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332 Textbook of Diagnostic and Therapeutic Procedures in Allergy
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Figure 5 Yoga postures
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10
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Mechanism
Jala Neti reduces the inflammatory response to allergens in the nasal mucosa by reducing histamines
and leukotriene (Georgitis 1994).
Contra-Indication
Jala Neti should be avoided in conditions like acute rhinitis, acute sinusitis and acute exacerbation
of asthma, nasal polyps and severe form of the deviated nasal septum.
Asana (Yoga Postures)
Asana is the third step of the yoga discipline. Asana involves different yoga poses performed with
mindfulness and slow breathing. According to Hatha Yoga Pradeepika, yoga postures bring stability,
strength and lightness to the body (Satyananda 2014). In yoga, therapy-specific postures are
recommended for a specific health condition, e.g., Bhujangāsana (cobras pose) is recommended for
asthma. Studies have confirmed that asana practice is associated with enhanced autonomic balance,
decreased sympathetic activity and increased vagal tone (Sarubin et al. 2014). Asana practice
reduces inflammation and regulates immune function (Estevao 2022).
These yoga practices should be performed on an empty stomach or 2–2½ hours after a meal.
Yoga postures should be done slowly with deep, slow and conscious breathing. Do not strain; try to
attempt the pose at your ease (it is okay if a final/perfect posture is not possible). After reaching the
final pose, one should hold the pose with their capacity with normal breathing.
Figure 5. Yoga Postures Useful in Allergic Disorders. (1) PādaHastāsana (hand-to-foot pose), (2) Ardha Chakrāsana
(half-wheel pose), (3) Ardhkati Chakrasana (half-waist bend), (4) Trikonasana (triangle pose), (5) Ustrāsana (camel pose),
(6) Saśankasana (moon pose), (7) Vakrāsana (twisted spine pose), (8) Bhujangāsana (cobra pose), (9) Savāsana (corpse pose)
and (10) Nādishuddhi Prāṇāyāma (alternate nostril breathing).
Role of Yoga and Ayurveda in the Management of Allergic Disorders 333
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Pranayama (Yogic Breathing)
Prāṇāyāma is slow-paced mindful breathing. There are various types of breathing practices according
to yoga, such as alternate nostril breathing (Nadishodhana Prāṇāyāma), left nostril breathing
(Chandra Nadi Pranayama), right nostril breathing (Surya Nadi Pranayama), etc.
These breathing techniques have specific physiological benefits. Studies have reported the
therapeutic benefits of Prāṇāyāma on the immune system and various chronic diseases, including
allergic disorders (Arora et al. 2018; Das et al. 2021). Further, studies have reported that the practice
of Prāṇāyāma helps to improve lung capacities, autonomic function, cardiac functions and cognitive
abilities (Moventhan and Khode 2014). Prāṇāyāma improves vagal tone by promoting sino-
respiratory arrhythmia and baroreflex (Bhavanani et al. 2012).
Meditation
Meditation is a yogic mental practice that involves the practice of mental focusing on a meditative
object, thought, mantra, etc., followed by defocusing. There are various stages of meditation.
In the initial phase, practitioners need to practice concentrating/chanting/visualising the object
of meditation effortfully; this phase of meditation is called Dhāraṇa. The second phase is called
Dhyāna, where the mind can be easily concentrated without/with minimum effort on the object
of meditation; in this phase of meditation, mindfulness increases. Samādhi is the third phase of
Table 1. The list of yoga practices for allergic disorders.
