There are two types of rhinitis: perennial; and seasonal (hayfever), a pollen sensitivity during late May to early August. Patients with rhinitis in early spring usually react to various wind-pollinated trees, weeds, shrubs or grasses.

Perennial rhinitis occurs all-year round and is like a cold that lasts forever.

Perennial rhinitis and sinusitis are frequent co-passengers, as the mucous membranes of the nasal passages and sinuses flow together. The continual allergic or fungal attack on these membranes often causes them to proliferate, leading to polyps, usually in the nasal passages. These polyps, in turn, make the problem worse by causing a physical obstruction in an already blocked nose.

What doctors tell you
The usual treatments for rhinitis are various drugs that only suppress the problem, such as antihistamines, which block the effects of histamine, a chemical released during an allergic reaction. Histamine is mainly responsible for the inflammation, sneezing and itching symptoms of rhinitis. Although antihistamines may be well tolerated, they commonly cause a dry mouth, nose and eyes, and drowsiness. The latest ‘second-generation’ drugs, such as Allegra and Clarityn, despite their claims, still come with a range of side-effects. Long-term use of topical steroid sprays, such as Beconase or Rhinocort, offers all the dangers of ordinary steroids.

The only conventional treatment of polyps is surgery, or a polypectomy. Although this can improve matters, it’s often only for a few months until the polyps recur because the underlying cause has not been addressed. Some of my patients have undergone as many as 10 polypectomies.

Perennial rhinitis has at least four main causes:
* inhalant allergies, such as housedust, dust mites, moulds, animals and feathers
* food allergies or intolerance
* fungal/yeast problems
* magnesium deficiency, which can worsen any or all of the above causes.

You will know you have this problem if you are worse:
*in dusty environments or first thing in the morning
* in August or September, especially on humid days before thunderstorms. In the hours before a thunderstorm, there is a marked increase in mould counts and a marked increase in hospital admissions for asthma
* after sweeping up mould-ridden leaves or turning over a compost heap
* in any damp, musty dwelling, indicating a reaction to indoor moulds.
Another clue is if you are better in hot dry climates, such as the Algarve or Greek islands. Dust mites don’t survive in high heat and are extremely thirsty for water, and can’t live in desert-like environments. If you don’t improve in these situations, suspect a food sensitivity or a fungal/yeast problem.

You can also test for inhalant sensitivity with prick tests and radioallergosorbent test (RAST; a blood test measuring immunoglobulin E reactivity).

Foods play a large part in perennial rhinitis. Milk sensitivity is very common and frequently described as ‘mucus-forming’, but any food can be implicated. Suspect a food sensitivity if you have:
* no history of inhalant sensitivity and a negative response to skin inhalant tests
* a history of food cravings
* abdominal distention after food, or puffy swelling of the ankles and fingers
* occasional bouts of a rapid heartbeat or sweating for no apparent reason
* weight problems and sudden, dramatic weight fluctuations from day to day.

Don’t discount alcoholic drinks. Scotch whisky, for example, comprises wheat, corn, yeast and sugar. If you’re sensitive to any of these, you’ll notice an increase in rhinitis after drinking it. As alcohol is absorbed incredibly quickly, the response is more obvious than if ingested as food.

Food intolerance usually involves several food groups, so excluding only milk and cereals, for example, rarely succeed, as only part of the problem is addressed.

The role of fungus
If the problem isn’t due to inhalants or food, it could be due to a fungus – fungal rhinitis (if it affects just the nose) or rhinosinusitis (affecting both the nose and sinuses).

Dr Jens Ponikau et al. reported on a new technique for collecting and testing mucus that showed that 202 of 210 patients with chronic rhinosinusitis had fungi in their mucus (Mayo Clin Proc, 1999; 74/9: 87784). They also detected eosinophils (a type of white blood cell commonly found in an allergic response) in the nasal tissues of nearly all of these fungal patients. Interestingly, most of these patients, however, were not sensitive to immunoglobulin E, suggesting that the rhinitis/sinusitis resulted from the body’s immune response to fungi. Such a non-allergic response may explain why many patients fail to respond to antihistamines.

