The Amish and the Hutterites are two farming communities in the United States with a great deal in common. Their genetic ancestry is similar, and so is the way they live, from what they eat to how they raise their children.
Except in one respect. The Amish still farm the old way, on small family farms with the animals close to home. The Hutterites farm with modern, industrial machinery. And when their children were tested, asthma was four times as rare among the Amish children, and allergies six times as rare. The dust in Amish homes carried nearly seven times as much bacterial material.
That one finding turns the usual advice on chronic allergies on its head. It suggests our immune systems are not overloaded with "toxins". If anything, they are underemployed. Bored, even.
What an allergy is
The word was coined in 1906 by Clemens von Pirquet in Vienna, after he noticed that some of his patients reacted faster and harder the second time they were given the same injection. He built the word from the Greek allos, other, and ergon, work. An allergy is the immune system doing other work: treating something harmless as if it were a threat.
People have known the problem for a long time. The first accurate description of what we now call hay fever comes from the Persian scholar al-Razi in the 10th century. It took until 1859 for Charles Blackley, in England, to show that pollen was the cause.
The usual culprits have not changed much since: pollen, dust mites, pet dander, mould and certain foods. To the immune system of someone with an allergy, each of them looks like an invader, and the sneezing, itching, streaming eyes and blocked nose are the defence going into action against something that never needed fighting. Like a guard dog barking at the postman, every single day.
Why the farm protects
The Amish children's protection seems to come from what they breathe in.
The difference was not only in the dust. The two groups of children had strikingly different innate immune cells, the first-line defenders that meet whatever comes in through the nose and lungs. Growing up around animals, hay and the bacteria that come with them seems to train those cells early, so that they stay calm in front of things that are harmless.
The finding cannot be copied as a remedy. The protection shows up in children who grow up with it. But it does change how we think about allergies. They look more like a defence system that never had enough real work to learn from.
The idea is older than the farm findings. In 1989, the Briton David Strachan noticed that hay fever and eczema were less common in children from larger families, and suggested that fewer infections in early childhood might explain why allergies had become so common. It became known as the hygiene hypothesis. It has since been refined. The "old friends" version, put forward by Graham Rook in 2003, says what matters is not colds and childhood infections, but the microbes that were with us all through human history and helped shape how the immune system develops. Not dirt, then, but the right company.
The same pattern shows up in ordinary homes. When 474 children in Detroit were followed from birth, 33.6% of those with no dog or cat in their first year had allergies on skin tests at six or seven, against 15.4% of those who grew up with two or more. One pet made no difference. Two or more seemed to. Dogs and cats, it seems, teach best in pairs.
Food follows the same rule. For years, parents of babies at high risk of peanut allergy were told to keep peanut away. Then 640 high-risk babies, with severe eczema, egg allergy or both, were either given peanut regularly or kept away from it until they were five. Among those who had no reaction on a skin test at the start, 13.7% of the avoiders had a peanut allergy by five, against 1.9% of those who ate it. Early, regular contact taught tolerance. Avoidance did not. For a baby at high risk, start peanut only with medical advice.
Find your triggers
Before changing anything, find out what you are actually reacting to.
Keep a diary. Note when your symptoms flare, where you are, what the weather is doing, what you ate, and whether there were animals, dust or damp nearby. A few weeks of notes usually shows a pattern. Worse in spring and summer points to pollen. Worse in bed and first thing in the morning points to dust mites. Worse around a friend's cat speaks for itself.
Look past the flowers. The pollen that sets off hay fever comes mostly from wind-pollinated plants, grasses and trees whose flowers we barely notice, which release great amounts of very light pollen that floats. The showy flowers in a garden or a vase have heavy, sticky pollen made for insects to carry, and it does not drift on the air. The bouquet on the table is rarely the problem. The lawn and the trees outside usually are.
Notice what itches your mouth. If raw fruit, vegetables or nuts make your lips, mouth or throat itch, a pollen allergy may be behind it. Some of their proteins look so much like pollen that the immune system mistakes one for the other. Cooking usually destroys those proteins, which is why the same food can itch raw and be fine cooked, though celery and nuts can still react after cooking. A ragweed allergy, for example, goes with melon, banana and cucumber. Swelling of the tongue or a tight throat is a different matter, and the signs further down apply.
Get tested if the pattern is unclear. Skin-prick and blood tests can show which allergens your immune system reacts to, which saves guessing and spending money on the wrong fixes.
The bedroom
If dust mites are your problem, the bedroom is where they live, and the usual advice is to wrap the mattress, pillow and duvet in mite-proof covers. It sounds sensible. It was put to a proper test, twice, and both tests came out the same way.
In the first, 1,122 adults with asthma were given either mite-proof covers or ordinary covers that looked the same, without knowing which. After a year, there was no difference between the two groups in how well their lungs worked, or in how many could come off their steroid inhalers.
