For a significant number of people, spring allergies are the pits. It is a constant runny-nosed, sniffling, sneezy battle against the allergens from flower buds and blooming trees. If this is you, you are not alone. According to the Centers for Disease Control and Prevention, seasonal allergies affect over 7% of American children and nearly 8% of adults, making them one of the leading chronic illnesses in the United States¹.

What are Spring Allergies and How Do Allergies Come About?

Along with the spring season comes an increase in the number of allergens, including pollen from trees and flowers, dry grass, and weeds, making life miserable for many.

A person develops an allergy when their immune system overreacts to a particular substance, typically something otherwise harmless.

In response to whatever this substance is, the body’s white blood cells create special immune system chemicals called antibodies. The antibody that is created will be specific to the given allergen. These antibodies attached to other immune system cells, called mast cells, causing them to release a cavalcade of chemicals, including histamines. In an effort to prevent allergens from entering the body, histamine causes swelling in the eyes and nose, production of more nasal mucus, and sneezing to clear the nose of allergens.

Seasonal allergies are extremely prevalent in both children and adults. The CDC estimates that 7.1 million children experienced respiratory allergies in 2018 and that 5.2 million children had hay fever symptoms². Children between the age of 12 to 17 are especially vulnerable to these allergens. Additionally, spring allergies might increase in severity and incidence of respiratory symptoms in people with asthma.

Symptoms of Spring Allergies

The symptoms of spring allergies can vary from person to person and trigger-to-trigger. Mostly, they consist of cold-like features, and commonly include one or more of the following:

• Itchy sensation
• Chest tightness
• Watery eyes
• Red or Itchy eyes
• Nasal congestion
• Coughing
• Breathing issues
• Wheezing
• Sneezing
• Sore or itchy throat
• Swelling of a specific area
• Sinus pressure

Causes of Spring Allergies

Outdoor Triggers

Plants produce pollen, which are tiny grains used for reproduction. Pollen is released into the atmosphere as plants begin to blossom. While some plants use insects to spread their pollen, others use the wind. When pollen is on the wind and someone with a pollen allergy breathes it in, it will trigger an allergic reaction.

There are as many different types of pollen as there are types of plants. Not everyone will spring allergies will be allergic to all types of pollen – you may have noticed your spring allergies are limited to only a couple of weeks a year, indicating you are likely allergic to only one or two species’ pollen, or they may continue all spring, suggesting you may be allergic to multiple species’ pollen. 

Here are some typical outdoor allergic triggers.

Trees

Early spring allergies are likely due to tree pollen, which is typically released between February and May depending on the location. Tree Pollen is associated with allergic rhinitis and is likely the most common trigger in the U.S. Triggering trees include:

• Oak
• Maple
• Ash
• Cypress
• Birch
• Walnut
• Poplar
• Western red cedar
• Hickory
• Elm
• Alder

Grass 

Although trees are typically the main cause of spring allergies, they are not the sole culprit. If spring arrives early in some areas, weeds and grasses can cause allergy symptoms as early as March, then the pollen count of grasses like rye and bermuda rises through May, but the peak pollen count usually doesn't occur until June.

Some of the types of grass most commonly associated with allergic reactions are:

• Red top grass
• Timothy grass
• Orchardgrass
• Bluegrass
• Sweet vernal grass

Indoor Triggers

Indoor triggers are present all year long, but become considerably more prevalent in the spring due to various factors. Some indoor triggers include:

Mold

Mold can be spotted outside on decaying logs and leaves, on grasses and grains, in compost piles, and in other moist areas. Plants that have not endured the winter cold can decompose in the spring, becoming breeding grounds for mold.

More pressingly, mold can grow indoors, especially in wet areas like bathrooms, basements, and kitchens³. Black mold is a common problem for wood and plaster in houses in damp environments.

Insects

Insects are more common outside but can definitely make their own homes in ours.

