Traditional Chinese herbal remedies for asthma and food allergy

The mechanism of Sanzi Yangqin decoction for asthma treatment based on network pharmacology and experimental verification

BACKGROUND

Asthma is a chronic airway inflammatory disease characterized by airway inflammation, mucus hypersecretion, airway hyper-reactivity. Sanzi Yangqin Decoction (SZYQD) is widely prescribed for asthma treatment. Its anti-asthma activities have been reported in animal model, but the exact mechanism and targets of SZYQD in asthma treatment have not been fully elucidated.

METHODS

A network pharmacological approach was used to predict the active components, targets, and signalling pathways of SZYQD in asthma, including potential target prediction, protein‒protein interaction (PPI) network construction and analysis, and Gene Ont (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. The active ingredients were identified from the SZYQD, and were molecular docked according to the results of network pharmacology. A mouse model of asthma induced by ovalbumin (OVA) and lipopolysaccharide (LPS) was constructed to evaluate the therapeutic effect of SZYQD. Furthermore, the effects of SZYQD and its active ingredients were tested in vitro for regulating inflammation and MUC5AC expression (two main pathophysiologic abnormalities of asthma) in macrophages and airway epithelial cells by using Real-time PCR and western blotting.

RESULTS

A total of 28 active ingredients and 111 HUB genes were screened in the relevant databases, including three key ingredients (luteolin, β-carotene, and Sinapine) and nine core target genes (JUN, CTNNB1, IL10, TP53, AKT1, STAT3, TNF, IL6 and EGFR). KEGG and GO analysis indicated that the potential anti-asthmatic mechanisms of SZYQD were related to PI3K-Akt signalling pathway and response to lipopolysaccharide, etc. In the in vivo asthmatic model, our findings demonstrated that SZYQD exerted a protective effect against asthmatic mice induced by OVA and LPS through the inhibition of inflammation and mucus overproduction. Consistently, cell experiments showed that the SZYQD extract or the key active ingredients luteolin significantly decreased lipopolysaccharide (LPS)-induced IL-6 expression and activation of the NF-κB pathway in macrophages. In addition, SZYQD extract or luteolin inhibited activation of the AKT pathway and expression of MUC5AC induced by EGF in airway epithelial cells.

CONCLUSION

The anti-asthmatic mechanism of SZYQD might be associated with inhibiting inflammation and airway mucus hypersecretion by regulating the NF-κB and AKT signalling pathways as predicted by network pharmacology, which provides more evidence for the application of SZYQD in asthma treatment.

Mechanism of Peitu Shengjin Formula Shenlingbaizhu Powder in Treating Bronchial Asthma and Allergic Colitis through Different Diseases with Simultaneous Treatment Based on Network Pharmacology and Molecular Docking

Background

Shenlingbaizhu powder (SLBZP), one of the classic Earth-cultivating and gold-generating prescriptions of traditional Chinese medicine, is widely used to treat various diseases. However, the pharmacological mechanisms of SLBZP on bronchial asthma (BA) and allergic colitis (AC) remain to be elucidated.

Methods

Network pharmacology and molecular docking technology were used to explore the potential mechanism of SLBZP in treating BA and AC with the simultaneous treatment of different diseases. The potential active compounds of SLBZP and their corresponding targets were obtained from BATMAN-TCM, ETCM, SymMap TCM@TAIWAN, and TCMSP databases. BA and AC disease targets were collected through DisGeNET, TTD, GeneCards, PharmGKB, OMIM, NCBI, The Human Phenotype Ontology, and DrugBank databases. Common targets for drugs and diseases were screened by using the bioinformatics and evolutionary genomics platform. The analyses and visualizations of Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment of common targets were carried out by R software. The key targets were screened by using the plug-in “cytoHubba” of Cytoscape software, and the “active compound-key target” network was constructed. Molecular docking analysis was performed using AutoDock software. The miRTarBase database was used to predict microRNAs (miRNAs) targeting key targets, and the key target-miRNA network was constructed.

Result

Through screening, 246 active compounds and 281 corresponding targets were obtained. Common targets were mainly enriched in 2933 biological processes and 182 signal pathways to play the role of treating BA and AC. There were 131 active compounds related to key targets. The results of molecular docking showed that the important active compounds in SLBZP had good binding ability with the key targets. The key target-miRNA network showed that 94 miRNAs were predicted.

Conclusion

SLBZP has played the role of treating different diseases with the same treatment on BA and AC through the characteristics of multicompound, multitarget, and multipathway of traditional Chinese medicine, which provides a theoretical basis for explaining the mechanism and clinical application of SLBZP treating different diseases with the same treatment in BA and AC.

Paeoniflorin ameliorates airway inflammation and immune response in ovalbumin induced asthmatic mice: From oxidative stress to autophagy

BACKGROUND

Asthma characterized by airway remodeling is a multiple pulmonary disease, which is associated with various physiological processes including inflammation reaction, immune response, oxidative stress and autophagy.

PURPOSE

This study aimed to investigate whether these processes are modulated by the total glucosides of Paeonia lactiflora Pall (TGP), and its active compound paeoniflorin (PF) with anti-inflammatory and immune-regulatory effects could alleviate ovalbumin (OVA)-induced mouse asthma.

