migraine patients had chronic sinusitis (this varies among geographies and patient subsets). Worsening of asthma and skin allergic conditions is also highly associated. Many studies show a clear association between gastrointestinal symptoms and chronic rhinosinuvitis as well. Addressing systemic health and improving the healthy function of the sinus membranes rather than just decreasing symptoms with antihistamines and steroidal medications may have broad benefits.

So we see that a variety of pathogens, allergens and environmental toxins are irritating the sinus membranes in all cases of chronic rhinosinuvitis. We see that blocking the natural histamine responses, using synthetic topical steroids, and antibiotics, do not restore sinus health in any way, and in fact gradually erode the health of the sinus membranes further. And we see that a variety of other health problems may be perpetuating, causing, or worsening the rhinosinuvitis, and contributing to such related conditions as post-nasal drip, nasal polyps, tissue thickening, and autonomic vasomotor responses. We also see a number of common health problems associated with chronic rhinosinuvitis that is not resolved, but only managed with symptom relieving pharmaceuticals. While this is a list of things we need to understand and address, ignoring them may lead to serious consequences. The first step in resolving these chronic problems is to gain a better understanding and adopt a proactive approach, since the patient is always the primary treater of disease. The Licensed Acupunturist and herbalist is ideally suited to provide many of the treatment options available to you, and whether you utilize pharmaceuticals to quiet symptoms or not, this Complementary Medicine physician can provide care that will eventually help you to restore your health and end the problem.

Progression of Chronic Rhinosinusitis to Nasal Polyps

Nasal polyps are a common and usually benign degeneration of nasal sinus mucosa seen in about 4 percent of the adult population, and are associated with poor sleep quality, frequency of headaches, and post-nasal drip. Although modern medicine still has not fully identified the causes, or pathogenesis, of nasal polyps, there is a strong association with allergies, infections, asthma and aspirin sensitivity, much like chronic rhinosinusitis, as well as an association with cystic fibrosis. A number of key characteristics histologically have been revealed, including mast cell degranulation, eosinophilia and the presence of large quantities of extracellular fluid trapped in the mucosa. While standard medicine has relied on surgical treatment alone for nasal polyps, the rate of recurrence has been alarming. A 2008 study at the Aberdeen Royal Infirmary Department of Otolaryngology, in Aberdeen, Scotland, revealed that "recurrence of the polyposis is common with severe disease" even after treatment with steroids and surgical correction. These experts reviewed studies and concluded that such recurrence is observed in 10 percent of patients. In addition, the standard protocol of CT scan to diagnose, with accumulative radiation, and use of corticosteroid medication, with many adverse effects, as well as the time and discomfort occurring with surgical correction, leaves most patients wanting a more benign therapeutic approach. Obviously, the need for a Complementary therapy is needed, whether or not this standard treatment is utilized.

Mast cell degranulation is a cellular process of membrane immune cells that release histamine to control the inflammatory process. Degranulation involves the release of antimicrobial cytotoxic molecules usually stimulated by allergens and interaction with IgE antibodies. Often, these mast cells in the membranes interact with eosinophils, which release antioxidant enzymes such as peroxidase, and protein immune signals. Both the mast cells and eosinophils are types of white blood cells. Eosinophils are specialized to control chronic parasitic infections, as well as chronic diseases with excess membrane tissue growth. Eosinophils may produce VEGF growth factors, leukotrienes, and cytokines such as TNF-alpha, IL-6, IL-5 and IL-2beta. To treat what is known about the causes and perpetuators of nasal polyps, Complementary Medicine provides an array of synergistic therapies to normalize these factors and directly improve membrane and immune health. The protocol in such a complex undertaking needs to be handled in a step-by-step approach with an intelligent practitioner guiding therapy for a persistent course. The patient choices involve whether they want to first try this comprehensive conservative approach, and then whether they want to increase the chance of long-term success if surgery is chosen. The intelligent patient will realize that there is no binary choice in this case between standard medicine and Complementary Medicine, but rather a choice of utilizing this integrative approach to achieve a healthier and more guaranteed outcome.

Understanding post-nasal drip

There is a normally a constant flow of fluid through the sinus membranes, even when we do not notice it. We are normally unaware of this fluid flow because of the healthy system of drainage in the sinuses. The flow of fluid is part of the evolved protection against outside debris, pathogens, toxins and allergens that threaten our health. When this flow of fluid is increased, and the drainage is inhibited, we end up with post-nasal drip, which irritates the throat, and eventually may contribute to chronic cough, bronchitis and asthma. Much research has been conducted to understand this mechanism. A study in Japan in 2000, at the Mie University School of Medicine, found that in about 50% of cases of chronic sinusitis, there is a decrease in the ability of the sinus membranes to clear mucus due to thickened nasal secretions, or pituita, which causes a progressive dysfunction of the membrane cilia to transport the mucus (cilia are small hairs that move on the membrane to transport mucus). Now mucus is important in the sinus immune protection, because the thickened fluid that coats the sinus membrane both protects it and traps debris, allergens, pathogens and toxins, so that our immune responses may break these down and render them harmless. When the pituita, or thick mucus, is not transported well, it stagnates and increases in quantity. Finally, over time, this progressively worsening condition will result in postnasal drip. If the pituita is full of allergens, unwanted bacterial strains, viruses etc., these may drip onto bronchial membranes or into the larynx and pharynx, causing an immune reaction in these tissues as well. To correct the problem, we can't just attack the mucus, but instead, we must restore the health to the mechanism. A step-by-step approach is needed over time.

Nasal and sinus inflammation are not the only conditions causing postnasal drip, though. Numerous studies show that in many cases, acid reflux into the larynx and pharynx is also contributing to this dysfunction. Tissue changes in these upper airways can also contribute to the condition. Tissue hypertrophy, or thickening, can be caused by a variety of conditions. Hormonal changes can greatly affect tissue maintenance, and chronic use of synthetic hormones, as in contraception and menopausal hormone replacement is linked to postnasal drip in many studies. Adverse hormonal balance in pregnancy is also shown to cause or worsen postnasal drip. Cysts and polyps may also change the tissues in the upper airways, as well as thyroid growths, tonsil stones, tissue calcification, or scarring from trauma or severe infection. Upper airway acid reflux, or extraesophageal reflux disease (EERD) is becoming more common. Heartburn is seen in less than 50% of cases studied, and a high percentage of cases are found to involve not excess stomach acidity, by gastric hypofunction and problems with gastric emptying, as well as chronic asthma. In asthmatic patients, the daily us of inhalers, with a combination of steroids, antihistamines and antileukotrienes, is shown to potentially worsen the upper airway acid reflux and gastric hypofunction.

Sometimes, the early stages of postnasal drip are not obvious to the patient. Signs include increased swallowing, spitting of mucus, an irritating tickle in the throat, increased clearing of the throat or an altered voice, the feeling of obstruction in the back of the throat, shortness of breath, chronic episodes of sore throat, tonsil irritation (tonsil stones, or calcifications), increased snoring, a chronic mild cough, and changes to the appearance of the mucosa in the back of the mouth and throat. Often, by the time the patient becomes fully irritated and aware of the postnasal drip, the situation is chronic and advanced, making it more difficult to treat. Restoration of the healthy sinus membrane, and sinus membrane function, should be the focus, not just temporarily relieving post-nasal drip.

Understanding vasomotor rhinosinusitis.

Vasomotor is a term that signifies that a neurohormonal stimulation is causing a motor dysfunction of vasodilation or vasoconstriction which may cause tissue swelling, congestion, drainage, and potentially bleeding. It is generally referred to as non-allergic rhinitis, or persistent nonallergic rhinosinusitis. This poorly understood and often ignored type of sinus pathology is generally divided into 2 subgroups, vasomotor rhinitis triggered by weather and temperature changes, and vasomotor rhinitis triggered by airborne irritants, although this classification may be obsolete, as the array of underlying mechanisms causing vasomotor rhinitis has expanded in recent years, and many patients may have a chronic vasomotor rhinitis triggered both by weather and barometric changes and airborne irritants.