In the second, 279 adults with a dust-mite allergy in the nose used either mite-proof or ordinary covers for a year. The mite-proof covers did their job: the mite allergen in the mattresses fell. But the people sleeping on them felt no better. Their symptoms were no different from the group with ordinary covers. Fewer mites, same sneezes.
So covers on their own are not the answer. What makes more sense is the whole bedroom. Natural Sinus Relief, linked below, has why a damp home feeds dust mites and mould (a small gauge such as this shows how damp your bedroom really is), why washing your hair and face before bed keeps the day's pollen off the pillow, and how a HEPA air purifier pulls dust, dander and pollen out of the air you breathe all night. A purifier such as this , by the bed, does that work while you sleep. Wash bedding hot, keep pets out of the bedroom, and vacuum with a machine that has a HEPA filter, so the dust does not just go back into the air.
Rinse
The best-supported thing you can do at home for an allergic nose is also the cheapest: rinse it with salt water. A squeeze bottle such as the NeilMed is all it takes.
Natural Sinus Relief, linked below, has the tests behind it, including the one where a squeeze-bottle rinse beat a saline spray: after eight weeks, 40% of the rinsers still had symptoms often or always, against 61% of the spray users. It also has the rule that matters most: use distilled or sterile water, or tap water boiled and cooled, never water straight from the tap.
Itchy eyes have their own gentle version. For mild symptoms, a cold compress over closed eyes, or an eyewash with artificial tears, can bring relief.
Butterbur
Butterbur got its name from its leaves, so big they were once used to wrap butter in warm weather. In other languages it is the "rain hat". It also has one of the more striking results in the herbal world.
In a test of 125 people with hay fever, half took a butterbur extract and half took cetirizine, a standard antihistamine, for two weeks, without knowing which they had. Both groups improved by a similar amount on every measure.
There is a serious catch. Natural Remedies for Headaches: Ways to Relieve Pain Without Medication has why: the plant naturally contains compounds that can damage the liver. Only extracts processed to remove them, sold as "PA-free", are worth considering at all, and rare cases of liver injury have been reported even with those. It is a plant remedy that behaves like a medicine, and it deserves the same care.
Local honey
Local honey is one of the most popular allergy remedies there is. The idea is that eating honey made from local flowers trains the body to tolerate the local pollen.
It has been tested. Thirty-six people with hay fever ate a spoonful a day of either local, raw, unfiltered honey, ordinary filtered honey from the shops, or corn syrup with honey flavouring. Neither honey gave any more relief than the syrup. Sweet, but not a treatment.
One likely reason goes back to the flowers: hay fever comes mostly from the light pollen of grasses and trees, and bees collect the heavy pollen of showy flowers.
What the evidence does not support
Some of the most repeated advice has nothing behind it.
Detox. There is no sign that allergies come from "toxins" building up in the body. How to Detox From Processed Foods has what actually does the detox: your liver and kidneys, every minute, free of charge.
Herbal teas and quercetin as antihistamines. Nettle, peppermint and ginger teas are pleasant, and a warm cup can soothe a sore throat. There is no good evidence that they work as antihistamines. The same goes for quercetin, which looks promising in a lab dish and has not shown the same in people. A lab dish does not sneeze.
Essential oils to clear the airways. A eucalyptus steam may feel good, but it treats the feeling, not the allergy. Essential Oils: What They Can Do and How to Use Them Safely has the cautions: oils are poisonous if swallowed, eucalyptus is a common cause of poisoning in children, and strong vapours do not belong near small faces.
The gut
The gut is home to trillions of bacteria, and they do talk to the immune system. That is part of why the farm children are so interesting.
Food can shift those bacteria. Are Fermented Foods Good for Your Gut? has the healthy adults who went from barely any fermented food to several servings a day for ten weeks: the range of bacteria in their gut widened and markers of inflammation in their blood fell. Whether that changes an allergy has not been shown. But sauerkraut, kefir and yogurt with live cultures are good foods in their own right, and an easy thing to try.
Training the immune system on purpose
There is one treatment that does what the "root cause" promise claims. In 1911, Leonard Noon and John Freeman gave people with hay fever small, rising amounts of pollen extract, to teach their immune systems to tolerate it. Allergen immunotherapy, as it is now called, is still the only treatment that addresses the cause of airborne allergies rather than only the symptoms. It is given as injections, which have the stronger evidence, or as drops or tablets under the tongue, and it is something to ask about if your allergies are severe and well identified. Little by little, the guard dog learns the postman's face.
When it is more
Most allergies are miserable rather than dangerous. Some are not.
Swelling of the lips, tongue or throat, trouble breathing or swallowing, or feeling faint after eating something, being stung or touching something can be a serious allergic reaction. Call your local emergency number.