METHODS

In vivo, models of mouse asthma were established by intraperitoneally with a mixture of OVA and aluminum hydroxide, plus a single nasal injected with OVA to female C57BL/6 mice. The results were observed with PET imaging, TEM, RT-PCR, western blotting. In vitro, CD4⁺ T cells were isolated and detected with flow cytometry.

RESULTS

TGP, either in its crude or processed form, and PF effectively ameliorated lung injury in mice induced by OVA, regulated immune/inflammatory response by inhibiting the release of pro-inflammatory cytokines, thereby decreasing Th2 cell proportion, inhibited oxidative stress by recovering mitochondrial membrane potential and regulating metabolic activity in dose-dependent manner. Moreover, PF could inhibit autophagy by regulating mitochondrial function. In addition, the therapeutic effects of TGP and PF on pulmonary injury in asthmatic mice were not affected by processing.

CONCLUSION

PF may be a valuable agent in ameliorating inflammation and immune response in asthmatic mice, and the possible mechanism involved in this response rang may from oxidative stress to autophagy.

Ligustrazine Inhibits Lung Phosphodiesterase Activity in a Rat Model of Allergic Asthma

Objectives

This study sought to examine whether ligustrazine was capable of inhibiting phosphodiesterase (PDE) activity and improving lung function in a rat model of asthma.

Methods

Rats were initially sensitized using ovalbumin (OVA) and then were challenged daily with aerosolized OVA beginning 14 days later (30 min/day) to generate a rat model of asthma. Changes in airway function following methacholine (MCh) injection were evaluated by monitoring lung resistance (R_L) and dynamic lung compliance (C_dyn) values using an AniRes2005 analytic system. In addition, serum IgE was measured via ELISA, while PDE expression was evaluated via qPCR and western blotting. Key Findings. Ligustrazine significantly impaired allergen-induced lung hyperresponsivity and inflammation in this asthma model system. Ligustrazine treatment was also associated with reduced expression of PDEs including PDE4 in the lungs of these rats.

Conclusions

Ligustrazine suppresses airway inflammation and bronchial hyperresponsivity in this rat model system, and these changes are associated with decreased PDE expression at the protein and mRNA levels.

Potential beneficial effects of kefir and its postbiotic, kefiran, on child food allergy

Food allergies are known as the public health problem, affecting people of all age groups, but more commonly in babies and children, with consequences for nutritional status and quality of life. The increase in the consumption of healthy foods has consequently led to an increased demand for functional foods with specific health benefits. Thus, the pharmaceutical industry's interest in natural products has grown every time and is therefore considered as an alternative to synthetic drugs. Kefir has been outstanding for several years as promising in the manufacture of various pharmaceutical products, due to its nutritional and therapeutic properties for the treatment of many diseases. Currently, a wide variety of new functional foods are appearing on the market, representing an important segment. Postbiotics, for example, has stood out for being a product with action similar to probiotics, without offering side effects. The kefiran is the postbiotic from kefir that promotes potential beneficial effects on food allergy from the intestinal microbiome to the immune system. In this context, it is necessary to know the main promoting component of this functional effect. This review compiles the benefits that kefir, and especially its postbiotic, kefiran, can bring to food allergy. In addition, it serve as a subsidy for studies on the development of innovative nutraceutical products, including the use of kefiran as an alternative therapy in food allergy.

Network pharmacology-based study of the protective mechanism of conciliatory anti-allergic decoction on asthma

BACKGROUND

This study aimed to explore the underlying anti-asthma pharmacological mechanisms of conciliatory anti-allergic decoction (CAD) with a network pharmacology approach.

METHODS

Traditional Chinese medicine related databases were utilized to screen the active ingredients of CAD. Targets of CAD for asthma treatment were also identified based on related databases. The protein-protein interaction network, biological function and KEGG pathway enrichment analysis, and molecular docking of the targets were performed. Furthermore, an asthma mouse model experiment involving HE staining, AB-PAS staining, and ELISA was also performed to assess the anti-asthma effect of CAD.

RESULTS

There were 77 active ingredients in CAD, including quercetin, kaempferol, stigmasterol, luteolin, cryptotanshinone, beta-sitosterol, acacetin, naringenin, baicalin, and 48 related targets for asthma treatment, mainly including TNF, IL4, IL5, IL10, IL13 and IFN-γ, were identified with ideal molecular docking binding scores by network pharmacology analysis. KEGG pathway analysis revealed that these targets were directly involved in the asthma pathway, Th1 and Th2 cell differentiation, and signaling pathways correlated with asthma (NF-κB, IL17, T cell receptor, TNF, JAK-STAT signaling pathways, etc.). Animal experiments also confirmed that CAD could attenuate inflammatory cell invasion, goblet cell hyperplasia and mucus secretion. The levels of the major targets TNF-α, IL4, IL5, and IL13 can also be regulated by CAD in an asthma mouse model.

CONCLUSION

The anti-asthma mechanism of CAD possibly stemmed from the active ingredients targeting asthma-related targets, which are involved in the asthma pathway and signaling pathways to exhibit therapeutic effects.

