Author: Dr. Steven Johnson, DO

Part 1: How Allergy Demonstrates the Dynamic Principles of Anthroposophic Medicine
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Conventional understanding of hay-fever or allergic rhinitis is that they are produced by an IgE-mediated immune response to allergens caused by aberrantly high Th2 cytokines. Over 400 million people suffer from allergic rhinitis and related conditions globally. This is exacerbated by urbanization and the increase in environmental pollutants (amounting to an overload of both the immune system and our nervous system, from an anthroposophic perspective). Allergic rhinitis (AR) prevalence has increased significantly since the 1990s.  It is reported to affect approximately 25% and 40% of children and adults globally. Approximately 80% of AR symptoms develop before the age of 20 years and peak at age 20–40 years before gradually declining. The incidence rate of AR in children over the first 5 years of life was reported to be 17.2%, with a peak age at diagnosis between 24 and 29 months. Meta-analysis studies have shown the sex-specific differences in the prevalence of AR with male predominance in childhood and a female predominance in adolescents (Front. Med., 06 April 2022, Sec. Pulmonary Medicine Volume 9 – 2022).

Food allergies can be related to pollen type IGE-mediated reactions in a condition called “Pollen Food Allergy Syndrome” (PFAS). Pollen allergies often lead to food allergies, particularly to fruits, vegetables, and nuts. This is a slightly different immune-mediated process than non-IgE-mediated food reactions that are also possible. The prevalence of PFAS and the foods involved vary between regions and pollen types. For example, in Sweden, 70% of those with birch-pollen allergy had PFAS, whereas it affected only 19% of those with other pollen allergies. In Korea, PFAS is also more commonly associated with tree pollen allergy (48%) than grass pollen allergy (13%). PFAS is reported to affect approximately 50% of children in Britain and Korea with birch-pollen allergy, ranging from 17–36% of children under 5 years of age, up to 70% aged 10–18 years. A study from Sydney, Australia, reported 12% of children (4–17 years of age) with rye grass allergy had PFAS, most commonly due to watermelon (DermNet Update May 2021). Severe and/or isolated food allergies causing allergic reactions and anaphylaxis will not be part of the discussion in this article.  Symptoms of hay fever and allergic rhinitis include nasal congestion, irritation of the eyes, mouth, and throat, which can cause a cough or even allergic asthma in severe cases. Common causes include pollens from trees, grasses, weeds, and plants. Also, mold spores, animal dander, cockroach saliva and droppings, and dust mites. Food allergies and sensitivities associated with pollen and other antigens induced allergies can improve as allergies are successfully treated.

Anthroposophic medicine offers some clinically effective treatment options for hay fever and allergic rhinitis. This is often overlooked in favor of over-the-counter antihistamines, decongestants, and steroid medications, all of which work symptomatically for the most part and do nothing to cure the condition. Anthroposophic treatment is especially worth consideration due to the potential for long-term stabilization and, further, the partial or complete remission of allergy conditions. Naturally, the more observant and accurate the constitutional diagnosis by the clinician, the better the outcomes may be! Therefore, taking some time to understand the anthroposophic picture of the human being will enhance your clinical diagnosis and choice of treatments.

It is important to always remember that anthroposophic medicines and treatments are based on the understanding that the mineral-based physical body we recognize in medical science today is only one part of the human constitution. We can quantitatively measure the effects of health on the physical body, which can grow, regenerate, and heal, because we have an “etheric” or regenerative principle that is active in the fluids of our bodies at all times. We have an etheric body in common with plants. The etheric activates most anabolic, regenerative and growth processes within the human being, even if we cannot directly perceive it yet due to the dependence we have on our senses. In pathological allergy processes we can however, experience the imbalanced etheric body or fluid body as physical swelling of the mucous membranes, mucous formation, wet cough and watery eyes.

We also have an “astral body” which grants us consciousness which we mostly experience through our nervous system and senses. We experience this most deeply in our sympathies and antipathies. We share an astral body with animals, which also possess consciousness. The astral body moves in the element of the airy and gaseous realm. In pathological allergy processes we can experience the imbalanced astral body as physical symptoms of itching, pain, discomfort, burning of the eyes and throat. One picture of allergy is that the astral body hypertrophies outside the boundaries of the nervous system; sensing the outer physical environment too strongly, leading to an over-sensitization or allergy.  It is interesting to note that the founder of anthroposophic medicine Rudolf Steiner, suggested that individuals with environmental allergens observe in the most practical detail the plants that offend them in order to keep their astral forces from over-extending beyond the region of their active consciousness.

