Placeholder Content Image

How do hay fever treatments actually work? And what’s best for my symptoms?

<p><em><a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a></em></p> <p>Spring has sprung and many people are welcoming longer days and more time outdoors. But for <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis">almost one in five Australians</a>, spring also brings the misery of watery, itchy red eyes, a runny, congested nose, and sneezing.</p> <p>Hay fever (also known as allergic rhinitis) is caused when an allergen enters the nose or eyes. Allergens are harmless airborne substances the body has incorrectly identified as harmful. This triggers an immune response, which leads to the release of inflammatory chemicals (mediators) – one of which is histamine.</p> <p>Allergens that trigger hay fever differ from person to person. Common seasonal allergens include tree, grass and weed pollens (year-round allergens include dust mites, mould and pet dander). It’s now <a href="https://www.sciencedirect.com/science/article/pii/S132602002302191X">pollen season</a> in many parts of Australia, with pollen counts at their highest and hay fever cases surging.</p> <p>So what medicines can prevent or reduce hay fever symptoms, and how do they work?</p> <h2>Antihistamines</h2> <p>Knowing the release of histamine is a cause of hay fever symptoms, it’s unsurprising that <em>anti</em>-histamines are one of the most frequently recommended medicines to treat hay fever.</p> <p>Antihistamines block histamine from binding to histamine receptors in the body and having an effect, reducing symptoms.</p> <p>In Australia, we broadly have two types. The older sedating (introduced in the <a href="https://www.tga.gov.au/news/safety-alerts/first-generation-antihistamines-winter-warning">1940s</a>) and newer, less-sedating (introduced in the 1980s) antihistamines.</p> <p>Less-sedating antihistamines used to treat allergic rhinitis include bilastine (Allertine), cetirizine (Zyrtec), loratadine (Claratyne) and fexofenadine (Telfast). Bilastine, which came onto the Australian market only last year, is only available from a pharmacy, on recommendation from a pharmacist. The others have been around longer and are available at supermarkets and in larger quantities from pharmacies. Cetirizine is the <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/35-cetirizine-hydrochloride#:%7E:text=Risks%20of%20cetirizine%20hydrochloride%20use,significant%20at%20the%20proposed%20doses.">most likely</a> (of the less-sedating antihistamines) to cause sedation.</p> <p>The older sedating antihistamines (such as promethazine) cross the blood-brain barrier, causing drowsiness and even brain fog the next day. They have lots of side effects and potential drug interactions, and as such have little place in the management of hay fever.</p> <p>The newer less-sedating antihistamines are <a href="https://australianprescriber.tg.org.au/articles/antihistamines-and-allergy.html#:%7E:text=Less%20sedating%20antihistamines%20are%20equally,an%20ongoing%20good%20safety%20profile">equally effective</a> as the older sedating ones.</p> <p>Antihistamines are usually taken orally (as a tablet or solution) but there are also topical preparations such as nasal sprays (azelastine) and eye drops. Antihistamine nasal sprays have <a href="https://www.sciencedirect.com/science/article/abs/pii/S108112061000743X">equal to or better efficacy</a> than oral antihistamines.</p> <p>The individual response to antihistamines varies widely. For this reason, you may need to trial several different types of antihistamines to see which one works best for you.</p> <p>Increasing the dose of an antihistamine, or combining an oral and topical antihistamine, does not provide any additional benefit. Paying extra for a brand name doesn’t offer any more or less effect than the generic (both have the same active ingredient and are <a href="https://www.tga.gov.au/news/news/generic-prescription-medicines-fact-sheet">bioequivalent</a>, which means they have the same outcomes for patients).