Allergy tips from a giant anthropomorphized allergy

I have mast cell activation syndrome (MCAS), aka "randomly allergic to everything" including heat, vibration, pain and, at times, — most fucked of all — water. So I've got an elaborate system of allergy prevention and management.

A lot of the elements of this system are useful for people with regular and seasonal allergies, but you'll rarely hear about them because, well, you have normal allergies. And regular doctors don't really know about them either. (And not all allergists know about them, strangely.)

So I thought I'd put my tips in one place for you, the normal person.

First, a few definitions…

What is an allergy?

An allergy is an unpleasant-to-dangerous immune response to a trigger. For most people, triggers are things like pet dander, pollen, food, perfumes, and so on.

There are multiple types of immune response. The one most people think of is immunoglobulin E (IgE) allergies, where you have a permanent antibody response.

You can be allergic to something without an IgE allergy such as with FPIES.

There are other types of stable allergies (some allergies produce T Cells instead), and also other types of immune response, such as "histamine reaction" and "mast cell activation" (with or without the syndrome).

Mast cells are your frenemy

Mast cells are a type of cell that outputs "mediators" to try and protect you, such as histamine (H1 and H2), norepinephrine, heparin, prostaglandins, and many more, in response to an allergy trigger.

When mast cells react to a trigger, it's called degranulation.

Given the right situation, anything can trigger a mast cell to degranulate. Even things that you "can't" be allergic to, like pain, or temperature, or movement, water, even sunlight. If you have MCAS, your triggers can change day to day because it's not a disorder of specific allergies but of general allerginicity.

Of course, I'm probably sharing this link with you because you don't have mast cell activation syndrome like me.

But you still have mast cells and they can still get angry and degranulate.

Once mast cells are aggravated — again, MCAS or not! — they tend to remain more reactive for some time. My flares tend to last about a week.

Mast cells both cause and are triggered by systemic inflammation, with a flywheel effect.

Four types of allergy tools

There are essentially 4 ways to manage allergies:

1: Avoidance.

This one's obvious. Avoidance includes air filters, barrier sprays for adhesive etc. allergies, and wearing KN/KF95 or other particulate masks when there's a lot of airborne particulate allergies (aka pollen) about outside.

2: Receptor blockers. Aka, antihistamines.

Antihistamines don't stop allergies, they only stop the cascade once mast cells are already triggered (and only to a degree).

The reality is a little more complicated… different antihistamines can prevent allergic reaction cascades to varying small degrees, but their main action is blocking receptors.

Ironically this can worsen allergies because the histamine was pumped out by your mast cells and so it keeps floating around your bloodstream with nowhere to "dock." This is called histamine pooling and can lead to histamine intolerance (more sensitivity) due to a "full bucket" that starts to overflow. This doesn't mean antihistamines aren't useful — they are! But with chronic exposure to allergens and chronic use of antihistamines, there is a diminishing effectiveness. And you can experience rebound if you miss a dose.

H1 antihistamines like Benadryl, Allegra, Hydroxyzine, etc. block the H1 histamine receptors.

H2 antihistamines like Pepcid, Zantac, and Tagamet block the H2 histamine receptors. If your "regular" allergies are pretty bad, adding an H2 can help, especially if your environmental allergies cause you to then become sensitive to foods. But H2 is systemic, not just in the gut, even though these meds are marketed as for the stomach/gut.

If your regular allergies are very bad, your Dr might prescribe you to take modern H1s and H2s like Allegra and Zantac twice a day instead of once. That's perfectly safe unless you have health conditions that contraindicate it, because they are much less anti-cholinergic than Benadryl. Benadryl, of course, is an old school antihistamine and even though IMO the concern about it is exaggerated (it's entirely correlation, not causation) — you should try to limit your use of it when possible, in part because it doesn't last as long. (I can't tolerate any of the next-gen H1s so I take Benadryl.)

There are various substances — Rx and OTC — that can stabilize or inhibit mast cells, making them less reactive to begin with. That means less allergic response to begin with.

Usually only patients with MCAS and related disorders use mast cell stabilizers, but everyone can use them.

Mast cell stabilizers and inhibitors include:

Quercetin
DAO* (src)
PEA (src)
Luteolin (src)
Vitamin C (src)
Vitamin D (src; do not take if you have good blood levels, it accumulates)
Curcumin*
Stinging Nettle (src)
Melatonin (src)
Cromolyn sodium
Ketotifen
Aspirin
Low dose nicotine patches* (see Weird Science)
Monteleukast (Singular) WARNING: DANGEROUS, DO NOT RECOMMEND UNLESS DIRE
Xolair and Dupixent shots (biological anti-anti-body medicines; big guns, if you have terrible uncontrolled allergic asthma or constant hives)
Steroids
Benzodiazepines

(Italics = prescription only.)

Here's a more exhaustive list, including a bunch of different types of therapies.

