Me too…

As a lifelong allergy sufferer, I dread spring because this is the season when my allergies are most intense (and miserable). Suddenly, everything is abloom. When my allergies kick in—and always with a vengeance—they manifest as headaches, itchy / burning eyes, runny nose and/or sinus congestion, brain fog and exhaustion. Pollen especially affects my throat and sinuses, triggering violent bouts of sneezing, frequent nose bleeds and back-of-the-throat post-nasal drip.

Does this sound familiar?!

The Problem with Allergy Meds

If you’re an allergy sufferer, you likely reach for antihistamines, decongestants or inhaled corticosteroids for relief. I sure did—for years: Benadryl, Zyrtec and Claritan were my trusty go-to’s.

While an antihistamine can help reduce or suppress allergy symptoms (itchy eyes, runny nose, congestion, etc.), it does not get rid of the allergen itself. Nor, do antihistamines stop your body from being allergic to whatever triggered your symptoms. In fact, taking antihistamines can actually suppress your immune system so effectively that your immune system will not work properly when you need it most.  This leaves you vulnerable to pathogenic invaders in certain parts of your body, like, the throat or sinuses.

Antihistamines are classified as H-1 first- or second-generation antihistamines, or as H-2 blockers. They include:

1.  H-1 First generation antihistamines, like Benadryl, Vicks NyQuil, DayHist and Children’s Dimetapp, were approved by the FDA in the 1930s. They target the histamine receptor on the brain, spinal cord and other receptors, and they cross the blood-brain barrier, which results in drowsiness as a common side effect.

2.  H-2 Second generation antihistamines, like Allegra, Zyrtec and Claritan, were introduced in the 1980s. They do not cross the blood-brain barrier and typically do not cause drowsiness. However, they can have other side effects.

3.  H-2 Blockers, like Tagamet, Zantac and Pepcid, are designed to help with stomach issues, like heartburn and GERD. Common side effects can include joint or muscle pain, headaches and drowsiness.

Most of us who have taken antihistamines are familiar with their side effects: dry mouth, headaches, drowsiness, rapid heart rate, constipation, dizziness, stomach cramps, pain….and, yes, weight gain(!)—depending on whether you are taking a first or second generation antihistamine (1).

Less known, are the adverse health effects associated with chronic or long-term use of allergy medications.

For example, antihistamines, like Benadryl, belong to a class of medications with anticholinergic effects that block acetylcholine, a brain neurotransmitter involved in learning and memory. Blocking acetylcholine also inhibits involuntary muscle movements and different bodily functions, which is why anticholinergic drugs are also used to treat overactive bladder and GI disorders (2).

A longitudinal 2015 study published in JAMA Internal Medicine found an increased risk between long-term use of anticholinergic medications, like Benadryl, and dementia.

This study, which began in 1994, included nearly 3,500 participants, aged 65 or older, who took part in Adult Changes in Thought (ACT), a long-term study conducted by the University of Washington and Group Health, a Seattle healthcare system. None of the participants had dementia. What researchers found: Long-term use of anticholinergic medications, like Benadryl, is associated with an increased risk for all-cause dementia and Alzheimer’s Disease(3). Dementia risk increased with cumulative dose. For example, taking an anticholinergic for three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less (4).

Many people are also not aware that chronic or long-term inhalation of nasal corticosteroids (e.g., Flonase) for allergies or asthma can contribute to the development of adrenal dysfunction (inability for adrenals to properly respond to stress), osteoporosis, loss of bone density and growth, skin thinning, thrush, a.k.a., oral candida (creamy white lesions with a cottage cheese-like texture on tongue, inner cheeks, gums or back of throat) and lack of growth in children (5, 6).

But, but, but….I hear you saying…sometimes, the misery is so great that you need symptom relief right now….long term consequences be damned!

I get it.

