allergic rhinitis & nutritional medications

Presented byMahdi SufianNutrition Sciences undergraduate student atScience & Research Branch of Islamic Azad University- Faculty of Nutrition & food industry sciences

Fall 2012

[email protected]

04/12/23All rights reserved by Mahdi

Sufian 1

Introduction Epidemiology Pathology Medical Management Diet therapy Best foods Reference


Sufian 2

Prevalence of AR in EuropePrevalence of AR in Europe

28.5%

24.5%

20.6%

16.9%21.5%

26%

Data from Bauchau & Durham, Eur Respir J 2004; 24: 758–64


Sufian 4

Allergic rhinitis involves inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, sinuses,& pharynx. The nose invariably is involved, and the other organs are affected in certain individuals. Inflammation of the mucous membranes is characterized by a complex interaction of inflammatory mediators but ultimately is triggered by an immunoglobulin E (IgE)–mediated response to an extrinsic protein.[7]

PathologyPathology

Symptoms (patient may not present with all)

Majority of patients experience worst symptoms in the morning

Majority of patients experience associated symptoms Quality of life is significantly impacted

Sneezing

Nasal itchAnterior rhinorrhea

Posterior rhinorhea (postnasal drip)Congestion

Ocular symptoms

Клинические рекомендации. Аллергология / под редакцией Р.М.Хаитова, Н.И.Ильиной- М.-ГЭОТАР-Медиа.-2006.-240 стр

Domestic (indoor): dust mite, cockroach etc.

Animals/ birds (hair, dandruff, saliva of cats, dogs, guinea pig, horse etc.)

Spores of fungi Pollen (outdoor) Food Drugs Insects

Аллергология. (Общая аллергология). Т.1. Под ред. Г.Б.Федосеева.-Санкт-Петербург: «Нормед-Издат»б 2001.-816 стр

Animals/ birds (hair,Animals/ birds (hair, dandruffdandruff, , salivasaliva of of cats, dogscats, dogs, , guinea guinea pig, horse etcpig, horse etc.).)

A magnified view of sunflower pollenA magnified view of sunflower pollen

Peanuts, fishfish, , eggseggs, , milkmilk, , sea-food sea-food are common allergens

Itch, rhinorrhea,sneezing

Conjunctivitis

Bronchospasm

Wheals, flare

Nasal congestion

Hyperreactivity of nasal

and bronchial mucosa

Asthma

Chronic urticaria

Early symptomsEarly symptoms

Late, persistent symptomsLate, persistent symptoms

Eosinophil

Mast cellMast celleFcRIeFcRI

AllergenAllergen

Th2Th2

Антигенпрезентирующаяклетка

Lymphocyte

CD80/86CD28

IL-4IL-13

VCAM-1

IL-3, IL-5

GM-CSF

HistamineLeucotrieneProstaglandinsBradykinins, PAF etc.

BBLymphocyte

IgEIgE

?

H1

Mast Cells Mediate Allergic and Inflammatory ReactionsMast Cells Mediate Allergic and Inflammatory Reactions

Mast Cell Histamin

e

FceRIIgE +

Nose: itch, sneezing, rhinorrhea;

Eyes: itch, redness, watery eyes;

Skin: itch, wheals, flare

Bronchi: bronchospasm, hypersecretion.

Courtesy of Prof. M. Maurer.

17

Mast Cells Mediate Allergic and Inflammatory Reactions Mast Cells Mediate Allergic and Inflammatory Reactions