Studies have found that about one fourth of the adolescent and adult population of patients with persistent sinusitis have vasomotor, or non-allergic rhinosinusitis, although some European studies have found that about 40 percent of patients had vasomotor rhinosinusitis, generally with a more severe presentation. Women were found to have vasomotor rhinosinusitis twice as often as men, with symptoms that were more persistent, usually non-seasonal, and involved congestion and drainage that were usually without sneezing and itchy eyes. Patients with vasomotor rhinosinusitis usually had used antihistamines within the last 4 weeks prior to episodes, and were less likely to have concurrent food allergies, or prevalence of asthma. Some studies have shown little correlation between subjective symptoms and mucosal changes with measurable nasal patency tests, such as nasal resistance and acoustic rhinometry (PMID: 21215046). This would explain the failure of standard drug therapies. Allergic and non-allergic, or vasomotor, rhinitis may also exist concurrently, and other explanations for the symptom complaints may include nasal polyps, deviated septum, metabolic conditions, autoimmune disorders, and immunodeficiency. Often, these are not thoroughly evaluated in standard medicine, and the steroidal and antihistamine drugs are prescribed as a one-size-fits-all approach. The patients themselves may need to insist on a thorough diagnostic evaluation if a non-allergic, non-infectious sinusitis is evident.

Vasomotor rhinitis, now termed nonallergic non-infectious rhinitis, is currently thought to be a collection of sinus pathologies, including drug-induced rhinitis, nonallergic rhinitis with eosinophilia syndrome (NARES), occupational rhinitis (environmental toxins), hormonal rhinitis, emotion-induced rhinitis, physical/chemical induced rhinitis, etc. Idiopathic (no known cause) vasomotor rhinitis is still poorly understood, with no agreement on the physiological causes or etiology. Some studies have indicated that a non-IgE-mediated inflammatory and/or neurogenic set of causes are involved. Neurogenic rhinitis induced as a reflex to environmental factors appears plausible. There may also be an imbalance of the autonomic nervous system, with excess parasympathetic responses and deficient sympathetic. This has been demonstrated by increased sinus congestion, or mucosal swelling, induced by cold stimulation of the feet, whereas this trigger would normally cause mucosal contraction. C-fibers of the nervous system have also been implicated. These afferent nerve fibers of the somatic sensory system convey signals to the central nervous system, and are unmyelinated, resulting in slow signal conduction. These C-fiber sensory nerve fibers carry signals to the spinal cord, and generally respond to temperature changes, chemical stimuli, or mechanical stimuli, even light touch when sensitive. C-fibers respond more easily to accumulations of chemicals from muscle metabolism, to hypoglycemia, hypoxia, and an array of physiological changes in the body, and this may explain the difficulty in assessing the etiopathology of vasomotor rhinitis. To help physicians form a clear diagnostic evaluation and treatment strategy, hopefully integrating Complementary Medicine where applicable, the patient may be advised to keep a careful diary of symptoms and potentially causative, or aggravating, factors.

In 2005, experts at Georgetown University (study link cited below) suggested that even the term vasomotor rhinitis may be obsolete, based upon the complexity of the syndromes of persistent nonallergic rhinosinovitis. These experts suggested that the cases be divided between types associated with inflammatory mediators (granulocytes), and those where an abscence of these inflammatory mediators of pathological concentration were found. The first type may be called Chronic Eosinophilic Sinusitis Syndrome, or CESS, and the second type, noninflammatory, could be divided into types based on underlying causative mechanisms. These types would include a) hormonal imbalances, b) sympathetic nervous system, or autonomic, dysfunction, c) cholinergic rhinitis, and d) nociceptive syndromes. These experts agreed that syndromes of autonomic sympathetic dysfunction should include cases caused by beta-adrenergic hypertension medications. The nociceptive syndromes should include those associated with Chronic Fatigue Syndromes, as well as chronic pain syndromes with hyperalgesia. The term cholinergic refers to that part of the nervous system related to the neurotransmitter acetylcholine, such as the parasympathetic system, basal forebrain, and brain stem complexes, although the preganglionic (CNS) portion of the sympathetic nervous system, and neuromuscular junctions, are also largely controlled by acetylcholine. These experts at Georgetown University concluded: "Therapy based on the most likely pathological mechanism is anticipated to have the most success, but requires acceptance of the wide differential diagnosis of nonallergic rhinitis and rejection of the obsolete term "vasomotor rhinitis"." We see from this assessment that a more thorough diagnostic evaluation is needed for patients with persistent nonallergic rhinosinusitis, and a more holistic approach to therapy as well.

A characteristic of more severe vasomotor rhinitis is a worsening of symptoms in the upright posture, with relief of symptoms lying down. A 2013 study at the National Yang-Ming University in Taipei, Taiwan (cited below in additional information with a link to the study summary), investigated the reasons for this. Both patients with vasomotor rhinitis and healthy controls were analyzed with heart rate variability to determine if an autonomic dysfunction was measurable in the patients with vasomotor rhinitis (the heart rate and rhythm is controlled via the autonomic nervous system and the vagal system). In the patients diagnosed with vasomotor rhinitis, but not the healthy controls, the ECG (electrocardiogram) readings showed significantly different readings of the RR interval, low-frequency power, and ratio of the low-frequency power to the high-frequency power, in the sitting and supine (lying) postures. The RR interval (time between heart beats) was significantly increased, while the low-frequency percentage and LF/HF ratio were decreased significantly in the sitting, or upright, position, suggesting that the sympathetic regulation of vasomotor control was indeed altered in vasomotor rhinitis. The sympathetic nervous system secretes norepinephrine and other neurotransmitters around the smooth muscle of the arteries and arterioles, which stimulate alpha- and beta-adrenergic receptors. Normally, the alpha-adrenergic receptors predominate, and these are thought to be responsible for promoting vasoconstriction, while the beta-adrenergic receptors promote vasodilation.

Another study, in 2002, at the Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A., found that autonomic dysfunction was measurable both in patients with vasomotor rhinitis and gastroesophageal reflux disease (GERD), and patients with both GERD and vasomotor rhinitis showed evidence of increased autonomic dysfunction over those with just vasomotor rhinitis. GERD, too, may manifest with worse symptoms posturally, but the symptoms may worsen in the supine position. This study showed that patients with both GERD and vasomotor rhinitis seemed to demonstrate increased hypofunction of the adrenergic component of the autonomic nervous system (sympathetic). In contrast, vasomotor rhinitis is thought to be a result of increased cholinergic (acetylcholine, or parasympathetic) activity. Perhaps, with chronic excess of parasympathetic cholinergic stimulation, the relative deficiency of sympathetic stimulation results in changes to the adrenergic receptors, with over-expression of a type of adrenergic receptor. We see that an array of components may be involved in the mechanisms of vasomotor rhinitis, and changes in the adrenergic receptor functions may occur with advancing disease. The restoration of homeostatic function thus should involve a more holistic and persistent, step-by-step approach. Complementary Medicine, especially with Traditional Chinese Medicine (acupuncture, herbal and nutrient medicine), would be ideal to achieve this therapeutic goal. Of course, this would involve more than just a few treatments to relieve symptoms, and include an individualized assessment of the neurohormonal health.

