Ask the Doctor – Enlarged Adenoids

Hello Dr. Rona:

I have a 6 year-old son who was prescribed Avamys for his adenoids which were previously removed but have now grown back again. I am using Avamys because the alternative was to use Nasonex which appears to have cataracts as a possible side effect. Is the use of Avamys safe for children (as it’s only been in Canada I think since 2008)? Is there another natural alternative I can use rather than medication? Is surgery a better option than medication?

I appreciate your feedback.

Thank you, M. Ying

Dear M: Adenoids are composed of lymphatic tissue (similar to the tonsils) and are located high in the mouth behind the nose and the roof of the mouth. They are difficult to visualize and even doctors need special instruments to see them. Adenoids play a role in filtering lymphatic flow and trapping microbes that pass through the nose and mouth. They also produce antibodies against viruses, bacteria and other bugs. They therefore have a role as a natural defence mechanism against infections. Yanking them out as if they are a useless part of the body should be a last resort.

Steroid sprays like Avamys and Nasonex serve to suppress symptoms and are effective short-term quick fixes for swollen adenoids, but they do not address the source of the problem. Besides, children for the most part do not have synthetic steroid deficiencies.

As you mentioned, steroids in excess can lead to potentially dangerous side effects and are not meant for chronic, long-term use. As soon as they are stopped the symptoms tend to flare up again. The good news is that most children eventually grow out of adenoids as they become older, without any drastic treatments.

Surgery is certainly an option, especially if breathing is severely obstructed, but I think it would be wise to get food intolerance tests done before resorting to the knife, if at all possible. Enlarged adenoids have been linked in the medical literature to food intolerances. Over 90% of the documented adverse reactions to foods are not true allergies, occur on a delayed basis (up to four days after exposure), and will escape detection by conventional skin scratch tests.  They are often referred to as “Type 2 allergies” and they may have either immune or non-immune system mechanisms. Skin testing for such intolerances (Type 2 allergies) is a waste of time since this type of allergy does not show up as a skin reaction.

Checking for Allergies
Skin testing is a good way of determining if your child is sensitive to things like dust, mould, mites, grasses, trees, weeds, fabrics, detergents, chemicals and other environmental allergens. Your family doctor or allergist can perform this type of test. With most of these Type 1 allergies, avoidance, an air purifier, and the use of more natural laundry detergents and cleaning products would be helpful.

The most accepted method of identifying the non-classical food reactions is by an elimination diet. This is accomplished by following a hypoallergenic diet for three weeks, eliminating the most commonly eaten foods (wheat, grains, milk, eggs, yeast, corn, soy, citrus and other foods eaten on a daily basis), and then challenging the body with the eliminated foods one by one, noting the reactions. My experience is that dairy products, grains, and sugar are the commonest foods leading to enlarged adenoids.

During the three weeks before testing, symptoms such as fatigue, anxiety, wheezing, breathing difficulties, runny nose, joint pain, headaches, itching and hundreds of others will improve or disappear in those suffering from chronic ingestion of the eliminated foods. If one then reintroduces the individual to these foods and the symptoms reappear, the person is most probably allergic to the test foods. He or she is then advised to abstain from these foods for a period of months or years. This process only works if all the foods are discontinued abruptly or by “cold turkey”. Easing into this diet slowly or through some other compromise does not work at all.

This approach is not recommended for severely ill people and is best performed under the supervision of a qualified health care practitioner. A safer and more accurate alternative to the elimination diet is the IgG (subclass 4) RAST blood test. This test is now available from Gamma Dynacare Labs (905-790-3000). They offer a 120 food and a 220 food panel.[4]

Sugar in all its many forms must be eliminated from the diet in addition to the foods that are discovered on any allergy tests. Sugar suppresses immunity and makes adenoid problems worse. Make sure your child avoids fruit juices, pop, cookies, cakes, ketchup, chocolate bars, and other common sugar sources.

Recently published studies conclude that eliminating sugar and the foods detected by these tests are at least 80% effective in reversing or reducing the symptoms of dozens of chronic illnesses, including enlarged adenoids.

Nutrient Deficiencies and Enlarged Adenoids
Since adenoid enlargement can also be the result of deficiencies and toxins in the body, testing should be done for these possibilities as well. Deficiencies in vitamins A, D and C, along with zinc, iodine, and selenium can all make adenoid problems persist. Toxins such as mercury, cadmium, lead, fluoride and others can also have a suppressive effect on immunity. Testing for these should also be done through a natural health care practitioner.

Natural remedies to help reduce the size and impact of adenoids include echinacea, garlic, zinc, vitamins A, C and D as well as probiotics (acidophilus and bifido bacteria).

The bioflavonoid food supplement known as quercetin can stabilize the mast cell membrane and prevent excessive histamine release. It thus reduces the impact of any known or unknown allergy. I have often used it in practice with success for what appeared to be allergic symptomatology. Other good natural anti-allergy supplements include stinging nettle, MSM (methyl sulfonyl methane), bee pollen, grape seed extract, pycnogenol, and citrus bioflavonoids. See a naturopath or holistic doctor to get a personalized diet and supplement program.

Zoltan Rona, MD, M.Sc.