Laurie Menk Otto, ND, MPH

Naturopathic Medicine | Portland, Oregon

Tag Archives: Allergy Treatment

Portland Allergy Naturopath Dr. Laurie Menk Otto


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Comprehensive allergy treatment and the “allergic load” – what does it mean?

Allergy treatment in my practice often extends beyond direct treatment of the allergy alone. Whether or not a person has allergy is determined by genetics, as well as environment and other factors about the person. The “allergic load” is a helpful concept to understand how I view comprehensive treatment of allergy and asthma, and how I get better results with patients who haven’t had relief in the past.

The most powerful direct tool I have for treating allergy is immunotherapy, which changes the way the immune system reacts in response to allergen exposures and relieve symptoms over time, directly addressing the genetic predisposition towards allergy. I also go deeper to address other factors that may trigger symptoms. The allergic load refers to the non-genetic factors that may lead to and influence overall inflammation in the body, and therefore increase expression of allergy and allergic symptoms. Addressing and understanding allergic load as a concept helps to minimize the influence of irritating factors that have the potential to make allergy symptoms worse.

Some patients come to see me having had allergy treatment in the past, usually through allergy shots, or medications to reduce symptoms, and they tell me that those therapies “helped a little bit,” or “ I think that helped mostly,” but their symptoms weren’t completely relieved. Why are treatments sometimes only partially effective? Why are symptoms worse some days than others, and sometimes inconsistent?

The answer is that there were likely some factors causing inflammation in the body that were not addressed as part of treatment – factors that weren’t addressed using allergy therapy alone, and only temporarily calmed by using medications for symptom control. This is where you gain the most benefit from working with me. We’ll go deeper, and here is what is different:

  • Trigger management. Irritating triggers such as dust, pet dander and hair, mold and pollens are removed or managed, and personal care measures to reduce exposures are addressed. Reducing trigger exposure by cleaning, air filtration, and avoidance is specifically important.
  • Other environmental factors are addressed. Irritant triggers like smoke, perfumes and other chemicals in the home or work environment are addressed when possible.
  • Individual health factors are addressed. Things like hormones and other chronic illnesses or low level infections can worsen allergy symptoms, although they have nothing to do with allergy technically, but aggravate inflammation and symptoms, are addressed or minimized as much as possible.
  • The role of diet. Diet is a very important intervention not only for allergy but also for overall health and longevity. Getting the right nutrients through diet, and reducing foods that are irritating to the system has the effect of reducing inflammation, improves nutritional status, and reducing allergy symptoms. Diet changes always include increasing vegetable consumption to increase intake of chemicals called flavinoids, which help manage inflammation and allergy expression.
  • Digestion and biome. Digestion, absorption of foods, and the intestinal biome influence allergy and inflammation. Elimination of food intolerances, where relevant, are important to decrease inflammatory load and support the biome in such a way that allergy and inflammation are minimized.
  • Chronic stressors such as stress, and sleep have a significant impact on allergy. High stress and poor sleep drive inflammation and tax all body systems, negatively influencing repair and immune balance.

What would it feel like to live with minimal allergy symptoms next year? With some work and investigation, along with carefully chosen therapies, it is possible.

References:

Allergy choices website


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Immunotherapy FAQs

What is sublingual immunotherapy, and how does it work?
Sublingual immunotherapy is a treatment for hay fever type allergies.  Allergen extracts containing antigen are mixed with glycerin as a preservative and delivered in drops under the tongue. The formulation is specific to your allergy test results and symptom picture. Immunotherapy is used, in this case, to “re-train” the immune system away from the allergy-type reaction and towards a reaction that tolerates the same allergens without allergy symptoms.

How are allergy drops different from allergy shots or tablets?
SLIT works in a similar way to allergy shots, and use the same FDA-approved antigens, but the route of administration is drops under the tongue rather than shots. The main difference is that treatment is delivered at home on a daily basis, rather than at an allergist office. Allergy tablets treat single allergens or allergen types (grass, ragweed, dust) rather than multiple allergens and do not come in different dosages.

What kind of allergies are treated with allergy drops?
At our clinic, allergy to tree, grass and weed pollens, animals, dust, and mold are treated using SLIT. Your exact prescription is determined based upon the results of your allergy test. SLIT can treat allergy to multiple antigens at the same time.

Can food allergy be treated with SLIT?
Allergy to foods are treated with SLIT, and may be sought at an allergist’s office.

Who can be treated with SLIT?
At this clinic, anyone over age 3 is a good candidate for allergy treatment using SLIT. Some people may choose allergy drops over shots due to the convenience of in home administration, fewer doctor’s office visits, the safety profile, or if they don’t respond well to or tolerate shots well. Young children, people with asthma, highly sensitive people, and people with multiple allergies may choose to treat their allergies with SLIT rather than allergy shots. Anyone with uncontrolled asthma symptoms is not a good candidate for this type of allergy therapy.

How is the treatment managed?
There are two phases of treatment. The first phase of treatment is the “buildup phase” during which the dose of allergy drops is increased every week over a series of weeks or months. Appointments in buildup phase are held every 5 weeks. The second phase of treatment is the “maintenance phase,” where drops are at the highest dose and appointments are held every 10 weeks. Symptoms are monitored carefully to troubleshoot the best additional treatments.