The problem is that when you rely on a pharmaceutical remedy for allergy relief (or any health issue for that matter)….and it delivers relief—at least in the moment—casual usage can morph into a chronic dependency that can result (eventually), in long-term consequences that you may not even associate with a seemingly innocuous OTC remedy.

The Seasonal Allergy-Food Connection

Even if you do take an antihistamine for relief, consider incorporating a more holistic approach to managing allergy symptoms.

Personally, I stopped taking antihistamines about 12 years ago. These days, instead of reaching for an antihistamine during allergy season, I am mindful of supporting my immune system by adjusting my food choices, taking specific supplements and by prioritizing rest and sleep.

If you suffer from seasonal allergies—like hay fever—know that your food choices matter.  This is especially true if you have an autoimmune disease, like Hashimoto’s thyroiditis, rheumatoid arthritis, lupus, psoriasis or psoriatic arthritis, because you will, in all likelihood, already have multiple food sensitivities (7, 8).  The seasonal allergy-food connection adds yet another layer of heightened sensitivity and inflammation. If you feel absolutely miserable from the intensity of your allergy symptoms, this is sign that you need to pay attention to your liver and digestive health.

An allergy is a hyperactive response of the immune system to substances called “allergens”—including (but not limited to) food, pollen, dust mites, mold, medications, and insect stings—that your body perceives as “foreign”.

Once an allergic response is activated, histamine is released.  Histamine is a neurotransmitter that acts as a chemical messenger for different parts of the immune system. High histamine levels trigger symptoms that are typically associated with allergy symptoms, such as a runny nose, itchy eyes, coughing and sore throat.

High Histamine Foods

It makes sense then that eating high histamine foods can be like pouring gasoline on the fire. In other words, increasing your body’s histamine load can cause diarrhea, headaches, flushing, congestion, hives and/or worsen existing allergy symptoms.

The worst culprits are aged and fermented foods, which contain high levels of histamine (9).  These include—and are not limited to—the following:

• Alcohol: Wine, Champagne and beer.
• Fermented foods: Sauerkraut, vinegar, kefir and kombucha .
• Processed meats that are cured, smoked, dried, or preserved: Salami, pepperoni, sausage, etc.
• Aged cheeses: Cheddar, Parmesan, camembert.

Even foods considered “healthy” contain high levels of histamine—or stimulate the release of histamine, including (10):

• Spinach
• Tree nuts
• Citrus fruits
• Tomatoes
• Avocado
• Coffee
• Cocoa / chocolate

Pollen-Food Syndrome or Oral Allergy Syndrome

Many people who are allergic to pollen can also have oral allergy syndrome (OAS)— also called, pollen-food allergy syndrome—triggered when certain foods are eaten raw (11). Because the proteins in some fruits, vegetables and nuts are similar to the proteins found in pollen, the immune system gets confused and attacks the “invader”, causing a “cross-reactivity” allergic reaction, such as redness, swelling or itchiness of the lips, mouth or throat (12, 13).

Unfortunately, I have both hay fever and oral allergy syndrome.  I am highly allergic to tree pollen, especially maple, oak and birch.  I am especially sensitive to birch pollen. This means that if I eat foods containing similar proteins found in birch pollen—such as raw fruit (e.g., apple, pear, any kind of stone fruit, like cherries, plums, peaches, nectarines); raw vegetables (e.g., celery, carrots, green pepper, fennel); tree nuts (e.g., almonds, walnuts, hazelnuts); or peanuts, beans and lentils, which contain similar proteins found in pollen—my lips will swell, and both my mouth and throat will itch mercilessly!  So, I avoid eating these foods in the spring, at least through end-June.

The good news? Cooking the offending food can denature the protein cross-reacting with the pollen to which you are allergic.  For example, if eating raw celery or raw carrots triggers an allergic reaction, you may be able to eat cooked celery or roasted carrots without consequence. It will depend on your level of sensitivity and tolerance.

So, when even “healthy” foods cause your immune system to go haywire, what can you eat?!  I know…it can get confusing.

