An allergy or hypersensitivity reaction occurs when the
body's immune system overreacts to a substance that is normally harmless
(allergen), such as mold, pollen, animal dander, or dust mites. Allergy
symptoms may include runny nose, watery eyes, urticaria (hives), angioedema
(swelling beneath the skin), and atopic dermatitis (red, itchy dry skin). The
most severe allergic reaction, known as called anaphylaxis, can lead to low
blood pressure, breathing difficulties, shock, and loss of consciousness, all of
which can be fatal.
During pregnancy, women who have allergies may experience
changes in the way they respond to allergens. Allergy symptoms may improve,
worsen, or remain the same; there is no way to predict how an individual's
allergies will change during pregnancy. Researchers estimate that about
one-third of pregnant women who have allergies experience reduced allergy
Allergic rhinitis and allergic asthma are the most common
types of allergies that affect pregnant women. In addition, some pregnant women
may experience non-allergic rhinitis (inflammation of the nose), also called
rhinitis of pregnancy, which appears to be caused by an increase in pregnancy
hormones (such estrogen and progesterone). Allergy symptoms are usually most
severe between 29 and 36 weeks of pregnancy, according to researchers.
Minimizing exposure to known allergens may help reduce or
prevent allergy symptoms. There are also many treatment options that are safe
for pregnant women who have allergies. Certain asthma medications (like inhaled
bronchodilators and beclomethasone), antihistamines (like diphenhydramine), and
cromolyn sodium nasal sprays have been shown to be safe and effective for the
treatment of allergies during pregnancy.
General: An allergy, or hypersensitivity reaction, occurs
when the body's immune system overreacts to a substance that is normally
harmless (allergen). Common allergy triggers include pollen, dust mites, molds,
animal dander, latex, foods, and insect venom.
The white blood cells of an allergic individual produce an
antibody called immunoglobulin E (IgE), which attaches to the allergen. This
triggers the release of histamine and other inflammatory chemicals that cause
allergic symptoms, such as runny nose, watery eyes, hives, angioedema, and
atopic dermatitis. The most severe allergic reaction, known as called
anaphylaxis, can lead to low blood pressure, breathing difficulties, shock, and
loss of consciousness, all of which can be fatal.
Most allergies are inherited, which means they are passed on
to children by their parents. Although people inherit a tendency to be
allergic, they may not inherit an allergy to the same allergen. When one parent
has allergies, each of his/her children has a 50% chance of developing
allergies. That risk increases to 75% if both parents have allergies.
Allergic rhinitis: Pregnant women with allergies often
suffer from seasonal allergic rhinitis, also called hay fever or nasal
allergies, which occurs when airborne allergens like dust, dander, or pollen are
inhaled. Allergic rhinitis is characterized by a collection of allergic
symptoms, predominantly in the nose and eyes. When pollens cause the allergic
symptoms, the allergic rhinitis is commonly referred to as hay fever. Perennial
allergic rhinitis is an allergic reaction that has little or no seasonal
variation. It is persistent, chronic, and generally less severe than seasonal
Non-allergic rhinitis (rhinitis of pregnancy): Non-allergic
rhinitis appears to be caused by an increase in pregnancy hormones, including
estrogen and progesterone.
Allergic asthma: Pregnant women often suffer from allergic
asthma, which occurs when allergens cause the airway to become inflamed. Asthma
is one of the most common, potentially serious medical problems that occurs
during pregnancy. According to some studies, asthma may complicate up to seven
percent of all pregnancies. If asthma is not controlled, the mother has lower
levels of oxygen in her blood. This may result in decreased oxygen in the fetal
blood, which may also cause growth deficiencies in the fetus or death.
Pregnant women with asthma have an increased risk of
delivering prematurely or giving birth to an infant with low birth weight. In
addition, pregnant women with asthma are more likely to experience high blood
pressure or a related condition called pre-eclampsia (swelling, high blood
pressure, and kidney malfunction).
Proper treatment and management of asthma symptoms may help
reduce the risk of complications, according to research.
Allergic rhinitis: Most cases of allergic rhinitis are
generally mild, and do not cause complications during pregnancy. Common
symptoms include cough, headache, itchy nose, itchy mouth, itchy throat, itchy
skin, nosebleeds, impaired smell, watery eyes, sore throat, wheezing, fever,
cross-reactivity allergy to some fruits, conjunctivitis (pinkeye), nasal
congestion, post-nasal drip, runny nose, and swelling of the nasal tissues.
Non-allergic rhinitis (rhinitis of pregnancy): Symptoms of
non-allergic rhinitis are the same as allergic rhinitis.
Allergic asthma: Common symptoms include: bronchospasms
(abnormal contraction of the bronchi resulting in airway obstruction), coughing
(constantly or intermittently), wheezing or whistling sounds when exhaling,
shortness of breath or rapid breathing, chest tightness or chest pain, and
fatigue. Infants may have trouble feeding and may grunt during suckling.