Why do changes in body posture from sitting to lying affect vasomotor rhinitis symptoms? Autonomic imbalances and adrenergic dysfunction may lead to increased vasodilation, and thus increased swelling and edema of the sinus membranes. Vasodilation is increased when the parasympathetic (cholinergic) stimulation is relatively greater than the sympathetic. Vasodilation may also occur when the adrenaline (epinephrine, or norepinephrine) is deficient, as in adrenal insufficiency. With lower levels of adrenaline (epinephrine), beta-adrenergic receptor stimulation dominates over alpha-adrenergic receptors, producing an overall vasodilation. With chronic vasomotor rhinitis, the balance of alpha to beta adrenoreceptors may become upset in the smooth muscle of blood vessels in the sinus membranes. Although alpha-adrenoreceptors are less senstive to adrenaline (epinephrine), they override the vasodilation mediated by beta-adrenoreceptors. This imbalance of autonomic signals, adrenal receptors, adrenal insufficiency, and excess cholinergic dominance creates a situation where nasal airway resistance changes, induced by postural changes affecting blood pressure and drainage, are not well controlled. Chronic use of beta-adrenergic inhibiting drugs may also contribute to this imbalance, as they may induce increased expression of beta-adrenergic receptors to compensate. Obviously, the only real way to correct this problem is to systematically correct these underlying imbalances, which is no simple task. Attention to overall health, restoration of adrenal and autonomic function, and eventual correction of the receptor expression on vascular membranes of the sinuses is needed, and perhaps clearing of sinus irritation, better immune health, and improved circulation to these membranes. A systematic and patient approach is needed, even though these symptoms cry out for an immediate relief.

Currently, there are no approved standard pharmaceuticals for chronic vasomotor rhinosinuvitis, although corticosteroids, antihistamines and decongestants are routinely prescribed. A number of studies (cited below) reveal that vasomotor rhinitis triggered by weather and temperature changes does not respond to corticosteroid inhalants. Chronic use of antihistamine decongestants, while immediately effective to relieve congestion and promote sleep, has been proven to perpetuate and often worsen the pathology, having negative effects on the immune function of the sinus membranes. Anticholinergics are also being explored, although each of these medications comes with risk of side effects and problems with chronic use. Herbal anticholinergics, such as Huperzine A, derived from Chinese Herbal Medicine, may be a safer addition to the treatment protocol. Clearly, the patient that wants to address this problem effectively will seek a better treatment protocol than standard medicine presently offers, and Complementary Medicine, in the form of acupuncture, herbal and nutrient medicines, offers an array of therapeutic protocols that can be individualized and integrated with standard medicine. This integration of Complementary Medicine involves assessing and treating the underlying conditions as well as decreasing symptoms. As stated, the most common underlying causes are autonomic dysfunction, hormonal imbalances, neurohormonal problems, drug side effects, and rebound vasomotor effects from chronic use of decongestants. These need to be assessed with a careful history, and the patient and physician need to spend some time going over the treatment options for each individual case.

A number of medications are implicated in chronic vasomotor rhinitis syndrome, including beta-adrenergic inhibiting and angiotensin-converting enzyme inhibiting medications prescribed for hypertension (beta-blockers and ACE inhibitors), as well as gabapentin (Neurontin) prescribed for neuropathic pain and seizures disorders, methyldopa prescribed for Parkinsonism and difficult hypertension, synthetic hormones in contraceptives and menopausal treatment, or topical estrogens, penicillamine, aspirin, and NSAIDS, all with chronic use gradually affecting neurohormonal receptor functions, or membrane immune function (e.g. NARES). A more direct cause of chronic vasomotor rhinitis occurs with nasal sprays that contain sympathomimetics, which may gradually desensitize the alpha-adrenergic receptors in the sinus membranes with use. Typically, if this is acknowledged, a steroid nasal spray may be substituted, which is also problematic, as steroids may cause immune dysfunction and fungal overgrowths that aggravate the rhinitis. This type of pathology is called Rhinitis Medicamentosa. Obviously, the use of nasal sprays are common with rhinitis, presenting a dilemma. The patient may be told to avoid nasal sprays for some time to see if the vasomotor rhinitis improves. Use of Complementary Medicine, with acupuncture and herbal sinus medicines, may be useful in this situation, as well as for treatment of other health problems when the above medications are discontinued for a period of time. This integration of Complementary Medicine could be very valuable.

A number of scientific studies in recent years have demonstrated the efficacy of acupuncture, herbal medicine, and nutrient medicine with vasomotor rhinitis, as well as allergic rhinitis. Some of these studies are cited below in additional information. Acupuncture therapies that treat neurovascular reactivity are being studied, such as the pricking bleeding technique on the nose, and needling at the spine. Complementary Medicine in the form of Traditional Chinese Medicine provides a thorough treatment strategy that holistically evaluates and treats the array of both symptoms and underlying causes. A combination of these therapies, acupuncture, herbal and nutrient, integrating with standard medicine to allow minimal pharmacological dosage, will be more effective, and a course of therapy that addresses the patient holistically will also be more effective in the long run. Complementary Medicine is thus ideal to treat this problem, and integrate with the standard therapies, and the Licensed Acupuncturist and herbalist is an ideal choice.

Understanding Allergies: Do We Manage or Cure?

As we take a hard look at allergies in the United States we can clearly see that there is an oversimplification of this increasingly prevalent and important problem. The medical community on the whole, and the public, still views the subject of allergies as primarily limited to the common hayfever and allergic rhinitis, and groups such as the Mayo Clinic still stress that allergies affect about 10-16% of the population and are well controlled by steroid and antihistamine medications. This is a small piece of the big picture, and most studies confirm a steady increase in allergic diseases over the last 30 years, mostly in developed industrialized countries. The alarming prevalence of serious food allergies, and episodic allergic reactions such as angioedema, are a cause of great concern. At least 12 million Americans have food allergies and severe episodes account for more than 30,000 emergency room visits each year. Even more prevalent are the allergies to dust mites, pet dander, molds and fungi that are ubiquitous in our homes. The underlying connection between the variety of serious and not-so-serious allergic reactions is the function of the immune system and the health of your reactions to allergens.

Clinically, one sees a greater and greater percentage of patients aware of allergies today, as well as a growing body of scientific study pointing to a more serious and complex problem. As you look more closely at the subject of allergies on the Mayo Clinic website, you see that there are more and more types of allergic reactions that are presenting serious, prevalent, and growing health problems. Are we taking the subject of allergies too lightly? Are we looking inside of ourselves to see what is wrong or are we blaming the environment and failing to see what we need to do to shore up our defenses? An interesting study in Japan in 2010 found that patients with allergies had a much improved immune response to their allergies when they took regular walks in nature, such as parks and forests (see the link to a NY Times article on this study below in information resources). It seems that plant chemicals, such as phytoncides, an airborne chemical emitted from plants to protect them from pathogenic antigens and insects, also works on the human physiology. This is why herbal chemicals are effective in the treating of allergic pathologies. While we develop allergies that cause unwanted symptoms, simply blaming and avoiding nature, rather than utilizing nature to restore our immune defenses, is not a productive attitude.

One of the most significant new health threats with chronic allergies is the fact that these chronically inflamed membranes leave a patient more vulnerable to community infections, drug resistant staph and other bacterial infections, as well as more serious viral infections such as avian flu etc., which are becoming more prevalent in the U.S. For many individuals, the chronic immune stress in allergies and frequent infections contributes to much more serious and chronic syndromes, such as autoimmune disorders, neuroendocrine disorders, etc. which depend upon optimum health and function of the immune system. Working to improve immune function and membrane health, rather than just relying on prescription medications to relieve symptoms, will provide your body with protection that may prevent a host of serious pathologies. Complementary Medicine will help you to achieve these goals.

With public attention and concern about allergies and related health problems there has, of course, developed a new health industry around allergy testing and treatment. With this new attention to allergies has grown the oversimplification of diagnosis, as well as the oversimplification of treatment. The diagnosis of food allergies from standard testing is problematic, and this will be explained later in the article, and many patients without a serious allergic reaction to foods are diagnosed with multiple food allergies with these tests. All foods and external chemicals produce some antibody immune reaction in the human, and judging which of these are serious allergens is not entirely clear from tests that measure antibodies. They do point to potential allergic reactions when the body is producing higher than normal antibodies. The sensible thing for the patient to do is to objectively analyze whether these potential food allergens do produce the symptoms, by noting symptoms after eating the foods. With serious allergic reactions, there are clinics that challenge the patient with the food allergens while monitoring them in a safe clinical environment. For most patients, who have not had serious reactions, this is prohibitively expensive, though. Often, for the patient analyzing mild potential allergic symptoms, a diary is useful, noting each day the foods consumed, and the relationship to symptoms, such as digestive upset, skin reactivitiy, etc.

