You’ve committed to helping your patients feel better with allergy testing and immunotherapy. Now you’re wondering, “What else can I do to prevent and manage allergies and asthma?”
It’s no surprise that positive lifestyle changes such as regular physical activity, weight control, eating a healthy diet that is rich in fruits and vegetables, being a non-smoker, and eliminating exposure to second-hand smoke can help (Moreira et al. 2014). Many patients know they need to make these lifestyle changes, but too often they don’t take it seriously until they hear it from a trusted medical professional. So be sure to remind your patients about healthy lifestyle choices.
In addition to allergy skin testing and allergen immunotherapy, there are few supplemental things we can do to help patients improve the quality of their lives.
Exercise, fresh air and sunlight
Encourage physical activity and exercise in green spaces such as parks, forests, lakes and beaches (when patients are asymptomatic to pollen triggers) and especially in direct sun light where possible.
The “Biodiversity Hypothesis” purports that reduced biodiversity and alterations in the composition of the gut and skin microbiota are associated with various inflammatory conditions including asthma and other allergic and inflammatory diseases.
- General microbial deprivation, due to the modern lifestyle of urban people appears to be a risk factor for immune dysregulation and impaired tolerance.
- Natural habitats reduce the number of good bacteria from the environment, thereby reducing interaction with the human commensal (especially the gut and skin) microbiota diversity.
- Studies of immigrants moving from non-affluent to affluent regions indicate that tolerance mechanisms can rapidly become impaired in microbe-poor environments, such as western modern living environments and less green space.
- Current evidence supports a role for gut colonization in promoting and maintaining a balanced immune response in early life. An altered or less diverse gut microbiota composition has been associated with atopic diseases and/or obesity. Moreover, certain gut microbial strain or strains have been shown to inhibit or attenuate immune responses associated with chronic inflammation. (Haahtela 2013).
Vitamin D supplements
Vitamin D deﬁciency is widespread and on the increase.
The “Sunshine Hypothesis” states that vitamin D possesses immunoregulatory properties and has direct effects on naïve and activated helper T cells, regulatory T cells, activated B cells, and dendritic cells (Modh et al. 2014). The medical research community is currently compiling scientific evidence regarding the role Vitamin D deficiency plays in allergies. The exact dosage required to combat allergy symptoms is not yet determined, however David Perlmutter MD, in his book “Brain Maker” (Little Brown and Company 2015) suggests 5,000 IU’S of vitamin D3 daily as a supplement.
Additionally, in following the “do no harm” line of thinking, prebiotics and probiotics could aid in building a more robust, microbe rich, anti-inflammatory, defensive immune system. Consuming regular prebiotics in the diet, such as garlic, onion, leak, chicory root, and asparagus are highly recommended. Probiotics may also aid in relieving some symptoms; this includes fermented cabbage, sauerkraut, kimchi, pickles, buttermilk, and live cultured yogurts.
Diagnosing and treating your patients’ allergies with immunotherapy is the first step. By encouraging your patients to follow a healthy lifestyle, get an adequate level of natural sunlight, regular exercise, fresh air, a stable amount of vitamin D, and eat a healthy diet that promotes good gut bacteria, you are fast on the way to improving their overall quality of life.