Skin testing: While skin testing is the most common method
of allergy testing, it is generally not performed in pregnant women because
there is a slight risk of anaphylaxis, a severe allergic reaction. Anaphylaxis
is a rapid, allergic reaction that affects the whole body. Anaphylaxis is a
medical emergency that requires immediate medical treatment, as well as
follow-up care with an allergist or immunologist. Symptoms of anaphylaxis can
vary from mild to severe and may be potentially life threatening. The most
dangerous symptoms are low blood pressure, breathing difficulties, shock, and
loss of consciousness, all of which can be fatal. Epinephrine is a medication
used to treat anaphylaxis.
Radioallergosorbent test (RAST©): A radioallergosorbent test
(RAST©) is considered a safe alternative for pregnant women. A RAST© is a type
of blood test that can determine whether a patient is allergic to particular
substances. During the procedure, a sample of the patient's blood is exposed to
suspected allergens (like dust mites, pollen, or animal dander) to determine
whether the patient has developed allergen-specific immunoglobulin E (IgE)
antibodies. Antibodies are proteins that recognize and bind to specific
antigens. A qualified healthcare provider will interpret the results of the
test. In general, the sensitivity of these tests ranges from 50-90%, with the
average being about 70-75%. The patient will receive test results in about
seven to 14 days.
Safety: The US food and Drug Administration (FDA) evaluates
the safety of medications during pregnancy, and grades them on a scale of A
through D and X. Class A is considered the safest. These medications have
proven to be safe for use in pregnant women. Class B medications are considered
safe during pregnancy, but definitive evidence from human trials is lacking.
Class C medications are potentially harmful, according to animal studies,
although no human studies are available. Class D medications should be avoided
during pregnancy because they have been shown to be harmful to the human fetus.
Class X drugs are considered teratogenic because the risks outweigh the
benefits in pregnant women. Studies in animals or humans have shown that these
drugs cause fetal abnormalities.
If allergies are severe, and the patient is not responding
to current treatment, a healthcare provider may recommend class C medications
like pseudoephedrine decongestants (Sudafed©) or corticosteroid nasal sprays
like fluticasone (Flonase©). Since there are risks associated with these
treatments, healthcare providers will only recommend class C medications when
the benefits clearly outweigh the risks. Class D and X are not recommended
during pregnancy, even if allergies are severe.
Pregnant women should not take any medication (prescription
or over-the-counter), herb, or supplement without first consulting their
obstetricians because they may interact with other agents or cause harm to the
fetus. Patients should carefully read the packaging labels on medications and
they should take the medication exactly as directed by their healthcare
Asthma medications: Asthma can potentially cause harm to the
fetus if the condition is uncontrolled. The safety of asthma inhalers varies.
Most are assigned to Class B or Class C. Studies show that most asthma inhalers
are safe during pregnancy. The risks of uncontrolled asthma appear to be
greater than the risks of necessary asthma medications. However, oral
medications should be avoided unless necessary to control symptoms.
Medications that have been used in pregnant women include
inhaled bronchodilators, cromolyn sodium nasal spray (Nasalcrom©), and
beclomethasone nasal spray (Beconase© or Vancenase©), all of which have a local
effect. Theophylline (Bronkodyl©, Elixophyllin©, Slo-bid©, Slo-Phyllin©,
Theo-24©, Theo-Dur©, Theolair©, Uniphyl©) has also been taken orally during
pregnancy if the asthma is not adequately controlled by the other medications.
Oral steroid medications, such as prednisone, should only be used when
necessary for severe asthma during pregnancy.
Antihistamines: Most, but not all, antihistamines are Class
B rated for pregnancy safety. Commonly used antihistamines that are considered
safe (Class B) for pregnancy include chlorpheniramine (Chlor-Trimeton©),
diphenhydramine (Benadryl©), and loratadine (Claritin©). In addition,
cetirizine (Zyrtec©) is a commonly prescribed antihistamine that is considered
safe for pregnancy. Pregnant women should avoid the popular antihistamine
fexofenadine (Allegra©) because it is a Class C drug.
Cromolyn sodium: Cromolyn sodium nasal spray (Nasalcrom©) is
another option with a Class B rating that can be used to control nasal allergy
symptoms during pregnancy. The spray is used to treat and prevent allergy
symptoms, such as stuffy or runny nose and sneezing. It may take up to four
weeks for the spray to take effect. Eye drop versions of cromolyn sodium are
also available for itchy, bloodshot eyes.
Note : Many integrative therapies are considered unsafe for
use during pregnancy and lactation. Specific safety data for pregnancy and
lactation may also be unavailable in some cases. Patients should always consult
with their healthcare providers and licensed obstetrician/gynecologist before
using integrative therapies for any indication.
Good scientific evidence :
Boswellia : Boswellia has been proposed as a potential
therapy for asthma. Future studies are needed to assess the long-term efficacy
and safety of boswellia and to compare the efficacy of boswellia to standard
therapies. Boswellia should not be used for the relief of acute asthma
Boswellia is generally believed to be safe when used as
directed, although safety and toxicity have not been well studied in humans.
Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or
stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble
medications, agents metabolized by the liver's cytochrome P450 enzymes, or
sedatives. Use cautiously with impaired liver function or liver damage or lung
disorders. Use cautiously in children. Avoid if pregnant due to potential
abortifacient effects or if breastfeeding.