Sl No Practice Duration – 60 Minutes
1 Loosening practices 10 Minutes
2 Quick Relaxation Technique (QRT)
3 Breathing practices 15 Minutes
Prasarita Hasta Swasah (Hands in and out breathing)
Utkashita Hasta Swasah (Hands stretch breathing)
Vyaghraswasah (Tiger breathing)
Ankle-stretch breathing
Straight-leg raising breathing
Sethubandhasana breathing (breathing in bridge pose)
Bhujangāsana breathing (Breathing in cobra pose)
4 Asanas 20 Minutes
Tadasana (straight pose)
Trikonasana (triangle pose)
Ardhachakrasana (half-wheel pose)
Padahasthasana (hand-feet pose)
Vajrayana (tree pose)
Ardhakaticharasana (half-waist pose)
Ustrāsana (camel Pose)
Shavasana (corpse pose)
5 Deep relaxation technique (DRT) 10 Minutes
6 Prāṇāyāma (yogic breathing practices) 5 Minutes
Bhastrika Pranayama (bellows breath)
Nadishodha Prāṇāyāma (alternate nostril breathing)
Brahmari Prāṇāyāma (humming)
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meditation, which is the state trance. In this phase, the mind is entirely free from all negative
emotions, traumas and conflicts, and it becomes pure awareness of aloneness. In this phase, one
attains purity, unconditional love, compassion, forgiveness and universal oneness; in the last few
years lot of research on meditation (Kim et al. 2022). Their various tailor-made meditation techniques
have evolved recently (Farias et al. 2020). Meditation is effective in allergic disorders (Lack
et al. 2020). Mediations such as OM meditation, mindfulness meditation, Vipassana meditation and
cyclic meditation are recommended for allergic diseases. Meditation is associated with decreased
inflammatory cytokines, catecholamine, cortisol and sympathetic overactivity (Househam et al.
2017; Henneghan et al. 2021).
Scientific Evidence for Yoga
The therapeutic effects of yoga have attracted the attention of the medical and scientific community
in the last three decades. The number of research publications on yoga for health benefits in healthy
and clinical populations has increased (Alvarez et al. 2022).
Yoga and Immune Modulation
A large body of data confirmed the positive effects of yoga on the immune system. Yoga has
immune-modulation properties. Yoga reduces inflammatory cytokines (Prinster 2014; Bower et al.
2014) and increases NK cell number and immune cell activity (Rao et al. 2008). Clinical trials have
shown the positive role of yoga in immune-compromised conditions, such as HIV, tuberculosis and
cancer (Dadang and Wahyu 2021; Visweswaraiah and Telles 2004; Sinclair 2020; Cramer et al.
2012; David et al. 2017; Jiang et al. 2021). Yoga intervention demonstrated an increase in NK-cell
activity and T-lymphocytes, CD4, CD8 and NK-cell count and reduced inflammatory cytokines such
as IL-1, IL-2, IL-6 and TNF alpha. Further, psychological factors such as anxiety, depression, stress
and mood, which are known to affect immune function reduced after yoga intervention (Rao et al.
2008; Vempati and Telles 2002). Yoga brings the immune-modulation by reducing catecholamines,
cortisol and inflammatory cytokines via down-regulating HPA axis hyperactivity and improving the
vagal tone (Rajak et al. 2016; Ray et al. 2001).
Yoga in Allergic Rhinitis
Several RCT studies have demonstrated the benefits of yoga in allergic rhinitis. An RCT on an
8-week Hatha yoga intervention (3 times/week) among 27 allergic rhinitis patients has shown
significant improvement in clinical symptoms of rhinitis and cytokine profiles (Chanta et al. 2019).
Another study on 51 healthy volunteers and 51 allergic rhinitis patients who received 3 months
of Hath yoga intervention showed a significant decrease in nasal airway resistance. It increased
forced vital capacity and a non-significant increase in FEV1. Further, mental health measures and
Sino-nasal outcome tests also improved significantly (Chellaa et al. 2019). Following yoga practice,
the positive changes in allergic rhinitis may be attributed to immune modulation by reducing
inflammatory cytokines, improved circulation to the nasal mucosa and decreased hypersensitivity
of the nasal mucosa (Eda et al. 2018; Ye et al. 2020; Meera et al. 2020). Persons with allergic rhinitis
are recommended regular yoga practices consisting of loosening practices, yoga postures and yoga
breathing practices minimum (listed in Table 1) a minimum of three times a week, and Jala Neti
practise a minimum of twice a week for a minimum of three months.