The subject of superantigens (explored on a different article on this website) also complicates the subject, with the potential that food molecules could induce a state of sensitivity and/or exagerrated immune responsiveness after a latent period of days to weeks, and stimulate a broad unwanted immune response that lasts well after the food is not consumed. Superantigens are now asociated with a variety of diseases, and appear to be the link between the prevalence of chronic allergic respiratory diseases and skin allergies producing eczematous reactions. This mechanism, of course, makes the analysis of food allergies more complicated. The patient must realize that foods are not the problem, though, but rather the dysfunction acquired in the individual immune system, and that a thorough holistic approach may be needed to restore a healthy immune response, and get past these potential allergies. The patient who simply starts being fearful of many foods may wind up with health problems related to poor nutrition.

Allergic reactions point to a more systemic problem in your overall health and the health of the community. Overcoming allergic reactions depends on a holistic look at all of the potential insufficiencies in your health that allows immune missense to occur. We cannot entirely eliminate allergens from our environment, so we must take the steps to insure that our immune response to allergens is healthy.

The most alarming aspect of allergic immune dysfunction that can be seen clinically has to do with the percentage of children now affected by allergies. Health problems that we overlook may be passed onto our children. Research conducted in the last few decades, delving into the subject of inheritable traits, has proven that common health problems may be acquired and passed on in one generation, and that these traits may be cleared from inheritance in subsequent generations if addressed (see the Feb.19, 1981 issue of the British journal Nature on acquired trait inheritance; RM Gorczynski and EJ Steele). P. Brock Williams announced at the 2005 American Academy of Allergy, Asthma and Immunology that his objective measurement of increases in IgE antibody levels in asthmatic parents and their children confirms this acquired immune trait, and in fact shows that offspring had dramatically higher numbers of allergen-specific IgE than their parents with allergies. Proper holistic treatment of these allergic dysfunctions will result in these children not passing on increasingly difficult allergic traits to their children and their children's children. Simply using steroids, antihistamines and antibiotics to control the symptoms is a ticket for failure in this regard.

The International Study of Asthma and Allergies in Childhood (ISAAC) shows that our community immune health is declining steadily. One of the most striking relationships in this study is the MacDonald's index: the more MacDonalds outlets you have in a country, the higher is the prevalence of allergy and allergic asthmatic symptoms. Clearly this shows a complex relationship to the overall health of the community and not just the changing environment.

The most striking thing one notices when looking at the research into allergies is the lack of specific reasons or patterns. Different types of allergic diseases have increased dramatically in different areas while other have stayed steady. Objective evidence has also been non-specific, with different types of T-cell responses seen and increases in IgG more than IgE responses noted in subsets of the affected population. This also confirms that we should be looking at overall immune health and problems that affect our immune health rather than looking for the magic bullet.

Complementary and Integrative Medicine, acupuncture, herbal medicine and nutraceutical prescription can effectively manage symptoms, but also offers the patient with allergic disease the opportunity to correct the underlying mechanisms and perhaps cure the problem, or at least see the symptoms better controlled by your own immune responses. With the failure of standard medicine to provide more than just treatment to temporarily relieve symptoms, and the proscription against daily use, more and more research is turning to Complementary Medicine, with these treatments integrated with more minimal use of standard allergy, sinus and asthma medications, and a number of randomized controlled clinical trials at University medical schools now prove that a combination of these treatments, along with sensible dietary changes, do work and have no adverse effects, other than better overall health (see study links below).

Examining the Risk vs Benefit of Standard Medication

There are a few reasons why patients currently choose to incorporate Complementary and Integrative Medicine into their treatment of allergies. One, they want to decrease their use of prescription medications due to side effects or warnings of risk with chronic use; two, they want to lessen the side effects and risks; and three, they want to not only control symptoms but to actually get healthier, and to improve the health of the systems contributing to immune missense. Currently, standard allopathic medicine alone offers no evidence of significant benefit in many types of chronic allergy, yet produces risk with chronic use that engenders much concern from the medical community, and has prompted numerous warnings from the FDA and other health regulatory commissions. Because of this, more and more medical doctors are starting to incorporate Complementary Medicine into their practice. Thoughtful patients will turn to the physicians that specialize in these therapies to improve the results of a multidisciplinary treatment stategy. The best outcome is to overcome allergies and to escape the need for future therapy at all, especially allopathic medications that come with risk when taken chronically. This requires a more thorough and comprehensive treatment protocol in most cases.

There are still only 3 types of standard medication to treat allergies. Antihistamines, Decongestants and Anti-inflammatories, although in allergic asthma and other serious allergic reactions Bronchodilators, such as Anitcholinergic agents, Beta-adrenergic agonists, Theophylline, and Anti-IgE antibody meds are used. Many current allergy medications combine these various types of drugs. The problems with this approach is that it not only presents serious negative consequences of long term chronic use, but also overlooks key features of various allergic mechanisms, and fails to address underlying non-inflammatory parameters and contributing health problems. Evidence also points to damage to the membranes and natural immune responses by continous use of these drugs and authorities now recommend a treatment protocol that at least alternates these types of drugs each month or so if the patient uses them daily.

"A modern treatment of chronic rhinosinovitis syndrome should adapt its schemes to evidence-based medicine. Unfortunately, basic evidence on drug efficacy in CRS is still missing. As mentioned by the EPOS expert panel, validated trials are lacking even for the most prescribed medications against CRS such as antibiotics. Finally, as for all treatment for chronic diseases, an adequate management of CRS should include a regular evaluation of efficacy (and a) multidisciplinary approach."

- (an NIH PubMed citing of a paper published in Therapeutic Clinical Risk Management 2007 March; 3(1) by the Dept of Otorhinolaryngology, Univ of Ghent and Univ Catholique de Louvain, Belgium)

Antihistamines: while short term use of antihistamine presents little threat of risk other than drowsiness, hypotension or interaction with other drugs that may potentiate depression or anxiety, the FDA has issued serious warnings concerning long term chronic use. In 1992, the FDA warned that nonsedating antihistamines, astemizole (Hismanal) and Seldane, could cause cardiac arrhythmias if accumulation of blood levels increased above therapeutic indications. Some of these antihistamines had to be taken off the market due to the serious risk due to the problem with accumulation to toxic dose, yet are we concerned with mildly toxic blood levels with chronic use?

Concurrent use of the antibiotic erythromycin, ketoconazole, itraconazole and other drugs have been shown to cause great increases in blood level accumulation of antihistamine. Keep in mind also that antihistamines are now added to a variety of common over-the-counter products, including sleeping aids, allergy remedies, cold and flu meds, etc., and are added to a number of pain medications, usually denoted by the PM version of the drug. Also, antihistamines have been documented to excrete in breast milk and nursing mothers have been cautioned, especially if levels rise. Many antihistamines are broken down mostly in the liver and poor liver function or competition in catabolism could decrease an individuals rate of drug breakdown. Risk of toxic blood levels seems to be largely ignored.

Chronic use of antihistamines are documented to cause weight gain and insomnia, as well as other common health problems that are typically ignored by the prescribing physicians. Insomnia is often improved at first by the taking of antihistamines, many of which affect the CNS sleep centers and cause drowsiness, but chronic use typically results in a disruption of healthy sleep regulation. Natural allergic responses are sometimes diminished with chronic antihistamine use and patients will become more prone to frequent viral, fungal and bacterial infections.