Bromelain : Bromelain may be a useful addition to other
therapies used for sinusitis (such as antibiotics) due to its ability to reduce
inflammation/swelling. Studies report mixed results, although overall bromelain
appears to be beneficial for reducing swelling and improving breathing. Better
studies are needed before a firm conclusion can be made.
Avoid if allergic to bromelain, pineapple, honeybee, venom,
latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen,
papain, rye flour, wheat flour or other members of the Bromeliaceae family. Use
cautiously with history of bleeding disorders, stomach ulcers, heart disease,
liver disease or kidney disease. Use cautiously before dental or surgical
procedures or while driving or operating machinery. Avoid if pregnant or
Buteyko breathing technique : The Buteyko breathing
technique (BBT) consists of breathing techniques, relaxation exercises, and asthma
education. The technique aims to reduce hyperventilation. Studies have shown
reduced use of rescue inhalers among patients receiving BBT. Improvements in
other measures of asthma severity have not been shown. Additional study is
BBT is generally considered safe. Avoid with asthma that
changes suddenly ("brittle asthma"). BBT may interact with asthma
medications and should be used with caution when decreasing asthma medication.
Asthma should be treated by a qualified healthcare professional and patients
should always carry a rescue inhaler. Avoid if pregnant or breastfeeding.
Butterbur : Good scientific evidence suggests that butterbur
may be effective for allergic rhinitis prevention in susceptible individuals.
Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra©)
and cetirizine (Zyrtec©), have reported similar efficacy. Additional studies
are warranted before a firm conclusion can be made.
Avoid if allergic or hypersensitive to Petasites hybridus or
other plants from the Asteraceae/Compositae family (like ragweed, marigolds,
daisies and chrysanthemums). Raw, unprocessed butterbur plant should not be
eaten due to the risk of liver or kidney, damage or cancer. Avoid if pregnant
Choline : Choline is possibly effective when taken orally
for asthma. Choline supplements seem to decrease the severity of symptoms,
number of symptomatic days and the need to use bronchodilators in asthma
patients. There is some evidence that higher doses of 3 grams daily might be
more effective than lower doses of 1.5 grams daily.
Choline is generally regarded as safe and appears to be
well-tolerated. Avoid if allergic/hypersensitive to choline, lecithin, or
phosphatidylcholine. Use cautiously with kidney or liver disorders or
trimethylaminuria. Use cautiously with a history of depression. If pregnant or
breastfeeding it seems generally safe to consume choline within the recommended
adequate intake (AI) parameters; supplementation outside of dietary intake is
usually not necessary if a healthy diet is consumed.
Coleus : There is a lack of sufficient data to recommend for
or against the use of coleus in the treatment of bronchial asthma. Preliminary
data appears to be promising. However, larger, randomized, controlled trials are
needed to confirm the safety and efficacy of coleus for this use.
Coleus is generally regarded as safe, as very few reports
have documented adverse effects. However, only a few short-term trials have
assessed its safety in a small sample size of patients. Avoid if allergic to
Coleus forskohlii and related species or with bleeding disorders. Avoid if
pregnant or breastfeeding.
Ephedra : Ephedra contains the chemicals ephedrine and
pseudoephedrine, which are bronchodilators (expand the airways to assist in
easier breathing). It has been used and studied to treat asthma and chronic
obstructive pulmonary disease, such as asthmatic bronchoconstriction, in both
children and adults. Other treatments such as beta-agonist inhalers (for
example, albuterol) are more commonly recommended due to safety concerns with
ephedra or ephedrine.
The US Food and Drug Administration (FDA) has collected
thousands of reports of serious toxicity linked to ephedra (including over 100
deaths). Ephedra products are banned from dietary supplements because of
serious health risks, including heart attack, heart damage, breathing
difficulties and fluid retention in the lungs. Avoid ephedra if pregnant or
Nasal irrigation : Good scientific evidence suggests that
nasal irrigation may effectively treat allergies and chronic sinusitis. Well
conducted clinical study is needed to make a conclusion in this area.
Nasal irrigation is generally well tolerated. Use cautiously
with a history of frequent nosebleeds. If the irrigation liquid is hot, the
nose may become irritated.
Probiotics : Use of probiotic Enterococcus faecalis bacteria
in hypertrophic sinusitis (sinus inflammation) may reduce frequency of relapses
and the need for antibiotic therapy.
Probiotics are generally considered safe and well tolerated.
Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose
Pycnogenol : Pycnogenol© is the patented trade name for a
water extract of the bark of the French maritime pine (Pinus pinaster spp.
atlantica), which is grown in coastal south-west France. Pycnogenol may offer
clinical benefit to both children and adults with asthma. Additional study is
needed before a conclusion can be made.
Avoid if allergic/hypersensitive to pycnogenol, its
components, or members of the Pinaceae family. Use cautiously with diabetes,
hypoglycemia, or bleeding disorders. Use cautiously if taking hypolipidemics,
medications that may increase the risk of bleeding, hypertensive medications,
or immune stimulating or inhibiting drugs. Avoid if pregnant or breastfeeding.