HistamineIL-1, IL-2, IL-3, IL-4, IL-5, IL-6,

IL-8, IL-10, IL-13, TNFa, MIPs, IFNg,

GM-CSF, TGFb, bFGF,

VPF/VEGF, PGD2, LTB4, LTC4, PAF, serotonin,heparin,

Chondroitine sulphate,Chimase, Tryptase

Catepsin G

Recruitment of inflammatorycells

Extravasation

Vasodilatation

Activation

ТК

Courtesy of Prof. M. Maurer.18

ARIA = Allergic Rhinitis and Its Impact on Asthma.ARIA UPDATE 2008

Intermittent• <4 days per week or• <4 weeks

Persistent• > 4 days per week and• > 4 weeks

MildNormal sleep and

• No impairment of daily activities, sport, leisure

• Normal work and school

• No troublesome symptoms

Moderate-SevereOne or more items

• Abnormal sleep• Impairment of daily

activities, sport, leisure

• Abnormal work and school

• Troublesome symptoms

ARIA 2008ARIA 2008

CongestionCongestion RhinorrheaRhinorrheaItching/Itching/

SneezingSneezing DurationDuration

Intranasal steroidsIntranasal steroids ++++++ ++++++ ++/+++++/+++ 12-48h12-48h

Oral antihistaminesOral antihistamines ++ ++++ +++/+++++/++ 12-24h12-24h

Oral decongestantsOral decongestants ++ -- -/--/- 3-24h3-24h

Intranasal cromonesIntranasal cromones ++ ++ +/++/+ 2-6h2-6h

AnticholinergicsAnticholinergics -- ++++ -/--/- 4-12h4-12h

AntileukotrienesAntileukotrienes ++++ ++ -/--/- Not reportedNot reported

Bousquet et al. Allergy. 2003;58:192.Bousquet et al. Allergy. 2002;57:841.Van Cauwenberge et al. Allergy. 2000;55:116.

“Corticosteroids are the most effective pharmacological treatment for allergic rhinitis.”

“The effect of topical corticosteroids on nasal blockage and their anti-inflammatory properties favor them above

other treatments.”

Omega-3 Fats Vitamin C Quercetin

& Probiotics


Sufian 22

Research suggests that a high consumption of omega-3 fatty acids is associated with a decreased risk of allergic rhinitis.

While omega-3 fats can reduce inflammation, many omega-6 fats can produce inflammatory prostaglandins and may thus worsen hay fever.


Sufian 23

Shown to suppress allergic reactions in test animals and, more recently, in humans. In mice, rosmarinic acid has been shown to work by suppressing allergic immunoglobulin responses and inflammation caused by leukocytes.

Rosmarinic acid is found in many culinary herbs such as oregano, lemon balm, sage, marjoram, peppermint, thyme, and rosemary.


Sufian 24

is a bioflavonoid that has antioxidant, anti-histamine, and anti-inflammatory properties, and research suggests that it may help ease allergic symptoms. sources of quercetin : capers, apples, lovage, red and yellow onions, broccoli, red grapes, cherries, citrus fruits, tea, red wine, and many berries including lingonberries, raspberries, and cranberries.


Sufian 25

Studies have also shown that high levels of vitamin C help reduce histamine release in the body and make histamine break down faster.

The potentially positive effects of vitamin C on AR may be more pronounced when vitamin C is consumed in combination with vitamin E because these two vitamins work synergistically and protect each other.


Sufian 26

Scientific research suggests that vit E may be effective at suppressing allergic reactions, including symptoms associated with AR

In one study, the participants received either 800 IU of vitamin E per day or a placebo. During the ten week trial period, nasal symptoms( sneezing, itching, congestion, and a runny nose) were reduced significantly in the group who were given vit E, compared to the placebo group. However, eye symptoms (itching, watery eyes, redness, and swelling ) did not react to the vit E supplementation in this study.


Sufian 27

The ability of selenium to ease allergic rhinitis symptoms is linked its role in the antioxidant system of the body: selenium is a key component of several enzymes responsible for antioxidant defense. To get the most out of selenium's health benefits, combine selenium-rich foods with foods that boast vitamin E (selenium and vitamin E work synergistically).


Sufian 28

Lactobacillus acidophilus (L. acidophilus) & Bifidobacterium bifidum (B. bifidum) are probiotics which live in the GI tract where they aid digestion and control the growth of harmful bacteria.

Several suggest that these health-promoting bacteria may also be effective at alleviating symptoms associated with AR. Dietary sources of probiotics include yoghurt containing live cultures of them, milk and sour milk enriched with the bacteria, miso, and tempeh. Increasing your intake of probiotics may be particularly helpful if you have recently been taking an antibiotic medication as antibiotics are known to destroy the healthy flora in the intestines.


