Integrative approach for Pediatric Allergies

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Integrative approach for Pediatric Allergies

• Richaritha Gundlapalli MD, FAAP

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Disclaimer

• No financial intention or association to any
  companies.
• Not intended to use for prevention, treatment or
  cure any disease.

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Objectives

• Discuss Conventional Approach for allergies
• To learn about holistic approach for management
  of allergic rhinitis
• Ayurveda
• Naturopathy
• Chinese medicine
• Aromatherapy
• Chiropractice

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Allergy

• The word allergy derives from the Greek words
  allos meaning "other" and ergon meaning
  "reaction" or "reactivity".
• An allergy is a immune malfunction whereby a
  person's body is hyposensitized to react
  immunologically to typically nonimmunogenic
  substances.

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Epidemiology

• Marked increase in prevalence of AR in urban
  setting and small rise in rural areas.
• 20-40 of children suffer from AR.
• Recent study showed
• 73 of class rooms contain 4 or more allergens
• 85 of class rooms have irritants

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Allergies on rise..

• ? Small genetic mutation
• Allergen Exposure Hypothesis
• Diverse and exotic foods with artificial flavors,
  preservatives, additives
• Spend more time indoors - contact with dust,
  synthetic materials, chemicals, indoor pets.
• Technical development - air conditioning, central
  heating, wall to wall carpeting, sealed windows,
  increase use of formaldehyde, plastics.
• Electro magnetic pollution
• Hygiene Hypothesis
• Inadequate exposure to genuinely harmful agents
  leads to immune dysfunction.
• Increase use of antibiotics, vaccinations,
  obsession with germs, sanitizers.
• Ig E in the absence of harmful agents, attacks
  harmless environmental substances.

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Allergies on rise

• Severe virus infection damage immune system
• Stress, Stress, Stress..
• Diet
• Too early weaning
• Abundant in calories and low in nutrients
• Depleted soil

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Allergic rhinitis

• Allergic rhinitis inflammation of the lining
  of the nose, characterized by one or more of the
  following symptoms
• Nasal congestion
• Rhinorrhea
• Itching
• Conjunctival irritation
• Sneezing
• Tiredness

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Complications

• Chronic sinusitis
• Nasal polyps
• Otitis media, ET dysfunction
• Adenotonsillar hypertrophy, mouth breathing
• Co-exist with asthma
• Obstructive sleep apnea, day time fatigue
• Learning difficulty

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External aggravators

• Seasonal allergies (Intermittent) 20
• Weed (late summer)
• Grass (early summer)
• Tree pollens (spring)
• Fungal spores (after rain)
• Perennial allergies (persistent) 40
• Animal dander, cockroaches, dust mites, molds.

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Internal Aggravators

• Allergic Personality - nervous, with neurotic and
  hypochondriacal tendencies.
• Chronically stressed and hyper-alert state
  demands high alpha-sympathetic activity (nor
  epinephrine). Chronic histamine elevation.
• Adrenal exhaustion blunted cortisol production
  in response to normal daily stressors, or,
  functionally low cortisol activity with normal to
  high serum or salivary cortisol.
  (Buske-Kirschbaum A. Psychosom Med. Sep-Oct
  200365(5)806- 810).

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Environmental triggers

• Indoors (school)
• Chalk powder
• Insufficient air flow
• Magic markers
• Paints
• Dust mites, molds
• Glue
• Cleaning agents

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Medical Management

• Avoidance
• Antihistamines
• Glucocorticoids
• Leukotriene modifying agents
• Chromones
• Immunotherapy.

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Ayurvedic perspective

• Allergy is explained in Ayurvedic literature as
  the concept of asatmya.
• Aushadha anna viharanam upayogam sukhavaham sahi
  satmyam. Satmya is when persons doshas accept and
  adjust to medicines, dietary, and environmental
  changes.
• Satmya means tolerance.
• Asatmya (intolerance) is when one or more
  doshas do not accept these things and they react
  often as an allergy.
• The root cause is imbalanced agni.