Will medical insurance cover the costs?
At this time, most insurance companies cover the cost of diagnostic allergy testing and office visits. However, because allergy drops are an off-label use, they are not covered by insurance. Allergy drops often do qualify for HSA or flex spending reimbursement.

How long will I need to take allergy drops?
Most often, SLIT will be prescribed for 2-5 years, after which point the need for it will be reassessed. Benefits are often felt within in the first few months, with some variance among individuals. For the greatest symptom control (no reaction to what causes your allergy symptoms) 2-5 years is generally recommended. Please be aware that SLIT is intended for long-term use, and if discontinued early, benefits may not be experienced. This treatment “re-trains” the immune system over a period of time.

Are allergy drops safe? Are there studies that evaluate their effectiveness?
SLIT has been used in other countries for many years, and studies document their safety and effectiveness. The World Health Organization has endorsed SLIT as a viable alternative to allergy shots. The Cochrane Collaboration, which is the world’s most trusted international organization dedicated to reviewing health care treatment, concluded that allergy drop immunotherapy (SLIT) significantly reduced allergy symptoms and use of allergy medications.


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Beyond Allegra and Flonase: Naturopathic Tips for Portland’s Allergy Season

Allergy treatment from Dr. Laurie Menk OttoYou know that feeling…the little itch in your nose or eyes. That’s when you know allergy season is on its way. Last year in Portland we had what felt like a very long allergy season. Did you know that you don’t have to suffer from allergies forever?

Immunotherapy is the only treatment for allergy that changes the way immune system reacts to allergens, ultimately leading to fewer or no symptoms after treatment. In other words, immunotherapy re-trains your body to stop reacting. I use sublingual immunotherapy or “allergy drops” to treat allergy. This treatment is very convenient—it’s as easy as taking drops under your tongue each day, and it does not require frequent office visits or shots. Relief can be felt as early as several weeks into treatment.

Your allergy drops are mixed specifically for your allergy. This is important, because drops allow you to receive treatment for all of your environmental allergens. Treating for just one or two allergens would not bring about strong symptom relief. If you are allergic to trees, dust, and dogs, you can be treated for all of them at the same time.

Is this different from taking an antihistamine?

Yes. Antihistamines and nasal sprays are often recommended to control allergy symptoms, but many people don’t like the side effects or don’t want to rely on medications forever. That’s where I can help develop treatment that is very specific to your symptoms.

What else can be done?

Identifying what you are allergic to, controlling your environment to reduce exposure, and starting immunotherapy are your best bets to feel lasting relief and stop symptoms for good.

First, allergy testing is used to identify exactly what you are reacting to. It’s an easy test that takes one hour, and you have results by the time you walk out the door. You will leave the appointment that day with a list of actions that you can take to remove allergens from your environment, which alone will help to reduce symptoms. But it doesn’t stop there. Diet or other changes can help to reduce symptoms further, and if you are looking for alternatives for symptom control, I can help you with other options.

When should I start?

Ideally, start the process of identifying your allergies with skin or blood tests at least three months before your allergy season. Allergy evaluation and immunotherapy, however, can be started at any time.

Make this your year to start treatment to end your allergies. Stay tuned for future installments on my blog to learn about naturopathic allergy treatment options, or give me a call to schedule a consultation.

 


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Why see an ND for comprehensive allergy treatment

Comprehensive allergy treatment – what does this mean?

Naturopathic doctors are well known for addressing diet and lifestyle with every single patient, regardless of their underlying health condition. Treating allergy is no exception.

The most powerful direct tool I have for treating allergy is immunotherapy, which changes the immune system to relieve symptoms. But there might be more to the picture for complete symptom relief, and this is where working with me, or a naturopathic physician, will benefit you. We go deeper to figure it out.

Some patients come to see me to inquire about sublingual immunotherapy having had allergy treatment in the past, usually through allergy shots, or medications to reduce symptoms, and they tell me that those therapies “helped a little bit,” or “ I think that helped mostly,” but their symptoms weren’t completely relieved. Why is this? There must be an answer, right?

This is where you gain the most benefit from working with me, or a naturopathic physician. We’ll go deeper, and here is what is different:

  • We look at the local environment. Irritant triggers like smoke, perfumes and other chemicals in the environment, as well as hormones and weather changes can cause allergy-type symptoms that have nothing to do with allergy, so we find and reduce or minimize them as much as possible.
  • We pay attention to diet. What we eat and how our body uses the food is one of the foundations of health. Getting the right nutrients in and reducing foods that are irritating to the system reduces inflammation, improves nutritional status, and reduces allergy symptoms.
  • We make sure digestion is working well. Digestion and absorption must be strong in order to use all of the great foods that are being eaten. Elimination is also important, so we correct diarrhea, constipation, and other digestive disturbances.
  • We evaluate energy, stress, and sleep. All of these comprise the greater environment of the person. High stress and poor sleep cause inflammation and tax all body systems, and poor energy is a sign that something is out of balance. Think of it this way – will your garden produce with deficient, sandy, or nutrient deficient soil? No, it won’t. If your body has underlying inflammation or is depleted due to any of the above imbalances, or is deficient due to poor diet or high stress, or if the underlying environment is unhealthy, symptoms are an expression of this.

What would it feel like to live without allergy symptoms next spring? With some work and investigation, along with directed therapies, it is possible.