In contrast to the symptoms of seasonal allergies to pollen, such as sneezing and congestion, insect bites and stings typically result in pain, itching, redness, and/or swelling around the afflicted area. Additionally, stings and bites can cause anaphylaxis, a severe or potentially fatal allergic reaction. Allergic reactions to insects account for over 10% of all cases of anaphylaxis⁴.

Therefore, if you experience major symptoms after a bite or sting, such as hives, lips, tongue, or throat swelling, difficulty breathing, or other symptoms, you must seek medical attention immediately.

Pet Dander

It's common to be allergic to pet dander⁵. Pet dander is what we call a type of protein present in most animals’ fur or feathers. As it gets warmer outside, many pets start to molt their winter coats. As a result, there is more dander than usual, which can worsen allergy problems.

People can also be allergic to pet saliva and skin oils, both also present on animals’ fur or feathers, as well as their urine and feces.

Dust Mites

Around half of the asthmatic population, and 1–2% of the global non-asthmatic population, is also allergic to dust mites, making them potentially the most important indoor allergy trigger⁶.

Dust mites are present all year long, but their populations typically rise through spring and summer to peak in July and September⁷. Particularly, if you engage in spring cleaning you can see an upsurge in symptoms, as you release the dust mite allergens from carpets and rugs. )), but how are spring allergies diagnosed?

To diagnose a spring allergy, a doctor may run several tests, including:

• Skin prick test – A small amount of the allergen is scratched into the patient's skin to check for a reaction. Results typically take 10 to 20 minutes.
• Intradermal test – During this process, the allergen is injected very thinly under the skin to check for a reaction
• Blood test – A sample of blood is taken and tested to see the levels of allergy-specific antibodies there are in it.

The doctor might inquire further about your symptoms, living and working conditions, and medical history in your family.

Read on to know how you can eliminate these annoying spring allergies.

Spring Allergy Management And Treatment

Now that you have general information about the symptoms and causes of spring allergies, let’s find out how you can easily eliminate or control them.

Always discuss your symptoms and available treatments with your doctor or a board-certified allergist.

Medication

Fortunately, several over-the-counter and prescription remedies are available to ease the symptoms of spring allergies. These medications include:

• Antihistamines – These reduce histamine levels in your body, which decreases sneezing, sniffling, and itching
• Decongestants – These relieve congestion, allowing you to breathe more easily
• Corticosteroids for the nose – Alongside other effects, corticosteroids suppress your immune system (the cause of any allergic reaction)
• Leukotriene receptor antagonists – As well as histamines, your body releases leukotrienes during an allergic reaction. These cause swelling in the lungs, making it difficult to breathe, alongside increased mucus production. Leukotriene receptor antagonists reduce the number of leukotrienes your body can detect, even if they’re in your blood, by blocking up the receptors.

To keep your symptoms under control, your doctor may prescribe a mix of medications. Usually, you have to take these medications in the form of:

• Regular shots (Injections)
• Pills, tablets, or under-the-tongue drops 
• Liquids
• Inhalers
• Nasal sprays 
• Eye drops
• Skin creams

Immunotherapy

Your doctor may also prescribe immunotherapy⁸ if these medications are unable to treat your symptoms totally. Immunotherapy exposes you to the allergen in progressively higher doses until your body becomes tolerant to it. 

Compared to other allergy medications, the treatment can reduce your symptoms for a longer period of time. Additionally, the intensity of your allergic reactions may be lessened with this long-term treatment, even if they don’t go away entirely.

Epinephrine Injection

Those who suffer from severe allergies may need to always have an emergency epinephrine injection (Auvi-Q, EpiPen) on them. When given at the first sign of a severe allergic reaction, an epinephrine injection can lessen the symptoms sufficiently for the person to survive long enough to recieve further medical treatment. 

Epinephrine injection is a first-aid measure and not a long-term treatment plan. It can save a life by giving more time to get someone to a hospital.