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Vata Type

• Gas, bloating, distension, discomfort.
• Breathlessness, sneezing.
• Headache, insomnia, tinnitus.
• Due to Vishama agni (irregular digestion).
• Season Winter, Fall
• Emotionally -Repressed fear, anxiety, insecurity.

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Chikitsa (treatment)

• Two categories
• Shamana Palliative therapy for acute phase of
  allergies
• Shodana Detoxification program to remove doshic
  causes of allergies. Panchakarma is only done
  once the acute symptoms are under control.

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Management

• Herbal formula
• Ashwagandha (Withania somnifera) - 2 parts
• Bala (Sida cordifolia) - 1 part
• Vidari Kanda (Ipomoea digitata) - 1 part
• Yastimadhu (Glycyrrhiza glabra) - 1 part
• Haritaki (Terminalia chebula) - 1 part
• 1/4 tsp TID with warm water before meals.

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For Wheezing..

• For Wheezing
• 1/4 tsp ginger (Zingiber officinale)
• 1/4 tsp Yastimadhu (Glyceriza glabra)
• 1/4 tsp Pippali (Piper longum)
• A pinch of salt
• 1 cup hot water
• Panchakarma Basti (Enema)
• Dashamoola decoction

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Management

• Vata Herbal Tea
• Ashwagandha 20gm
• Vidhari 20gm
• Tagar 20gm
• Trikatu 10gm
• Triphala 30gm
• Make tea with 10gm of the mixture
• Vata Massage oil Mahanarayana Tailam

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Pitta type

• Stomach ache, diarrhea, nausea, vomiting
• Hives, rashes, urticaria, eczema, psoriasis.
• Due to Teekshna agni (sharp digestion)
• Season Summer season.
• Allergic - peanuts, strawberries, citrus fruits,
  eggs, hot spicy foods, hard cheeses.
• Environmental chemical sensitivity.
• Emotionally Anger , hate, irritability, envy

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Management

• Herbal formula
• Shatavari 500mg
• Guduchi or Gulwel Satva 300mg
• Kama dudha 200mg
• Take ½ tsp with warm water or cilantro juice
  after meals.

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Management

• Blood cleansing
• Manjishta (Rubia cordifolia) - 3 parts
• Nimba (Azadirachta indica) - 1 part
• Turmeric (Curcuma longa) - 2 part
• Amalaki (Phyllanthus emblica) - 2 parts
• Guduchi (Tinospora cordifolia) - 1 part
• Beneficial for Allergic skin problems

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Management

• Blood purification
• Burdock tea - three times daily
• Dermatological problems
• Apply liberally Neem oil externally on the skin.
• Rose water for cooling effect on the skin
• Cilantro pulp
• Mix equal parts of sandal wood and turmeric with
  water and apply on the affected area.

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Management

• Panchakarma
• Raktamokshana
• (Blood letting / blood donation) Donate 1/2 pint
  or 100 cc blood to blood bank.
• Virechana (Purgation therapy)
• 2 Tbs Castor oil or Flax seed oil or Olive oil
• 1/4 teaspoon dry ginger powder
• 1 cup hot milk / soy milk / rice milk
• Bed time for 3 consecutive days

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Management

• Pitta Herbal Tea
• Dhania 5gm
• Saunf 5gm
• Jeera safed 5gm
• Dalchini 5gm
• Guduchi 10gm
• Punarnava 20gm
• Brahmi 10gm
• Make tea with 10gm of mixture

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Kapha Type

• Hay fever, cold, congestion, cough, sinus
  infection, or asthma.
• Due to Mandagni (Slow digestion).
• Season spring season.
• Sensitive to milk and dairy products, wheat, red
  meat and other kapha aggravating foods.
• Emotionally - lethargy, depression, repressed
  greed, possessiveness, attachment.