Sufian 29

Functions as a cofactor for sulfite oxidase, a health promoting enzyme. Sulfite oxidase helps the body destroy sulfites. (chemicals that are used as food preservatives.) people sensitive or allergic to sulfites, sulfites can cause itching, hives, allergic rhinitis, fainting, and respiratory problems.

Beans such as cannellini beans are rich in molybdenum, but also whole grains, dark green leafy vegetables, and potatoes contain significant amounts of this allergic rhinitis fighting mineral


Sufian 30

suffer from AR caused by birch, grass or mugwort pollen, the chances are that you are also allergic to foods like celery or parsley

Radish microgreens can offer you a great alternative. Harvested at about two inches tall, these peppery seedlings are great in salads and cold soups


Sufian 31


Sufian 32

Apple Horseradish Roseships Sunflower seeds Rosemary Dandelion Greens Turmeric Garlic Sweat Potatoes Flaxseeds Mushrooms Mustard creams


Sufian 33

Apples help prevent the release of histamine. A study conducted by Japanese researchers found apple polyphenols to be

highly effective at reducing symptoms associated with persistent allergic rhinitis. The scientists divided the 15 to 65 year old patients, all of which suffered from moderate or severe persistent allergic rhinitis, into three groups: those who received no apple polyphenols (control group), those who were administered a low dose of apple polyphenols, and those who were treated with a high dose of apple polyphenols. The study participants in both apple polyphenol groups experienced improvements in nasal discharge and sneezing attacks. The researchers also found reduced nasal swelling in the apple polyphenol groups.

Quercetin is one of the key polyphenols present in apples; in fact, apples are one of the best food sources of quercetin. Quercetin has been shown to effectively protect against allergic reactions, including those associated with allergic rhinitis. Quercetin works its protective magic by stabilizing the cell membranes of mast cells and basophils, thereby preventing them from releasing histamine.

Note: Some people with hay fever cross-react with certain foods. The most common symptoms are swelling, itching, and tingling in the mouth. Hay fever patients at the highest risk of developing an oral allergy to apples include those who are sensitive to mugwort, timothy, or birch pollen. Cooking apples helps reduce the likelihood of an allergic reaction.


Sufian 34

If you looking for a food that can help fight a stuffy nose associated with allergic rhinitis, try horseradish. When horseradish root is cut or grated, enzymes start breaking down sinigrin, a chemical compound naturally present in horseradish. Sinigrin is broken down into allyl isothiocyanate, a pungent compound that facilitates drainage of the nasal mucous membranes and sinuses. Note that if you don't mix cut or grated horseradish root with vinegar or eat it immediately, it will darken and lose its pungency.


Sufian 35

Rosehips, the fruits of the rose plant, are loaded with powerful nutrients. They are one of the best natural sources of proanthocyanidins, phytochemicals that inhibit enzymes that produce histamine and can thus help bring relief from the distressing symptoms of hay fever. In addition, rosehips are packed with vitamin C. They are also a relatively good source of vitamin E. Rosehips, which have a tangy taste similar to cranberries, can be eaten fresh or used in jams and pies. In some countries, like Sweden, they are also used in soups and stews. Note: before consuming rosehips, the outer fleshy part of each orb must be removed because of the fine hairs they contain.


Sufian 36

If you read at the nutrition facts label on a bag of sunflower seeds, you'll find out that these nutty tasting seeds are very high in calories and fat. But that should not be a reason to shy away from them! Although it is true that sunflower seeds are rich in calories and fat, consuming these little seeds in moderation can offer great health benefits, especially to people with hay fever. Not only are sunflower seeds among the seeds and nuts that are least likely to cause allergic reactions, they are also packed with nutrients that help prevent allergic reactions caused by other substances. Sunflower seeds are loaded vitamin vitamin E, but they are also a good source of selenium, with one cup providing more than a third of the recommended daily intake for this important allergic rhinitis fighting mineral.


Sufian 37

Rosemary provides a concentrated source of rosmarinic acid, a natural polyphenol that has been shown to suppress allergic reactions. Rosmarinic acid works it magic by suppressing allergic immunoglobulin responses and inflammation caused by white blood cells. Rosemary can be used to flavor roast meats, fish, and sauces, but also some fruits such as oranges.


