There are few references to hay fever in any medical literature before the 19th century. The first clear description of a case of hay fever was documented by Dr. John Bostock of London in 1819. In the early 20th century, hay fever, also called “seasonal allergic rhinitis,” was often viewed as a “fashionable” disease of the rich.

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In the 21st century, however, the prevalence of hay fever and other allergic diseases—allergic asthma, atopic eczema, and food allergies—has reached epidemic proportions. With the rising incidence of allergic diseases, many different theories (or models) of allergy have also evolved. These theories suggest many different approaches to the prevention and treatment of allergic diseases.

IgE Model
According to Western medicine, allergies are caused by an excess of the Immunoglobulin E (IgE) antibodies in the blood. These antibodies bind tightly to allergic cells (called mast cells) in the skin, airways, and around blood vessels. The allergic cells get activated when the bound IgE recognizes an allergen, typically a protein such as dust mite, grass or ragweed pollen. These cells then release “allergy mediators”  like histamines and leukotriene’s which cause many of the common allergy symptoms such as airway constriction in asthma, local inflammation in eczema, and increased mucus secretion in allergic rhinitis.

Although the IgE model of allergy provides a good explanation of the proximate causes of allergy symptoms, it does not explain the root causes of allergy. For example, it is not clear why some people develop an excess of IgE antibodies and react abnormally to otherwise harmless natural substances (allergens) while other people don’t.

Also, it does not explain why the prevalence of allergic diseases has risen so dramatically in modern times.

Hygiene Hypothesis
Another theory, called the “hygiene hypothesis,” which may take us closer to the root causes, arose from epidemiological evidence which shows that allergy rates (and autoimmune disease rates) are much higher among children born and raised in the extremely hygienic (germ-free) and “unnatural” environments that are more commonly found in developed countries. For example, during a Cesarean birth, the newborn is deprived of his life’s first and most crucial natural exposure to germs, namely, bacteria from his mother’s birth canal. (Note that the fetus is essentially germ-free when it leaves the amniotic sac).

Similarly, many babies miss out on a variety of healthy germs when their office-going mothers are unable to breastfeed them for long. Furthermore, clean suburban homes provide a relatively germ-free living environment. Finally, modern practices like pasteurization of milk, sterilization of food, and generous use of antibiotics and antimicrobials (such as antibacterial soap) continue to protect the children from most germs and infectious diseases. According to the hygiene hypothesis, this obsessive avoidance of germs interferes with the normal growth and development of a child’s immune system, and may be a major cause of the modern epidemic of allergic and autoimmune disorders.

Bucket Theory
Another theory, called the bucket theory posits that everybody has a virtual “bucket” in his body that holds all the allergens that the body ingests or inhales. As long as this bucket of allergens is not full, one does not experience significant allergy symptoms even when exposed to allergens. But after this bucket gets full, any further exposure to allergens starts causing allergy symptoms.

An interesting implication of the bucket theory is that if you are allergic to, say, grass pollen and milk, and it is very hard to avoid exposure to grass pollen, you can reduce your sensitivity to the pollen by reducing your consumption of milk. Note that the IgE model of allergy does not permit this type of trade-off among allergens.

Ayurvedic Model
The bucket theory can also be viewed as a simplified version of the Ayurvedic model of allergy. In the Ayurvedic model, you have a bucket that is filled by kapha dosha when you eat kapha-increasing foods. As your bucket of kapha dosha fills up and starts overflowing, you start experiencing the symptoms associated with excess kapha dosha such as symptoms of seasonal allergy. Although imbalances in the other two doshas (pitta and vata) can also contribute to some allergy symptoms, kapha dosha plays the dominant role during spring allergies.

An important premise of the Ayurvedic model is that the root causes of allergy are not in the external environment, but within you. If you keep your doshas in balance through an appropriate ahaara-vihaara (diet and lifestyle), then the environmental triggers will not cause any allergy symptoms. Thus there is no need to go to great lengths to keep your beds, carpets, and furniture ultraclean, dust-free, and pollen-free; an approach that can be quite exhausting, and often impractical.

