Environmental and Seasonal Allergies

What is Environmental and Seasonal Allergies?

Environmental and seasonal allergies are immune reactions to normally harmless substances in the air around you. The most common form is allergic rhinitis, also called hay fever, which affects about one in six people and causes nasal congestion, a runny nose, sneezing and an itchy nose.^[1] Allergic rhinitis is called seasonal when it follows pollen seasons and perennial when triggers such as dust mites or pet dander are present all year. Many people have features of both.^[1]

Common symptoms

The typical symptoms are nasal congestion, a clear runny nose, sneezing, postnasal drip, and itching of the nose, eyes and throat.^[2] Allergic pink eye (itchy, red, watery eyes) and a dry cough are common, and allergic rhinitis often goes along with asthma and eczema.^{[1, 2]}

Allergies can also affect sleep and mood. A review of meta-analyses found that allergic rhinitis was associated with a higher risk of sleep disorders, although such links do not prove cause.^[3]

Causes and risk factors

Allergic rhinitis begins when allergens cross the lining of the nose and the immune system responds with a T-helper type 2 inflammatory reaction and allergen-specific IgE antibodies.^[2] Common triggers include tree, grass and weed pollen, mold spores, dust mites, pet dander and cockroach debris.^[1] Having asthma or eczema is linked to allergic rhinitis, because these conditions share an underlying allergic tendency.^[1]

How it is diagnosed and treated conventionally

Diagnosis rests on your symptoms, an examination of the nose and, when needed, tests for allergen-specific IgE.^[2] Avoiding the triggers you react to is the first step.^[2]

Medicines are chosen by severity. Mild symptoms are often treated with a second-generation oral antihistamine or an antihistamine nasal spray. Moderate to severe or persistent symptoms usually call for a nasal corticosteroid spray, alone or combined with a nasal antihistamine.^{[1, 2]}

Why Environmental and Seasonal Allergies calls for a whole-person approach

Allergy symptoms come from more than the allergen itself. The nose, eyes, lungs and skin are linked parts of one allergic system, and sleep, stress and mood can shape how much the symptoms affect daily life.^{[1, 3]}

Care that looks at these factors together is a reasonable addition to trigger avoidance and medicines, not a substitute for them.

One airway, several conditions

The nose and lower airways are described as a single connected airway, and allergic rhinitis shares an underlying systemic allergic process with asthma and atopic dermatitis.^[1] That is why we ask about asthma and eczema, and why wheezing or chest tightness needs a physician's attention.

Inflammation of the nasal lining

Symptoms reflect ongoing inflammation of the nasal lining, driven by the T-helper 2 response and IgE.^[2] This is the process that standard medicines and some complementary approaches aim to calm.

Sleep and tiredness

Allergic rhinitis is tied to sleep problems. In pooled data, people with allergic rhinitis had about twice the odds of a sleep disorder compared with people without it.^[3] Poor sleep and daytime fatigue are a common part of the burden.

Stress and mood

Allergic diseases are associated with a higher risk of several mental health conditions, with the strongest evidence for asthma, and the authors note that these associations do not prove cause.^[3] Because stress and low mood can color how symptoms feel, we pay attention to them.

Acupuncture for Environmental and Seasonal Allergies

What the research shows

Research suggests acupuncture may modestly improve nasal symptoms and quality of life in allergic rhinitis, but the benefit is small in many studies and the quality of the evidence varies.

A meta-analysis of 30 trials with 4,413 participants found acupuncture improved nasal symptoms and quality of life in adults compared with no treatment, and was better than sham acupuncture on a nasal symptom subscale and on quality of life. It found no clear difference from cetirizine or loratadine. A trial sequential analysis did not confirm these results, and serious bias was common in the included studies. Evidence in children was insufficient.^[4]

Another meta-analysis of 30 trials of needle acupuncture reported lower symptom scores, better quality of life and less rescue medication use than sham acupuncture, with most of that evidence rated as high confidence. Comparison with medicines was rated very low quality.^[5] A 2024 review of 14 trials of acupuncture inside the nose found improved symptoms and quality of life, a lower recurrence rate, and only mild adverse effects, and also called for larger, higher-quality trials.^[6]

Two large trials show both the promise and the limits. In a German trial of 422 people with seasonal allergic rhinitis, 12 acupuncture sessions over 8 weeks improved quality of life and reduced antihistamine use compared with sham acupuncture or medicine alone, but the authors noted the improvements may not be clinically significant.^[7] An Australian sham-controlled trial of 175 people found that 12 sessions over 4 weeks reduced some symptoms and improved quality of life, and was well tolerated.^[8]

How acupuncture may work

Researchers have proposed several ways acupuncture could act in allergic rhinitis, and these remain proposals. Reviews describe effects on the balance of immune cell types, lower IgE levels, less inflammatory cell build-up in the nasal lining, and changes in nasal nerve signaling.^[9]

Human data are mixed. In a small substudy of 29 people, acupuncture lowered some inflammatory markers in nasal fluid but did not shift the Th1 and Th2 balance.^[10]