A whole foods detox, like my 7-Day Body Reset Cleanse, can help jumpstart your liver and digestive health, and ease the intensity (or even eliminate) the worst of your allergy symptoms.

Here, too, are 11 tips to ease spring allergy symptoms.

Continue Reading About Allergies (see below):

–Spring Allergies? Love Your Liver (Part 1)
–11 Tips to Ease Allergy Symptoms (Part 3)

Sources

1  Cleveland Clinic. Antihistamines. 7/13/2020.

2  Medical News Today. Anticholinergic Drugs: What to Know. July 16, 2021.

3  Coupland CAC, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med. 2019;179(8):1084–1093.

4  Harvard Health Publishing. Common anticholinergic drugs like Benadryl linked to increased dementia risk. Jan. 19, 2022.

5  Pandya D, Puttanna A, Balagopal V. Systemic effects of inhaled corticosteroids: an overview. Open Respir Med J. 2014 Dec 31;8:59-65.

6  Mayo Clinic. Oral Thrush. April 23, 2021.

7  Molnar I, et al. The Prevalence and Characteristics of Allergy in Autoimmune Thyroid Diseases. Journal of Clinical and Cellular Immunology. March 22, 2015; 6:2.

8  Lai NS, Tsai TY, Koo M, Lu MC. Association of rheumatoid arthritis with allergic diseases: A nationwide population-based cohort study. Allergy Asthma Proc. 2015 Sep-Oct;36(5):99-103.

9, 10  Swiss Interest Group Histamine Intolerance. Histamine Elimination Diet. July 7, 2017.

11  American Academy of Allergy, Asthma & Immunology. Oral Allergy Syndrome. 1/10/24.

12  Chimielewska A, Mazur M, Sacha M, Myszkowska D, Dyga W, Obtułowicz K, Czarnobilska E. Zespół alergii jamy ustnej u pacjentów z alergia pyłkowa [Oral allergy syndrome in patients with pollen allergy]. Przegl Lek. 2013;70(11):885-7.

13  Sussman G, Sussman A, Sussman D. Oral allergy syndrome. CMAJ. 2010 Aug 10;182(11):1210-1.

You are not alone!

Amid budding trees, shrubs, flowers and plants, spring can, unfortunately, feel absolutely wretched for some 81 million Americans—that’s apx. 26% of American adults and 19% of children—who suffer from seasonal allergies, also called allergic rhinitis or hay fever (1).

Seasonal allergic rhinitis is an allergic reaction to pollen from trees, grasses, and weeds and to airborne mold spores. This type of rhinitis occurs mainly in the spring and fall when pollen and mold spores are most abundant. Lucky me…I have both spring and fall allergies [eye roll]!

Common symptoms of seasonal allergies include (2, 3, 4, 5):

–Headache
–Sinus congestion
–Nasal congestion
–Sniffling
–Sneezing
–Runny nose
–Excess mucous
–Post-nasal drip
–Scratchy throat
–Itchy throat
–Frequent throat clearing
–Fatigue
–Brain fog
–Watery, red and / or itchy eyes
–Puffy eyes
–Large dark circles under the eyes, a.k.a., “allergic shiners”
–Clogged or itchy ears
–Asthma symptoms (newly triggered or a worsening of asthma if you already have it)
–Coughing
–Wheezing
–Shortness of breath
–Itchy skin
–Hives
–Rashes

The Consequences of Allergies

Allergy symptoms can compromise your quality of life. 

Standardized quality of life measures have found that among patients with allergic rhinitis, 62% acknowledged that their allergies had a significant, negative impact on their daily life (6).