Behavioral and Environmental Changes

Avoid Outdoor Allergens 

One can avoid outdoor allergens in the following ways:

• Know what pollen you’re allergic to – Pollen levels vary throughout the day, but the pattern depends on the species. You need to know whether you are allergic to grass, tree, or another type of pollen. This will indicate what time of day it is safer to go out, and what times of day should be avoided.
  • Grass pollen – Usually at its highest in the mid-afternoon (2–4 pm)⁹, although in some places grass pollen levels rise around 9 am and don’t fall until the evening¹⁰.
  • Tree pollen – Polle level patterns vary by type of tree¹¹¹²:
    • Alder and birch – Steady levels all day
    • Spruce and oak – High levels from early morning to early evening
    • Juniper trees – Levels peak during the morning
    • Willow, poplar, and aspen – Peak around midday
    • Pine – Peaks mid-afternoon
    • Elm – Peaks early evening
• Stay inside when it’s windy and dry – Pollen is more prevalent in the air in this weather. If you want to go for a walk, wait for the rain to clear pollen from the air and then go outside 
• Avoid lawn mowing, weed pulling, and other gardening chores – These stir up allergens
• Remove clothes you've worn outside as soon as you come inside and wash them – This reduces the amount of time you are in contact with outdoor allergens, and stops you from bringing them into your home.
• Don't hang laundry outside – Pollen can stick to sheets and towels
• Wash your laundry at high enough temperatures – You need to wash your clothes and sheets at 130°F (54°C) or more to remove all allergens¹³
• Shower regularly – This helps to remove pollen and other allergens from your hair and skin
• Keep windows and doors closed during the night – Allergens may be blown in during the night, and cause you to cough or have other allergic symptoms
• Avoid outside activities in the early morning – This is when pollen counts reach their highest
• Wear a face mask outdoors – If it is necessary to do outside chores

Clean Up Indoor Air

There isn't a magic solution that will purge every allergen from the air in your house; however, the following ideas could be useful¹⁴:

• Use the air conditioner systems in your vehicle and home, especially if you can install filters
• Use a high-efficiency particulate air (HEPA) filter to clear the air inside your home – filtering the whole house is best, but if you can’t afford this, then focusing on one room, such as your bedroom, is better than nothing¹⁵
• Use a HEPA-filter vacuum cleaner to often clean the floors
• If your home has forced air heating or cooling, utilize high-efficiency filters and adhere to scheduled maintenance
• Use a dehumidifier to keep the air inside drier – this will reduce the number of dust mites¹⁶

Check Your Allergy Forecast

Certain weather conditions can contribute to the severity of allergies. For example, dry, windy days cause an increase in pollen in the air, while rain helps reduce the amount. 

It can be helpful to check the pollen count via local weather reports, allergy forecast apps, the national allergy bureau, or online weather reports before you go out. This will help you decide what other precautions, such as daily antihistamines or face masks, you need to take. 

Asthma Allergy Network’s forecast is available here, and the American Academy of Allergy, Asthma & Immunology (AAAAI) hosts a pollen and mold forecast available here.

Natural Remedies to Snap Away Spring Allergies

Using organic plant extracts and foods that serve as antihistamines can provide relief for people with allergies. Such remedies include:

Butterbur (Petasites hybridus/Petasites Officinalis/Tussilago hybrida)

This plant gets its name from people using its big leaves to wrap around butter in warm weather. Extracts from this plant are traditionally used for fever, headaches¹⁷, and nasal allergies¹⁸. It also blocks the creation of some leukotrienes¹⁹ (the chemical that causes swelling and increased mucus production in the nasal passages).

Butterbur might not be very well known, but may be one of the most effective herbal ways to fight off allergic reactions. A study in 2002²⁰ tested the effects on 125 patients and found that this plant has similar effects to an antihistamine.

Use a Neti Pot

A neti pot looks similar to a small teapot or bulb syringe made of plastic, ceramic, or porcelain. It’s used to flush out the mucus in the nasal cavity using a saline solution. 

A study in 2006²¹ showed that using a neti pot can be beneficial to patients experiencing hay fever, other nasal allergies, and colds. It can also relieve any cough you’ve developed from your allergies²².

When making your saline solution, adjust the amount of salt so you don’t experience stinging or burning sensations. Use the neti pot three to four times a day for the best outcome.