Yoga : Multiple human studies report benefits of yoga (such
as breathing exercises), when added to other treatments for mild-to-moderate
asthma (such as standard drug therapy, diet, or massage). Better research is
needed before a firm conclusion can be drawn.
Yoga is generally considered to be safe in healthy
individuals when practiced appropriately. Avoid some inverted poses with disc
disease of the spine, fragile or atherosclerotic neck arteries, risk for blood
clots, extremely high or low blood pressure, glaucoma, detachment of the
retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain
yoga breathing techniques should be avoided in people with heart or lung
disease. Use cautiously with a history of psychotic disorders. Yoga techniques
are believed to be safe during pregnancy and breastfeeding when practiced under
the guidance of expert instruction (the popular Lamaze techniques are based on
yogic breathing). However, poses that put pressure on the uterus, such as
abdominal twists, should be avoided in pregnancy.
Unclear or conflicting scientific evidence :
Acupressure, shiatsu : Preliminary research suggests that
acupressure may be of benefit in improving quality of life in asthma. Further
well-designed studies are needed before firm conclusions can be drawn.
With proper training, acupressure appears to be safe if
self-administered or administered by an experienced therapist. No serious
long-term complications have been reported, according to scientific data. Hand
nerve injury and herpes zoster ("shingles") cases have been reported
after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture : There is currently insufficient available
evidence on which to base recommendations for acupuncture in non-allergic
rhinitis. However, studies suggest that it may offer possible benefits.
Additionally, more studies are needed of stronger design to determine whether
or not acupuncture offers benefit in sinusitis.
Acupuncture should be avoided in patients with heart
disease, pulmonary disease, infections, bleeding disorders, medical conditions
of unknown origin, or neurological disorders. Pregnant women, the elderly,
diabetics, people with a history of seizures, and those receiving radiation
therapy and/or taking drugs increasing bleeding risks should also avoid
Alexander technique : The Alexander technique is an
educational program that teaches movement patterns and postures, with an aim to
improve coordination and balance, reduce tension, relieve pain, alleviate
fatigue, improve various medical conditions, and promote well-being. There is
currently not enough scientific evidence to make a strong recommendation for
the use of the Alexander technique in chronic asthma patients. More study is
needed in this area.
Serious side effects have not been reported with use of the
Alexander technique. It has been suggested that the technique may be less
effective with learning disabilities or mental illnesses. The Alexander
technique has been used safely in pregnant women.
Applied kinesiology : Applied kinesiology is commonly used
for food allergy diagnosis. However, there is conflicting scientific evidence
as to whether applied kinesiology is an effective diagnostic tool. Study
results are also mixed in regards to bronchial asthma. Further research is
needed before conclusions can be drawn.
Applied kinesiology techniques in themselves are generally
considered to be safe. However, medical conditions should not be treated with
AK alone, and should not delay appropriate medical treatment.
Aromatherapy : Despite widespread use in over-the-counter
agents and vapors, there is not enough scientific evidence to recommend use of
eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form). The
available studies are of poor quality, and have used combination therapies or
1,8-cineole (eucalyptol), which is a component of eucalyptus. Further studies
are needed before a firm conclusion can be made.
Skin rash (dermatitis) from direct contact with various
essential oils has been reported in humans, and skin irritation and allergies
may develop with regular use. Peppermint and eucalyptus oils may burn the skin
if applied at full strength. Severe skin sensitivity to light may occur.
Aromatherapy vapors may irritate the eyes, and affect breathing. There are
reports of agitation, drowsiness, nausea, and headache with the use of
aromatherapy. Some oils may have toxic effects on the brain, liver and kidney;
long-term use may also increase cancer risks. Caution is advised in people who are
driving or operating heavy machinery. Essential oils may be toxic if taken by
mouth, and should not be swallowed. Fragrances may contain unknown and
potentially toxic contaminants. The use of these oils is discouraged during
pregnancy, and infants and young children may be especially sensitive.
Ayurveda : There is early evidence that daily
supplementation with gum resin of Boswellia serrata, known in Ayurveda as Salai
guggal, may reduce dyspnea (shortness of breath), rhonchi, and the number of
attacks in bronchial asthma. Another herb, Devadaru (Cedrus deodara), may have
antispasmodic effects and reduce symptoms in bronchial asthma, particularly for
patients with shorter histories of asthma and lower frequencies of attacks.
Further research is needed in this area before a recommendation can be made.
Ayurvedic herbs should be used cautiously because they are
potent and some constituents can be potentially toxic if taken in large amounts
or for a long time. Some herbs imported from India have been reported to
contain high levels of toxic metals. Ayurvedic herbs can interact with other
herbs, foods and drugs. A qualified healthcare professional should be consulted
before use of any herbs or supplements. Use guggul cautiously with peptic ulcer
disease. Avoid sour food, alcohol, and heavy exercise. Mahayograj guggul should
not be taken for long periods of time. Pippali (Piper longum) should be taken
with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica
officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid
Ayurveda with traumatic injuries, acute pain, advanced disease stages and
medical conditions that require surgery.
Black seed : Studies in patients with allergies found that
black seed decreased allergic disease severity, slightly decreased plasma
triglycerides (levels of fat within the blood), and slightly increased HDL
cholesterol. The effect of black seed for allergies is still not clear and
further study is required.