The fourth element of our human constitution recognized through anthroposophical medicine is the “I.” This can be difficult to describe but each human being is an individual because they have an “I” organizing principle or “I” -organization” active in all aspects of their body, soul and creative capacities. In German, there is a word “gestalt” which is difficult to translate into English. It describes what makes us a “unique whole” but also what gives things form. If we think of the three pillars of the physical body, etheric body an astral body, it is the “I-organization” which enables them to function as a “whole” and structures how they function cooperatively together forming a healthy whole organism.
There is another way to look at the human constitution of active forces which the “I-organization” both defines into a unique “gestalt” and regulates or organizes for every human being. We observe this system of forces as:

• A nerve-sense system where the center of our consciousness and sensory processes are found. The nerve sense system is inherently catabolic and active in the sculpting and forming processes of as the body grows and maintains. While these forces are active everywhere in the body, they pre-dominate in the region of the head and nervous system. These forces work centripetally from the periphery inwards, where our “I” and “astral body” are most active. These forces can be observed in the processes of sculpting our organs and countenance. Also, the hardening or sclerosis of our arteries and joints.
• A metabolic-limb system which predominates as anabolic forces working centrifugally from the center outwards, especially in the region of the digestive organs, and the metabolic processes, both their own and in the movement physiology of the limbs. They find a boundary in the nerve and sensory processes and in the specific organ functions. These forces, primarily etheric processes can be observed as warmth processes, growth, regeneration, and as the illness processes of fever, anaphylaxis and inflammation to name just a few things.
• A rhythmic system defines the polarities of the Nerve-sense system and the Metabolic-limb system. In allergies, if metabolic processes are too strong and the formative nerve-sense process too weak, undigested foodstuffs can overwhelm our consciousness, causing headaches, drowsiness, watery congestion, and a sense of fullness in the head. On the other hand, if the Nerve-Sense system is working too strongly into our digestive processes, our metabolism becomes weak and inadequate, contributing to food allergies, sensitivities, and digestive weakness. This could also lead to allergic eczema. In typical environmental allergies, we could observe that the antigen invades the body too deeply, and the antibody reaction penetrates too deeply into our blood and organ systems via the nervous system. Then, the nervous system is unable to regulate and balance the inflammatory and watery tendancies of the metabolic processes. These then overwhelm us as allergy. The rhythmic system lives in the balance and harmonious regulation of these polarities and processes.

We could say further that environmental allergies represent an intensive inflammatory and metabolic process in the sensory realm. For instance, rhinitis in the nasal area of smell or urticaria in the region of the skin sensory processes. These are displaced metabolic processes acting in the wrong sphere, causing extreme sensitivity or too strong a “sensing” of the environment. In this way, it is more than just an intensive inflammation, as in, for instance, bronchitis. A successful treatment needs to structure this process and help bring the metabolic activity back into a balanced sphere of activity. Often, in allergic bronchitis, we will see improvement as the child gets older and their metabolic processes mature and are better regulated (for instance, after adolescence when hormone functions settle). We frequently observe that allergic-mediated asthma will go away or improve after this period. If they do not master their metabolism, the allergic condition will persist into adulthood.

Part 2: Using Anthroposophic Medicines for Allergies

Rudolf Steiner suggested that fruits with a leather-like rind would be an effective treatment for hay fever. This led to the formulation of Citrus Cydonia (1%,3%,5% and 7%) by WALA and Uriel—also, Gencydo by Weleda pharmacy. Weleda products and Gencydo are no longer available in the USA. Uriel now makes most of the former Weleda medicines for the United States.  With patience and repetition, both of these anthroposophic medicines can be quite effective over time. The author exemplifies this potential, having suffered from profound pollen allergies in the spring that disappeared completely over three years. The condition has since remained mild, manifesting as hay fever for only two weeks a year, which is not severe enough to warrant treatment. This was part of my journey into anthroposophic medicine as a doctor. Similar results have been observed by anthroposophic physicians in numerous countries worldwide.

Anthroposophic treatments can include ampules (used off-label as injections), oral medications, ointments, and other therapies. Let’s start with Citrus Cydonia produced by the manufacturer Uriel and Gencydo, which is recently unavailable in the United States. I mention this only for those doctors who have used Gencydo frequently in the past.