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Kapha type

• Herbal formula
• Sitopaladi 500mg
• Mahasudarshan 300mg
• Licorice 300mg
• Pippali 200mg
• ½ tsp with warm water after meals.

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Management

• Herbal formula
• Sitopaladi - 4 parts
• Tulasi (Ocimum sanctum) - 2 parts
• Yastimadhu (Glycyrrhiza glabra) - 2 parts
• Kantakari (Solanum xanthocarpum) - 1part
• Vasa (Adhothoda vasica) - 1 parts
• Bibhitaki (Terminalia belerica) - 1part
• 1/2 tsp three times daily with honey before meals

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Management

• Panchakarma Vamana (Vomiting therapy)
• Licorice tea with rock salt, drink full stomach
• Rub or irritate the back of the tongue to induce
  vomiting reflux
• Kapha herbal Tea
• Mulati 20gm
• Shatawari 10gm
• Trikatu 10gm
• Tulasi 40gm
• Gokshru 10gm
• Triphala 10gm
• Use 10gm for making tea

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Tri-dosha Allergies

• Triphala - Combination of three fruits
• Haritaki - Balances Vata
• Amalaki - Balances Pitta
• Bibhitaki - Balances Kapha
• Natural antioxidant, removes free radicals, help
  to maintain doshic balances by detoxifying cells
  and increasing longevity.

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Rejuvenation

• Rejuvenation program (Rasayana) Art of
  rebuilding and revitalizing tissues through
  proper lifestyle, diet, herbs, yoga and
  meditation.
• Allergy is natures demand for physical, mental
  and emotional cleansing through radical change.
• Haritaki - vata type allergies
• Amlaki - pitta type allergies
• Vibhitaki - kapha type allergies
• Combination of all three is triphala.

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Dietary Regimen

• Vata allergy - Vata pacifying foods
• Eat warm, lubricating foods.
• Pitta allergy - Pitta pacifying foods
• Eat cooling foods.
• Kapha allergy - Kapha pacifying foods
• Warm, spicy foods.

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Viruddha Ahara

• Milk - Yogurt, fish, sour fruits
• Meat, Poultry -Diary products
• Corn - dates, raisins, bananas
• Nightshades - yogurt, milk, melon, cucumber
• Fruits, Melons - Starches, Grains
• eg banana milk shakes, fruit smoothies etc.

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Breathing Exercises

• Sukha Pranayama (Alternate nostril breathing) -
  hay fever, wheezing, sneezing, Immune system.
• Bhastrika Pranayama - Congestion
• Ujjayi Pranayama - Improve immunity

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Yoga

• Yoga Postures
• Surya Namaskar (Sun salutations) - Kapha, Vata
• Chandra Namaskar (Moon salutations) - Pitta
• Stress Management
• Meditation mindfulness, mantra, guided
  meditation.

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Naturopathy - treatment

• Body Detoxification
• Most allergies - due to impaired digestive system
  
• Bentonite clay 1 tsp in 10 oz water.
• Hydrotherapy colonics and enemas
• Fasting Watermelon lemon fast is great
  detoxifier.
• Detoxifying home, school
• Air filters, plants

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Naturopathy

• Diet Best menu for preventing allergies -
  Rotation diet
• Lifestyle changes Avoid commercial products with
  artificial ingredients.
• Soaps without artificial scents, colors,
  petroleum products.
• Shaving cream made from natural soap
• Moisturizer sesame oil (Vit E)
• Room deodorizer lemon juicevinegar

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Naturopathy- cont

• Avoid pesticides. Boric acid get rid of ants,
  roaches.
• Glass cleaner 3Tbs vinegar 1 quart water
• Baking powder for scouring powder
• All purpose cleaner Borax with water
• Fabric softener 1 cup vinegar to final rinse
  cycle
• Avoid dry cleaning if possible