The reasons that antihistamines may cause increased CNS depression when combined with alcohol or other anti-depressants and anti-anxiety drugs is alarming to some. This serious threat is why second and third generation of antihistamines were developed to decrease risk, and are called nonsedating. First generation antihistamines easily crossed the blood brain barrier and affect the central nervous system (CNS). The first generation antihistamines are also lipophylic and are metabolized by the liver P450 oxidative enzymes, thus competing for enzyme breakdown with antidepressants, anti-arrhythmics, beta blocking blood pressure medications, and antipsychotic medications used for common depression and anxiety. Second generation non-sedating antihistamines, while not directly crossing the blood brain barrier to effect the CNS, were the first drugs studied in relation to drug interactions with P450 enzyme competition, and still contain this threat of altering blood levels of both the antihistamine and these other drugs. Third generation non-sedating antihistamines do not cause these interactions, but studies show that clinical response varies widely among and within patients (Armstrong and Cozza M.D. analysis published in Psychosomatics 2003; 44:430-34). This study also asserts that Claritin/Altavert safety profile has been the subject of much professional debate, and drug interactions and competition is still problematic with certain patients, especially concerning patients taking concurrent anti-histamine antacid medications and cardiovascular drugs.

Histamines are important chemicals in the area of proper stomach function also, and inhibition has shown potential nutrient depletion of B12, calcium, folic acid, iron, zinc and vitamin D. The FDA has issued warnings that caution should be used in prescribing these drugs to patients with peptic ulcers or small bowel obstructions, as well as those with prostrate hypertrophy, glaucoma and bladder obstruction. Certain antihistamines come with precautions that caution should be observed in use with patients with history of bronchial asthma, hyperthyroidism, cardiovascular disease and hyptertension.

Coupled with these extensive problems of risk with antihistamines are the consequences of long term corticosteroid use (see article on this website) and the damage done to sinus membranes from chronic use of decongestants. Common prescriber warnings state that there are potential side effects with decongestants of nervousness, sleeplessness, increased blood pressure, racing heart, and rebound rhinitis, where more than three days use in a row of nasal decongestant spray may cause the congestion to become more severe which will lead to increased use of the decongestant and dependency on the medication.

The key question in evaluating long-term risk versus benefit is not whether we may be one of the unlucky few who face serious consequences, but rather, if these medications can cause such significant harm, what are they doing to my general health. As far as benefit concerns, are these drug regimens correcting the immune membrane health and addressing key health factors that contribute to the problem? Are they possibly perpetuating the health problem while controlling symptoms?

New Recommendations for Treatment Strategy for Chronic Rhinosinusitis Syndrome (CRS), commonly called Hayfever, Rhinitis or Sinusitis:

The NIH has published recent extensive analysis of rhinosinusitis syndromes and recommended a change in treatment guidlines. These recommendations are that instead of just focusing on reducing mucosal inflammation, swelling, infection and aeration of the membranes, that modern treatment should, "First of all...consider the patient in totality: from etiology (indlcuding contributing health problems) when possible, to (differences in individual) clinical features. When considering patients with CRS, comorbidities (associated health problems)... must not be underestimated...A modern treatment of CRS should adapt its schemes to evidence-based medicine. Unfortunately, basic evidence on drug efficacy in CRS is still missing. As mentioned by the EPOS expert panel, validated trials are lacking even for the most prescribed medications against CRS such as antibiotics...A multidisciplinary approach and follow-up is mandatory as diseases such as cystic fibrosis can generate sinus diseases."

Such recommendations have come in response to the failure of standard treatment to provide safe and effective therapy. A treatment protocol that has failed to address the individualized underlying causes of the pathology, much less correct them, and has relied on medications that temporarily relieve symptoms, but worsen the disease with long-term daily use, is now realized as unacceptable. We have taken the health issue too lightly. Complementary Medicine provides just the array of treatment protocols and strategies described above in the United States National Institutes of Health recommendations.

Understanding the Mechanisms of Allergic Reactions

One theory in allergic immune missense is that the immune system makes mistakes when it is overtaxed. The cytotoxic immune system is a very complex interaction of chemical mediators in our body because it has to respond to millions of potential threats from viruses, fungi, mold, mildew, pollen, toxic chemicals, etc. As our environment gets more complex and less healthy, and as our community becomes more global, the stress on the cytotoxic immune system increases exponentially. When our general health suffers, this immune system is struggling even more, as the body is less capable of producing the right metabolic chemicals to supply the needs of the immune complex. As the cytotoxic immune complex recognizes allergens, the cytokines, or protein messengers, activate the T-cell and B-cell responses. When the B-cell responses are triggered too easily, unwanted inflammatory responses cause allergy symptoms, and when a superantigen response bypasses that normal B-cell responses, systemic T-cell responses may be triggered. By creating a healthier immune system, there is a chance that this immune memory response can be modified.

B-cells are immune blood cells that are able to use a 'memory' mechanism to produce specific protein antibodies to the allergens. The whole process of activating B-cells to produce the antibodies involves both the protein complement system and the T-cells though. The B-cell binds to the allergen or antigen and combines this with a protein marker, such as MHC, that is then recognized by a T-cell, which carries a matching receptor to this marker. This activates the T-cell, which releaeses complement protein cytokines, or interleukins, that transform the B-cell into an antibody-secreting blood cell.

B-cells are produced and processed in the bone marrow and liver, with billions of types of antibodies produced. Problems with the metabolic function of the liver and marrow may thus produce specific problems with the allergic responses. Increasing the healthy functions of the liver and marrow may be just as important as avoidance of the allergens in correcting the allergic reaction. Some of our complex B-cell memory was obtained from the colostrums of our mother's first breast milk. One theory states that problems with this memory B-cell system may contribute much to certain allergic states. Bovine colostrums have proven to be beneficial in some instances to correct this problem.

A complete process of trying to stop the allergic memory of overreaction must involve therapy aimed at improving the healthy function of all of these aspects of the immune response. The allopathic approach, which still tries to target a single problem in a part of the cooperating immune system, will not achieve this goal, and hence, modern pharmaceutical research has been stymied. The patient that chooses a holistic approach to improve the whole health of the system has a great chance to stop this allergic missense.

This holistic process involves identification of the right allergens, decrease in exposure to these allergens as you work to improve the health of the immune system, stimulation and restoration of the immune memory, stimulation of more healthy B-cells and T-cells, stimulation of healthy complement proteins and inflammatory mediators by improving liver health, and improving the health of the membranes, where ill health and inflammatory processes may be altering the healthy function of these antibodies and complement proteins. Testing may be the first step in correctly identifying allergens. Other methods may be to keep a diary of symptom onset and compare this to exposure. Some patients have utilized physicians using muscle testing reactions.

Testing

Testing for allergies usually involves testing either reactivity or antibody levels that are somewhat specific for the allergen. Both of these testing methods do fall short in assuring complete objectivity. Skin reactivity may gauge the immune reactivity of an area of skin but this may be different than the reactivity by antibodies or other immune complex in the membranes or in the lining of the gastrointestinal tract. Blood tests may find high IgE antibody levels to specific antigens, but for the individual these may or may not indicate a real allergic response, as the body creates antibodies for all foreign molecules, and some of these tests are affected by medications such as antihistamines.

Analysis is sometimes subjective. Tests often indicate allergic reaction to a substance that the patient isn't bothered by, and often tests show little evidence of allergic reactivity while the patient still has episodes of allergic symptoms. Nevertheless, tests are a good addition to the accumulation of objective evidence that can be assembled to find a comprehensive treatment plan. Other methods of objective assessment include keeping a diary of exposure and reaction, keeping in mind that some symptoms may not occur immediaately after exposure and so need a pattern analysis, and use of muscle testing, which is a reactivity of the strength of contraction with exposure, and is subtle.