Vitamins and Supplements

A healthy, balanced diet keeps your immune system in its best shape. However, it can be difficult to maintain a perfect diet and it's likely that your immune system could use a boost of certain nutrients. In this case, dietary supplements may be beneficial.

Inflammation and other biological responses brought on by allergic reactions can also be controlled with the use of specific vitamins and herbs such as:

Quercetin

A great deal of research has been done on how quercetin inhibits enzymes and inflammatory mediators to produce anti-allergic effects²³. Its primary natural sources in the diet are fruits, onions, wine, tea, and broccoli.

Vitamin C

This vitamin reduces the duration of the common cold through generally improving the immune system’s function²⁴; however, when taken as a dietary supplement, high doses are required²⁵. It is most effective through intravenous methods in hospitals²⁶

Bromelain

This pineapple extract reduces coughing and loosens mucus²⁷. It can also inhibit allergic responses and the level of sensitization to a trigger²⁸

Probiotics

These are dietary supplements that include beneficial bacteria that naturally live in your gut; this increases their population in your body, which is purported to have various health benefits. A review of several studies indicated some benefits of taking probiotics in reducing hay fever²⁹.

Stinging nettle (Urtica dioica)

Not so nice to brush against, but stinging nettle extract may reduce symptoms of hay fever and other seasonal allergies³⁰ through reducing inflammation³¹.

Aromatherapy

There are many great benefits of essential oils and aromatherapy is one way to deliver them; not only does it help you feel relaxed and calm your mind, but it can alsohelp with your seasonal allergies³². 

Essential oils from plants such as eucalyptus, rosemary, and oregano all have significant inflammatory factors³³ making them excellent for treating respiratory problems such as asthma, COPD³⁴, or coughing from allergies.

For best results, you might need to stick to this treatment for a while, at least a month³⁵, as this can be a long-term condition. Also, you can use the essential oils from these plants with a humidifier or as a nasal spray if suitably prepared³⁶.

Acupuncture

In traditional Chinese medicine, acupuncture³⁷ is used to treat conditions like allergy problems, including runny noses, itchy eyes, congested sinuses, and chronic pain. While some people might not think much of this kind of medication, it has a growing basis of scientific support³⁸.

A 2018 research study found that acupuncture patients reported fewer sinus problems and an improvement in quality of life³⁹, similar to a 2017 study that found acupuncture worked well as an additional treatment⁴⁰

To discuss your allergy symptoms, make an appointment with a qualified acupuncturist, perhaps through a referral from your doctor 

Conclusion

Spring allergies, like hay fever, can be annoying. Fortunately, there are medications you can take that relieve the symptoms. Unfortunately, allergy medicines occasionally have unpleasant side effects. However, there are various natural alternatives that you can use in place of them if you wish to avoid their adverse effects or additional prescriptions in general. Avoiding any known triggers is the simplest and safest strategy to help allergies. 

Including extra fruits and vegetables in your diet could also be beneficial to increase the level of vitamins and minerals. There is also the option of taking supplements like quercetin and vitamin C. However, it's critical to be aware of any possible prescription interactions and dangers – before using any supplements, go to your doctor if you have any questions about what is safe for you.

