Laurie Menk Otto, ND, MPH

Naturopathic Medicine | Portland, Oregon

Tag Archives: Portland Allergy Naturopath


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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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Alternatives to antihistamines safer, equally effective

SLIT Allergy TreatmentWith spring allergies in full swing and summer allergies on the way, many turn to over-the-counter (OTC) medications for relief. Antihistamine use, however, often comes with undesired side effects such as drowsiness, loss of libido, increased appetite, and depression. Additionally, recent studies suggest that common allergy drugs with antihistamines may have more severe impacts on health, creating additional risks for allergy sufferers. I can help with options for allergy relief when OTC medications raise concerns.

Caution with antihistamines

Researchers at the University of Oregon discovered that muscle recovery and muscle gain after exercise may be blunted by over the counter drugs commonly used for allergy and acid reflux. After rigorous exercise, thousands of genes activate to help the body recover. But with elevated antihistamine levels, nearly 30 percent of genes don’t respond as effectively.
It turns out that histamine, the bodily substance most often associated with allergy symptoms, is also important for helping blood vessels relax, increasing blood flow, and ensuring the body recovers. Antihistamines, therefore, could create problems for those who exercise often or competitively.

Antihistamines have also been identified as problematic for people with restless legs syndrome, a condition that affects nearly 12 million people in the US. OTC medications such as Benadryl, taken to relieve allergies, or sleeping pills with antihistamines, can make the symptoms worse. This creates added difficulties during allergy season and the need for alternatives for sleep aid and allergy relief.

Another recent study from the University of Washington’s School of Pharmacy links diphenhydramine use (common for allergy relief) to increased rates of dementia. Tracking 3,500 men and women over the age of 65 for an average of seven years, the study found that the use of anticholinergic drugs, including some antihistamines and antidepressants, resulted in an increase risk for dementia. Findings indicated that, “Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.” This finding adds to a growing body of research that says these drugs are not intended for long-term use.

Alternatives to antihistamines

Patients seeking alternatives to antihistamines for allergy relief have options at Heart Spring Health. I offer comprehensive allergy evaluation and testing followed by allergy treatment with a customized prescription of allergy drops tailored to address your specific allergic reactions. Also known as sublingual immunotherapy (SLIT), allergy drops are noninvasive, cost-effective, and convenient. No shots or antihistamines are necessary, and SLIT therapy is effective for people of all ages.

Over time, use of SLIT results in a decreased sensitivity to your allergens, decreased symptom severity, and decreased medication use when exposed to the allergens in the environment to which you are sensitive. SLIT works in a similar way to allergy shots, uses the same FDA-approved antigens, and is recognized internationally as safe and effective. By taking drops under the tongue, they are also easier to administer and result in fewer office visits.

If you are new to allergy drops, here’s how your treatment would begin:

  1. Initiate a comprehensive allergy evaluation to assess symptoms and exposures
  2. Complete allergy testing with skin prick or blood tests
  3. Begin using your customized prescription of liquid allergy drops, taken under the tongue
  4. Plan for long-term use for maximum relief (2-5 years)

Call 503-956-9396 to schedule with me for allergy evaluation and treatment today.

More reading

Sublingual Immunotherapy Allergy Treatment
Immunotherapy FAQs
When is the best time to start immunotherapy?


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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.


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Oral Allergy Syndrome

If you have seasonal or perennial allergies and experience itching in your mouth, throat, or ears when eating certain foods, your symptoms may have oral allergy syndrome. This is caused because the food and pollen to which you are reacting containing proteins that are similar enough that your body recognizes and reacts to them as if they are the same. So, if you have strong allergic symptoms to birch pollen, you may consider avoiding intake of the associated foods during the spring, as symptoms may be worse during allergy season.

Common sense note: if you have any unusual or strong symptoms after eating specific foods, consult a physician for full evaluation, as your symptoms could be due to a more serious form of allergy.

See the chart below (Source: UpToDate®) for foods that may cause oral allergy syndrome, listed by allergy causing pollen:

OAS1OAS2

 

 

 


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When is the best time to treat allergies using immunotherapy?

Birch tree catkin is a common allergen.

Birch tree catkin is a common allergen.

People often ask me this question when discussing treatment for allergies. Any proactive steps towards treating allergy and reducing associated inflammation is a good time. Treatment can be started at any time, however, there are certain times that are ideal for starting immunotherapy, especially for seasonal allergies to tree, grass, or weed pollens. The rationale is that you will experience fewer allergy type symptoms if you start when the allergens are not in large doses in the air.

To avoid making allergy symptoms worse, immunotherapy should be started at least 3 months before your peak allergen season hits. If you have completed allergy testing and identified what you are allergic to, you will know the general season in which your symptoms flare. Then, you can plan to start immunotherapy 3-6 months earlier. Trees, grasses, and weeds pollinate the spring, summer, and fall, respectively, with windows of overlap, leaving many feeling miserable for a few months, especially in the case of multiple allergies. To get a head start without increasing your symptoms, starting immunotherapy during the early winter months is a good bet.

If your allergies are to dust, mold, or pets, which are present year-round, treatment can be started at any time. Medications and supplements used to alleviate allergy symptoms can still be taken while taking allergy drops.

Dr. Laurie Menk Otto does skin (intradermal and skin prick) allergy testing, and sublingual immunotherapy, or “allergy drops” at her practice at Heart Spring Health. With winter approaching, it is a good time to make an appointment for an allergy evaluation and to discuss your symptom picture. Wouldn’t it be nice to get through your next allergy season with less sneezing, runny nose, and itchy eyes?