Three years later, the same team reported the results of fungal treatment for their patients (Immunology, 2002; 110: 862-6). Amphotericin B was applied intranasally (at a dose of 20 mL of a 100 mcg/mL solution) twice a day. Sinusitis symptoms improved in 75 per cent of the patients and almost half of these were shown, by endoscopic examination, to be totally disease-free. Other studies have reported similar findings.

As the source of these yeasts or fungi lies in the gut, further improvements may result from the more fundamental approach of restoring balance to the gut flora using an anti-Candida regime.

Magnesium deficiency
Don’t forget the role of magnesium. A deficiency of this mineral can lead to instability of mast cells, which release histamine during an allergic response, thereby causing the symptoms of rhinitis. This was shown in animal experiments (using rats) carried out at Brigham Young University in Utah (J Am Coll Nutr, 1990; 9/6: 616-22).

The study concluded that both the blood and urine histamine levels of severely magnesium-deficient rats were significantly higher than those of other rats throughout the study, particularly after specific antigen challenges. The amount of antigen used in the challenges also had the effect of exacerbating the magnesium deficiencies in the blood and urine.

Although animal studies don’t always apply to humans, similar findings were made in clinical trials at the University of Turin (Allergy, 1987; 42: 186-8). These results suggest that a magnesium deficiency can aggravate diseases that are caused by abnormal histamine release as a result of allergic responses to inhaled or food allergens.

Dr John Mansfield
Dr Mansfield runs the Burghwood Clinic (see http://www.burghwoodclinic.co.uk) and specialises in environmental and nutritional medicine.

Researchers in Nottingham surveyed the vitamin E intake of a random sample of 2633 adults, aged 18 to 70. Each of the individuals supplied information on their intake of vitamins E and C, magnesium, polyunsaturated fats and other nutrients, via a food frequency questionnaire.

The participants also underwent measurements to determine their sensitivity to grass pollen, cat fur and other allergens, as well as to provide information on the nature of their asthma and hayfever.

On putting all of the information together, the researchers found that those with the highest daily intake of vitamin E were least likely to suffer from allergen sensitive atopic conditions such as asthma, rhinitis and hayfever.

In addition, none of the other nutrients measured appeared to have the same protective effects nor did vitamin E appear to be more effective in combination with any other nutrient (Lancet, 2000; 356: 1573-4).

Glutathione peroxidase, a selenium containing enzyme, is critically important for reducing the formation of leukotrienes, which are the compounds responsible for allergic reactions. To help ensure optimal activity of glutathione peroxidase, and hence reduce the production of leukotrienes, supplement with approximately 200 mcg per day of selenium (Med Hypo, 1984; 13: 45-50).

An excellent homoeopathic remedy for hay fever is Galphimia glauca, which underwent a German clinical study in 1964 (Allgemeine homoeo-pathische Zeitung, 1967; 212: 533-42) and has been shown to be effective as an anti allergic and an anti asthmatic remedy in controlled trials (Int Arch Allerg Appl Immunol, 1991; 94: 262-5; Planta Med, 1993; 59: 164-7).

In my own practice, I have found a 3DH potency of Galphimia to be very reliable for hay fever related sneezing bouts, swollen eyelids, runny nose and watery, itchy eyes, as well as for mild hay asthma, prickly heat and other minor eruptions of pores.

Other proven homoeopathic remedies for hay fever include: Aranea tela (nervous asthma and sleeplessness); Arundo mauritanica (sneezing, itching in nostrils, roof of mouth, Eustachian tubes and ears); Euphrasia officinalis (allergic conjunctivitis); Histaminum hydrochloricum (allergic muscle pain, skin/mucous membrane irritations); Phaseolus nana (angst, frontal headaches, dilated pupils without sensitivity to light, rapid pulse); Sabadilla (sneezing bouts with all the classic hay fever symptoms); Sambucus nigra (oppressed chest, hoarseness, suffocative coughing); Sanguinaria canadensis (burning eyes, nose and throat, watery discharge from nose); and Marum verum (red, puffy eyelids, ringing earache, mucous membrane growths or inflammations, runny nose, blocked nostrils, sneezing).