</p> <h2>Steroid nasal sprays</h2> <p>If your symptoms don’t improve from antihistamines alone, a nasal spray containing a corticosteroid is often recommended.</p> <p>Corticosteroids prevent the release of several key chemicals that cause inflammation. How they work is complex: in part, corticosteroids “turn off” the production of late phase inflammatory mediators (cytokines and chemokines). This reduces the future release of more inflammatory mediators, which reduces inflammation.</p> <p>Corticosteroids and antihistamines have different mechanisms of action. Research shows corticosteroid nasal sprays are <a href="https://journals.sagepub.com/doi/full/10.2500/ajra.2016.30.4397">more effective</a> than antihistamines in controlling an itchy, runny, congested nose. But when instilled into the nose, corticosteroids <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1016/j.otohns.2007.10.027">also reduce</a> the eye symptoms of hay fever.</p> <p>There are also nasal sprays that contain both an antihistamine and corticosteroid.</p> <p>While there are a range of corticosteroid nasal sprays containing different active ingredients, a large study published this year shows they are all <a href="https://www.frontiersin.org/articles/10.3389/fphar.2023.1184552/full">about as effective as each other</a>, and work best when they have been taken for several days.</p> <h2>Sodium cromoglycate</h2> <p>Another medicine used to treat hay fever symptoms is sodium cromoglycate, which is available as an eye drop and over-the-counter in pharmacies.</p> <p>This medicine is known as a mast cell stabiliser. As the name suggests, it stabilises or prevents mast cells from breaking down. When mast cells break down, they release histamine and other chemicals that cause inflammation.</p> <p>This eye drop is both a preventative and treatment medicine, usually used before allergies strike. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375451/">Evidence shows</a> it is effective at reducing the symptoms of allergic conjunctivitis (eye inflammation from allergies).</p> <h2>Decongestants</h2> <p>Decongestants constrict blood vessels. They can be taken orally, administered as a nasal spray, or instilled into the eyes. When administered into the eyes it will reduce redness, and when administered into the nose, it will stop it from running.</p> <p>However, decongestants should be used for a short duration only and are not for long term use. In fact, if a nasal spray decongestant is used for more than five days, you can experience something called “rebound congestion”: a severe stuffy nose.</p> <h2>Saline</h2> <p>Saline (saltwater) nasal sprays or irrigation products are also available to flush out the allergens and provide hay fever relief. While there are not many studies in the area, there is evidence that saline irrigation <a href="https://www.cochrane.org/CD012597/ENT_nasal-saline-allergic-rhinitis#:%7E:text=Saline%20irrigation%20may%20reduce%20patient,any%20outcomes%20beyond%20three%20months">may reduce hay fever symptoms</a>. Saline is safe and is not associated with adverse effects.</p> <p>If you’re suffering from hay fever symptoms and unsure what to try, talk to your prescriber or pharmacist, who can guide you through the options and identify the best one for your symptoms, medical conditions and medicines.</p> <p>Allergen immunotherapy (or allergen shots) is another option hay fever sufferers <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-immunotherapy-faqs">may discuss</a> with their doctors. However it’s not a quick fix, with therapy taking three to five years.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213071/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Assistant Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-hay-fever-treatments-actually-work-and-whats-best-for-my-symptoms-213071">original article</a>.</em></p>