Understanding Citrus Cydonia and Gencydo:

These are some of the best-known and effective remedies for allergies, most often given as sub-Q injections to the upper arm, between the shoulder blades, or acupuncture meridians. Citrus Cydonia and Citrus Quartz from Uriel are made according to special anthroposophic/alchemic pharmaceutical processes. These have proven very effective for many clinicians.One point of confusion many doctors have is understanding how the Citrus Cydonia is made. Understanding this can dramatically affect treatment outcomes. The former Gencydo uses only lemon juice in addition to “Cydonia” (quince). Citrus Cydonia is made from the juice, rind, and peel, in addition to the quince, which is always at 1% in both products, no matter the overall concentration of the lemon components. Thus, if some patients respond more strongly to the lemon juice component, you can escalate the Citrus Cydonia strength more quickly. For instance, use a 3% or 5% mixture more quickly. Below is a list of available Uriel preparations:

-Citrus Cydonia 1%
-Citrus Cydonia 3%
-Citrus Cydonia 5%
-Citrus Cydonia 7%

Typical injection protocols involve daily injections for one week (and often longer). In severe allergy and asthma situations, two or three times a week. For maintenance and milder allergies, a standard regimen is 1-2 times a week during the allergy period. Often, beneficial results are seen within days, and benefits compound over time when effective.

For eye irritation, Uriel produces preservative-free Citrus Cydonia 1% eye drops. These include Citrus e. fruct. 2X and Cydonia e. fruct. 2X and rose oil in an isotonic solution. Instill 1-2 drops into affected eyes 1-4 times daily. Keep refrigerated as they are suitable for 30 -45 days. Citrus Cydonia, as injections or eye drops, is most effective when started 4 weeks before the offending pollens begin to appear in the environment.

A protocol for significant allergies in the Vademacum of anthroposophical remedies suggests giving an escalating dose of these preparations. Monday through Friday, starting 4 weeks before the allergy season. You can also escalate the dosing strength each time, for example, (1%, 3%, 5%, and 7%). Or escalate each week. The author has also seen that doing these 3 times a week can be effective if the allergy condition is moderate and not severe. Be aware that as the strength increases, it may cause a slight burning sensation for a few seconds under the skin during injection due to the acidity—especially with a 7% treatment.

For experienced doctors, nebulization is possible especially in the case of bronchial allergic asthma. Citrus Cydonia nebulized (1%-5%) is commonly administered twice a week and can be adjusted according to the severity and results. For children up to 5 years old, 1% inhalation has been administered twice a week. For those aged 5-9 years, the dose is 1%-5%. Other additions to the nebulized Citrus Cydonia are possible. For instance, in a metabolic constitution or congestion symptoms, one ampule of Citrus Quartz can be added to the nebulizer or injection protocols. For a more hysteric, excitatory situation or poor psychological/soul boundaries, an Antimonite 6X or 20X ampule can be added to the nebulization solution or injection protocol. Remember, our goal is to treat the immediate symptoms while also improving the allergy condition over time, unlike conventional medical therapy of today.

Generally, all treatments can be continued throughout allergy season, and dosing can be adjusted as the condition improves. With constitutional treatment, a significant reduction of allergy conditions can be achieved.  A randomized controlled study comparing Gencydo nasal spray and Citrus Cydonia injections was performed, showing both to be effective (1). Clinically, doctors find that using higher concentrations of Citrus Cydonia injections (stronger than 1%) and Lemon Quince Nasal Spray together (spray each nostril 2-4 times daily) improves outcomes with hay fever and allergic rhinitis. Lemon Quince nasal spray from Uriel is a similar option. The nasal spray also adds Berberis e fruct. 3X and Quartz 20X to the formulation. Notice how the fruits of particular plants are chosen to address the excessive metabolic activity seen in allergy-caused exudates.

1.Citrus/Cydonia Compositum Subcutaneous Injections versus Nasal Spray for Seasonal Allergic Rhinitis: A Randomized Controlled Trial on Efficacy and Safety
Erik W. Baars, Miek Jong, Andreas F. M. Nierop, Inge Boers, Huub F. J. Savelkoul
First published: 18 July 2011 : https://doi.org/10.5402/2011/836051

When Citrus Cydonia is insufficient, one study suggested that adding Calcium carbonicum plus Quercus Cinis could help in very resistant allergies and acute allergic reactions. Calcium can help stabilize acute allergic reactions and the vasomotor reactions associated with allergy. The tannins in oak bark have a stabilizing effect on mucous membranes and the skin, and also can stabilize allergic reactions. Uriel produces Quercus Cinis 5X pellets and Calcium Carbonicum 3X powder, two distinct substances that, when administered together (5-10 pellets and 1/16th of a teaspoon of powder, three times daily), can help alleviate acute and severe allergic reactions. Also, when not responding to Citrus Cydonia, or to treat allergic dermatitis. There is a good article to expand your knowledge if you Google (anthromedlibrary.org) called “Oak and Birch: Medicinal Agents for Allergic and Dermatological Conditions, Part 1.”