Hay fever can reach the lungs too. In November 2016, a thunderstorm over Melbourne brought ten times the usual number of asthma cases to the city's emergency departments, and ten people died. The proposed explanation is that moisture bursts pollen grains into fragments small enough to slip past the hairs in the nose and into the lungs. Of those affected, 95% had hay fever, and 96% of them were allergic to grass pollen. If your hay fever ever comes with a wheeze or a tight chest, have it looked at.
And if symptoms come and go after meals without a clear allergy, Histamine Intolerance, linked below, has the other reaction that can look like one.
Back to the farm
We cannot grow up again on an Amish farm. But the farm children tell us something useful: allergies are not a sign that the body is overloaded with poisons. They are a defence system that has picked the wrong fight. We can help it choose its battles.
So the most helpful things are plain ones. Find out what you are reacting to. Keep it out of the bedroom and off the pillow. Rinse your nose. Be wary of remedies that promise to cleanse you. If your allergies are severe, ask about immunotherapy. And be patient, because the small changes add up.
Tonight, before bed, wash your face and hair, and start a note of when your symptoms flare.
Nose blocked all year? Natural Sinus Relief: What Works, and What Makes It Worse — the nasal spray that keeps you blocked, the rinse that helps and the water that keeps it safe, and two of the best tools, which cost nothing at all.
Reacting to meals, but no allergy shows up? Histamine Intolerance: The Hidden Trigger Behind Your Mystery Symptoms — what histamine does, why there is still no reliable test, why freshness beats any food list, and the simple way to find out whether histamine is your problem.
Know someone who sneezes their way through every spring? Send them this, before they buy another jar of local honey.
Disclaimer: This article is general information. For advice about your own health, talk to a qualified health professional, especially before trying butterbur or before giving peanut to a baby at high risk of allergy. Swelling of the lips, tongue or throat, or trouble breathing, needs emergency help straight away.
Affiliate Disclosure: This article contains affiliate links. As an Amazon Associate, All For Life earns from qualifying purchases, at no extra cost to you. We only link to products we would recommend without the commission.
Sources
Stein MM, Hrusch CL, Gozdz J, et al. (2016). Innate immunity and asthma risk in Amish and Hutterite farm children. New England Journal of Medicine 375(5):411–421. doi.org/10.1056/NEJMoa1508749
Wikipedia. Allergy. en.wikipedia.org
Wikipedia. Allergic rhinitis. en.wikipedia.org
Strachan DP (1989). Hay fever, hygiene, and household size. BMJ 299(6710):1259–1260. doi.org/10.1136/bmj.299.6710.1259
Wikipedia. Hygiene hypothesis. en.wikipedia.org
Ownby DR, Johnson CC, Peterson EL (2002). Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA 288(8):963–972. doi.org/10.1001/jama.288.8.963
Du Toit G, Roberts G, Sayre PH, et al. (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine 372(9):803–813. doi.org/10.1056/NEJMoa1414850
Wikipedia. Pollen. en.wikipedia.org
Wikipedia. Oral allergy syndrome. en.wikipedia.org
Woodcock A, Forster L, Matthews E, et al. (2003). Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. New England Journal of Medicine 349(3):225–236. doi.org/10.1056/NEJMoa023175
Terreehorst I, Hak E, Oosting AJ, et al. (2003). Evaluation of impermeable covers for bedding in patients with allergic rhinitis. New England Journal of Medicine 349(3):237–246. doi.org/10.1056/NEJMoa023171
Pynnonen MA, Mukerji SS, Kim HM, Adams ME, Terrell JE (2007). Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Archives of Otolaryngology–Head & Neck Surgery 133(11):1115–1120. doi.org/10.1001/archotol.133.11.1115
Wikipedia. Allergic conjunctivitis. en.wikipedia.org
National Center for Complementary and Integrative Health. Butterbur: Usefulness and Safety. nccih.nih.gov
Schapowal A (2002). Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 324(7330):144–146. doi.org/10.1136/bmj.324.7330.144
Rajan TV, Tennen H, Lindquist RL, Cohen L, Clive J (2002). Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Annals of Allergy, Asthma & Immunology 88(2):198–203. doi.org/10.1016/S1081-1206(10)61996-5
Wikipedia. Quercetin. en.wikipedia.org
Day LM, Ozanne-Smith J, Parsons BJ, Dobbin M, Tibballs J (1997). Eucalyptus oil poisoning among young children: mechanisms of access and the potential for prevention. Australian and New Zealand Journal of Public Health 21(3):297–302. doi.org/10.1111/j.1467-842x.1997.tb01703.x
Wastyk HC, Fragiadakis GK, Perelman D, et al. (2021). Gut-microbiota-targeted diets modulate human immune status. Cell 184(16):4137–4153.e14. doi.org/10.1016/j.cell.2021.06.019
Noon L (1911). Prophylactic inoculation against hay fever. The Lancet 177(4580):1572–1573. doi.org/10.1016/S0140-6736(00)78276-6
Wikipedia. Allergen immunotherapy. en.wikipedia.org
Wikipedia. Thunderstorm asthma. en.wikipedia.org