Autoimmune Encephalopathy/ PANS Flares and the Link to Seasonal Allergies
Many children with PANS/ Autoimmune Encephalopathy who seem to flare despite having a good treatment plan perhaps forget the inflammation of a seasonal allergy.
Many patients have seasonal flares. Usually in early Spring, when tree pollen and grass allergens are revving up. I think at times we forget just how inflammatory allergens are and the disruption they cause. Remember, the immune system loves balance! It works diligently to quell any inflammatory response in the body. Infections aren’t the only entities to tip immunity!
As I gaze outside excitedly at the tree buds itching to bloom and scratching my own eyes in tandem, I’m reminded of this trend. Many parents have contacted me recently reporting increased AE/ PANS flares that correlate with the season.
Certainly follow up with your provider should you suspect your child’s exposure to an infection is triggering a flare and needs further evaluation but in the meantime it may benefit to begin a combination of mast cell stabilizers, H1 and H2 blockers and those things that calm down cytokines if deemed appropriate for your child.
Inflammation around the blood brain barrier as a result of allergens, infections or otherwise cause increased permeability or loosening of the tight junctions that keeps bad things out! Mast cells activated by allergens create this increased stress and contribute to this loosening.
An easy and mostly tolerable treatment is to trial a mast cell stabilizer such as disodium cromoglycate or Nasalcrom. It’s over the counter and readily available for use. I’m a personal fan and use it often in patients.
An age old mast cell stabilizer traditionally used with asthmatics, Nasalcrom is effective at blocking mast cells and quelling the immediate waterworks associated with allergies. Secondly, it has a positive effect upon decreasing inflammation around the blood-brain barrier which we know to be an incredibly sensitive protective layer that contributes to neurocognitive changes if disrupted.
Another medication proven to resolve inflammation is cimetidine or Tagamet. Traditionally an H2 blocker for stomach acid also known to cross the blood brain barrier and effectively calm the histamine effect. In studies, histamine is one of the central nervous system neurotransmitters found to cause blood-brain barrier opening if over stimulated. Tagamet can be found over the counter but unlike Nasalcrom carries more precautions and side effects. Check with your provider for interactions and weigh the risks and benefits. Not a favorite given potential long-term use side effects but short-term is generally well tolerated.
Natural supplements that may prove helpful are those that balance cytokines. Quercertin, vitamin C , curcumin, Alpha Lipoic Acid are a few supplements, if tolerated, can be useful assisting with symptoms.
Homeopathy may be beneficial but I find isn’t as quick acting in this scenario.
In addition to medications, supplements and herbals, evaluating and modifying your environment can provide monumental gains. Use HEPA filters during peak seasons, wash linens weekly, keep windows closed, and take showers at night washing hair more frequently to prevent any pollen picked up during your daily travels from making it to your bed causing further reaction.
Although a bit more invasive, I am prescribing oxygen therapies using major autohemotherapy to further balance the immune system. This certainly isn’t something to begin with the expectation of immediate response during allergy season. However, if your child suffers seasonal allergies, it may be a viable option to consider prior to the season.
Always follow up with your provider to discuss options and evaluate your individual needs before employing a treatment regimen on your own. Hopefully this provides some guidance in combating those nasty AE and PANS flares during the Spring season!