What treatment involves

A visit usually involves a short review of your symptoms and triggers, then fine, sterile, single-use needles placed at points on the face, hands, arms and legs, typically left in for about 20 to 40 minutes. The two main sham-controlled trials used 12 sessions over 4 to 8 weeks, and we reassess after a short course of visits.^{[7, 8]}

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Environmental and Seasonal Allergies

The Ayurvedic view

In Ayurveda, recurrent sneezing and nasal discharge are described under the classical name Pratishyaya. It is traditionally explained as an imbalance of the doshas, most often Vata and Kapha, affecting the head and nasal passages, sometimes together with weak digestion (agni) and the build-up of ama, a sticky residue of incomplete digestion. These are traditional categories used to guide care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, such as warm, freshly cooked meals, limiting cold and heavy foods, and regular sleep hours
• Nasya, the application of medicated oil to the nasal passages, and steam inhalation
• Nasal rinsing with salt water, a practice thought to have originated in the Ayurvedic tradition
• Herbs, prescribed individually, such as triphala, guduchi (Tinospora cordifolia), tulsi and turmeric

Panchakarma cleansing procedures are traditionally used for allergic conditions only when a person is strong enough, and are not appropriate during pregnancy, acute illness or frailty.

What the research shows

The research on Ayurveda for allergic rhinitis is limited. A review of herbal trials found two small trials of an Indian herbal combination called Aller-7 with positive results, plus a single trial of Tinospora cordifolia, and called for larger, better-designed studies.^[12] A 2021 review noted that no studies have tested triphala itself in allergic rhinitis; its case rests on overlap with the ingredients of Aller-7.^[13]

No systematic review of Ayurvedic medicine as a whole for allergic rhinitis was found. A review of complementary treatments for allergy described the evidence for complementary therapies, including Ayurvedic ones, as varied and under-researched.^[14]

Herbal medicine for Environmental and Seasonal Allergies

Herbs and formulas that have been studied

One widely studied Chinese formula is Yu ping feng san, a traditional blend commonly used for allergic rhinitis.^[15] Other herbs studied include butterbur (Petasites hybridus), the Indian combination Aller-7, Perilla frutescens and Tinospora cordifolia.^{[12, 16]} Herbs and formulas are prescribed individually after review of your health and medicines.

What the research shows

The evidence is limited and mostly of low certainty. A meta-analysis of 18 trials found oral Chinese herbal medicine may improve nasal symptoms and quality of life compared with antihistamines, but the authors cited few trials, poor trial design and substantial inconsistency.^[17] A review of Yu ping feng san, with 22 trials, found it no better than a second-generation antihistamine, and combining it with medicine looked more beneficial than medicine alone, on low-quality evidence.^[15]

A 2021 review of 32 studies of herbal medicines found benefit over placebo for nasal symptoms and quality of life for up to 12 weeks. Longer use showed no benefit over placebo, and herbs were no different from standard treatment.^[18] A 2024 review of single medicinal plants judged the evidence for symptom improvement over placebo to be very low to low certainty and concluded that clear evidence of benefit is still lacking.^[16]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reported interactions include bleeding when danshen, garlic or ginkgo is combined with warfarin, and lower blood levels of some medicines with St John's wort, including ciclosporin.^[19] Tell us about all medicines you take, including anticoagulants, immunosuppressants and antidepressants.

Product quality matters. In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding or have liver or kidney disease. A review of complementary allergy treatments also warns that some products carry significant risks.^[14]

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes allergic rhinitis as a pattern of weak defensive qi (wei qi) of the lungs, with wind and cold entering the nose. Researchers who study acupuncture and formulas such as Yu ping feng san look at measurable parallels: IgE levels, immune cell balance, inflammatory cells in the nasal lining and nasal nerve signaling.^{[9, 15]}

Ayurveda's Kapha excess and ama describe congestion and thick secretions in the head and chest. Biomedicine talks about mucosal inflammation and mucus production in the nose. No study has shown that a dosha or ama corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for allergies is complementary. Keep your physician or allergist, and do not stop or change prescribed medicines, including nasal sprays, antihistamines or allergy shots, without talking to your prescriber. We do not diagnose allergies or perform allergy testing.

Please bring your diagnosis or allergy test results, a full list of medicines and supplements, and details of any asthma or eczema. Because asthma often accompanies allergic rhinitis, new or worsening wheeze or chest tightness should be assessed medically.^[1]

When to seek urgent medical care

Allergies can occasionally cause severe reactions, and some symptoms need prompt assessment.

• Trouble breathing, wheezing or chest tightness that is new or getting worse
• Swelling of the lips, tongue or throat, or a feeling that the throat is closing
• Widespread hives with dizziness, fainting or vomiting after exposure to an allergen
• Facial pain or pressure with fever, or thick discolored discharge lasting more than about ten days
• Eye pain or changes in vision

If any of these occur, call 911 or go to the nearest emergency department.