References

1. Centers for Disease Control and Prevention. (2022, September 6). FastStats - Allergies and Hay Fever. U.S. Department of Health and Human Services. https://www.cdc.gov/nchs/fastats/allergies.htm Retrieved 2022 December 4[↩]
2. Centers for Disease Control and Prevention. (2022, September 6). FastStats - Allergies and Hay Fever. U.S. Department of Health and Human Services. https://www.cdc.gov/nchs/fastats/allergies.htm Retrieved 2022 December 4[↩]
3. Asthma and Allergy Foundation of America. (2022, July). Mold Allergy. Asthma and Allergy Foundation of America. https://aafa.org/allergies/types-of-allergies/mold-allergy/ Retrieved 2022 December 4[↩]
4. Tankersley, M. S., & Ledford, D. K. (2015). Stinging Insect Allergy: State of the Art 2015. The Journal of Allergy and Clinical Immunology: In Practice, 3(3), 315–322. https://doi.org/10.1016/j.jaip.2015.03.012[↩]
5. informedhealth.org. (2020 April 23). Allergies to animals. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen. https://www.informedhealth.org/allergies-to-animals.html Retrieved 2022 December 4[↩]
6. ICalderón, M. A., Linneberg, A., Kleine-Tebbe, J., De Blay, F., Hernandez Fernandez de Rojas, D., Virchow, J. C., & Demoly, P. (2015). Respiratory allergy caused by house dust mites: What do we really know? In Journal of Allergy and Clinical Immunology (Vol. 136, Issue 1, pp. 38–48). Elsevier BV. https://doi.org/10.1016/j.jaci.2014.10.012[↩]
7. Lintner T.J. & Brame K.A. (1993). The effects of season, climate, and air-conditioning on the prevalence of Dermatophagoides mite allergens in household dust. Journal of Allergy and Clinical Immunology. 91. 862–867. https://doi.org/10.1016/0091-6749(93)90343-e[↩]
8. Walker, S. M., Durham, S. R., Till, S. J., Roberts, G., Corrigan, C. J., Leech, S. C., Krishna, M. T., Rajakulasingham, R. K., Williams, A., Chantrell, J., Dixon, L., Frew, A. J., Nasser, S. M., & British Society for Allergy and Clinical Immunology (2011). Immunotherapy for allergic rhinitis. Clinical and experimental allergy: Journal of the British Society for Allergy and Clinical Immunology, 41(9), 1177–1200. https://doi.org/10.1111/j.1365-2222.2011.03794.x[↩]
9. Norris-Hill, J. (1999). The diurnal variation of Poaceae pollen concentrations in a rural area. Grana, 38(5), 301–305. https://doi.org/10.1080/001731300750044528[↩]
10. Latałowa, M., Uruska, A., Pe˛dziszewska, A., Góra, M., & Dawidowska, A. (2005). Diurnal patterns of airborne pollen concentration of the selected tree and herb taxa in Gdańsk (northern Poland). Grana, 44(3), pp. 192–201. https://doi.org/10.1080/00173130500219692[↩]
11. Käpylä, M. (1984). Diurnal variation of tree pollen in the air in Finland. Grana, 23(3), 167–176. https://doi.org/10.1080/00173138409427712[↩]
12. Latałowa, M., Uruska, A., Pe˛dziszewska, A., Góra, M., & Dawidowska, A. (2005). Diurnal patterns of airborne pollen concentration of the selected tree and herb taxa in Gdańsk (northern Poland). Grana, 44(3), pp. 192–201. https://doi.org/10.1080/00173130500219692[↩]
13. Mayo Clinic Staff. (2020). Allergy-proof your home – Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy/art-20049365 Retried 2022 December 4 [↩]
14. Mayo Clinic. (2022, April 27). Seasonal allergies: nip them in the bud. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hay-fever/in-depth/seasonal-allergies/art-20048343 Retrieved December 8 2022[↩]
15. Sublett, J. L. (2011). Effectiveness of Air Filters and Air Cleaners in Allergic Respiratory Diseases: A Review of the Recent Literature. Current Allergy and Asthma Reports, 11(5). https://doi.org/10.1007/s11882-011-0208-5[↩]