The reasons for this accumulation of objective evidence is not merely to avoid the allergen for the rest of your life. Often times, even partial avoidance of the allergens during a period of increasing the healthy response of the immune system may help tremendously to change the pattern of hyperreactivity. In other cases, the persistence or duration of exposure may be a key factor in the allergic response. Studies indicate that certain populations may have high percentages of allergy to certain allergens simply because exposure lasts for months instead of weeks. Often, the patient reports that their specific allergy resolved when they moved to a new geographical place, even though both places obviously contain the allergen. Changes in allergic reactivity are commonly reported over time, and this indicates that the body does have the capacity to resolve specific allergies. Knowledge of the specific allergens may be very important to this process of cure.

Atopic allergen reactivity may be tested by blood samples or skin tests. ImmunoCAP is a blood test that measures allergen-specific IgE and is not affected by antihistamine use, with claims of more accuracy and objectivity. RAST, or radioallergosorbant test, has been shown to be less sensitive than skin tests.

Food allergies may be identified with the ELISA (enzyme-linked immunoSorbent assay), which detects antibodies or antigens, from the blood. Great Smokies Laboratory has performed these tests along with tests of stool samples for analysis of the bacteria, fungi etc. in the intestines. The ELISPOT (enzyme-linked immunosorbent spot) test is a modified version of the ELISA that is very sensitive. IgG antibody assessment (ELISA/EIA) has been used to identify food allergens that contribute to irritable bowel syndrome, with mild improvement from eliminating these foods from the diet. Once again, relying on just one focus, and not treating with a thorough, holistic approach, is often a recipe for failure. Attention to potential allergies should be part of a broader treatment protocol.

Reliability of the labs is a problem shown in testing and review, and the patient is advised to request that a reliable lab be used. Ultimately, these lab tests show possible ranges of allergic responses and the patient must still go through a series of elimination diets and see if possible results support the lab findings. As always, the cure is often more complicated than we would like it to be. Often, diagnosis of food allergies is best left to the naturopathic doctor.

Other testing facilities that are recommended by experts include: Geneva Diagnostic Laboratory or Asheville, NC: 800-522-4762; and ImmunoScience Inc. of Las Vegas, NV: 925-460-811.

Nutrient medicine

A 2007 systematic meta-review of scientific evidence of efficacy of Complementary Medicine in the treatment of rhinitis by the University Hospital Aintree Department of Otolaryngology in Liverpool, UK, cited below, found that few nutritional supplements and herbs had been cited in standard medical databases related to randomized, placebo-controlled human clinical trials for the treatment of chronic rhinosinuvitis. Nevertheless, there was proven efficacy with human trials with the use of spirulina, an algae supplement. Studies showed that 12 weeks of spirulina supplementation increased mucosal immunity and relieved symptoms. This review of scientific studies and human clinical trials also showed that the use of bromelain (an enzyme found in pineapple and various Chinese herbs) proved effective to speed recovery when used as an adjunct to standard therapy.

Herbal products

As stated, the National Institutes of Health in 2007 published a meta-review of scientific evidence of efficacy of standard medicine to treat chronic rhinosinuvitis (CRS) conducted by the University of Ghent and the Universitie Catholique de Louvain, Belgium, who found that basic evidence of drug efficacy was still missing. An EPOS expert panel found that validated trials are lacking for even the most prescribed medications to treat CRS. We have seen limited funding in the West for clinical trials to evaluate herbal medicines to treat CRS, but have observed a long history of clinical success around the world. More and more scientific study is proceeding to human clinical trials with placebo control and blinding to prove efficacy with both herbal medicine and acupuncture, though, and some of this evidence is cited below. A variety of herbal products are effective if they are of high quality and prescribed properly. Herbal medicines are able to control inflammatory mechanisms, increase vascular and neural vasomotor responses, promote healing of tissues, act as broad spectrum antibiotic, antiviral and antifungal agents, support healthy immune responses, both specific local and systemic, and address potential contributing health problems such as fibrosis, sublinical hypothyroidism, acid reflux and other esophageal reflux syndromes, and asthmatic mechanisms. In addition, herbal products may help alleviate some of the risk of damage to the membranes and overall health from chronic use of drugs. Some of the common herbal pill formulas in my clinical practice are listed below. Other tinctures and raw herb formulas are used as more specific and stronger phytomedication when needed.

  • Allergen: a general herbal formula to alleviate symptoms and help the immune system is very effective in many cases, especially with nasal and eye symptoms
  • Advanced Defense: a formula to stimulate better immune responses
  • Colostroplex: bovine colustrum supplement may help with food allergy problems especially, as well as the innate immune responses
  • Ecliptex: a liver tonic with milk thistle is often useful to improve B-cell response
  • Astra C: a simple immune tonic with 3 forms of Vitamin C to improve the health of the mucosa to correct localized immune dysfunctions in nasal allergies and asthma, delivering an effective 5000 IU dose of Vitamin C from 3 different natural herbal and food sources, with the most classic simple formula in Chinese medicine to improve immune membrane function, called the Jade Screen.
  • Nasal Tabs: a symptom relieving formula for nasal/sinus allergies
  • Xanthium relieve surface: a simple formula to relieve eye or skin symptoms, as well as head congestion symptoms related to allergies, such as sinus headache.
  • EpiCor: a patented nutritional formula derived from a species of nutritional yeast called Saccahramyces cervisiae, utilizing a unique fermentation and extraction method, that supplies a number of amino acids, vitamins, and enzymes that have proven effectiveness in clinical human trials to boost red blood cell glutathione, balance membrane antibody responses, improve NK cell activity and efficiency, exert significant antioxidant effect on sinus membranes, and reduce symptoms of allergic sinusitis, making EipCor an effective part of the thorough treatment of sinus membrane immune health.
  • Histamine Balance / QuerCelain: studies have shown that aiding the ability of the body to regulate histamine response may be greatly aided with herbal and nutrient chemicals that work by inhibiting mast cell histamine release as well as regulating the release of histamine, or the histamine response. This product contains Quercetin and Bromelain, a component of a number of common Chinese herbs, with a Magnesium Vitamin C compound, called magnesium ascorbate. By aiding healthy histamine homeostasis instead of blocking histamine with a drug, the results could be a return of normal histamine responses that help maintain tissues, and not a dependency on anti-histamines or this formula. The side effects are numerous and they are all good for you, helping with gastrointestinal health, joint health, neurological health, etc.

Information Resources

Treatment with Complementary and Alternative Medicine for allergies in Europe is proving very successful and well utilized. Some of the data on the practice and research support is listed below with links to published data.