Ma Xing Shi Gan Decoction Protects against PM2.5-Induced Lung Injury through Suppression of Epithelial-to-Mesenchymal Transition (EMT) and Epithelial Barrier Disruption

This research was designed to explore the effect of Ma Xing Shi Gan decoction (MXD) in alleviating particulate matter less than 2.5 μm in diameter (PM2.5) induced lung injury from the perspective of epithelial barrier protection and inhibition of epithelial-to-mesenchymal transition (EMT). Rats were exposed to PM2.5 to establish a lung injury model in vivo, and a PM2.5-stimulated primary cultured type II alveolar epithelial cell model was introduced in vitro. Our results indicated that MXD alleviated the weight loss and pathologic changes and improved the epithelial barrier dysfunction. MXD also significantly inhibited the TGF-β/Smad3 pathway, increased the level of ZO-1 and claudin-5, and reversed the EMT process. Notably, the protection of MXD was abolished by TGF-β in vitro. Our results indicated that MXD has a protection against PM2.5-induced lung injury. The proposed mechanism is reversing PM2.5-induced EMT through inhibiting TGF-β/Smad3 pathway and then upregulating the expression of tight-junction proteins.

Berberine Inhibits Pro-inflammatory Cytokine-induced IL-6 and CCL11 Production via Modulation of STAT6 Pathway in Human Bronchial Epithelial Cells

Berberine is an isoquinoline alkaloid isolated from various Chinese herbs that has potential of anti-inflammatory, anti-lipidemic, anti-neoplastic, and anti-diabetic activity. In this study, we evaluated the anti-inflammatory efficacy of berberine on allergic airway inflammation by targeting epithelial cells. Allergic airway inflammation driven by T helper 2 (Th2)-type immunity is characterized by airway hyperresponsiveness, elevated IgE production, and eosinophilic infiltration. For eosinophil recruitment, major chemoattractant CCL11 (eotaxin-1) was secreted by lung epithelial cells. BEAS-2B cells, a human bronchial epithelial cell line, were pre-treated with berberine and then activated by IL-4 plus TNF-α. The viability of BEAS-2B cells was assessed. Expression levels of IL-6 and CCL11 were determined using ELISA and real-time PCR. The signaling pathways of MAP kinases, NF-κB, and STAT6 were analyzed by western blot. Berberine treatment (≤1 μM) didn't significantly affect the viability of BEAS-2B cells with or without IL-4 plus TNF-stimulation. Berberine significantly inhibited the secretion of IL-6 and CCL11 from pro-inflammatory cytokine-activated BEAS-2B cells. NF-κB and MAP kinase pathways were seemingly unaffected in BEAS-2B cells with berberine treatment. Significant reduction of nuclear STAT6 protein expression in activated BEAS-2B cells with berberine treatment was observed. Current study reveals that berberine has inhibitory effect in pro-inflammatory cytokine-activated BEAS-2B cells through reducing IL-6 and CCL11 production, which is possibly modulated by suppressing STAT6 signaling pathway.

Site-Specific Immobilization of β2-AR Using O6-Benzylguanine Derivative-Functionalized Supporter for High-Throughput Receptor-Targeting Lead Discovery

The past decade has witnessed the great promise of strategies for ligand discovery based on surface-immobilized GPCRs. We present here a method for preparation of immobilized GPCRs. Key features include covalent immobilization with high specificity and robust application in drug-receptor interaction analysis and ligand screening. In our example assay using beta2-adrenergic receptor (β2-AR), the human DNA repair protein O6-alkylguanine-DNA alkyltransferase (hAGT) fusion receptor expressed in Escherichia coli was directly captured onto polyethylene glycol polyacrylamide (PEGA) resin. We observed even distribution and physiological functions of β2-AR on the resin. The immobilized β2-AR as a stationary phase enabled us to rapidly determine the binding of four drugs to β2-AR. By coupling this assay to mass spectrometry, we screened rosmarinic acid as a bioactive compound targeting β2-AR in Fructus Perillae. We concluded that O6-benzylguanine derivative-functionalized supporter is promising for specific immobilization of hAGT-tagged proteins; immobilized receptor chromatography has great potential in screening receptor-binding leads from herbal plants or traditional medicine recipes.

Schisandra Chinensis Lignans Suppresses the Production of Inflammatory Mediators Regulated by NF-κB, AP-1, and IRF3 in Lipopolysaccharide-Stimulated RAW264.7 Cells

Schisandra Fructus (SF) is a traditional Chinese herb used in the treatment of inflammatory disorders like hepatitis. One of the main anti-inflammatory components of SF is the lignans. However, the underlying anti-inflammatory mechanism of Schisandra Chinensis lignans (SCL) remains unclear. This study aims to investigate the effects of SCL on inflammatory mediators in lipopolysaccharide-stimulated RAW264.7 cells and explore the underlying mechanism. The production of nitric oxide (NO) was determined by Griess reaction. ELISA was used to determine cytokine levels and chemokines secretion. To estimate protein levels and enzyme activities, we employed Western blotting. Nuclear localization of NF-κB, AP-1, and IRF3 was detected using immunofluorescence analyses. The results showed that SCL significantly reduced the release of inflammatory mediators, including NO and PGE2, which may be related to down-regulation of iNOS and COX-2 expression. The production of cytokines and chemokines was suppressed by SCL treatment. SCL also decreased the phosphorylation of IKKα/β, IκB-α, Akt, TBK1, ERK, p38, JNK, NF-κB (p65), AP-1 (c-Jun), and IRF3 in RAW264.7 macrophages activated with LPS. The nuclear protein levels and nuclear translocation of AP-1, NF-κB and IRF3 were suppressed by SCL. These results indicated that SCL suppressed the IKKα/β/NF-κB, MAPKs/AP-1 and TBK1/IRF3 signaling pathways in LPS-stimulated RAW264.7 macrophages.

