Seasonal Support
Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.
To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.
The following protocols were developed using only A through C-quality evidence.
Symptoms of seasonal allergies often prompt individuals to seek alternatives to conventional treatments like antihistamines and corticosteroids, which may carry unwanted side effects such as sedation. Certain supplements, including probiotics, butterbur, quercetin, and stinging nettle, have emerged as promising natural options for potentially managing allergy symptoms. (Luo 2022)(Schapowal 2002)(Schapowal 2005)(Bakhshaee 2017)(Yamada 2022) Integrating these supplements into a wellness plan provides individuals with allergic rhinitis a potential alternative or adjunct to traditional therapies, aiming for comprehensive relief while minimizing adverse effects.
The ingredients present in the protocol below reflect research findings that demonstrate efficacy when used prophylactically and therapeutically to support individuals experiencing symptoms of seasonal allergies.
Probiotics
~10 billion CFU per day (Luo 2022)
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- A 2022 meta-analysis of 28 studies revealed that probiotics significantly alleviated allergic rhinitis symptoms, improved Rhinoconjunctivitis Quality of Life Questionnaire scores, and increased the T helper cell 1 (TH1) to T helper 2 (Th2) ratio, but did not lead to significant changes in overall or specific IgE levels compared to the control group. (Luo 2022)
- Another meta-analysis of 22 randomized, double-blind, placebo-controlled studies indicated significant clinical benefits of probiotics, particularly with Lactobacillus paracasei strains, showing improvements in symptoms, quality of life scores, and immunologic parameters, with notable reductions in nasal and ocular symptoms and improvement in TH1/TH2 ratio compared to placebo. (Güvenç 2016)
- Probiotics containing Lactobacillus and Bifidobacterium may prevent allergy recurrences, reduce symptom severity, and enhance the quality of life in allergic rhinitis patients by modulating the immune system through the induction of cytokine production, leading to a dominant TH1 response and balancing the TH1/TH2 ratio. (Nogueira 2011)
Petasites officinalis (butterbur)
8 mg eremophilan type sesquiterpenes (petasin) 3–4 times per day for 2 weeks (Schapowal 2002)(Schapowal 2005)
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- One study demonstrated that butterbur and cetirizine were equally effective in improving SF-36 scores and global improvement scores on the clinical global impression scale, with both treatments being well tolerated. However, in the cetirizine group, most reported adverse events were associated with sedative effects, suggesting that butterbur may be a suitable alternative for seasonal allergic rhinitis treatment when avoiding sedative effects is necessary. (Schapowal 2002)
- In another study, butterbur Ze339 was shown to be an effective and well-tolerated treatment for intermittent allergic rhinitis in a dose-dependent manner. The best results were seen in the high-dose group, which received one tablet containing 8 mg of total petasin three times daily, versus the low-dose group receiving one tablet twice daily. (Schapowal 2004)
- Butterbur extract was significantly more effective than placebo in alleviating symptoms of intermittent allergic rhinitis. Notably, Butterbur Ze 339 was as efficacious as fexofenadine, an antihistamine. (Schapowal 2005)
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Quercetin and Urtica dioica (stinging nettle)
Quercetin: 200 mg per day minimum for at least 8 weeks (Yamada 2022); Stinging nettle: 150 mg per day for at least 1 month (Bakhshaee 2017)
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- Quercetin may be helpful for relieving the symptoms of pollen allergies, including itchy eyes, sneezing, runny nose, and sleep issues. (Yamada 2022)
- In one study investigating the effects of enzymatically modified isoquercitrin (EMIQ), the group taking EMIQ consistently had significantly lower ocular symptom and medication scores compared to the placebo group. Notably, during weeks five through six, ocular symptoms and congestion scores were significantly reduced. (Hirano 2009)
- In a randomized, double-blind, placebo-controlled trial, the total ocular and ocular itching scores for the EMIQ group were significantly lower compared to the placebo group. (Kawai 2009)
- One study aimed to assess the efficacy of Urtica dioica in managing allergic rhinitis symptoms through a randomized trial demonstrated that stinging nettle has positive effects in the management of allergic rhinitis. (Bakhshaee 2017)
- In a double-blind. randomized study involving 98 participants with allergic rhinitis, Urtica dioica showed higher global assessment ratings compared to placebo, although only slightly higher ratings were observed in daily symptom diaries. (Mittman 1990)
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Disclaimer
The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.
- Bakhshaee, M., Ah, M. P., Esmaeili, M., F, J. A., G, A. T., Salehi, M., & M, N. M. (2017). Efficacy of Supportive Therapy of Allergic Rhinitis by Stinging Nettle (Urtica dioica) root extract: a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial. PubMed, 16(Suppl), 112–118.
- Güvenç, İ. A., Muluk, N. B., Mutlu, F., Eskı, E., Altıntoprak, N., Öktemer, T., & Cingi, C. (2016). Do Probiotics have a role in the Treatment of Allergic Rhinitis? A Comprehensive Systematic Review and Metaanalysis. American Journal of Rhinology & Allergy, 30(5), e157–e175.
- Hirano, T., Kawai, M., Arimitsu, J., Ogawa, M., Kuwahara, Y., Hagihara, K., Shima, Y., Narazaki, M., Ogata, A., Koyanagi, M., Kai, T., Shimizu, R., Moriwaki, M., Suzuki, Y., Ogino, S., Kawase, I., & Tanaka, T. (2009). Preventative effect of a flavonoid, enzymatically modified isoquercitrin on ocular symptoms of Japanese cedar pollinosis. Allergology International, 58(3), 373–382.
- Kawai, M., Hirano, T., Arimitsu, J., Higa, S., Kuwahara, Y., Hagihara, K., Shima, Y., Narazaki, M., Ogata, A., Koyanagi, M., Kai, T., Shimizu, R., Moriwaki, M., Suzuki, Y., Ogino, S., Kawase, I., & Tanaka, T. (2009). Effect of enzymatically modified isoquercitrin, a flavonoid, on symptoms of Japanese cedar pollinosis: a randomized Double-Blind Placebo-Controlled trial. International Archives of Allergy and Immunology, 149(4), 359–368.
- Luo, C., Peng, S., Li, M., Ao, X., & Liu, Z. (2022). The Efficacy and Safety of Probiotics for Allergic Rhinitis: A Systematic Review and Meta-Analysis. Frontiers in Immunology, 13.
- Mittman, P. (1990). Randomized, Double-Blind Study of Freeze-Dried Urtica dioicain the Treatment of Allergic Rhinitis. Planta Medica, 56(01), 44–47.
- Nogueira, J. C. R., & Da Conceição Rodrigues Gonçalves, M. (2011). Uso de probióticos na rinite alérgica. Brazilian Journal of Otorhinolaryngology, 77(1), 129–134.
- Schapowal, A. (2002). Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. The BMJ, 324(7330), 144.
- Schapowal, A. (2004). Butterbur ZE339 for the treatment of intermittent allergic rhinitis. Archives of Otolaryngology-head & Neck Surgery, 130(12), 1381.
- Schapowal, A. (2005). Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine‐controlled study of Butterbur extract Ze 339. Phytotherapy Research, 19(6), 530–537.
- Yamada, S., Shirai, M., Inaba, Y., & Takara, T. (2022). Effects of repeated oral intake of a quercetin-containing supplement on allergic reaction: a randomized, placebo-controlled, double-blind parallel-group study. DOAJ (DOAJ: Directory of Open Access Journals), 26(12), 4331–4345.
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