  1. A 2010 analysis of nasal congestion, or rhinosinusitis, from Weill Cornell Medical College in New York, outlines the complex array of types of this disease, its associations with such problems as sleep apnea, its impact on work productivity, and the 6 billion dollars in annual healthcare costs that it creates: http://www.ncbi.nlm.nih.gov/pubmed/20463822
  2. A 2011 analysis of nasal congestion, or rhinosinusitis, from Brown University Alpert Medical School, in Providence, Rhode Island, outlines the importance of assessing the subtypes of rhinitis in individualized diagnosis, with at least 9 subtypes evaluated. These include drug-induced rhinitis, hormonal-induced rhinitis, nonallergic rhinitis with eosinophilia syndrome (immune dysfunction), gustatory rhinitis (related to gastrointestinal health problems), occupational rhinitis (environmental toxins), atrophic rhinitis (tissue atrophy generally attributed to overuse of medication), and senile rhinitis: http://www.ncbi.nlm.nih.gov/pubmed/21737037
  3. A 2009 analysis of rhinitis, or rhinosinusitis, by the David Geffen School of Medicine at UCLA and the Respiratory and Allergic Disease Foundation, debates how to improve diagnosis and evaluation of the most prevalent health problem facing Americans. Up to 87 percent of rhinitis may be a combination of allergic and nonallergic subtypes, with numerous underlying health problems and environmental triggers contributing to the symptoms. Fatigue, sleep disturbance, headache, cognitive impairment and asthma are highly associated, sometimes dramatically impacting the quality of life: http://www.ncbi.nlm.nih.gov/pubmed/19781517
  4. Antibiotic resistant bacteria are now found in about 10 percent of all cases of rhinosinusitis studied, indicating that the standard protocol for treating sinus infections and flare-ups of chronic sinus congestion have probably contributed greatly to the rising incidence of chronic rhinosinusitis: http://www3.interscience.wiley.com/journal/121609485/abstract?CRETRY=1&SRETRY=0
  5. The U.S. Agency for Healthcare Research and Quality (AHRQ) provides current research for standard diagnosis and treatment of acute bacterial rhinosinuvitis, revealing that more than 10 percent of the population is affected with these acute infections, and that a variety of factors cause of predispose the patient to acute infections, including viral illness, immune hyperreactivity to fungi, allergic disorders, anatomic abnormalities, systemic diseases, noxious chemicals and environmental toxins, and trauma. The array of diseases that could contribute are many, including endocrine, or hormonal disorders, metabolic diseases, and more, many of which are subclinical and undiagnosed: http://www.ahrq.gov/clinic/epcsums/sinussum.htm
  6. Non-allergic and non-infectious rhinitis may be due to a variety of causes, including environmental toxins, and immune disorder (eosinophilia), but non-allergic rhinitis classified as vasomotor rhinitis is usually idiopathic (no known cause). A variety of mechanisms have been studied to explain this poorly understood vasomotor reactivity. This 1999 study at Chiba University School of Medicine, in Japan, provided proof that an autonomic dysfunction, or imbalance, was involved: http://www.ncbi.nlm.nih.gov/pubmed/10474036
  7. Further review of scientific study of vasomotor rhinitis from the faculty of medicine at Creteil, France, in 2004, suggests that nonallergic inflammatory processes, combined with neurogenic dysfunction, with autonomic imbalance between the parasympathetic and sympathetic responses, and reactivity of C-fibers of the sensory nervous system, may be involved, creating a complex set of potential underlying problems and triggers: http://www.ncbi.nlm.nih.gov/pubmed/14984550
  8. A review of the pathology of vasomotor rhinitis in 2005, by Georgetown University, concluded that the term vasomotor rhinitis may now be obsolete, and should be replaced with more specific terms to better guide individualized therapies. Assessment of pathology of persistent, or chronic, nonallergic rhinosinusitis should be classified according to specific inflammatory mediators for inflammatory disorders, and non-inflammatory rhinosinuvitis could be categorized by the underlying cause; dividing these cases into a) hormonal, b) sympathetic dysfunction, including those induced by hypertension medication with beta-adrenergic inhibitors, c) cholinergic rhinitis, and d) nociceptive syndromes, with hyperalgesia (chronic pain sensation enhanced in the central nervous system) and other features, which is often associated with chronic fatigue syndromes: http://www.ncbi.nlm.nih.gov/pubmed/15842962
  9. A 2009 study at the Biogenics Research Institute of San Antonio, Texas, revealed that vasomotor rhinitis triggered by weather and temperature changes did not respond (was refractory to) intranasal corticosteroid treatment (nasal inhalants). These typical one-size-fits-all sinus medications affected the allergic aspect of the disease, but not the idiopathic vasomotor rhinosinuvitis: http://www.ncbi.nlm.nih.gov/pubmed/19463202
  10. A 2012 study of vasomotor rhinitis, at the National Yang-Ming University, in Taipei, Taiwan, found measurable evidence of autonomic dysfunction in patients with vasomotor rhinitis that would explain why some patients had worsening symptoms sitting up rather than lying down. Measurements with ECG of heart rate intervals, low-frequency and high-frequency vagal signals, showed this dysfunction in patients with vasomotor rhinitis, but not in healthy controls: http://www.ncbi.nlm.nih.gov/pubmed/23476153
  11. A 2002 study of autonomic dysfunction in patients with vasomotor rhinitis, and patients with both vasomotor rhinitis and GERD, showed measurable autonomic dysfunction and adrenergic dysfunction with vasomotor rhinitis, measured by blood pressure responses to the valsalva maneuver, and that patients with both GERD and vasomotor rhinitis had increased autonomic dysfunction, although these patients showed adrenergic hypofunction, while those with only vasomotor rhinitis showed adrenergic hyperfunction, implying that the adrenergic receptor function may be damaged by progressive disease: http://www.ncbi.nlm.nih.gov/pubmed/11997777
  12. A 2003 study at the State University of New York, Buffalo, New York, U.S.A. found that a majority of patients with chronic sinusitis that exhibited excess growth of tissues, or hyperplasia, especially the growth of nasal polyps, may be afflicted with a superantigen response: http://www.ncbi.nlm.nih.gov/pubmed/14750606
  13. A 2007 study at The Queen Elizabeth Hospital in Woodville, Australia, found that the superantigen Staphylococcal Superantigen Type B, or SEB, is often seen in peripheral blood lymphocytes with chronic rhinosinusitis, in both patients with nasal polyps and without, and is often combined with fungal antigens. The addition of the staph superantigen significantly increased the interferon gamma response, showing that many cases of chronic sinusitis may involve a combination of fungal and bacterial antigens with a superantigen resonse: http://www.ncbi.nlm.nih.gov/pubmed/17279054
  14. A 2011 study at the University of Pennsylvania Hospital working with Shandong University Provincial Hospital showed that chronic rhinosinusitis with a superantigen response may contribute to insensitivity to standard gluococorticoid, or steroidal, medications by inducing excess expression of glucocorticoid receptor beta (GRbeta), or an imbalance of alpha and beta types of glucocorticoid receptors: http://oto.sagepub.com/content/early/2011/06/27/0194599811413859.abstract
  15. A 2000 review of all published studies of nasal polyps by experts at the University Hospital of Aarhus, Denmark, and the University Hospital in Ghent, Belgium, shows that the causes and pathological implications in nasal polyps are complex, and poorly understood. Such study points to the need for a more comprehensive treatment protocol, not a single pharmacological solution. The key known pathological factors are chronic fungal infections, overexpression of mast cells, chronic inflammation, increased expression of TNF-alpha, IL-1, IL-5, denervation of the nasal mucosa, and aggravation by allergens: http://thorax.bmj.com/content/55/suppl_2/S79.full
  16. Current use of Complementary and Alternative Medicine by medical doctors in Europe as far back as 2002 proves that this treatment protocol works for a growing body of patients: http://www.ncbi.nlm.nih.gov/pubmed/12121187
  17. A 2009 survey of Israeli patients with chronic rhinosinusitis found that 21 percent of these patients reported successful utilization with Complementary Medicine, including acupuncture, herbal and nutrient medicine, homeopathy, massage, and chiropractic medicine.: http://www.ncbi.nlm.nih.gov/pubmed/19755095
  18. A 2012 Pilot Study of acupuncture with dietary and lifestyle modifications added to standard treatment of chronic sinusitis, or rhinosinusitis, at the University of Californa Los Angeles, found that this integrated TCM protocol was successful in improving a number of parameters of the disease, with no adverse effects noted: http://www.ncbi.nlm.nih.gov/pubmed/22431875