In Oriental Medicine, a preparation with proven success is made from fructus Xsanthii sibirici and sesame oil (called cang er zi in Chinese and sojishi in Japanese) which is applied into the nose. In one study testing the remedy on 207 patients with recurrent allergic rhinitis (runny nose), symptoms disappeared in all but 15 cases. Follow up for as long as three years revealed no recurrences (D Bensky and A Gamble, Chinese Herbal Medicine Materia Medica, Seattle, Washington: Eastland Press, 1993: 163).

This herbal medicine may also be combined with fructus Liquidambaris taiwanianae (lu lu tong or feng guo in Chinese and rorotsu in Japanese), which has also been shown in controlled clinical studies to successfully resolve a number of allergic syndromes. Even when taken in combination, follow separate instructions for each of the remedies. Avoid taking either during pregnancy.

In European herbalism, certain species of Ephedra (E vulgaris and E helvetica, in particular) and other sub species have been found to be extremely effective in hay fever (British Herbal Pharmacopoeia, Part 2, 1979: 75-7). One double blind study proved not only that extract of Ephedra was effective against hay fever, but also that patients did not develop a tolerance for it meaning that they did not require progressively more to treat symptoms successfully (J Am Med Assoc, 1977; 237: 553-7).

If your hay fever produces sore throat, an infusion of Salvia officinalis (red sage) may be used as a gargle. It’s wise to remember when suffering from seasonal hay fever that you’re more likely to react to foods, pets and other allergens.

!AHarald Gaier

Harald Gaier is a registered naturopath, homoeopath and osteopath.

Some drugs are more often implicated than others, say researchers at the Drug Safety Research Unit at the University of Southampton. For example, those formulas which use cetirizine or acrivastine were three times more likely to produce drowsiness and sedation than those with loratadine or fexofenadine.

The study found no differences between drugs in terms of the number of accidents and injuries, falls and fractures which patients experienced while taking them. Nevertheless, the findings have clear implications for people in certain types of jobs where safety is critical, such as airline pilots or those operating heavy machinery (BMJ, 2000; 320:1184-7).

The Netherlands examined daily death rates during the pollen season (April to September) between1986 and 1994, and compared these to the reported levels of pollen in the air.

During the study periods, there was an average of 322.5 deaths each day of which 14.8 were heart related, 15.8 due to respiratory disease and 9.8 due to pneumonia. High concentrations of several pollens, particularly the Poaceae variety, were related to higher death rates especially from respiratory disease and pneumonia. Higher pollen concentrations resulted in a small increase in the risk of death from heart failure.

The researchers believe that pollen acts indirectly in the way that it can cause death. Increased mortality, they say, can be explained by the allergic reaction and the inflammatory effect it produces in the body (Lancet, 2000; 355: 1517-8).

Prickly heat (and itchy skin, thrush etc.) may be a symptom of Candida overgrowth. Try an anti-Candida diet, so cut out sugars, simple carbohydrates, and remove fruit – and especially bananas – for a while. . .

With hayfever season upon us (certainly for us in the West), the Bowen technique may help relieve symptoms, says one reader, who is presumably a Bowen practitioner. . .

Threadworms can be treated by eating only halal or kosher meat as any microbes are drained out with the blood.

* I would suggest you check to see if it might be acid reflux or heartburn. This causes a dry cough because of the acid irritating the oesophagus.

If the problem turns out to be school, why not consider home educating? – Barbara Stark

* My son suffered similar symptoms. A homoeopathic doctor diagnosed swollen adenoids that were dripping into the back of his throat. He prescribed silica and the symptoms cleared up within a month (although individual consultation is recommended to obtain a personalised treatment). – Maggie Stocks

Acupuncture
In one study of 174 hayfever sufferers, acupuncture (nine sessions over three weeks) and laser acupuncture (15 sessions) were both shown to have significant effects over placebo procedures (Zeitschr Allg Med, 1998; 74: 45-6).