Yoga in Asthma
Several randomised controlled trials have been conducted to investigate the efficacy of yoga in asthma
(Das et al. 2019; Cramer et al. 2014). These studies have reported a significant reduction in asthma
symptoms, frequency of asthma episodes, inflammatory markers and need for bronchodilators. This
study observed a significant improvement in lung function and quality of life (Cramer et al. 2014).
Role of Yoga and Ayurveda in the Management of Allergic Disorders 335
Vata
Pitta
Kapha
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A systematic review of 11 clinical trials in adolescents 14–18 years with asthma reported the
efficacy after 3–12 weeks of yoga. The study reported a positive impact of yoga on forced vital
capacity, peak expiratory force, peak expiratory volume, reserve volume, respiratory rate, anxiety,
stress, medication use and quality of life (Arora et al. 2017). A meta-analysis of 14 RCT studies
on yoga in asthma found beneficial effects on various parameters of asthma, including symptoms,
quality of life, asthma medication use and lung functions (Yang et al. 2016).
Yoga practice in asthma helps to improve lung capacities and reduce inflammatory cytokines
(Papp et al. 2017; Swami et al. 2010; Venkatesh et al. 2020). It reduces hypersensitivity of the
respiratory mucosa and improves breathing (Meera et al. 2020; Das et al. 2020).
Ayurveda
Ayurveda is an ancient life science, probably the first healthcare system on earth. The meaning of
“Ayurveda” is “science of life.” It is a science of a healthy lifestyle. The concept of “Tridosha” is
unique to Ayurveda. It recognises three basic bio-energy principles in the body called Tridosha; Vāta,
Pitta and Kapha are the Tridosha. These three bio-energy principles maintain normal functioning
of the body such as vātagoverns all movements and transportation, pitta governs metabolism and
temperature, Kapha governs growth and production, etc. Imbalance in the Tridosha results in disease.
Each dosha disturbance leads to a specific disease when imbalanced (Padma 2005).
Prevention of the disease, according to Ayurveda, is through following a lifestyle that helps
maintain balance in the Tridoshas, and treatment of the disease includes restoration of Tridosha
balance. The Tridosha balance is affected by an unhealthy diet, inadequate or excessive physical
activity, mental afflictions such as anxiety, depression, stress, hate, worry, etc. or seasonal variations.
Ayurveda recommends a healthy lifestyle in Dinachary (daily regimes) and Rituchary (seasonal
regimens) to maintain doshas in a balanced state (Mukherjee et al. 2017; Singh et al. 2007).
Characteristics: Light, mobile, cold, penetrating,
Functions: Movements, transport, respiration, circulation
• Characteristics: Hot, corrosive, penetrating, liquid
• Functions: Digestion, metabolism, temperature, vision
• Characteristics: Heavy, cold, slimy, liquid etc.
• Functions: Cell growth, mucus production, secretion ad reproduction
Figure 6. Characteristics of Tridosha: Vāta, Pitta and Kapha Have Distinctive characteristics.
Ayurveda Treatment Approach to Allergic Disorders
According to Ayurveda, allergic disorders such as skin allergies, food allergies, asthma, nasal allergy,
etc., are due to an imbalance in the Tridosha.
Nidanaparivarjana (Avoidance of Causative Factors)
Ayurveda recommends Pathya (do’s) and Apathya (dont’s) for every disease. For allergic disorders,
one should avoid the following things:
1. Exposure to cold weather, cold water bath, drinking cold water, milk and milk products.
2. Strongly Spiced foods, sweets, fried foods, heavy and cold food.
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3. Excessive exercise or no exercise.
4. Avoid excess worry, stress and anxiety-provoking activities/situations.
Recommendations
• Eat food that is fresh, warm, free from preservatives and colouring agents and easy to digest,
such as porridges, oats, etc.
• Keep yourself warm; drink warm water. Perform yoga, meditation, yoga Nidra and prayers to
keep mental affliction away.
• One can use brown sugar and spices like ginger, turmeric, peppers, etc.
• Soups and warm drinks are beneficial.