Now which of these theories is right? Perhaps all of them are valid to a certain extent. There is some empirical evidence to support each of these theories, yet they all suggest rather different approaches to the prevention and treatment of allergies.

Allergy Prevention and Treatment

Allergy Drugs
Under the Western or IgE model, the standard treatment is to use drugs to inhibit inflammatory allergy mediators (histamines, etc.) thereby preventing allergy symptoms like runny nose and sneezing. Common classes of allergy drugs include antihistamines (popular brand names: Claritin, Allegra), anti-leukotriene’s (Singulair) and corticosteroid nasal sprays (Flonase, Nasacort).

The main problem with this approach is that these drugs don’t address the root causes of allergy, and, therefore, may become addictive. Moreover, they do have significant side effects. Over time, the drugs may become less effective and the side effects more pronounced.

Allergy Shots
An alternative approach that avoids these drugs is called desensitization immunotherapy or allergy shots. Immunotherapy builds tolerance to allergens by gradually decreasing the IgE-dominated response. In this approach, sometimes called subcutaneous immunotherapy (SCIT), the upper arm is injected with allergens like dust mites and pollens. These shots start with a small weekly dose of allergens which is gradually increased to a maintenance dose given every 2-4 weeks for 3-5 years. Eventually, the body becomes desensitized to these environmental allergens. However, it is difficult to predict how long this desensitization will last after you stop taking the shots.

More recently (2014), the FDA has approved a version of immunotherapy that uses a sublingual allergen extract to treat pollen allergies. In this new approach, called sublingual immunotherapy (SLIT), only the first dose needs to be administered at the doctor’s office. All subsequent doses (one tablet a day) can be taken at home. Oralair is one of the approved drugs for SLIT. It contains a mixture of freeze-dried extracts from the pollens of several grasses.

Healthy Germs
Based on the hygiene hypothesis, it may be possible to prevent allergies in children by taking a strategic and more friendly approach towards germs, e.g., by proactively planning for a natural childbirth, by breastfeeding longer, and by minimizing the use of antibiotics and anti-microbials. Exposure to farms and cow sheds very early in life also helps, especially if the mother is exposed during pregnancy. If a Cesarean delivery becomes inevitable, wiping the face and body of the newborn with his mother’s birth-canal bacteria can partially restore his natural micro biota. Recent studies also suggest that certain probiotics (taken orally) can be effective in treating allergic rhinitis.

Ayurvedic Remedies
The Ayurvedic approach offers a drugless strategy for the lifelong prevention and management of allergy symptoms. The basic idea is to “pacify” or reduce kapha dosha with appropriate adjustments to your diet and lifestyle. Avoid or minimize dairy foods, sweet and sour foods, and cold drinks while increasing pungent and bitter foods and spices such as bitter greens, garlic, ginger, green chilies, black pepper, and turmeric. Fasting and exercise also help in pacifying kapha.

Some other Ayurvedic remedies for allergy include hot shower, sauna, neti (nasal cleaning) and nasya (nasal oil drops). More specific (personalized) diet and lifestyle guidance should be obtained from a vaidya (Ayurvedic doctor). In stubborn cases of spring allergy, a form of panchkarma called vamana (therapeutic emesis) may be used to rid the body of accumulated kapha dosha. However, vamana therapy should be undertaken only under the guidance of an experienced vaidya.

Ultimately, most allergy sufferers realize that allergy is a chronic condition that may impact the quality of their life for the rest of their life. By addressing the root causes of their allergy, and by making practical and sustainable changes in their diet and lifestyle, they can prevent or minimize their allergy symptoms while avoiding long-term dependency on allergy drugs.

Vijay Gupta studies and writes about health issues from a consumer’s perspective. As a long-time allergy sufferer, he has tried most of the treatments described herein. Currently, he uses the Ayurvedic approach to prevent and treat his allergy symptoms.

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