Part 3: Adjuvant Support for Hay fever and Allergic Rhinitis

Other supportive remedies may further enhance the treatment of patients with hay fever or allergic rhinitis. It is up to the physician what is best to prescribe. It is not recommended to use all of the remedies listed below, but rather to determine what is best for your patient.  It is essential to mention the minerals Quartz and Antimonite. Quartz strengthens and organizes the nerve-sense system and the centripetal forces we discussed earlier. If a person is particularly weak in this direction, a preliminary course of Quartz can be used (look up potencies). Suppose you study the structural needle-like qualities of Antimonite. In that case, you can sense its capacity to bring form to an overactive metabolism, which is overwhelming the nerve-sense system all too often. As is the case in allergies. This can also serve as a pre-treatment or foundational constitutional treatment to enhance the effectiveness of other medicines and, over time, strengthen the constitutional weakness in a patient. Stibium-containing creams or ointments (Calendula Stibium ointment from Uriel) are ideal for treating allergic skin conditions as an adjunct to constitutional treatment. Rarely, the mineral treatment alone is enough, but these can contribute to the long-term stability and healing process.

In severe hay fever, characterized by an abundance of metabolic forces (inflammation, exudates, and swelling), and poor mucosal boundaries, defined by significant swelling and redness, additional support is helpful. Anthroposophic medicine recognizes that the Saturn or (Plumbum) forces represent inner boundaries and help with the formation of the bones and skin. Lead (Plumbum), also blocks radioactivity. Where the patient is too “permeable” to outside influences, safely potentized. Plumbum is a good remedy to consider. If the patient seems de-vitalized, weak, and neurasthenic, consider (through being overwhelmed) Plumbum in low homeopathic potency. Uriel has 6X pellets and 12X liquid given 1-3 times daily. If poor vitalization of the individual is observed and/or premature aging, Argentum 6X-8X, from Uriel can be used in a similar dose to lead. Argentum or silver always helps to both reset and balance a difficult immune imbalance.  If it is clear that patients have difficulty mastering the “exudative” and “watery” elements, Calcium Carbonicum 3X can be used 2-3 times daily.  When there is extreme sensitivity to allergens and the environment in general, where the astral body needs to be better integrated with the etheric body, Arsenicum album in an 8X or low potency is helpful.

For difficult-to-treat allergies in the acute phase where nasal congestion and concern for sinusitis exist, consider Hepar sulfuris Sinus injections or pellets. Here, homeopathic preparations of paranasal, maxillary, frontal, and sphenoid sinus membranes are added to Hepar sulfuris Sinus to harmonize overactive fluid activity and sulfur to balance metabolic activity. Injections are given daily or 1-3 times a week. When the metabolic inflammation is acute and watery exudate is overwhelming, this is particularly helpful.

With severe nasal congestion again with concerns for developing sinusitis, consider Berberis Quartz or Berberis Prunus from Uriel. Both have Tunica mucosa nasi in the medicine supporting the mucous membranes. Berberis e fruct. plus, Quartz stabilizes and supports mucous membranes. The Berberis Prunus adds Argentum 8X, Vivianite 6X, Echinacea e rad. 2X and Prunus spinosa e flor. sum. 2X supporting vitality, constitutional tendency to geographic allergies, and early infection symptoms. This is particularly helpful when infections are a concern. These remedies are also effective for treating colds with nasal congestion, in addition to other cold and flu remedies.

In the European anthroposophic vademecum, Absinthium Resina larcis 3X is suggested for patients sensitive to pollens. Typically, adults should take 5-10 drops per day, and children should take 3-6 drops per day. For a detailed dosing schedule for children, please refer to the section at the bottom of this article. This can also be taken once a day, starting 4-6 weeks before allergy season for best results. There is no Uriel or anthroposophic equivalent for this remedy unless it is mixed with several other compounds. These can be gotten quite easily as general homeopathic medicines.