  19. A 2009 randomized controlled human clinical trial of acupuncture to treat nasal congestion at the University of Heidelberg Medical College, Germany, Department of Otorhinolaryngology, found that acupuncture points standard to treat the sinus congestion (verum) produced highly significant improvements in subjective symptoms (VAS) and objectively measured nasal air flow (NAF), while acupuncture points not specific to sinus congestion (controls) produced significant symptom improvement but not improvement in measured nasal air flow. The improvement in symptoms over time occurred with use of the correct acupuncture points but not with the controls. This suggests that acupuncture is proven to effectively treat sinus congestion: http://www.ncbi.nlm.nih.gov/pubmed/19769799
  20. A 2007 randomized controlled trial of acupuncture for persistent allergic rhinitis, by the World Health Organization (WHO) Collaborating Centre for Traditional Medicine and RMIT University in Melbourne, Australia, found that acupuncture treatment for 8 weeks is effective in the symptomatic treatment of sinusitis or rhinitis. A number of large follow-up studies are being conducted at present in various countries to duplicate this RCT proof of efficacy: http:/www.ncbi.nlm.nih.gov/pubmed/17874980
  21. A 2012 study of the integration of acupuncture, herbal and nutrient medicine, and dietary modification into the treatment protocol for chronic rhinosinusitis found that a course of 8 treatments with TCM resulted in significant improvement in symptom relief and quality of life: http://www.ncbi.nlm.nih.gov/pubmed/22431875
  22. A 2009 randomized controlled study of the effects of acupuncture on vasomotor rhinitis by the University of Munich, Germany, shows that this treatment is proven to work to relieve symptoms of vasomotor rhinitis: http:/www.ncbi.nlm.nih.gov/pubmed/19388861
  23. A study of rebound rhinitis (rhinitis medicamentosa induced by chronic overuse of prescription drugs), in 2009, at a hospital in Greece, showed that diagnosed incidence of this problem increased dramatically after heavy advertising for these pharmaceutical products. One can surmise that the situation must be worse in the U.S.: http://www.ncbi.nlm.nih.gov/pubmed/19902852
  24. A 2010 meta-analysis of medication induced rhinitis, or rhinosinuvitis, found that a variety of medications were potentially linked to this disease, with 3 categories: inflammatory dysfunction, neurogenic, and idiopathic (unknown mechanisms of cause): http://www.ncbi.nlm.nih.gov/pubmed/20210811
  25. This video from Vanderbilt medical college show that many cases of post nasal drip are caused by upper airway acid reflux from gastric hypofunction and problems with the esophageal gastric sphincter. Unfortunately, the standard cure has not evolved past use of blockers of stomach acids, despite the acknowledgement that these patients usually do not have an excess of stomach acids: http://www.youtube.com/watch?v=m4OccOuAnuU
  26. This video from the Mayo Clinic shows how mold and fungi in the air will create a hyperactive immune response when fungal antigens stimulate excess T-cell responses with eosinophils, and how normal healthy immune responses will not produce these symptoms causing responses: http://www.youtube.com/watch?v=H1FIBSXz7fc
  27. By 2004 studies showed that 30 percent of all patients with in Europe chose to treat with Complementary and Alternative Medicine, with a great percentage choosing acupuncture and herbal medicine: http://www.ncbi.nlm.nih.gov/pubmed/15330007
  28. A German study at the Medical University of Lubeck found that patients who chose Complementary and Alternative Medicine to treat allergies were motivated by concern for Quality of Life and desire to take control of their health: http://www.ncbi.nlm.nih.gov/pubmed/14642985
  29. A Japanese study in 2010 found that when patients spent time in nature, such as parks and forests, that their immune system functioned better due to inhaling phytochemicals that plants create to protect them from the harmful effects of antigens, allergens and insects: http://www.nytimes.com/2010/07/06/health/06real.html?_r=1
  30. A 2008 meta-analysis of the effectiveness of acupuncture in the treatment of allergies in Germany, tested with double-blinded placebo trials, demonstrate the proven benifits: http://www.ncbi.nlm.nih.gov/pubmed/19055209
  31. A 2006 meta-analysis in Australia of current clinical trials and evidence supporting the use of acupuncture and herbal medicine in the treatment of allergic rhinitis: http://www.ncbi.nlm.nih.gov/pubmed/16670510
  32. A 2009 study of acupuncture to treat vasomotor, or non-allergic rhinitis, found in a pilot study that acupuncture, even in the constraints of a limited set treatment, was significantly effective in a double-blind placebo controlled study to treat vasomotor rhinitis. This study was also conducted at the University of Munich, in Germany: http://www.ncbi.nlm.nih.gov/pubmed/19388861
  33. A 2010 study at Kyung Hee University, South Korea, found that a Chinese herb Corydalis hereocarpa, with the active chemical Libanoridin, effectively inhibits allergic inflammatory response by the inflammatory mediators found to be excessive in the allergic responses, IL-1beta, IL-6, IL-8 and TNF-alpha: http://www.ncbi.nlm.nih.gov/pubmed/20100031
  34. A 2007 study at the Chosun University Medical School in Gwangju, South Korea, found that Quercetin, an antioxidant chemical found in a number of Chinese herbs, including Sang ji sheng (Loranthus parasiticus), Fan shi liu (Psidium guajava fruit), Di er cao (Hypericum, or St. John's wort), and Man shan hong (Rhododendrum dahuricum), and available in a purified extract, effectively treats allergic inflammatory responses by decreasing the inflammatory mediators IL-6, IL-8, TNF-alpha, and attenuating NF-kappaB and p38 chemokines: http://www.ncbi.nlm.nih.gov/pubmed/17588137
  35. A 2007 study at Kyung Hee University in Seoul, South Korea, also found that green tea, with the active chemical epigollocatechin, was an effective addition to an allergy regimen, inhbiting the production of the inflammatory mediators that drive allergic responses, IL-6, IL-8, and TNF-alpha, through inhibition of intracellular calcium ion triggering: http://www.ncbi.nlm.nih.gov/pubmed/17135765
  36. A 2010 study at the Tunghai University in Taiwan found that the Chinese herb Anoetochilus formosanus (Jin xian lian) effectively modulates inflammatory allergic responses by modulating immune cytokines in allergic asthma, reducing IgE responses, and airway hyperresponsiveness: http://www.ncbi.nlm.nih.gov/pubmed/20092984
  37. A 2013 study at the Kyungpook National University, Daegu, South Korea, found that a chemical in the Chinese herb Alpinia officinarum (Gal liang jiang), or Galanga, called galangin, a flavonoid, attenuates histamine release from mast cells, and downregulates a number of pro-inflammatory cytokines, such as TNF-alpha, IL-6, and IL-1beta, that drive the symptoms of chronic allergic sinusitis: http://www.ncbi.nlm.nih.gov/pubmed/23535185
  38. A 2005 study of the genus of medicinal orchids, Anoetochilus, found that the popular herbal medicine from Anoetochilus formosanus not only provides significant immunomodulating effects, without toxicity, but may provide specific benefits for liver function, and anti-cancer effects as well. Jin xian lian is used traditionally in China to treat nephritis and cystitis (kidney and urinary tract infections), as well as pneumonia: http://www.thefreelibrary.com/Antitumor+and+immunostimulating+effects+of+Anoectochilus+formosanus...-a0147344278
  39. A 2013 study at Tianjin University of Science and Technology, in Tianjin, China, found that an active chemical in the Chinese herb Psoralea corylifolia (Bu gu zhi), Bavachinin, was a potent inhibitor of Th2 cytokine production, IL-5, IL-4, and IL-13, providing a potentially effective treatment for asthmatic inflammation as well as nasal polyps: http://www.ncbi.nlm.nih.gov/pubmed/24013845
  40. A 2008 study at the Medical School of Zhejiang University, in Hangzhou, China, showed that a prolonged course of the Chinese herb Astragalus (Huang qi) significantly decreased allergic airway inflammation in laboratory animals with airway hyperreactivity related to Th2 response inhibition: http://www.ncbi.nlm.nih.gov/pubmed/18226482
  41. A 2001 study in Germany showed that Siberian ginseng, or Eleutherococcus senticosus, extract effectively inhibited the replication of human rhinovirus and respiratory syncytial virus, making this Chinese herb an effective addition to treatmento protocol: http://www.ncbi.nlm.nih.gov/pubmed/11397509?dopt=Abstract
  42. A 2007 meta-analysis of Western human clinical trials of herbal and nutrient medicines to treat chronic rhinosinuvitis by the University Hospital Aintree in Liverpool, UK, found that evidence was confirmed for the use of spirulina supplement for 12 weeks to decrease symptoms and improve mucosal immunity. Bromelain also showed efficacy in promoting a faster recovery for acute sinusitis when added to the treatment protocol: http://www.ncbi.nlm.nih.gov/pubmed/17125579