Lignans Isolated From Flower Buds of Magnolia fargesii Attenuate Airway Inflammation Induced by Cigarette Smoke in vitro and in vivo

The flower buds of Magnolia fargesii, known traditionally as Xinyi, exert anti-inflammatory effects against inflammatory lung diseases such as COPD. Lignans isolated from Xinyi are an important group of plant-derived anti-inflammatory compounds. However, the mechanisms of action underlying their protective effects against COPD are not yet fully understood. Here, we showed that seven lignans (lignans 1–7) obtained from a CHCl₃ fraction of Xinyi effectively suppress the inflammatory response in CSC-stimulated airway epithelial cells (in vitro) and in a mouse model of COPD established by exposure to CS and LPS. The CHCl₃ fraction was found to inhibit CSC-induced IL-6 expression in human airway epithelial cells and to suppress the infiltration of inflammatory cells (neutrophils and macrophages) and secretion of inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the mouse model. Similarly, each of the seven lignans isolated from the CHCl₃ fraction also suppressed the infiltration of inflammatory cells (neutrophils and macrophages) and secretion of inflammatory mediators such as reactive oxygen species (ROS), TNF-α, and IL-6 in vivo. Notably, all lignan compounds significantly suppressed both extracellular signal-related kinase (ERK) and Akt phosphorylation levels in CSC-stimulated human lung mucoepidermoid carcinoma (NCI-H292) cells. Of these, lignan 1 (dimethylpinoresinol) inhibited the expression of CSC-induced inflammatory cytokines (IL-1β, -6, and -8) in vitro in a dose-dependent manner by suppressing the activation of epidermal growth factor receptor (EGFR) and its downstream effectors, including ERK and Akt, in NCI-H292 cells. Our results show that the lignans isolated from Xinyi may prevent airway inflammatory diseases through the suppression of EGFR and its downstream effectors.

Pediatric Integrative Medicine

The practice of pediatrics from an integrative framework is based on physician-patient relationship, informed by evidence, and approaches the health of children and their families from a broad perspective. This article reviews the basic principles of integrative pediatrics and summarizes data and integrative approaches to common pediatric conditions seen in the primary care setting.

Complementary and Alternative Treatment for Allergic Conditions

This article explains the proposed pathophysiology, evidence of efficacy, and adverse effects of several complementary and alternative medicine modalities, for the treatment of allergic conditions, such as traditional Chinese medicine formula, herbal treatments, acupuncture, and homeopathy.

Network pharmacology-based identification of key pharmacological pathways of Yin-Huang-Qing-Fei capsule acting on chronic bronchitis

For decades in China, the Yin-Huang-Qing-Fei capsule (YHQFC) has been widely used in the treatment of chronic bronchitis, with good curative effects. Owing to the complexity of traditional Chinese herbal formulas, the pharmacological mechanism of YHQFC remains unclear. To address this problem, a network pharmacology-based strategy was proposed in this study. At first, the putative target profile of YHQFC was predicted using MedChem Studio, based on structural and functional similarities of all available YHQFC components to the known drugs obtained from the DrugBank database. Then, an interaction network was constructed using links between putative YHQFC targets and known therapeutic targets of chronic bronchitis. Following the calculation of four topological features (degree, betweenness, closeness, and coreness) of each node in the network, 475 major putative targets of YHQFC and their topological importance were identified. In addition, a pathway enrichment analysis based on the Kyoto Encyclopedia of Genes and Genomes pathway database indicated that the major putative targets of YHQFC are significantly associated with various pathways involved in anti-inflammation processes, immune responses, and pathological changes caused by asthma. More interestingly, eight major putative targets of YHQFC (interleukin [IL]-3, IL-4, IL-5, IL-10, IL-13, FCER1G, CCL11, and EPX) were demonstrated to be associated with the inflammatory process that occurs during the progression of asthma. Finally, a molecular docking simulation was performed and the results exhibited that 17 pairs of chemical components and candidate YHQFC targets involved in asthma pathway had strong binding efficiencies. In conclusion, this network pharmacology-based investigation revealed that YHQFC may attenuate the inflammatory reaction of chronic bronchitis by regulating its candidate targets, which may be implicated in the major pathological processes of the asthma pathway.

Acupoint Application for Asthma Therapy in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

To evaluate the evidence available on the effects of acupuncture point (acupoint) application for asthma therapy in adults.