Avoid with a known allergy/hypersensitivity to black seed,
its constituents, black seed oil, or to members of the Ranunculaceae family.
Allergic contact dermatitis has been reported after topical use of black seed
or the oil from the seed.
Black tea : Research has shown caffeine to cause improvements
in airflow to the lungs (bronchodilation). However, it is not clear if caffeine
or tea use has significant clinical benefits in people with asthma. Better
research is needed in this area before a conclusion can be drawn.
Avoid if allergic or hypersensitive to caffeine or tannins.
Skin rash and hives have been reported with caffeine ingestion. Use caution
with diabetes. Use caution if pregnant. Heavy caffeine intake during pregnancy
may increase the risk of SIDS (sudden infant death syndrome). Very high doses
of caffeine have been linked with birth defects. Caffeine is transferred into
breast milk. Caffeine ingestion by infants can lead to sleep
disturbances/insomnia. Infants nursing from mothers consuming greater than 500
milligrams of caffeine daily have been reported to experience tremors and heart
rhythm abnormalities. Tea consumption by infants has been linked to anemia,
decreased iron metabolism, and irritability.
Borage seed oil : The flowers and leaves of borage (Borago
officinalis) are often pressed to produce oil very high in gamma-linolenic acid
(GLA). Preliminary evidence suggests that gamma linolenic acid (GLA) may have
some immunosuppressant activity that may be helpful in reducing asthma
Avoid if allergic or hypersensitive to borage, its
constituents, or members of the Boraginaceae family. Use cautiously in patients
with bleeding disorders or taking warfarin or other anticoagulant or
antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy
or taking anticonvulsants. Avoid in patients with compromised immune systems or
similar immunological conditions. Avoid in pregnant patients as borage oil may
be contraindicated in pregnancy given the teratogenic and labor-inducing
effects of prostaglandin E agonists, such as borage oil's GLA. Avoid if
Butterbur : Historically, butterbur has been used to treat
asthma. Pre-clinical studies report anti-inflammatory and leukotriene
inhibitory properties, which may lead to clinical effects. Initial human
research suggests possible benefits. However, controlled trials with adequate
sample sizes are necessary in order to clarify whether there are true benefits
Use caution if allergic or sensitive to Petasites hybridus
or other plants from the Asteraceae/Compositae family (like ragweed, marigolds,
daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be
eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or
Cat's claw : It has been suggested that cat's claw may help
treat respiratory diseases involving allergies. However, there is limited
scientific evidence to support this claim. More well-designed trials are needed
to determine whether cat's claw is a beneficial treatment.
Avoid if allergic to cat's claw or Uncaria plants or plants
in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a
history of conditions affecting the immune system (such as AIDS, HIV, some
types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis,
lupus). Use cautiously with bleeding disorders or a history of stroke, or if
taking drugs that may increase the risk of bleeding. Discontinue use two weeks
before surgery/dental/diagnostic procedures with bleeding risk, and do not use
immediately after these procedures. Cat's claw may be contaminated with other
Uncaria species. Reports exist of a potentially toxic, Texan grown plant,
Acacia gregii being substituted for cat's claw. Avoid if pregnant,
breastfeeding, or trying to become pregnant.
Chiropractic : Several studies report the effects of
chiropractic spinal manipulative therapy on breathing indices and quality of
life in children and adults with asthma. Results are variable, and in the
studies with positive results, mostly subjective but not objective (lung
function test) changes are reported. Due to methodological problems and
variable results, clear conclusions cannot be drawn at this time.
Use extra caution during cervical adjustments. Use
cautiously with acute arthritis, conditions that cause decreased bone
mineralization, brittle bone disease, bone softening conditions, bleeding
disorders, or migraines. Use cautiously with the risk of tumors or cancers.
Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms,
unstable spondylolisthesis, or arthritis. Avoid with agents that increase the
risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if
pregnant or breastfeeding due to a lack of scientific data.
Coenzyme Q10 : CoQ10 may benefit asthma patients when added
to other therapies. Further research is needed.
Allergy has not been associated with Coenzyme Q10
supplements, although rash and itching have been reported rarely. Stop use two
weeks before surgery/dental/diagnostic procedures with bleeding risk and do not
use immediately after these procedures. Use caution with a history of blood
clots, diabetes, high blood pressure, heart attack, or stroke, or with
anticoagulants (blood thinners) or antiplatelet drugs, or blood pressure, blood
sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.
Choline : Oral tricholine citrate (TRI) effectively relieved
allergic rhinitis symptoms in limited available study. However, further
research is needed before a firm conclusion can be made.
Choline is generally regarded as safe and appears to be well
tolerated. Avoid if allergic to choline, lecithin, or phosphatidylcholine.
Cordyceps : Cordyceps may reduce some asthma symptoms.
Additional studies are needed to make a firm conclusion.
Avoid if allergic or hypersensitive to cordyceps, mold, or
fungi. Use cautiously with diabetes or bleeding disorders or if taking
anticoagulant medications. Use cautiously with prostate conditions, if taking
immunosuppressive medications, or if on hormonal replacement therapy or oral
contraceptives. Avoid with myelogenous-type cancers. Avoid if pregnant or
Danshen : Danshen (Salvia miltiorrhiza) is widely used in
traditional Chinese medicine (TCM), often in combination with other herbs.