If you have regular degular allergies that reach unpleasant-but-not-dangerous level, I highly recommend you check out some mast cell stabilizers.

Quercetin is an easy supplement to start with. It's not as powerful as luteolin, but it is cheaper and easier to try. It's a substance found in a lot of whole food plants, but not in enough amounts to make a difference. I used to use the isolated powder from Bulk Supplements but you can find it in a lot of mast-cell-stabilizing OTC supplements like D-Hist.

Note: if you have a rare-ish genetic SNP called Slow COMT, quercetin can make you really tired and, in my case, very sensory sensitive. It goes away when you stop, though; no real risk.

DAO isn't a stabilizer but it's part of the packet because it actually helps your body break down histamine. If you've got regular allergies, you probably have enough DAO already for normal day to day life, but adding it can help if you're having bad seasonal allergies.

Curcumin also isn't a stabilizer afaik, but it reduces inflammation in general, and mast cell activation is a type of inflammation and inflammation has that flywheel effect on mast cells.

You'll often find OTC supplements for allergy prevention, like D-Hist, includes multiple mast cell stabilizers for an increased effect.

A combo supplement like D-Hist is a great place to start because it has multiple ingredients that work in symphony. I can't take D-Hist (I'm allergic to the fillers, and also bromelain) but I know a lot of people swear by it. D-Hist is not the only combo therapy option, but I don't remember others by name since I can't take any of them.

Cromolyn sodium is a medication that's prescription only for oral and inhalation routes. But you can get it over the counter for sinus allergies (Nasalcrom) and eye allergy symptoms (Cromolyn Opthalmic). My specialist says Nasalcrom is good for allergy headaches too.

Note: Some people with MCAS get more reactive with cromolyn — including me — but that doesn't seem to be an issue for most normies.

Ketotifen is a combo mast cell stabilizing medication and weak H1 antihistamine. Ketotifen is also available OTC as eye drops (several brands available). If you have very bad systemic allergies, you might want to try oral ketotifen for systemic support. You'll need to either order the pills from Japan, where it's OTC, or get a prescription and take it to a compounding pharmacy. Ketotifen works very well, and isn't a strong anti-cholinergic (unlike Benadryl) but it can make you very tired at first. Start with a low dose. Ketotifen can also be compounded as a nasal spray if you don't tolerate cromolyn sodium.

Aspirin helps with prostaglandins specifically. Not probably a thing for most people with seasonal allergies and of course is only good for people who can safely take it.

4: Weird science.

Here are some wild-sounding things that can help with allergies:

Sauna
Red light therapy (aka photobiomodulation)
Low dose nicotine patches

I am actually a major proponent of #2: Red light therapy. I've read a lot of the research on red light therapy — I was looking for medication alternatives because I have oh so many drug and drug excipient allergies, and I can't tolerate either ketotifen or cromolyn sodium. Avoiding allergies for me is like living The Floor Is Lava. So anything that's not a drug, or even oral, is interesting to me.

I bought this cheap device off Amazon ($20, Rubylux "brand") and you can also find it for $3-5 on AliExpress. I had zero hopes it would be powerful enough to be useful… but, to my utter shock, it really, really helps.

I use it daily for 15-30 minutes first thing in the morning and it clears up a lot of my congestion, to the point that when I stopped using it for a few days, my husband Thomas asked if I had a cold.

I cut the little plastic connector between the two diodes because it wouldn't stay in my nose otherwise. This way I can really shove 'em up there. I sanitize the little plastic caps with hypochlorous acid.

Be aware: There's no point whatsoever in buying a more expensive one unless you go all the way and buy the Vielight MIP. You'll want one with the 655nm but they also have other options.

Systemic red light therapy will also likely help because photobiomodulation is a whole body thing. But body light panels that are strong enough to be worth it are hundreds of dollars, and it's much more direct to just stick a diode up your nose.

Last but not least: Nicotine probably seems like a very strange thing to put on this list.

Nicotine is complex and down-regulates some immune system processes. Nicotine patches, for me, have a similar effect as monteleukast but without the psychiatric risks. I'm not making this up.

Singulair/monteleukast carries a black box warning for depression, suicide, and I personally experienced clinical levels of OCD which I never had before).

Nicotine patches have been studied for a lot of autoimmune and neurological disorders, and definitely show positive results for some, and don't show addictive properties, unlike smoking.

I only use 3-7mg per day in the form of a slow release nicotine patch, with half covered by the little plastic sticker backing.

Low dose patches are the only way to safely use nicotine. And it's still something I'd recommend for anything in the realm of "normal" allergies but if you're truly miserable with a lot of breathing issues, it's worth a shot, assuming it's not contraindicated for you. Smoking, vaping, and chewing not only won't help, they're addictive and actively inflammatory.

Note: NEVER CUT A NICOTINE PATCH. It can cause the entire amount to release quickly. That's why I always just cover up the other half with the original plastic sticker backing.