Body

Placeholder Content Image

Achoo! 5 essential reads for pollen season

<p>As spring expands across North America, trees, shrubs and flowers are releasing <a href="https://www.britannica.com/science/pollen">pollen</a>. This fine, powdery substance is produced by the male structures of cone-bearing and flowering plants. When it’s carried to the plants’ female structures by wind, water or pollinators, fertilization happens. </p> <p>As pollen travels, it also triggers allergies in <a href="https://www.aafa.org/allergy-facts/">some 25 million Americans</a>. Pollen exposure can cause sneezing, coughing, itchy eyes, runny nose and postnasal drip – unwelcome signs of spring for sufferers. This roundup of articles from our archives describes recent findings on protecting pollinators and coping with pollen season.</p> <h2>1. Hey pollinators, over here</h2> <p>Since pollen grains carry the cells that fertilize plants, it’s critical for them to get where they need to go. Often wind or gravity is all it takes, but for many plants, a pollinator has to carry the pollen grains. Some plants offer nectar or edible pollen to attract insects, bats or other animals, which carry pollen from plant to plant as they forage. Many flowers also <a href="https://theconversation.com/why-do-flowers-smell-151672">lure pollinators with scent</a>.</p> <p>“Similar to the perfumes at a department store counter, flower scents are made up from a large and diverse number of chemicals which evaporate easily and float through the air,” writes Mississippi State University horticulturalist <a href="https://scholar.google.com/citations?user=dJ8gD7MAAAAJ&amp;hl=en">Richard L. Harkess</a>. “To differentiate itself from other flowers, each species’ flowers put out a unique scent to attract specific pollinators. … Once pollinated, the flower stops producing a floral scent and nectar and redirects its energy to the fertilized embryo that will become the seed.”</p> <h2>2. Bees at the buffet</h2> <p>It’s well known that many species of insects have <a href="https://theconversation.com/insect-apocalypse-not-so-fast-at-least-in-north-america-141107">declined in recent years</a>. One big focus is <a href="https://www.aphis.usda.gov/aphis/ourfocus/planthealth/plant-pest-and-disease-programs/honey-bees/honeybees">honeybees</a> and <a href="https://theconversation.com/beyond-honey-bees-wild-bees-are-also-key-pollinators-and-some-species-are-disappearing-89214">other species of bees</a>, which pollinate many important crops. </p> <p>In a 2021 study, University of Florida agricultural extension specialist <a href="https://scholar.google.com/citations?user=I8IjAnIAAAAJ&amp;hl=en">Hamutahl Cohen</a> found that when bees visited fields where sunflowers, grown as crops, were blooming over many acres, they <a href="https://theconversation.com/planting-mixes-of-flowers-around-farm-fields-helps-keep-bees-healthy-170527">picked up parasites at a high rate</a>. In contrast, bees that foraged in hedgerows around crop fields and could choose from diverse types of flowers to feed on spread out farther and had lower rates of infection.</p> <p>“The more bees in sunflower fields, the more parasites,” Cohen observed. “Sunflower blooms were aggregating bees, which in turn was amplifying disease risk.” However, “in the presence of many flower types, bees disperse and spread across resources, reducing each individual bee’s likelihood of encountering an infected individual.”</p> <h2>3. Warmer weather means more pollen</h2> <p>As climate change raises average temperatures across the U.S., growing seasons are starting earlier and ending later in the year. That’s <a href="https://theconversation.com/pollen-season-is-getting-longer-and-more-intense-with-climate-change-heres-what-allergy-sufferers-can-expect-in-the-future-179158">bad news for allergy sufferers</a>. </p> <p>“The higher temperature will extend the growing season, giving plants more time to emit pollen and reproduce,” write University of Michigan atmospheric scientists <a href="https://clasp.engin.umich.edu/people/zhang-yingxiao/">Yingxiao Zhang</a> and <a href="https://scholar.google.com/citations?user=3dWPwz8AAAAJ&amp;hl=en">Allison L. Steiner</a>. And by increasing the concentration of carbon dioxide in Earth’s atmosphere, climate change will make it possible for plants to grow larger and generate more pollen. </p> <p>“Southeastern regions, including Florida, Georgia and South Carolina, can expect large grass and weed pollen increases in the future. The Pacific Northwest is likely to see peak pollen season a month earlier because of the early pollen season of alder,” Zhang and Steiner report.</p> <h2>4. Providing better forecasts</h2> <p>With all that pollen out there, how can allergy sufferers know when counts are high? Today the U.S. has only a rudimentary network of 90 pollen observation stations across the country, staffed by volunteers and run only during pollen season, so often there isn’t good information available when people need it.</p> <p><a href="https://scholar.google.com/citations?user=sUwveOEAAAAJ&amp;hl=en">Fiona Lo</a>, an environmental health scientist at the University of Washington, is working with colleagues to develop a model that can predict airborne pollen releases. “Our forecast can predict for specific pollen types because our model includes information about how each plant type interacts differently with the environment,” Lo reports.</p> <p>So far, the model only predicts levels of four types of common pollen in areas where there are observation stations. Ultimately, though, Lo and her collaborators “want to provide a forecast every day during pollen season to give allergy sufferers the information they need to manage their symptoms. Allergies are often undertreated, and knowledge about self-care is limited, so a reliable pollen forecast that is easy to access – for example, via an app on your phone – along with education on allergy management, could really help allergy sufferers.”</p> <h2>5. Support pollinators in your garden</h2> <p>Pollen season is also gardening season, since it’s when plants are blooming. West Virginia University mycologist <a href="https://www.researchgate.net/profile/Brian-Lovett">Brian Lovett</a>offers advice for gardeners who want to <a href="https://theconversation.com/to-help-insects-make-them-welcome-in-your-garden-heres-how-153609">attract beneficial insects to their yards</a> for pollination and other purposes. </p> <p>One step is to replace grass with native wildflowers, which will provide pollen and nectar for insects like ants, bees and butterflies. “Just as you may have a favorite local restaurant, insects that live around you have a taste for the flowers that are native to their areas,” Lovett notes.</p> <p>Replacing white lightbulbs with yellow or warm-hued LED bulbs, and providing water in dishes or other containers, are also insect-friendly steps. Local university extension offices and gardening stores can offer other suggestions. </p> <p>“In my view, humans all too often see ourselves as separate from nature, which leads us to relegate biodiversity to designated parks,” Lovett observes. “In fact, however, we are an important part of the natural world, and we need insects just as much as they need us.”</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/achoo-5-essential-reads-for-pollen-season-181672" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Home & Garden

