Dietary Advice for Patients with Nasal Polyps

Nasal polyps are outgrowths of the nasal mucosa common in patients with allergic rhinitis, particularly those who are also asthmatic. If they become large enough they cause nasal obstruction and a surgical polypectomy can be performed. Unfortunately they usually reappear. Relief can be achieved with a heavy dose of oral corticosteroids for a week or two, but will only be temporary.

I suffer from asthma and allergic rhinitis and I have been treated for recurrent nasal polyps and middle ear infections for many years. The reason for this site is that I have discovered a number of dietary factors which have enabled me to reduce my nasal symptoms and nasal medication considerably. Unfortunately it is not widely accepted by the medical community that diet plays a role with these problems so advice is hard to come by.

It is well established that many patients are allergic to house dust. Fit special barrier covers to the mattress, duvet and pillows, and wash the outer covers regularly at high temperature (60C) - Alprotec covers are very good quality (inexpensive Tyvek covers are also effective, but less hard wearing). It is also advisable to fit a micro filter on the vacuum cleaner in the housing between the exhaust grill and the dust bag - universal filters are available cheaply on eBay and can be cut to size. Radiators are a magnet for dust and should be cleaned out with a radiator brush before vacuuming. In the summer months it can be helpful to have an air filter in the bedroom at night - I run a Filtaire 300 at low speed overnight. Place the unit on a piece of hardboard to avoid it sucking dust from the carpet! (Avoid ionisers as they create ozone which is harmful.) I should add that no pets should be allowed in the house or handled outside and smoky atmospheres must be avoided at all times. Also avoid perfume, paint and other fumes. Although dust avoidance has been helpful I was having polyp removals under local anaesthetic at 6 monthly intervals despite using Betnesol nose drops daily.

Incremental desensitising injections were once popular for inhalant allergens such as house dust and pollen. They are rarely given now on the NHS as they led to 26 deaths. I was very nearly one of these statistics and spent about a year in and out of hospitals with very severe asthma back in 1976. In 1986 the Committee on Safety in Medicine ruled that a resuscitation team must be available for 2 hours after each injection. This would not have helped in my case as the allergic reaction developed slowly over several weeks. Be warned. Neutralization Therapy (described in Asthma Epidemic) and Enzyme Potentiated Desensitization are different techniques that use far smaller doses and are quite safe, although of no effectiveness in my experience. EPD was developed by Dr Leonard McEwen although it is now prohibited by the US Food and Drug Administration (see http://www.fda.gov/ora/fiars/ora_import_ia5715.html) and appears to be a case of medical fraud. Since the FDA ban in 2002, Dr McEwen was sanctioned by the British General Medical Council in 2006 for soliciting donations from patients (see http://www.casewatch.org/foreign/mcewen.shtml). A double blind randomised controlled study published in the British Medical Journal (Volume 327, 2 August 2003) concluded that Enzyme Potentiated Desensitization allergen immunotherapy method had no treatment effect. Neutralisation Therapy (used by Dr John Mansfield at The Burghwood Clinic) is not available on the NHS either and has little evidence of any efficacy. West Midlands Regional Evaluation Panel Recommendation by the Department of Public Health and Epidemiology, University of Birmingham concluded: No evidence identified to suggest provocation-neutralisation testing is useful for diagnosis of food allergy: Insufficient evidence identified to recommend the use of neutralisation therapy for food allergy. While Dr John Mansfield charges patients 300 for a useless desensitization treatment this pales into insignificance compared with the 5,000 demand from Dr McEwen! Quackery is a very profitable business certainly judging by the size and location of The Burghwood Clinic and Dr McEwen's substantial property and grounds on the banks of Henley-on-Thames! Elimination diets are fine to see if symptoms improve. The quackery is the phoney desensitization which is what the unfortunate punters are charged for. The problem is that the British medical establishment is a closed society - they will never rat on their members and the penalties imposed are risible. However unseemly there may be some efficacy in quackery, provided that the correct medical treatment is followed as well. If the practitioner can engender the belief in the patient that the quack treatment is effective, it may improve their outlook on life and immunity to disease - but it's fraudulent nevertheless.

In addition to Immunoglobin E mediated allergy, which can be demonstrated by skin prick tests or measured from a blood test, some patients can also be allergic to foods without producing a raised IgE response. The mechanism of this form of delayed allergy to foods is not understood or acknowledged by the medical establishment, who only recognise IgE mediated allergy. What got me onto food was reading The Complete Guide to Hayfever by Professor Jonathan Brostoff and Linda Gamlin and Asthma Epidemic by Dr John Mansfield (these titles are available from many public libraries). The most methodical way to identify food intolerance is by using an elimination diet - go on to a restricted diet for a period and then introduce one food at a time. Unfortunately the restricted diet in Hayfever includes soya to which I am highly allergic. Brostoff states that patients with asthma and nasal polyps are often allergic to yeast and dairy products and in my case this was true, but including soya in the restricted diet could cause a worsening of symptoms.