Yes! I’ve had seasonal allergies forever—and they have always wreaked havoc on my energy, mood and productivity. I remember how, as a child, I spent summer and fall, sneezing my way through countless boxes of tissues. In college, I popped Benadryl like candy between August through October—even though it left me zombie-like—so desperate was I for symptom relief. The hope that I would “outgrow” my seasonal allergies…well, that never happened! In fact, after living in New York City for 10 years, I developed new (spring) allergies, which manifested as intense headaches, sneezing, congestion, brain fog, debilitating fatigue, lethargy, and modest weight gain because my body was perpetually inflamed. It took everything I had to get through the day.

Though seasonal allergies seem harmless—just a temporary inconvenience that we need to soldier through—allergies are the 6th leading cause of chronic illness in the U.S., with an annual cost exceeding $18 billion (7).

Allergies are also on the rise, affecting 30% of adults and 40% of children, with significant increases in food allergies and skin allergies among children under age 18 (8).

What Are “Allergies” Anyway?

Allergies are your body’s reaction to a foreign protein. If you have an allergy to a particular protein—for example, Fel d 1, a glycoprotein specific to cats—your immune system overreacts in its presence (9, 10) and produces IgE antibodies. These IgE antibodies travel to cells that release histamine, a chemical that plays an important role in your body’s inflammatory response, including allergic reactions. Histamine is mostly stored in mast cells (immune cells found in mucosal and epithelial tissues throughout the body) in tissues and in basophils (a type of white blood cell involved in inflammation and allergy) in blood. (11)

Histamine regulates several bodily functions, but it is best known for causing allergy symptoms in the nose, lungs, throat, and/or on the skin. For example: sneezing, wheezing, scratchy throat, hives and itching. An inability to break down histamine can lead to a condition called “histamine intolerance”, characterized by excess histamine levels in the body that can make you feel like you are allergic to everything all the time!

Aside from allergy symptoms causing mild to acute physical discomfort, other consequences associated with allergic rhinitis include (12):

• • Disruption of daily routine or activity
  • Disturbed sleep
  • Increased daytime fatigue
  • Inability to pay attention and focus
    *Note: Children with allergic rhinitis are more likely to be diagnosed with ADHD, have lower exam scores during peak pollen seasons, express low self-esteem and have impaired athletic performances.
  • Decreased cognitive functioning in both adults and children
  • Irritability or mood swings
  • Hyperactivity
  • Parenting stress and/or negative relationships between mothers and their children

“Good” vs. “Bad” Inflammation

Allergy symptoms result from inflammation caused by chemicals (e.g., histamine, prostaglandins and leukotrienes) that we release from our own cells in an attempt to “protect” us from an allergen (13). Because allergies = inflammation, it is important to understand the difference between “good” vs. “bad” inflammation.

Acute inflammation is considered “good” inflammation, a biological process where the body protects itself from foreign substances, such as bacteria, yeast, viruses, parasites and toxic chemicals. Acute inflammation occurs with an infection (e.g., sore throat) or an injury (e.g., a burn). Acute inflammation can last up to a few days; it is an immediate, adaptive and controlled response against infectious or foreign substances. The physiological goal of inflammation is to protect and rebalance the body and to help heal the site of injury or infection (14).

On the other hand, chronic inflammation = “bad” inflammation. Why? Because chronic inflammation is slow, long-term inflammation that can last for months, up to years. Prolonged, out-of-control inflammation increases the risk of damage to your tissues and organs, including the digestive system, endocrine system, joints, muscles, heart, and brain. Chronic inflammation is a root cause of chronic conditions, like heart disease, diabetes, overweight / obesity, autoimmune diseases (e.g. rheumatoid arthritis) and Alzheimer’s Disease.

Chronic inflammation can result from (15):

1. 1. Your body’s inability to get rid of the source causing acute inflammation.
   2. Chronic exposure to low levels of a chemical toxin(s).
   3. An autoimmune disorder (e.g., rheumatoid arthritis, Hashimoto’s thyroiditis, inflammatory bowel disease), where your immune system mistakenly attacks your body because it is unable to distinguish between your cells and foreign cells.
   4. A defect in the cells mediating inflammation.
   5. Repeat episodes of acute inflammation.
   6. High levels of oxidative stress, leading to increased free radical production that result in inflammatory markers, such as oxidized lipoproteins (small, dense LDL particles), high levels of homocysteine, or high uric acid.