METHODS

Six electronic databases were searched up to May 2014 to identify relevant studies. Randomized controlled trials, which assessed the effects of acupoint application for asthma treatment in adults, were included in our review. The methodological quality of eligible studies was assessed by the Cochrane Collaboration's tool. The standardized mean difference (SMD) and 95% confidence intervals (CI) of a random-effects model were calculated. The heterogeneity was assessed using I2 statistics.

RESULTS

Eight studies were included in our review. The aggregated results indicated that acupoint application improved forced expiratory volume in 1 second (FEV1) (SMD, 0.32; 95% CI 0.04-0.60; p = 0.03), FEV1/forced vital capacity (SMD, 0.89; 95% CI 0.70-1.09; p < 0.00001), interleukin (SMD, -0.26; 95% CI -0.50 to -0.01; p = 0.04) and immunoglobulin E (SMD, -0.49; 95% CI -0.83 to -0.16; p = 0.004) in patients with asthma, but not eosinophilic cation protein (SMD, -0.58; 95% CI -1.42 to 0.26; p = 0.18). There was no sufficient evidence for the follow-up effects of acupoint application for asthma therapy in adults.

CONCLUSIONS

Acupoint application may be a valid complementary and alternative therapy for asthma in adults. It contributes especially to improving pulmonary function and reducing the levels of interleukin and immunoglobulin E. However, more studies with longer follow-ups are warranted to confirm the current findings.

Complementary and alternative medicine in pulmonology

PURPOSE OF REVIEW

To provide a comprehensive review of complementary and alternative medicine (CAM) therapies for the treatment of pulmonary disorders in children.

RECENT FINDINGS

The use of complementary medicine (CAM) is commonly used by both children and adults with breathing problems, and especially in chronic pulmonary disorders such as asthma and cystic fibrosis. Many clinics and hospitals now offer CAM, even though most of the conventionally trained health practitioners have little knowledge or education regarding CAM therapies. Research in CAM that demonstrates overall benefit is lacking, especially in children. Often parents do not report CAM use to their child's healthcare provider and this could compromise their overall quality of care. Although many research studies evaluating CAM therapies have methodological flaws, data exist to support CAM therapies in treating children with pulmonary disorders.

SUMMARY

This review examines the latest evidence of CAM use and effectiveness in children with pulmonary disorders. Physicians should be aware of the many CAM therapy options and the research surrounding them in order to provide their patients with the most current and accurate information available.

Maternal Antiasthma Simplified Herbal Medicine Intervention therapy prevents airway inflammation and modulates pulmonary innate immune responses in young offspring mice

BACKGROUND

Maternal asthma is a risk factor for asthma in offspring; however, transmission of the risk for allergic asthma without direct offspring sensitization has not been explored.

OBJECTIVE

To determine whether offspring from mothers with ovalbumin (OVA)-sensitized asthma would develop airway disease at first-ever exposure to OVA and whether preconception maternal treatment with the Antiasthma Simplified Herbal Medicine Intervention (ASHMI) or dexamethasone (DEX) could modify this risk in offspring.

METHODS

Female BALB/c mice (F0) with OVA-induced asthma were generated using established protocols. Mice with asthma were treated with ASHMI, DEX, or water for 6 to 7 weeks. Naive mice served as controls. Subsequently, mice were mated. Twelve-day-old F1 offspring received 3 consecutive intranasal low- or high-dose OVA exposures without sensitization. Forty-eight hours later, airway inflammation, mucus hypersecretion, serum antibodies, and cytokines were evaluated.

RESULTS

Offspring from OVA-sensitized mothers, but not naive mothers, showed eosinophilic and neutrophilic airway inflammation, and mucus hyperplasia after OVA exposure and he presence of OVA-specific IgG1 and IgG2a. Offspring of ASHMI- and DEX-treated mothers showed decreased airway inflammation and mucus hypersecretion after low-dose OVA (P < .05-.001 for the 2 comparisons vs offspring of OVA/Sham mothers). Offspring of ASHMI-treated, but not DEX-treated, mothers were protected after the high-dose OVA challenge (P < .05-.01 vs offspring OVA/Sham). Maternal ASHMI therapy was associated with increased IgG2a (P < .01 vs offspring of OVA/Sham mothers) and decreased bronchoalveolar lavage fluid CXCL-1 and eotaxin-1 levels (P < .01 and P < .05, respectively, vs offspring of OVA/Sham mothers).

CONCLUSION

Offspring of mothers with OVA-induced asthma developed airway inflammation and mucus to first-ever OVA exposure without prior sensitization. Maternal therapy with ASHMI was superior to DEX in decreasing offspring susceptibility to airway disease and could be a strategy to lower asthma prevalence.

Phytochemical profiles and biological activity evaluation of Zanthoxylum bungeanum Maxim seed against asthma in murine models

ETHNOPHARMACOLOGICAL RELEVANCE

Zanthoxylum bungeanum Maxim seed (ZBMS) has been used in Traditional Chinese Medicine (TCM) as an ingredient of polyherbal formulations for the treatment of inflammation and asthma. The aim of this study was to analyze the major composition and to evaluate the anti-asthma activity of ZBMS.

MATERIALS AND METHODS

Some murine models including acetylcholine/histamine-induced asthma, ovalbumin-induced airway inflammation, ear edema and toe swelling measurement, citric acid-induced cough, and anti-stress abilities were investigated to fully study the anti-asthma activity of ZBMS.GC chromatography was also performed to analyze the major fatty acid composition of ZBMS.