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Supplements

• Vitamin C 3000mg in divided doses.
• Reduce histamine levels
• Detoxifies, strengthens immune system, reduce
  inflammation
• Best with 100-200mg bioflavonoid quercetin and
  100-200mg of pycnogenol.
• Vitamin E Strengthens endocrine, immunity.
• Women with allergies and hormone imbalance 600 IU
  a day.
• Men need 400 IU per day
• Vit E works well with 100mcg of selenium

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Supplements

• Probiotics
• Supporting immune function. Modulating T-cell
  activity
• Generate B vitamins
• Quercetin 500mg BID
• Inhibit histamine release and reduce nasal
  congestion
• Reduce IL, acts as antioxidant and cell membrane
  stabilizer.
• Best food sources - capers, fennel, bee pollen,
  cocoa powder
• Bee propolis and pollen
• Modulate mast cell degranulation, histamine
  activity. Anti-inflammatory
• Use local honey.

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Supplements

• B Complex
• Enhance immunity. B5, B6, B12
• B5 is building block of cortisone
• Minerals
• Zinc good for food allergies
• Calcium citrate
• EFA and GLA
• EFA stabilize mast cells
• Flax seed oil. GLA - primrose oil, black currant
  seed
• Fish oil 20mg/kg/day for children. Adults
  1-2g/d
• Digestive enzymes anti inflammatory.

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Herbs

• Garlic
• Builds immunity and natural antiseptic
• Astragalus
• Immune stimulant. Increase number and activity of
  immune cells
• Echinacea
• Boosts immunity and fast recovery. Should be used
  for short intervals.
• Ginseng
• Builds stamina and endurance by boosting
  immunity.

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Avoid

• STRESS physical, psychological
• Stimulants caffeine, cigarettes
• No White poisons- white flour, white sugar, salt
• Avoid low ph foods.
• Avoid chemicals in soaps, detergents, lotions..
• Avoid processed foods, stale foods.

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Aromatherapy

• Stress - Lowers immunity and decrease mast cell
  stabilization.
• Medical grade Essential oils of Lavender, Roman
  chamomile, Neroli, Petitgrain reduce NE release
  and central anxiolytic via GABA. (Perry N. CNS
  Drugs. 200620(4)257- 280).
• A 3-5 concentration of lavender and chamomile
  taken BID reduce nervous tension.
• Frankincense, peppermint hydrosol - relieve
  congestion
• Diluted lavender or frankincense essential oils
  for anti-inflammatory and skin regenerative
  properties

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Chiropractic

• Increase NK cell production, Ig, lymphocyte,
  neutrophils. Rectifies Autonomic imbalance.
• Specifically assess C6 to T3 and T7 to T12 (for
  adrenals) as well as L4 and L5.
• Applied kinesiology muscle testing

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Chinese

• Allergies are regarded mostly as being caused by
  either
• Spleen Qi deficiency, which tend to manifest as
  liquid/runny allergic response. (Kapha type)
• Yin deficiency which tend to manifest with
  redness, itching and dryness. (Pitta type)
• Bu Zhong Yi qi Tang classical prescription for
  allergic rhinitis.

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Acupuncture/Acupressure

• Wind-cold effecting the lung (Vata)
• Sneezing, runny nose, slight headache
• Protocol Expel wind-cold, restore descending and
  dispersing LU Qi.
• Treatment points
• UB 12 Main point for wind disorders
• UB 13 LU back shu
• GB 20 Expel wind (Karnamoola marma point)
• GV 23- Expel wind from nose
• LU 7 Restore descending dispersing function
  of LU Qi

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Acupuncture/Acupressure

• Root deficiencies of Spleen, LU, KD, GV
• Tonify Spleen SP 6
• Tonify Kidney KD 3, UB 23
• Tonify Lung UB 13, GV 12
• Strengthen governing vessel GV4, CV 4, GV 14

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• Namaste