Whether an allergic response to an allergen(s) is mild or severe depends on the extent to which your immune system is battling—and overwhelmed by—other sources of inflammation; for example, food intolerances, poor quality or too little sleep, hormone imbalances (e.g., Type 1 and 2 diabetes, Hashimoto’s thyroiditis, prostatitis), exposure to chemical toxins, and physical, psychological or emotional stressors.

Many people perceive allergic rhinitis as “temporary” (i.e. seasonal). However, if, in addition to hay fever, the immune system is simultaneously battling multiple inflammatory stressors (e.g., high sugar intake, excess alcohol consumption, birth control pills, sleep loss, work stress, etc.), severe hay fever can, over time, lead to other chronic inflammatory conditions, such as sinusitis, allergic asthma, eustachian tube dysfunction (eustachian tubes are the canals that connect the throat to the middle ear), or chronic otitis media (middle ear infection), particularly in children (16).

This is why getting relief from allergy symptoms means more than just suppressing symptoms with antihistamines, nasal steroid sprays or other pharmaceuticals. If you are an allergy sufferer, one of the best ways you can support your body is by making anti-inflammatory food and lifestyle choices to lighten the inflammatory load.

Working with a functional health coach can help address root causes of your allergies, as well as provide food and lifestyle guidance and support. If you have questions about functional health coaching or how we would work together, you can schedule a Free 15 Minute Consultation with me HERE.

A Leaky Gut Can Worsen Allergy Symptoms

Did you know: 70-80% of your immune system resides in your gut?

A healthy gut microbiome is key to improving how your body responds to seasonal allergies.

Having intestinal permeability or a “leaky gut” can lead to—or exacerbate— allergies. Your gut becomes leaky through a poor diet that is high in sugar, flours, starches, inflammatory fats (e.g. vegetable oils), processed foods and fast food; stress; hidden or chronic infections; heavy metals (e.g., mercury, lead, arsenic); pesticides; chemical toxins in food, water or the environment; undiagnosed food sensitivities; mold toxins; and poor gut flora (too much bad bacteria; too little good bacteria).

Our digestive tract is protected by a gate-like gut barrier that allows specific substances (e.g., vitamins and minerals) to go through, while keeping “foreign invaders”—such as food proteins, undigested food particles, bacteria, viruses, parasites and other xenobiotics (disease-causing compounds)—out of the bloodstream. With a compromised or “leaky” gut barrier, however, things like bad bacteria, toxic waste and gluten can pass from the intestinal wall into the bloodstream. This creates inflammation throughout the body, triggering—or worsening—allergy symptoms.

What You Can Do

Environmental precautions you can take include (17):

1. Limit the time you spend outdoors when pollen counts are high.
   Pollen counts are lowest before dawn, at their peak by midday, and slowly fall in the evenings. If you want or need to go outside, mornings are the best time to do so. Dry, windy weather increases the amount of pollen in the air; rain lowers it.

2. Keep windows closed during peak season or peak pollen times.

3. Use central air conditioning with a Certified Asthma and Allergy Friendly filter and/or a HEPA air purifier to reduce indoor airborne allergens, including pollen that may enter your home through windows, doors, pets or your clothes. Keep up with filter maintenance and make sure your air ducts are clean!

4. Avoid exposure to endocrine-disrupting synthetic fragrances from personal care products, perfumes, cleaning products, laundry detergents and air fresheners. Synthetic fragrances typically contain phthalates, a fixative for scent, and can aggravate an already overwhelmed immune system and trigger or worsen allergy symptoms, including respiratory problems, migraines, atopic dermatitis and asthma (18).