Better studies are needed in which danshen is compared with more proven
treatments for asthmatic bronchitis before a clear conclusion can be drawn.
Avoid if allergic or hypersensitive to danshen. Use
cautiously with altered immune states, arrhythmia, compromised liver function
or a history of glaucoma, stroke, or ulcers. Stop use two weeks before
surgery/dental/diagnostic procedures with bleeding risk, and do not use
immediately after these procedures. Use cautiously if driving or operating
heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin or
hypotensives including ACE inhibitors such as captopri, or Sophora subprostrata
root or herba serissae. Avoid with bleeding disorders, low blood pressure and
following cerebal ischemia. Avoid if pregnant or breastfeeding.
Elderberry and elder flower : Elder may offer benefits for
bacterial sinusitis, such as reducing excessive mucus secretion.
Herbal preparations containing elder may result in less
swelling of mucus membranes, better drainage, milder headache, and decreased
nasal congestion. Cyanide toxicity is possible. Avoid if allergic to elder or
to plants related to honeysuckle. Some reports exist of allergies from contact
with fresh elder stems. Use caution with diabetes, high blood pressure or
urinary problems, or with drugs used for any of these conditions. Use caution
with anti-inflammatories, diuretics ("water pills" for high blood
pressure), or laxatives. Avoid if pregnant or breastfeeding.
Ephedra : Preliminary study suggests that a nasal spray
containing ephedrine, a chemical in ephedra, may help treat symptoms of nasal
allergic rhinitis. Additional research is needed before a firm conclusion can
The US Food and Drug Administration (FDA) has collected more
than 800 reports of serious toxicity, including more than 22 deaths. Avoid use
in individuals younger than 18 years old. Avoid use for prolonged periods
(longer than seven days) due to risk of abuse or toxicity. Discontinue use at
least one week prior to major surgery or diagnostic procedures. Use cautiously
with cardiovascular disease, including structural heart disease, arrhythmia,
coronary artery disease, high blood pressure, cerebrovascular disease, or a
history of stroke or transient ischemic attack. Use cautiously with depression,
anxiety disorders, anorexia/bulimia, a history of suicidal ideation, insomnia,
tremors, urinary retention, enlarged prostate, diabetes, kidney disease,
glaucoma, thyroid disease, and peptic ulcer disease. Use cautiously with
monoamine oxidase inhibitor (MAOI) or stimulant use. Avoid if pregnant or
Eucalyptus oil : Despite widespread use in multiple
over-the-counter agents and inhalation vapors, there is currently insufficient
available evidence to recommend either for or against use of eucalyptus oil as
a decongestant-expectorant (in oral or inhaled form) and for upper and lower
airway diseases, such as asthma.
Avoid if allergic to eucalyptus oil or with a history of
seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal
disorders, liver disease, kidney disease, or lung disease. Use caution if
driving or operating machinery. Avoid with a history of actue intermittent
porphyria. Avoid during pregnancy or breastfeeding. A strain of bacteria found
on eucalyptus may cause infection. Toxicity has been reported with oral and
Gingko : Ginkgo biloba has been used medicinally for
thousands of years and is currently one of the top selling herbs in the United
States. Ginkgo may reduce symptoms in patients with asthma. More study is
needed to make a conclusion.
Avoid if allergic or hypersensitive to members of the
Ginkgoaceae family. If allergy to mango rind, sumac, poison ivy or oak or
cashews exists, then allergy to ginkgo is possible. Avoid with blood-thinners
(like aspirin or warfarin (Coumadin©)) due to an increased risk of bleeding.
Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are
dangerous and should be avoided. Skin irritation and itching may also occur due
to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or
Ginseng : Limited research suggests that ginseng has
positive effects on breathing, such as its proposed role as a bronchodilator.
More research is needed in this area.
Avoid ginseng with a known allergy to plants in the
Araliaceae family. There has been a report of a serious life-threatening skin
reaction, possibly caused by contaminants in ginseng formulations.
Goji : In traditional Chinese medicine (TCM), herbs are
almost always administered in combination formulas consisting of several herbs
that balance each other's effects and enhance the success of the treatment. A
case study provides some initial objective data on the formula
"Invigorating Kidney," which includes wolfberry together with six
other herbs. This herbal decoction showed that it may be possible to reverse
airway obstruction for patients convalescing from asthma.
Use cautiously in patients who are taking blood-thinning
medications, such as warfarin. Use cautiously in asthma patients and in
patients with sulfite sensitivities. The New York Department of Agriculture has
detected the presence of undeclared sulfites, a food additive, in two dried
goji berry products from China. Avoid in patients who are allergic to goji, any
of its constituents, or to members of the Solanaceae family.
Green-lipped mussel : Limited evidence suggests that
green-lipped mussel supplementation may help allergic diseases, such as atopic
asthma. Additional research is needed before a recommendation can be made.