RESULTS

The results demonstrated that the major fatty acid composition of ZBMS includes oleic acid (20.15%), linoleic acid (26.54%), and α-linolenic acid (30.57%), which was the leading component of ZBMS, and that the total fatty acid content of ZBMS was 77.27%. The murine models demonstrated that ZBMS displays a protective effect on guinea pig sensitization, a dose-dependent inhibition of the increases in RL and decreases in Cdyn, which resulted in the relief of auricle edema and toe swelling in mice and anti-stress activity.

CONCLUSION

Our results validate the traditional use of ZBMS for the treatment of asthma and other inflammatory joint disorders, and suggest that ZBMS has potential as a new therapeutic agent for asthma management.

Use of complementary and alternative medicine for children: a parents' perspective

OBJECTIVES

The present study aims to detect the frequency and types of complementary and alternative medicine (CAM) therapies used for children and to explore parental motivating factors for using CAM for their children in Riyadh, Saudi Arabia.

PARTICIPANTS AND METHODS

This is a cross-sectional study that involved 462 families selected through a multistage cluster-sampling technique covering Riyadh region, Saudi Arabia. The sample was selected from 40 clusters, distributed proportionally according to the size of the population in the catchment area of primary health care centres (PHCCs). A structured questionnaire that contains items fulfilling the research objectives was used to collect data by research assistants.

RESULTS

The study included 926 parents, comprising 351 fathers and 575 mothers; 37.3% of them reported the use of CAM for their children including reciting the Quran, honey and Ferula asafoetida (26.1%, 21.5% and 18.8%, respectively). CAM was used six times higher for children of parents using CAM for themselves than children of parents who did not use CAM themselves (odds ratio (OR)=6.03, 3.9-9.37). Multivariate logistic regression showed that parental use of CAM (OR=3.0, 2.2-4.0), keeping CAM remedies at home (OR=2.3, 1.8-3.1), perceived success of CAM in practice (OR=1.8, 1.3-2.4) and preference of use of natural materials (OR=1.7, 1.2-2.5) were independent predictors of use of CAM for children.

CONCLUSIONS

In this study, around one-third of the parents used CAM for their children. Quran (Muslims' holy book) was the most common CAM type used for children. Parents' use of CAM for themselves is the most important predictor of its use for children. An in-depth study to investigate CAM use for specific diseases in children is recommended.

Xiaoqinglong granules as add-on therapy for asthma: latent class analysis of symptom predictors of response

Xiaoqinglong granules (XQLG) has been shown to be an effective therapy in asthma animal models. We reviewed the literature and conducted this study to assess the impact of XQLG as an add-on therapy to treatment with fluticasone/salmeterol (seretide) in adult patients with mild-to-moderate, persistent asthma. A total of 178 patients were randomly assigned to receive XQLG and seretide or seretide plus placebo for 90 days. Asthma control was assessed by asthma control test (ACT), symptoms scores, FEV(1), and PEF. Baseline patient-reported Chinese medicine (CM)-specific symptoms were analyzed to determine whether the symptoms may be possible indicators of treatment response by conducting latent class analysis (LCA). There was no statistically significant difference in ACT score between two groups. In the subset of 70 patients with symptoms defined by CM criteria, XQLG add-on therapy was found to significantly increase the levels of asthma control according to global initiative for asthma (GINA) guidelines (P = 0.0329). There was no significant difference in another subset of 100 patients with relatively low levels of the above-mentioned symptoms (P = 0.1291). Results of LCA suggest that patients with the six typical symptoms defined in CM may benefit from XQLG.

Sphingosine kinase-1-dependent and -independent inhibitory effects of zanthoxyli fructus to attenuate the activation of mucosal mast cells and ameliorate food allergies in mice

Food allergy (FA) is relatively a common disease in infants, but effective drug therapies are not yet available. Notably, mucosal mast cells, but not connective-tissue mast cells, play important roles in food allergic reactions via the release of inflammatory mediators. Therefore, we screened medicinal herb extracts for in vitro and in vivo antiallergic activity through inhibiting mucosal mast cell activation. As a result, both antigen-induced and calcium ionophore-induced degranulation was significantly inhibited by Zanthoxyli Fructus water extract (ZF) in mucosal-type murine bone marrow-derived mast cells (mBMMCs). ZF suppressed the antigen-induced [Ca²⁺]_i elevation and the antigen-enhanced mRNA expression of TNF-α, IL-4, and IL-13. The transcriptome and real-time PCR analyses revealed that ZF greatly decreased the antigen-enhanced expression level of sphingosine kinase 1 (Sphk1), which plays a key role in the FcεRI-mediated immune responses in mast cells. Furthermore, ZF inhibited allergic symptoms in an ovalbumin-caused murine FA model and decreased the number of infiltrating mucosal mast cells and the enhanced mRNA expression levels of IL-4 and Sphk1 in the FA mice colons. These results indicate that ZF suppresses mucosal mast cell activities mainly through Sphk1-dependent mechanism, and ZF is utilized for the development of a novel, potent anti-FA agent.