5. Wipe pets off before they come into the house if they spend a lot of time outdoors.

6. Launder bedding and clothing in hot water at least once a week.

7. Shower before bed (to wash off any residual pollen from the day).

12 Tips for Natural Allergy Relief

External environmental measures for reducing allergy symptoms will only take you so far. The best defense is a good offense. Try the following food and lifestyle strategies during allergy season, roughly April through June. They can help mitigate the severity of spring allergy symptoms because you are reducing your overall inflammatory load.

1.  Eliminate or reduce caffeine. This includes all caffeinated coffees, teas and energy drinks. Herbal teas are fine to drink. Caffeine can inhibit the breakdown of histamine in your body and promote the release of histamine (19).

2.  Eliminate or limit alcohol. Remember: alcohol, especially red wine, is a major source of histamine (20).

3. Cut dairy. Milk and milk-based products (e.g., milk, cheese, yogurt, cream) has long been associated with increased respiratory tract mucous and with asthma (21). And if you were wondering: eggs are NOT a dairy product because they don’t come from the milk of a cow.

4.  Remove any foods, to which you have a known or suspected sensitivity.  Eating foods to which you are sensitive creates more inflammation, forcing your immune system to work overtime.  Common culprits include wheat, gluten, dairy, soy, corn, shellfish, eggs and peanuts.

5.  Minimize consumption of high histamine foods.  As much as possible, avoid high histamine food and drink during allergy season. This is not an exhaustive list, but main offenders include:

— Fermented foods:  Sauerkraut, kimchi, yogurt, soy sauce, vinegar
— Fermented drink:  Wine, beer, champagne, spirits, kombucha
— Vinegar-containing foods:  Pickles, mayonnaise, balsamic vinegar, ketchup
— Cured, smoked or processed meats:  Bacon, salami, deli meats, hot dogs
— Dairy:  Cheese, goat cheese
— Fish:  Canned or smoked fish (fresh fish is fine)
— Dried fruit:  Apricots, prunes, dates, figs, raisins
— Vegetables:  Spinach, eggplant, mushrooms
— Processed foods:  Contain preservatives that are high in histamine.

Be sure to check the pollen count.  When it’s high, you’ll want to be especially mindful of making low-histamine food choices that day.

6.  Eat fresh foods and freeze leftovers. What to eat? Stick with freshly cooked meats, poultry and fish; eggs; vegetables (especially leafy greens); fresh herbs; non-dairy milks and herbal teas. Store any leftovers in the freezer since the bacteria that produce histamines start to build up right away in leftovers, even when stored in the refrigerator.

7.  Eliminate refined and processed sugars.  The average American consumes 22 teaspoons of added sugars a day. Refined sugar consumption depresses immune function. One study found that consuming 3.5 ounces of a simple carbohydrate (e.g., fructose, honey, pasteurized orange juice) suppressed the immune system within 30 minutes of ingestion and lasted up to 5 hours (22).  

Not only does sugar lower your immune function, it also increases inflammation.  And, since allergy symptoms are the result of inflammation caused by the release of histamine, anything that makes you more inflamed (like sugar) worsens allergies.

8.  Avoid foods to which you have a known allergy or sensitivity AND cross react with seasonal pollen.For example, the pollen in birch is similar to the proteins in foods, like almonds, apples, carrots, celery, parsley, pear and plum. If you are allergic to birch pollen, and you eat, say, celery, your body can’t tell the difference between the pollen and the food protein in celery. Your immune system gets confused and treats the celery like a “foreign invader”, triggering an allergic reaction. This is “cross-reactivity”. Click here to read more about Pollen-Food Syndrome.

9.  Move your body daily—to tolerance.  During allergy season, you may experience headaches, fatigue and lethargy as your immune system battles allergens. Instead of pushing your body to exercise hard and long, give your body the rest it craves. Exercise to tolerance. Choose gentler forms of movement: taking long walks, yoga, Pilates, stretching or any other movement that you enjoy.