Placeholder Content Image

Hay fever alert: Experts advise to stay indoors as pollen hits 'extreme levels'

<p>Brace yourselves, hay fever sufferers! Pollen in the air is set to reach extreme levels over the weekend.</p> <p>The areas which are considered to be hit with the highest amount of pollen are Sydney, Perth, Bendigo and Adelaide, as experts advise people to avoid those locations.</p> <p>Peak period for hay fever is said to begin in November, but those who suffer from the allergy can start to feel irritated as early as September.</p> <p>According to Weatherzone, pollen levels are at its highest during hot days and days where there is dry wind present.</p> <p>Sydney-siders are going to be affected the most as winds are set to reach 17km/h on Friday and Sunday, with pollen levels set at “very high".</p> <p><span>Weatherzone has advised those who are sensitive to pollen to remain indoors, saying “most sufferers of pollen allergies will experience symptoms on very high pollen level days".</span></p> <p>Temperatures in Perth are set to soar, as the city will experience 30 degrees on Friday combined with winds of 20km/h. The pollen forecast is predicted to be high.</p> <p>Adelaide will have a warm Sunday as the weather is forecasted to be 33 degrees with four days of high-level pollen.</p> <p>Those in Melbourne are also expected to face high pollen levels by Monday but the weekend is set to be quite clear.</p> <p>But those in Bendigo, Victoria, are advised to stay indoors as pollen levels are set to reach extreme.</p> <p>Dr Connie Katelaris, head of the immunology and allergy unit at Campbelltown Hospital, spoke to the <a rel="noopener" href="https://www.dailymail.co.uk/news/article-6390783/Pollen-reach-extreme-levels-weekend-experts-warn-horror-season.html" target="_blank"><em>Daily Mail</em></a> and advised those who suffer from the allergy to remain cautious.</p> <p>“If you know you have regular problems, you should be starting up one of the preventative sprays, the nasal sprays, so that you can block the reaction before it gets going.”</p> <p>Close to 15 per cent of Australian’s suffer from hay fever, and speaking to the <a rel="noopener" href="https://www.dailymail.co.uk/news/article-6390783/Pollen-reach-extreme-levels-weekend-experts-warn-horror-season.html" target="_blank"><em>Daily Mail</em></a>, professor Simon Haberle, from the Australian National University who specialises in pollen, said the worst is yet to come.</p> <p>“Most of the pollen comes from trees in August and September, and now we’re moving into the grass pollen season, which starts around late October and November,” he said.</p> <p>“If you’re suffering from hay fever and asthma at the moment and feeling the effects of it, it’s probably relating to tree pollen because it’s quite prominent.”</p> <p>Do you suffer from hay fever or asthma? Tell us in the comments below. </p>