When food, cereal, gluten or grass allergies are involved in nasal congestion and upper respiratory congestion, using Flores tritici or Flores Formica ampules (daily for 1-2 weeks, then 1-3 times a week), or 7-10 drops or pellets. This contains formic acid and Vespa crabro ex animale, which help with the excretion and processing of untransformed proteins, as well as hornet venom potentized, which supports the stability and structuring of the mucous membranes. Consider Antimonite remedies and Kalium aceticum comp for over-permeable or damaged gut mucosa. These can be given alongside supplements like glutamine, probiotics, and other treatments to rebuild and strengthen the immune lining of the gut.
When dosing oral remedies for children, we suggest using the same number of drops or pellets as their age, and after seven years old, consider adult-type dosing. In the anthroposophical picture, avoiding high-protein diets or limiting protein, salt, and modest fluid intake can be of help.  Herbal remedies complement the products we’ve discussed so far and drug interactions are extremely rare. There are some non-anthroposophic adjuncts the author feels are worth mentioning as they effectively combine with the Uriel medicines. . Bio-Allers makes potentized drops of animal danders, grass and tree pollens, as well as a mold, yeast, and dust formulation. Taken before the acute allergy season in the off season, these can help to overcome severe allergens as a step before conventional allergy treatment. Additionally, Quercetin in the form of D-Hist by Orthomolecular products or Quercetin (a mast cell stabilizer) at 400mg-800 mg per day can, in mild to moderate situations, preclude the need for a histamine blocker (read about long-term use and potential kidney issues). In general, anthroposophic remedies will not interact with other homeopathic or botanical products that you also find helpful. However, it is essential to note that often, other products are not necessary. This protocol above is just an example of how remedies can be successfully combined.

Part 4: Prophylaxis of Allergies

Prophylaxis, between allergy seasons, is an integral part of chronic hay fever and allergy treatment for long-term success. Reducing foods that people are sensitive to is essential. If there is weak digestion or “gut inflammation,” this needs to be addressed, especially if there is a connection between pollen, environmental irritants, and food sensitivities.
Thus far, it has been frequently mentioned that you can start the remedies, such as Citrus Cydonia or Citrus Quartz injections or oral forms, 4-8 weeks before the start of allergy season. You can also use the injections once a week or the oral forms once a day during the entire off-season, perhaps inserting a week-long break every month. Additionally, other remedies can be helpful off-season.
Indeed, constitutional remedies like Calcium Carbonicum, Arsenicum album, Argentum, Plumbum, and Flores Tritici can be used constitutionally daily in the off-season. Lemon oil baths (Uriel) twice weekly can be beneficial. Nux Vomica is beneficial constitutionally for children and adults with a tendency to digestive weakness and aggressive or reactive behavior or even anger (same number of pellets or drops as age up to seven years old). If a person has very weak digestion, “bitter” substances in general are beneficial, such as Chicory Ginger Bitters by Uriel Pharmacy. In patients with weak digestion, more phlegmatic or sluggish liver function, Lycopodium Berberis pellets can be very helpful, administered at 10 pellets twice to three times daily or at a children’s dosage as previously mentioned. Both Nux Vomica pellets (taken in the same manner as Lycopodium Berberis) and Lycopodium have detoxification properties that assist in alleviating allergic diathesis. Carbo type remedies are excellent prophylaxis. Carbo Equesiti 6X is particularly beneficial for patients with strong allergies. Cinis Comp, a liquid that is a combination of Cinis Equiseti, Cinis Quercus, and Cinis Tabaci, helps with digestive, ecological and bronchial sensitivities. This is very helpful in the off-season, and the Uriel liquid can be taken 7-10 drops 2-3 times a day. The ashing process directs the medicine deeper into the physical symptoms of the body. Quercus is directed towards the skin and mucosal membranes, Equisetum towards the kidneys and lungs, and Nicotiana or tobacco towards the breathing and constrictions.

1. Patterns in the Development of Pediatric Allergy Fred Stanislaw J. et al., Gabryszewski, MD, PhD; Journal of Pediatrics, July 2023
2. Rachel L Peters et al: An overview of Environmental Risk Factors for Food Allergies; Int J Environ Res Public Health 2022 Jan 10;19(2):722. doi: 10.3390/ijerph19020722
3. Matthias Girke: “Internal Medicine”, Salumed Verlag 2016, page 179-184
4. Vademacum of Anthroposophic Medicines: Third Edition, 2017
5. Markus Sommer: “Healing Plants, ”Verlag FreiesGeistesleben & Urachhaus GmbH, Stuggart 2014
6. Rudolf Steiner: “Introducing Anthroposophical Medicine,” Anthroposophic Press 1999