Green-lipped mussel is generally considered safe. Use
cautiously with anti-inflammatory agents. Use cautiously with asthma. Avoid in
patients with liver disease. Avoid with allergy or sensitivity to green-lipped
mussel or other shellfish. Avoid if pregnant or breastfeeding.
Green tea : Research has shown caffeine to cause
improvements in airflow to the lungs (bronchodilation). However, it is not
clear if caffeine or tea use has significant benefits in people with asthma.
Better research is needed in this area before a conclusion can be drawn.
Avoid if allergic or hypersensitive to caffeine or tannins.
Use cautiously with diabetes or liver disease.
Honey : Currently there is insufficient human evidence to
recommend honey for the treatment of rhinoconjunctivitis. Poor quality study
reported no benefit of the use of honey for the treatment of
rhinoconjunctivitis. Further research is necessary before a firm conclusion can
Avoid if allergic or hypersensitive to honey, pollen,
celery, or bees. Honey is generally considered safe in recommended doses. Avoid
honey from the genus Rhododendron because it may cause a toxic reaction. Avoid
in infants younger than 12 months of age. Use cautiously with antibiotics.
Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be
found in some types of honey and should be used cautiously in pregnant or
Horseradish : Studies have indicated that some horseradish
constituents have antibiotic activity. Clinical study has used a combination
product that contained nasturtium herb and horseradish root to treat sinusitis.
Although the treatment had similar results as the standard antibiotic therapy
control, the effect of horseradish alone cannot be isolated due to the use of a
combination product. Additional high-quality clinical studies are needed before
a conclusion can be made.
Avoid if allergic or hypersensitive to horseradish
(Armoracia rusticana), its constituents, or members of the Brassicaceae family.
Large oral doses may provoke allergic reactions. Use cautiously with clotting
disorders, hypotension (low blood pressure), thyroid disorders, kidney disorders,
kidney inflammation, gastrointestinal conditions, skin ulcers, and stomach
ulcers. Use cautiously if taking anticoagulants or antiplatelets (blood
thinning agents), antihypertensives (blood pressure-lowering agents),
anti-inflammatory agents, or thyroid hormones. Use cautiously if undergoing
treatment for cancer. Avoid medicinal amounts of horseradish if pregnant or
breastfeeding, as glucosinolates from horseradish are considered a toxin that
can be excreted through breast milk and may pose a toxicity hazard. Also, based
on herbal textbooks and folkloric precedent, horseradish has been used to
Hypnotherapy, hypnosis : It has been suggested that
hypnotherapy may be effective for allergies and may help treat hay fever.
Preliminary research for the use of hypnosis for the management of asthma
symptoms does not provide clear answers. Anxiety associated with asthma may be
relieved with hypnosis. Further research is necessary to determine whether it
is an effective treatment.
Use cautiously with mental illnesses like
psychosis/schizophrenia, manic depression, multiple personality disorder or
dissociative disorders. Use cautiously with seizure disorders.
Kiwi : Currently, data on the therapeutic benefit of kiwi as
a preventative for lung and other respiratory problems is lacking. More
research is warranted before a recommendation can be made.
Avoid if allergic or hypersensitive to kiwi, latex, birch
pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame
seeds, and related substances. Kiwi is generally considered safe when taken in
amounts naturally found in foods. Use cautiously with anti-platelet drugs like
aspirin, cilostazol, or clopidogrel. Use cautiously with hormone therapies or
serotonergic drugs. Avoid if pregnant or breastfeeding because clinical trials
testing safety in supplemental doses are currently lacking. The amount found in
foods appears to be safe in most people.
Lactobacillus acidophilus : Limited available study suggests
that the Lactobacillus acidophilus (L. acidophilus) strain L-92 (L-92) may be
effective for the treatment of Japanese cedar-pollen allergy. Lactobacillus
acidophilus has also been suggested as a possible treatment for asthma.
However, further research is necessary before a firm conclusion can be made.
L. acidophilus may be difficult to tolerate if allergic to
dairy products containing L. acidophilus. Avoid with history of an injury or
illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid
with prescription drugs, such as corticosteroids, because of the risk of
infection. Use cautiously with heart murmurs. Antibiotics or alcohol may
destroy L. acidophilus. Therefore, it is recommended that L. acidophilus be
taken three hours after taking antibiotics or drinking alcohol. Some
individuals may use antacids, such as famotidine (Pepcid©) and esomeprazole
(Nexium©), to decrease the amount of acid in the stomach one hour before taking
Massage : Promising initial evidence suggests that massage
therapy may improve lung function in children with asthma. Additional research
is necessary before a firm conclusion can be drawn.
Avoid with bleeding disorders, low platelet counts, or if on
blood-thinning medications (such as heparin or warfarin/Coumadin©). Areas should
not be massaged where there are fractures, weakened bones from osteoporosis or
cancer, open/healing skin wounds, skin infections, recent surgery, or blood
clots. Use cautiously if history of physical abuse or if pregnant or
breastfeeding. Massage should not be used as a substitute for more proven
therapies for medical conditions. Massage should not cause pain to the client.
Meditation : Preliminary research of transcendental
meditation© for asthma reports benefits. However, due to unclear design or
study description, these results cannot be considered definitive.