Caring

Placeholder Content Image

Health Check: How to tell the difference between hay fever and the common cold

<p>You wake up with a runny nose and, come to think of it, you’ve been sneezing more than usual. It feels like the start of a cold but it’s October – the start of hay fever season – so what is the more likely affiliation?</p> <p>Hay fever and colds are easy to confuse because they share the clinical category of <span><a href="https://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/symptoms-causes/syc-20351229">rhinitis</a></span>, which means irritation and inflammation of the nasal cavity.</p> <p>The mechanisms share some similarities too, but there are some key differences in symptoms – notably, itchiness and the colour of your snot.</p> <p><strong>Similar mechanisms</strong></p> <p>The <span><a href="https://www.sciencedirect.com/science/article/pii/S0140673603121629?via%3Dihub">common cold</a></span> is a viral infection of the upper respiratory tract, usually caused by rhinoviruses. Colds spread easily from one person to the other via coughing, sneezing and touching infected surfaces.</p> <p>Hay fever, on the other hand, can’t spread from person to person. It’s an allergic response to an environmental irritant such as <span><a href="https://www.canberrapollen.com.au/">pollen</a></span> or dust.</p> <p>The nasal cavity contains cells that recognise foreign substances such as bugs and pollen. Once the body detects a bug or irritant, it activates an army of T cells that hunt down and destroy the substance. This is known as an immune response.</p> <p>In hay fever, the irritant triggers the same immune cells as viruses. But it also causes the release of IgE antibodies and histamines to produce an ongoing blocked nose, impaired sense of smell, and nasal inflammation.</p> <p><strong>How you tell the difference</strong></p> <p>Both hay fever and the common cold causes sneezing, runny or stuffy nose and coughing.</p> <p>One of the key differences is the colour of the nasal discharge (your snot): it’s more likely to be yellowish/green in colour in colds; while in hay fever, it’s clear.</p> <p>Facial itchiness – especially around the eyes or throat – is a symptom typically only seen with hay fever.</p> <p>If someone is allergic to a seasonal environmental trigger such as pollen, their symptoms may be restricted to particular seasons of the year. But if you’re allergic to dust or smoke, symptoms may last all year long.</p> <p>Hay fever, like asthma, is an allergic disease and can sometimes cause similar symptoms, such as coughing, wheezing and shortness of breath.</p> <p>A sore throat, on the other hand, is generally a precursor to cold. If you have cold-like symptoms and a sore throat or have had one in the last few days, your condition is more likely to be the common cold.</p> <p><strong>What if you’ve never had hay fever before?</strong></p> <p>You’re more likely to catch viral infections during winter when more bugs are circulating, but it’s possible to <span><a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072727/">catch a cold any time</a></span> of the year.</p> <p>It’s possible to develop hay fever in adulthood. This may be due to genetic predisposition that manifests only when certain other contributing factors are present, such as a high level of airborne pollen. Or it may be due to a major change in lifestyle, such as a move to a different location or change in diet.</p> <p>Most adults will get two to three colds per year, while hay fever affects <span><a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever-in-australia/contents/summary">nearly one in five</a></span> Australians.</p> <p>Around 10-20% of hay fever sufferers grow out of hay fever at some point in their lives and about half find their symptoms get less severe as they get older, which means that for the majority of sufferers, hay fever can <span><a href="https://www.allergy.org.au/patients/about-allergy/common-myths-about-allergy-and-asthma-exposed">last a long time</a></span>.</p> <p><strong>How are they treated?</strong></p> <p>An allergy test, using a skin prick or blood test, for allergen-specific IgE could inform you of the <span><a href="https://www.allergy.org.au/patients/allergy-testing/allergy-testing">specific irritants that trigger your condition</a></span>. These tests can be organised through your GP or pharmacist.</p> <p>Oral antihistamines are effective in hay fever patients with mild to moderate disease, particularly in those whose main symptoms are palatal itch, sneezing, rhinorrhoea or eye symptoms <span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112773/">hay fever treatments</a></span>.</p> <p>Generally, treatment isn’t necessary for a cold but over-the-counter medications such as paracetamol and ibuprofen can <span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928210/">help relieve some of the symptoms</a></span>.</p> <p><em>Written by Reena Ghildyal and Cynthia Mathew. Republished with permission of <span><a href="https://theconversation.com/health-check-how-to-tell-the-difference-between-hay-fever-and-the-common-cold-104755">The Conversation</a></span>. </em></p>