Effects of add-on therapy with NDC-052, an extract from Magnoliae Flos, in adult asthmatic patients receiving inhaled corticosteroids

BACKGROUND/AIMS

There is a need for new anti-asthmatic medications with fewer side effects. NDC-052, an extract of the medicinal herb Magnoliae flos, which has a long history of clinical use, was recently found to have anti-inflammatory effects. Herein, we evaluated the effects of NDC-052 as an add-on therapy in patients with mild to moderate asthma using inhaled corticosteroids (ICS).

METHODS

In a non-comparative, multi-center trial, 148 patients taking ICS received NDC-052 for eight weeks. We evaluated their forced expiratory volume in one second (FEV1), morning and evening peak expiratory flow rate (AM and PM PEFR), AM/PM asthma symptom scores, visual analogue symptom (VAS) scores, night-time wakening, frequency of short-acting β2-agonist usage, and adverse events.

RESULTS

After eight weeks, both AM and PM PEFRs were significantly improved. Asthma symptom scores, VAS scores, the frequency of nights without awakening, and the frequency of β2-agonist use were also reduced. Most of the adverse drug reactions were mild and resolved spontaneously.

CONCLUSIONS

The addition of NDC-052 to ICS had a beneficial effect on asthma control in patients with mild to moderate asthma, with good tolerability and fewer side effects. Further studies are necessary to evaluate the effects of NDC-052 in patients with severe and/or refractory asthma.

Food allergy

Food allergy appears to be increasing in prevalence and is estimated to affect >2% and possibly up to 10% of the population. Food allergies are defined by an immune response triggered by food proteins. Emerging data suggest that carbohydrate moieties on food proteins, specifically mammalian meats, may also elicit allergic responses. Food is the most common trigger of anaphylaxis in the community, which can be fatal. The underlying mechanisms of food allergy usually involve food-specific immunoglobulin E antibodies, but cell-mediated disorders account for a variety of chronic or subacute skin and gastrointestinal reactions. Eosinophilic esophagitis is an emerging food-related chronic disorder. The diagnosis of food allergy is complicated by the observation that detection of food-specific immunoglobulin E (sensitization) does not necessarily indicate clinical allergy. Diagnosis requires a careful medical history, laboratory studies, and, in many cases, oral food challenges to confirm a diagnosis. Novel diagnostic methods, many of which rely upon evaluating immune responses to specific food proteins or epitopes, may improve diagnosis and prognosis in the future. Current management relies upon allergen avoidance and preparation to promptly treat severe reactions with epinephrine. Studies suggest that some children with milk or egg allergy might tolerate extensively heated forms, for example milk or egg baked into muffins, without symptoms and possibly with some immunotherapeutic benefits. Novel therapeutic strategies are under study, including oral and sublingual immunotherapy, Chinese herbal medicine, anti-immunoglobulin E antibodies, and modified vaccines.

Dietary supplementation with omega-3-PUFA-rich fish oil reduces signs of food allergy in ovalbumin-sensitized mice

We investigated the effect of dietary supplementation with n-3 PUFA (fish oil source) in an experimental model of food allergy. Mice were sensitized (allergic group) or not (nonallergic group) with OVA and were fed with OVA diet to induce allergy signals. Mice were fed with regular diet in which 7% of lipid content was provided by soybean (5% of n-3 PUFA) or fish (25% of n-3 PUFA) oil. Allergic group mice had increased serum levels of antiovalbumin IgE and IgG1 and changes in small intestine, characterized by an increased edema, number of rolling leukocytes in microcirculation, eosinophil infiltration, mucus production, and Paneth cell degranulation, in comparison to non-allergic group. All these inflammatory parameters were reduced in mice fed high-n-3-PUFA diet. Our data together suggest that diet supplementation with n-3 PUFA from fish oil may consist of a valid adjuvant in food allergy treatment.

Immunologic similarities between selected autoimmune diseases and peanut allergy: possible new therapeutic approaches

Food allergies are an important medical problem in Westernized countries. Allergy to peanuts is a dramatic example of a food allergy that tends to be particularly severe and long-lived. This article examines food allergy-specifically peanut allergy-from the perspective that tolerance to foods is a normal state, just as tolerance to self-proteins is a normal state. From this vantage point, loss of tolerance to foods in food-allergic individuals can be viewed as parallel to the loss of tolerance to self-proteins in those with autoimmune diseases. Although our knowledge base is far from satisfactory, there are important similarities in the immunologic abnormalities that are characteristic of both peanut allergy and several autoimmune diseases. Delineation of these similarities may open the door to new therapeutic approaches for the treatment of severe food allergies.

Immunotherapy in food allergy

Food allergies are caused by immune responses to food proteins and represent a breakdown of oral tolerance. They can range from mild pruritus to life-threatening anaphylaxis. The only current consensus for treatment is food avoidance, which is fraught with compliance issues. For this reason, there has been recent interest in immunotherapy, which may induce desensitization and possibly even tolerance. Through these effects, immunotherapy may decrease the potential for adverse serious reactions with accidental ingestions while potentially leading to an overall health benefit. In this review, we discuss the mechanisms of food allergy and give an overview of the various immunotherapeutic options and current supporting evidence, as well as look towards the future of potential novel therapeutic modalities.