10.  Sleep 8 to 9 hours. Sleep is vital to immune health. During allergy season, you will likely be more fatigued than usual since your immune system is working overtime to fight allergens. Help your immune system recharge by being in bed between 10PM and 11PM and getting 8 to 9 hours of restorative sleep.

11. Supplements that support immune health.  Take a high-quality probiotic.  I favor this dairy-free probioticto support digestive and immune health during allergy season.  A big plus is that it does not need to be refrigerated. Other supplements that are helpful, especially during allergy season (and which I take myself) include:Quercetin, Vitamin D with K2, Vitamin C with Flavanoids and Liver GI Detox.

12.  Do a spring cleanse.  If you’re an allergy sufferer, spring is the perfect time to do a whole foods-based cleanse, like my DIY 7-Day Body Reset Cleanse, which eliminates common food allergens, including many high histamine foods, and supports liver detoxification. Removing foods to which you are sensitive—even temporarily—can help improve digestive health, boost immunity and tame inflammation in the body, enabling you to experience greater relief from allergy symptoms.

Functional Health Coaching and Allergies

If allergy symptoms are affecting your quality of life and/or you are dependent on antihistamines, nasal steroids or other medication to get through the day, you may have an underlying condition (e.g., hormone imbalance, digestive issues) that is driving your symptoms.

It IS possible to get natural relief from seasonal allergies. Personally, I have not taken an antihistamine in over 10 years. Every person is biologically unique and a one-on-one, custom-based approach can make a difference between spending your spring, holed up indoors near the air purifier; or, literally, smelling the flowers outside.

If you would like to speak with me about how functional health coaching can help you, schedule a Free 15 Minute Consultation HERE. Or email me HERE.

Sources:

1, 7, 17  Asthma and Allergy Foundation of America.

2, 3  American College of Allergy, Asthma and Immunology.

4, 13  Akhouri S, House SA. Allergic Rhinitis. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from NCBI / NLM.

5, 16  InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Hay fever: Overview. [Updated 2020 Apr 23]. Available from NCBI / NLM.

6, 12  World Allergy Organization. In Depth Review of Allergic Rhinitis. [Updated Oct 2020].

8  Jackson, K.D., Howie, L.D., Akinbami, L.J. Trends in Allergic Conditions Among Children: United States, 1997-2011. NCHS Data Brief. No. 121. May 2013.

9  Bonnet, B., Messaoudi, K., Jacomet, F. et al. An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen. Allergy Asthma Clin Immunol 14, 14 (2018).

10, 11 Cleveland Clinic. Histamine. Reviewed on 3/28/23.

14  Hannoodee S, Nasuruddin DN. Acute Inflammatory Response. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Acute Inflammatory Response. [Updated: 2022 Nov 14]. Available from NCBI / NLM.

15  Pahwa R, Goyal A, Jialal I. Chronic Inflammation. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from NCBI / NLM.

18  Steinemann, A. International prevalence of fragrance sensitivity. Air Qual Atmos Health  12, 891–897 (2019).

19  John J, Kodama T, Siegel JM. Caffeine promotes glutamate and histamine release in the posterior hypothalamus. Am J Physiol Regul Integr Comp Physiol. 2014 Sep 15;307(6):R704-10.

20  Zimatkin SM, Anichtchik OV. Alcohol-histamine interactions. Alcohol Alcohol. 1999 Mar-Apr;34(2):141-7.

21  Bartley J, McGlashan SR. Does milk increase mucus production? Med Hypotheses. 2010 Apr;74(4):732-4.

22   Albert Sanchez, J. L. Reeser, H. S. Lau, P. Y. Yahiku, R. E. Willard, P. J. McMillan, S. Y. Cho, A. R. Magie, U. D. Register, Role of sugars in human neutrophilic phagocytosis, The American Journal of Clinical Nutrition, Volume 26, Issue 11, November 1973, Pages 1180–1184,

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