Use cautiously with underlying mental illnesses. People with
psychiatric disorders should consult with their primary mental healthcare
professional(s) before starting a program of meditation, and should explore how
meditation may or may not fit in with their current treatment plan. Avoid with
risk of seizures. The practice of meditation should not delay the time to
diagnosis or treatment with more proven techniques or therapies, and should not
be used as the sole approach to illnesses.
Melatonin : Based on preliminary research, melatonin may
improve sleep in asthma. Further studies that evaluate the long-term effects of
melatonin on airway inflammation and bronchial hyper-responsiveness are needed
before a firm conclusion can be made.
Based on available studies and clinical use, melatonin is
generally regarded as safe in recommended doses for short-term use. Available
trials report that overall adverse effects are not significantly more common with
melatonin than placebo. However, case reports raise concerns about risks of
blood clotting abnormalities (particularly in patients taking warfarin),
increased risk of seizure, and disorientation with overdose.
MSM : According to preliminary clinical study, MSM reduces
symptoms associated with seasonal allergic rhinitis (SAR). However, larger
controlled trials are needed to confirm these findings.
Avoid if allergic or hypersensitive to MSM. Long-term
effects of supplementation with MSM have not been examined. Avoid if pregnant
Omega-3 fatty acids, fish oil, alpha linolenic acid :
Several studies do not provide enough reliable evidence to form a clear
conclusion on the use of fish oil for asthma. Because most studies have been
small without clear descriptions of design or results, the results cannot be
Avoid if allergic or hypersensitive to fish, omega-3 fatty
acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid
products that come from nuts. Avoid during active bleeding. Use cautiously with
bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements
that treat any such conditions. Use cautiously before surgery. The Environmental
Protection Agency (EPA) recommends that intake be limited in pregnant/nursing
women to a single 6-ounce meal per week, and in young children to less than 2
ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and
Drug Administration recommends that pregnant/nursing women and young children
avoid eating types with higher levels of methylmercury and less than 12 ounces
per week of other fish types. Women who might become pregnant are advised to
eat 7 ounces or less per week of fish with higher levels of methylmercury or up
to 14 ounces per week of fish types with about 0.5 parts per million (such as
marlin, orange roughy, red snapper, or fresh tuna).
Onion : Research shows that topical application of an
alcoholic onion extract significantly reduced responses to allergies. Although
intriguing, more research is needed in this area to establish the efficacy and
dosing of topical onion extracts.
Avoid if allergic or hypersensitive to onion (Allium cepa),
its constituents, or members of the Lilaceae family. Use cautiously with
hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), and
hypotension (low blood pressure). Use cautiously if taking anticoagulants or
antiplatelets (blood thinners). Avoid medicinal doses if pregnant or
Para-aminobenzoic acid : Although limited available clinical
study suggested that oral PAMBA (para-aminomethylbenzoic acid) administration
helped to prevent asthma exacerbation following bronchoprovocation challenge,
further studies are needed to confirm this effect.
Avoid oral use in children and pregnant or nursing women.
PABA must be used with caution in patients with renal disease because of its
predominantly renal route of excretion. Abnormalities of liver function tests
have been noted in patients taking PABA. Monitoring may be indicated for higher
doses (>8g per day). Blood sugar monitoring may be warranted in diabetics or
patients at risk for hypoglycemia who are taking PABA systemically. Discontinue
use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its
derivatives should only be taken under appropriate medical supervision.
Peppermint : There is currently not enough available
scientific evidence on the use of peppermint for asthma.
Use cautiously in patients with gastroesophageal reflux
disease or achlorhydria due to lower esophageal sphincter relaxing effects and
reports of dyspepsia. Peppermint oil should be used cautiously by people with
G6PD deficiency or gallbladder disease. Use cautiously in patients with hiatal
hernia or kidney stones. Avoid injection of peppermint oil, as it may result in
pulmonary edema and acute lung injury. Avoid topical use of peppermint oil
around the facial or chest areas of infants and young children, especially
around the nose, because the menthol constituent can induce apnea, laryngeal
and bronchial spasm, acute respiratory distress with cyanosis, or respiratory
arrest if applied directly to these areas.
Perilla : Preliminary evidence suggests some benefit of
perilla extract for seasonal allergies as well as asthma. Further clinical
trials are required before conclusions can be made.
Avoid exposure to known allergens, such as dust mites, mold,
pet dander, and pollen, and irritants, such as tobacco smoke and strong
chemical odors, which may worsen symptoms.
Pregnant women who suffer from allergic asthma should avoid
allergen triggers that cause attacks.
Keep windows closed, and if possible, use the air
conditioner in the house and car.
Do not dry clothes outside.
Regularly wash the hands and face to remove pollen.
An air purifier or high-efficiency particulate air (HEPA)
filter may help remove some of the allergens out of the air.
Consider using a humidifier, which adds moisture to the air,
to help keep the nasal passages open.
Vacuum carpets and fabric-covered furniture regularly to
remove indoor allergens. Use a vacuum cleaner with a double-layered microfilter
bag or HEPA filter.
Cover the bed mattress and pillows in dust-proof or
allergen-impermeable covers. Regularly change bed linens, including sheets and
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