Sufian 38

If you can develop a liking for their bitter taste, these unsung nutritional stars will reward you with a truckload of nutrients that help combat allergic rhinitis. Dandelion leaves are a very good source of vitamin C and a fairly good source of vitamin E. Fresh dandelion greens can be used in salads or they can be used as a basis for herbal infusions. If you cannot get used to their strong flavor, dandelion supplements are also available in many health stores.


Sufian 39

Turmeric, a root plant of the ginger family, has been used in Ayurvedic and Chinese medicine for centuries due to its beneficial effects on many diseases and other health problems. It is known to have strong anti-inflammatory properties, and it may be effective at preventing and alleviating allergic reactions in some people. Turmeric is a key ingredient in Indian style curries, but it can also be used to flavor many seafood, rice, meat, vegetable, or pasta dishes.


Sufian 40

Garlic has shown it to be effective at preventing and treating a wide range of ailments and diseases, including cardiovascular problems, cancer, and high blood pressure. But eating garlic on a daily basis may also help treat allergic rhinitis. The beneficial effects of garlic on allergic rhinitis are partially due to garlic's ability to inhibit the activity of certain enzymes that generate inflammatory prostaglandins and thromboxanes. Additionally, garlic — especially fresh garlic — contains a fair amount of vitamin C. It is also a good source of selenium, with one cup of raw garlic providing almost 30% of the recommended daily intake for an average adult.


Sufian 41

Sweet potatoes are one of the oldest vegetables known to man. They are also one of the most nutritious vegetables and a great addition to your diet if you suffer from allergic rhinitis as they are one of the foods that are least likely to cause allergic reactions (that is also why they are often recommended as a safe first food for babies). What's more, sweet potatoes boast vitamin C as well as unique root proteins which appear to have significant antioxidant properties.


Sufian 42

Provided that you're not allergic to the Linaceae or Linum plant families, flaxseeds can offer you great health benefits. Linum usitatissimum, which means 'most useful', is the botanical name for flaxseeds and an apt description of the power of these little nutrient powerhouses. Flaxseeds have been used to treat and prevent many common ailments and diseases, including cancer, constipation, heart disease, and joint pain. They may also help prevent and alleviate symptoms associated with hay fever and perennial allergic rhinitis due to their high concentration of selenium. One cup of flaxseeds provides more than 60% of the recommended daily intake for this important anti-rhinitis mineral. Furthermore, ground flaxseeds, as well as flaxseed oil, are one of the best plant-based sources of omega-3 fatty acids. A high intake of omega-3s has been associated with a decreased risk of allergic rhinitis.


Sufian 43

Provided that you are not allergic to fish, anchovies are an excellent food to add to your diet. They are very high in selenium, with a mere ounce of anchovies containing about 28% of the recommended daily intake for selenium. What's more, anchovies are an excellent source of the anti-inflammatory omega-3 fatty acids which have been shown to reduce allergic reactions in susceptible people. In addition, anchovies contain only low levels of mercury compared to many other fish.


Sufian 44

Research suggests that mushrooms may help alleviate allergic reactions such as symptoms associated with hay fever. The beneficial effects of mushrooms may be linked to their high selenium content. One cup of crimini mushrooms, for example, provides almost a third of the recommended daily intake for selenium. The anti-allergy effects of selenium are based on its role in the antioxidant system of the body.


Sufian 45

Chock-full of antioxidants and nutrients, mustard greens with their pleasant, peppery flavor can make an excellent addition to your diet if you suffer from hay fever or perennial allergic rhinitis. In addition to being one of the best sources of beta-carotene, they provide a good amount of vitamin C and vitamin E. The nutrients in mustard greens can scavenge free radicals, fight inflammation, and help break down histamine. Fresh mustard greens are available in the produce section of your local supermarket throughout the year.


Sufian 46


Sufian 47

MSD Co. scientific materials http://www.healwithfood.org/allergicrhinitis/

foods.php http://emedicine.medscape.com/article/134

825-overview#a0104


Sufian 48

allergic rhinitis & nutritional medications

Health & Medicine

flare il

persistent symptoms

allergic reactions

pathology allergic rhinitis

mayhelp ease allergic

worst symptoms

mast cells

symptoms patient