Elimination Diet

Asthma Epidemic contains a very methodical Elimination Diet. For 7 days only the following are allowed: lamb, venison, salmon, cod, trout, mackerel (not tinned or smoked), pears, avocados, parsnips, turnips, swedes, celery, chinese bean sprouts, sweet potatoes, marrow, courgette and marrow. Only bottled mineral water is allowed for liquid and sea salt may be used for flavouring. Bicarbonate of soda should be used as a substitute for toothpaste. Of course you will also need to avoid allergy causing chemical additives, yeast and foodstuffs which are found in some medicines. If you get no benefit from avoiding these items for a week you probably do not have food intolerance. If you do get an improvement in symptoms then each food has to be introduced in turn to discover the culprits. Reactions can take a few days to build up with some foods. In Asthma Epidemic most foods are introduced for only a single day but it can take 3 days before I get a reaction. If you suffer bad headaches from caffeine withdrawal you may be able to take caffeine tablets depending upon what foodstuffs are in them.

Only after lengthy experimentation I found the greatest improvement by avoiding all of the following:

Yeast - Avoiding bread improves my nasal symptoms. I was making my own bread with self raising flour for a while but found that the wheat worsened my asthma, although it made no difference to my rhinitis. If you take vitamin tablets make sure they are free of yeast and soya (cheaper brands often contain yeast).

Dairy Produce - avoid all dairy products initially (i.e. milk, butter, cream, cheese). I find that tinned evaporated and UHT (Ultra High Temperature) milk are no problem, since boiling destroys the allergy causing proteins.

Soya - I avoid soya entirely.

Peanuts - I have recently discovered a peanut allergy. After eating peanut butter and fresh peanuts for 3 days, I had a nasty asthmatic reaction requiring steroids, although no nasal symptoms.

Wheat & Rye - avoiding all wheat products including durum wheat semolina in pasta and rye (Ryvita) has certainly improved my asthma. Rice, oats and maize (in corn cakes) are no problem.

You will usually only benefit by removing all the problem foods, not just one or two. I find that the diet takes about 3 days to improve my symptoms - you should allow at least a week as responses vary. If I introduce a problem food it takes about 3 days for my symptoms to worsen. Recently I tried introducing soya milk to see whether I had lost my allergy. After 3 days I developed a middle ear infection without warning and had to take a week's course of prednisolone in addition to antibiotics to get the fluid to drain out. Keep careful notes and once you have proved a food is a problem it's best not to experiment with it if you are highly sensitive. I should add that I am not allergic to aspirin or ibuprofen (some polyp patients are). If the Elimination Diet does not reduce your symptoms then you may not be sensitive to foods. Alternatively you may have large polyps already which require surgery before you notice any improvement.

Since following this regimen I have had no new polyps in years, considerably less ear problems and only need to use Nasonex nasal spray daily (a modern alternative to Beconase), which is far safer than Betnesol nose drops. Nasal sprays are more effective if one kneels and places one's head down on a cushion for three minutes after application, as recommended in Hayfever (P.229). I also take Singulair tablets for asthma and find this is very helpful for rhinitis during the spring and summer (Accolate is similar). More recently I have found that fish oil capsules noticeably improve my asthma. Choose fish oil in preference to fish liver oil as you can absorb too much vitamin A from liver products. Before starting the diet I was having polyps removed every 6 months, despite using Betnesol nose drops daily. I have found gargling with warm salt water helpful in preventing ENT infections and also Sterimar Sea Water Nasal Spray as recommended by the Royal National Throat, Nose and Ear Hospital. Sterimar and other brands are commonly available at pharmacies in France and at larger branches of Boots. (I also find gargling with mouthwash to be helpful.) More recently antihistamine nasal sprays have been introduced (Astelin, Patanase) that I find far more effective than antihistamine tablets (again more effective if one kneels and places one's head down on a cushion for three minutes after application). If the nose becomes sore, rubbing a little Vaseline body lotion inside can be soothing. Exercise can often help to clear the sinuses but wear a woolly hat in cold weather. Using Karvol decongestion capsules in a saucepan of fairly hot water with a towel over one's head can help clear blocked ears, as can gargling with mouthwash. Finally, chewing gum (ideally sugar-free) can help keep the Eustachian tube free of blockage and gum containing xylitol (such as Wrigley's Orbit) may help prevent ear infections.

I have written this in the hope that my experience might benefit other patients. Nasal polyps and middle ear infections are very distressing conditions. I had problems for 25 years before discovering food intolerance. Maybe some day Ear, Nose and Throat clinics will give advice on diet. It could certainly save them a lot of surgery.

Finally may I please ask you not to email me for advice as I get too many to answer. I am not a doctor or an allergy expert - read the books above for further information. You should do the elimination diet for at least a week to see if you achieve any improvement and you must stick to it rigidly. We should also consider whether we are morally justified in inflicting our ailments on the next generation, since asthma and rhinitis are genetic disorders. It is my view that, except in mild cases, we should not.

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