16. Arlian, L. G., Neal, J. S., Morgan, M. S., Vyszenski-Moher, D. L., Rapp, C. M., & Alexander, A. K. (2001). Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. Journal of Allergy and Clinical Immunology, 107(1), 99–104. https://doi.org/10.1067/mai.2001.112119[↩]
17. Benemei, S., De Logu, F., Li Puma, S., Marone, I. M., Coppi, E., Ugolini, F., Liedtke, W., Pollastro, F., Appendino, G., Geppetti, P., Materazzi, S., & Nassini, R. (2017). The anti-migraine component of butterbur extracts, isopetasin, desensitizes peptidergic nociceptors by acting on TRPA1 cation channel. British Journal of Pharmacology, 174(17), 2897–2911. https://doi.org/10.1111/bph.13917[↩]
18. Schapowal, A. (2002). Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. British Medical Journal, 324(7330), 144–144. https://doi.org/10.1136/bmj.324.7330.144[↩]
19. Brune, K., Bickel, D., & Peskar, B. (1993). Gastro-Protective Effects of Extracts of Petasites hybridus: The Role of Inhibition of Peptido-Leukotriene Synthesis. Planta Medica, 59(6), 494–496. https://doi.org/10.1055/s-2006-959746[↩]
20. Schapowal, A., & Petasites Study Group (2002). Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. British Medical Journal, 324(7330), 144–146. https://doi.org/10.1136/bmj.324.7330.144[↩]
21. Rabago, D., Barrett, B., Marchand, L., Maberry, R., & Mundt, M. (2006). Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multimethod study. Annals of family medicine, 4(4), 295–301. https://doi.org/10.1370/afm.552[↩]
22. Lin, L., Chen, Z., Cao, Y., & Sun, G. (2017). Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. American Journal of Rhinology & Allergy, 31(2), 96-104. https://doi.org/10.2500/ajra.2017.31.4418[↩]
23. Mlcek, J., Jurikova, T., Skrovankova, S., & Sochor, J. (2016). Quercetin and Its Anti-Allergic Immune Response. Molecules (Basel, Switzerland), 21(5), 623. https://doi.org/10.3390/molecules21050623[↩]
24. Y.B. Shaik-Dasthagirisaheb , G. Varvara , G. Murmura , A. Saggini , A. Caraffa , P. Antinolfi , S. Tete' , D. Tripodi , F. Conti , E. Cianchetti , E. Toniato , M. Rosati , L. Speranza , A. Pantalone , R. Saggini , M. Tei , A. Speziali , P. Conti , T.C. Theoharides , F. Pandolfi. (2013). Role of vitamins D, E and C in immunity and inflammation. Journal of Biological Regulators and Homeostatic Agents. 27(2): 291-295. https://www.biolifesas.org/EN/Y2013/V27/I2/291[↩]
25. Chang, H.-H., Chen, C.-S., & Lin, J.-Y. (2009). High Dose Vitamin C Supplementation Increases the Th1/Th2 Cytokine Secretion Ratio, but Decreases Eosinophilic Infiltration in Bronchoalveolar Lavage Fluid of Ovalbumin-Sensitized and Challenged Mice. Journal of Agricultural and Food Chemistry, 57(21), 10471–10476. https://doi.org/10.1021/jf902403p[↩]
26. Vollbracht C, Raithel M, Krick B, Kraft K, Hagel AF. Intravenous vitamin C in the treatment of allergies: an interim subgroup analysis of a long-term observational study. Journal of International Medical Research. 2018;46(9):3640-3655. doi:10.1177/0300060518777044[↩]
27. Chakraborty, A. J., Mitra, S., Tallei, T.E., Tareq, A.M., Nainu, F., Cicia, D., Dhama, K., Emran, T.B., Simal-Gandara, J., & Capasso, R. (2021) Bromelain a Potential Bioactive Compound: A Comprehensive Overview from a Pharmacological Perspective. Life, 11(4), 317–343. https://doi.org/10.3390/life11040317[↩]
28. Secor, E. R., Jr, Szczepanek, S. M., Castater, C. A., Adami, A. J., Matson, A. P., Rafti, E. T., Guernsey, L., Natarajan, P., McNamara, J. T., Schramm, C. M., Thrall, R. S., & Silbart, L. K. (2013). Bromelain Inhibits Allergic Sensitization and Murine Asthma via Modulation of Dendritic Cells. Evidence-based complementary and alternative medicine: eCAM, 2013, 702196. https://doi.org/10.1155/2013/702196[↩]