Ayurveda recommends a specific daily regimen (Dinacharya) and season regimen (Ritucharya)
for healthy living.
Dinacharya – Daily Regimens
In order to promote health and longevity, one has to wake up in Brahm muhurta (approximately
45 minutes before sunrise) in the morning. After completion of morning oblations, one should brush
the teeth and perform Gandoosha (holding liquid/warm water or sesame oil for 1 minute). Following
Gandoosha, Vyayama (exercise) should be performed at a moderate intensity. Have adequate
relaxation after exercise. One may go for a whole-body massage followed by a bath. Warm water
is advised for the bath for patients with allergic disorders. Clean, soft, cotton cloths that provide
enough cool in the summer and warm in the winter should be used (Sharma and Bhagwan 2002).
Food should be light, wholesome and compatible. It should be consumed after feeling hungry
(should not consume food when there is no proper hunger). Patients with asthma and respiratory
diseases should consume light and small meals and drink warm water after meals. Patients with skin
allergies should avoid the opposite food (Virudhanna), such as a combination of cold and hot food
items, sweet and sour, milk, not consume curd at night and avoid sour fruits and pickles. Patients
with nasal allergies should avoid taking head baths daily and eating milk products and sour fruits.
Tridosha are subjected to changes to the change in season example; during winter Kapha Dosha
increases and Pitta Dosha comes down; and during midsummer, Vātadosha increases and Kapha
Dosha comes down. As disease results from an imbalance in the dosha and season can bring the
imbalance in the dosha, one prevents this imbalance due to changes in the season by following
certain seasonal norms called Ritucharya.
Ayurveda prescribes seasonal regimes for a healthy person to maintain health and prevent
disease.
Hemant and Shishir (four months) are when Kapha gets aggravates and exacerbates
respiratory-related allergic conditions. Hence, in these seasons, patients with respiratory-related
allergies should avoid Kapha aggravating food and activities. Food items such as dairy products,
black grams, sweets, deep-fried items, etc., should be avoided. Such patients should take warm
soups, have a light diet, drink warm water, include ginger, pepper and turmeric in the diet, wear
warm clothes, avoid exposure to cold and have a cold bath (Sharma and Bhagwat 2002). Similarly,
the person with different dominant dosha should take care of their diet and lifestyle during different
seasons.
Ritucharya
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Ayurveda Medications
A significant number of studies have shown the effects of Ayurveda in managing allergic disorders,
including skin allergies, asthma, and nasal allergy. Ayurveda is an individualised system of practice
based on individual assessments such as the basic and disturbed status of doshas (Prakriti and
Vikriti), Agni, Dhatu and many other parameters. Hence, the clinician selects a combination of
medications, such as Haridra Khanda, Chyavanaprash, Sitopaladichurna, Vasa Avaleha, etc., for
allergic disorders after assessing each case. For chronic allergic conditions, Ayurveda recommends
Panchakarma (systemic purificatory therapies), which is to be administered under the supervision
of an Ayurveda physician (Patel et al. 2013).
Ayurveda Nasyachikitsa (nasal medication) is the administration of a few drops (3–10) of
medicated oils or decoction in the nose. Clinical trials on Nasya therapy have shown positive effects
on nasal allergy. Thirty-seven patients with nasal allergy received Anu tail Nasya therapy daily for
two months in a study. Post-intervention, there was a significant decrease in nasal allergy symptoms,
Total Leucocyte Count (TLC), Absolute Eosinophil Count (AEC), Neutrophils and Lymphocytes
(Kumar et al. 2014).
Acknowledgement
Sujatha Reddy LPC. MSEd, BAMS, DCC Owner and CEO of Humanly Lakewood. Professional
Counsellor and Ayurvedic Doctor.
Glossary of Abbreviations
HPA Axis – Hypothalamus-Pituitary-Adrenal Axis
NK Cells – Natural Killer Cells
IL – Interleukin
HIV – Human Immunodeficiency Virus
CD – Cluster of Differentiation
TNF Alpha – Tumour Necrosis Factor Alpha
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