Body

Placeholder Content Image

3 tips to beat hay fever

<p>If you have hay fever, you know that it can be the bane of spring – or even autumn, winter and summer, too, if you have a bad case. If you’re not a sufferer, imagine having a cold that could flare up when at the turn of a corner. </p> <p>Thankfully, there are ways around it. Here are three that don’t involve expensive antihistamines.  </p> <p><strong>1. Find out what sets you off</strong></p> <p>You can do this one of two ways. You could a) either stick to a close process of trial and error or b) get yourself an allergy test. These are used to determine which particular allergens are responsible for provoking an allergic reaction. It will usually involve skin and blood tests or an oral food allergen challenge.</p> <p>Note: If your symptoms mainly start in spring or summer, you may have “seasonal” allergic rhinitis, which is usually triggered by higher pollen counts during these seasons.</p> <p><strong>2. Minimise exposure</strong></p> <p>This might sound impossible when it comes to pollen and other allergens that float around in the air, but there are ways you can reduce or even stop exposure.</p> <p> </p> <ul> <li>Check out a pollen calendar: this helps you identify plants that trigger your hay fever and when they’re most likely to be flowering.</li> <li>Smear petroleum jelly (like Vaseline) inside your nose when you are outdoors: this helps trap pollen and stops it reaching the inner lining of your nose.</li> <li>Wear sunglasses and frequently splash your eyes with water.</li> <li>Stay away from parks and gardens while lawns are being mowed.</li> <li>Shower after playing sport and other outdoor activities to rinse off any pollen you’ve been exposed to.</li> <li>Use re-circulated air in the car: especially when pollen levels are high, or keep the windows closed.</li> </ul> <p><strong>3. Evaluate your current medication</strong></p> <p>Are you currently spending upwards of a few dollars a tablet on medications that only last a day? You may be using the wrong one. For example, decongestant nasal sprays or drops, syrups or tablets may help reduce nasal stuffiness or “congestion”. But they don’t work on other hay fever symptoms, and oral forms often cause side effects like insomnia and irritability, and aren’t suitable if you have a heart condition or high blood pressure. </p> <p><strong>Related links:</strong></p> <p><em><span style="text-decoration: underline;"><strong><a href="http://www.oversixty.co.nz/health/body/2015/12/7-common-lies-about-fat/">7 common lies about fat</a></strong></span></em></p> <p><em><span style="text-decoration: underline;"><strong><a href="http://www.oversixty.co.nz/health/body/2015/12/bloating-food/">The best and worst foods for bloating</a></strong></span></em></p> <p><em><span style="text-decoration: underline;"><strong><a href="http://www.oversixty.co.nz/health/body/2015/11/what-your-food-cravings-mean/">What your body’s cravings really mean</a></strong></span></em></p> <p> </p>

Body

Our Partners