29. Zajac, A. E., Adams, A. S., & Turner, J. H. (2015). A systematic review and meta-analysis of probiotics for the treatment of allergic rhinitis. International Forum of Allergy & Rhinology, 5(6), 524–532. https://doi.org/10.1002/alr.21492[↩]
30. Bakhshaee, M., Mohammad Pour, A. H., Esmaeili, M., Jabbari Azad, F., Alipour Talesh, G., Salehi, M., & Noorollahian Mohajer, M. (2017). Efficacy of Supportive Therapy of Allergic Rhinitis by Stinging Nettle (Urtica dioica) root extract: a Randomized, Double-Blind, Placebo- Controlled, Clinical Trial. Iranian journal of pharmaceutical research: IJPR, 16(Suppl), 112–118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963652/[↩]
31. Roschek, B., Jr., Fink, R. C., McMichael, M., & Alberte, R. S. (2009). Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Phytotherapy Research, 23(7), 920–926. https://doi.org/10.1002/ptr.2763[↩]
32. Choi, S. Y., & Park, K. (2016). Effect of Inhalation of Aromatherapy Oil on Patients with Perennial Allergic Rhinitis: A Randomized Controlled Trial. Evidence-Based Complementary and Alternative Medicine, 2016, 1–7. https://doi.org/10.1155/2016/7896081[↩]
33. Horváth, G., & Ács, K. (2015). Essential oils in the treatment of respiratory tract diseases highlighting their role in bacterial infections and their anti-inflammatory action: a review. Flavour and fragrance journal, 30(5), 331–341. https://doi.org/10.1002/ffj.3252[↩]
34. Lin, W., Jianbo, S., Wanzhong, L., Yanna, L., Weiwei, S., Gang, W., & Chunzhen, Z. (2017). Protective effect of eucalyptus oil on pulmonary destruction and inflammation in chronic obstructive pulmonary disease (COPD) in rats. Journal of Medicinal Plants Research, 11(6), 129–136. https://doi.org/10.5897/jmpr2015.5910[↩]
35. Caimmi, D., Neukirch, C., Louis, R., Malard, O., Thabut, G., & Demoly, P. (2020). Effect of the Use of Intranasal Spray of Essential Oils in Patients with Perennial Allergic Rhinitis: A Prospective Study. International Archives of Allergy and Immunology, 182(3), 182–189. https://doi.org/10.1159/000510592[↩]
36. Caimmi, D., Neukirch, C., Louis, R., Malard, O., Thabut, G., & Demoly, P. (2020). Effect of the Use of Intranasal Spray of Essential Oils in Patients with Perennial Allergic Rhinitis: A Prospective Study. International Archives of Allergy and Immunology, 182(3), 182–189. https://doi.org/10.1159/000510592[↩]
37. Brinkhaus, B., Ortiz, M., Witt, C. M., Roll, S., Linde, K., Pfab, F., Niggemann, B., Hummelsberger, J., Treszl, A., Ring, J., Zuberbier, T., Wegscheider, K., & Willich, S. N. (2013). Acupuncture in patients with seasonal allergic rhinitis: a randomized trial. Annals of internal medicine, 158(4), 225–234. https://doi.org/10.7326/0003-4819-158-4-201302190-00002[↩]
38. Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. (Whit) W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., … Nnacheta, L. C. (2015). Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery, 152(1_suppl), S1–S43. https://doi.org/10.1177/0194599814561600[↩]
39. Mi, J., Chen, X., Lin, X., Guo, J., Chen, H., Wei, L., & Hong, H. (2018). Treatment of persistent allergic rhinitis via acupuncture at the sphenopalatine acupoint: a randomized controlled trial. Trials, 19(1), 28. https://doi.org/10.1186/s13063-017-2339-z[↩]
40. Brinkhaus, B., Roll, S., Jena, S., Icke, K., Adam, D., Binting, S., Lotz, F., Willich, S. N., & Witt, C. M. (2017). Acupuncture in Patients with Allergic Asthma: A Randomized Pragmatic Trial. The Journal of Alternative and Complementary Medicine, 33(4), 268–277. https://doi.org/10.1089/acm.2016.0357[↩]