Herbs
In herbal medicine, stinging nettle (Urtica dioica) can offer improvement even after just one week, according to a double-blind randomised controlled trial (Planta Med, 1990; 56: 44-7).

Ephedra sinica (known as ma huang gen in Chinese herbal medicine) has been used for more than 5000 years for allergic respiratory conditions in the Far East – and without significant side-effects. Indeed, based on studies of the herb in the 1920s, the pharmaceutical company Merck produced and marketed the synthetic alkaloid ephedrine. This was soon widely used in orthodox medicine for all kinds of allergic respiratory problems, including asthma.

However, after this active synthetic was linked with severe hypertension, glaucoma, hyperthyroidism and coronary thrombosis, the use of Ephedra was restricted in most Western countries.

Nevertheless, these problems were not caused by the use of the whole herb, but only by the isolated ephedrine. Apparently, the six or so constituents contained in the plant buffered the action of the ephedrine. One of these, called pseudoephedrine, for instance, reduces heart rate and lowers blood pressure. Consequently, this medicinal plant has been widely used for thousands of years, with no undesirable side-effects.

Despite this, the plant remedy has largely remained ‘restricted’ in the West (Richard Mabey, The Complete New Herbal, London: Penguin Books, 1991, pp 56, 188; British Herbal Pharmacopoeia, Part II, Cowling, West Yorkshire: British Herbal Medicine Association, 1979, pp 75-7).

Ephedra herbs should never be taken together with monoamine-oxidase inhibitors.

Homoeopathy
Homoeopathy has shown success in treating hayfever, as have two derivative versions of it: homotoxicology (using human toxins or ‘homotoxons’ to neutralise and eliminate human toxins) and isopathy (using preparations based on the causal agent). In a double-blind, randomised, controlled trial involving 146 hayfever sufferers, the homotoxicological nasal spray Luffa comp-Heel was just as effective as an orthodox nasal spray containing cromolyn sodium (Forsch Komplementärmed, 1999; 6: 142-8).

Likewise, another double-blind, randomised, placebo-controlled trial found that when sufferers were given homoeopathic dilutions of specific isopathic antigens – individually determined for each patient by prior skin tests – they had less need for antihistamines and their symptom scores were significantly reduced (Lancet, 1986; 2: 881-6).

The UK Pollination Calendar could be used instead of skin tests to determine the specific pollen(s) causing an individual’s seasonal hayfever. Having this information allows the appropriate isopathic remedy to be prepared.

A review of seven separately conducted, randomised, placebo-controlled trials, involving 752 patients in total, found Galphimia Glauca to be effective in 79 per cent of hayfever cases, eliminating or improving eye and nose irritations as effectively as did orthodox treatments (Forsch Komplementärmed, 1996; 3: 230-4).

Harald Gaier is a registered homoeopath, naturopath and osteopath.

Over 800 children living in the countryside were tested for their susceptibility to asthma and hayfever. Some of the children lived on farms, thus exposing them to high levels of dust contamination – including particles of animal manure. Samples of dust were taken from the beds of both the farm and non-farm children, and correlated with their allergic sensitivity.

On the face of it, the findings defy common sense because the least allergic children were discovered to be the ones who slept in the dust-covered farm beds.

The explanation put forward by the researchers is that endotoxins (bacterial poisons) in the farm dust act as ‘potent immunostimulants’ and strengthened the child’s immune system.

This ties in neatly with other studies showing that children growing up in pet-loving households have less asthma and allergies.

Timing appears to be crucial, however. The earlier the exposure to the endotoxins, the better – including even the first days of life.

In the past, the idea that eating a peck of dirt will bolster a child’s health has been regarded as something of an old-wives’ tale. But it has now been granted official status as the ‘hygiene hypothesis’ (N Engl J Med, 2002; 347: 869-77).