Asthma management in the developing world: achievements and challenges

Asthma is a serious global health problem that affects people of all ages. The best strategy to reduce the mortality and morbidty of asthma is evidence-based management based on guidelines. National and international guidelines are available worldwide but they are not being implemented. The main barriers to implementation include difficulties in implementing a structured-care approach, advocated by guidelines in different healthcare systems, and patient noncompliance. Additional barriers in developing countries include poverty, inadequate resources and poor infrastructure. Many of these barriers are potentially correctable or ameliorable, and the goal of guideline implementation is to translate evidence-based asthma-management recommendations into real-life practice to improve patient health and reduce healthcare cost. This article reviews the challenges and current status of asthma management and highlights the new global initiatives for bringing optimal asthma care to asthma sufferers in resource-poor countries.

Bambusae Caulis in Taeniam extract reduces ovalbumin-induced airway inflammation and T helper 2 responses in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Bambusae Caulis in Taeniam (BC) was known as traditional herbal medicine with anti-inflammatory property in the Orient.

AIM OF THE STUDY

Allergic asthma is inflammatory disease of airways associated with enhanced T helper (Th) 2 lymphocytes responses to allergens, leading to eosinophilic infiltration and elevated serum IgE levels. Although there were some studies that BC extract had an anti-inflammatory property, there was no study on asthma. In present study, we investigated the suitability of BC extract as a therapeutic candidate in the treatment of allergic airway disease in ovalbumin-induced asthma model.

MATERIALS AND METHODS

Balb/C mice (female, 6 weeks old) were treated by ovalbumin sensitization and nebulization, and used as asthma model. The number of eosinophil in bronchoalveolar lavage (BAL) fluid and the degree of eosinophila were investigated by hematoxylin and eosin stain and the infiltration of inflammatory cells into lung tissues was examined by staining by hematoxylin and eosin solution. The levels of interleukin (IL)-4 in BAL fluid, immunoglobulin E (IgE) in serum, interferon (IFN)-gamma and IL-4 production in splenocyte culture from Balb/C mice (not treated, 6 weeks old) that incubated with or without BC extract for 48 h were determined by enzyme-linked immunosorbent assay.

RESULTS

The level of eosinophils was decreased by treatment of the animals with BC extract (40 mg/kg) and correspondingly, a significantly lowered degree of eosinophila was also reported (p<0.01). In lung tissue, BC extract reduced the increased immune cell infiltration induced by OVA (p<0.05). Furthermore, the levels of IL-4 and IgE in BAL fluid or serum up-regulated by OVA was decreased by BC extract. Finally, IFN-gamma production was significantly increased (p<0.01), while IL-4 production significantly decreased (p<0.01), after treatment of the culture supernatants of splenocytes with BC extract.

CONCLUSIONS

These results indicated that BC extract reduces OVA-induced airway inflammation and Th 2 response in mice, suggesting that BC extract can be a therapeutic candidate for allergic airway disease, including asthma.

Asthma research performance in Asia-Pacific: a bibliometric analysis by searching PubMed database

BACKGROUND AND OBJECTIVE

Countries in the Asia-Pacific region have experienced an increase in the prevalence of asthma, and they have been actively involved in asthma research recently. This study aimed to analyze asthma research from Asia-Pacific in the last decade by bibliometric method.

METHOD

Asthma articles from Asia-Pacific countries published between 1998 and 2007 were retrieved from PubMed by searching MeSH for "asthma."

RESULTS

Most of published asthma articles in Asia-Pacific are from affluent countries in northeast Asia and Oceania. Australia and Japan have been the regional powerhouses since they contributed more than half of regional articles on asthma. Asthma publications from emerging economies in Asia such as South Korea, Taiwan, Hong Kong, and Singapore, have dramatically increased in the last decade in terms of quantity and quality aspects and were considerable sources of basic and translational research in the region. Mainland China and India have significantly increased their research capacity as well, but quality needs to be improved. Asthma publications from New Zealand and Australia, countries with the highest asthma prevalence rates in the world, yielded highest citation counts per articles and were published in journals with high impact factor. Asthma research parameters per million population correlate well with gross domestic product per capita. Almost half (41%) of total articles were produced from only 25 institutions in the region and almost half of them (47%) were published in 20 journals.

CONCLUSIONS

Asthma research in Asia-Pacific were mainly conducted in countries in Oceania and Northeast Asia and research performance strongly correlated with the nation's wealth. Interesting asthma research projects in the region were recommended.

Food allergy

Adverse immune responses to foods affect approximately 5% of young children and 3% to 4% of adults in westernized countries and appear to have increased in prevalence. Food-induced allergic reactions are responsible for a variety of symptoms and disorders involving the skin and gastrointestinal and respiratory tracts and can be attributed to IgE-mediated and non-IgE-mediated (cellular) mechanisms. Genetic disposition and environmental factors might abrogate oral tolerance, leading to food allergy. Disease outcomes are influenced by the characteristics of the immune response and of the triggering allergen. Diagnosis is complicated by the observation that detection of food-specific IgE (sensitization) does not necessarily indicate clinical allergy. Therefore diagnosis requires a careful medical history, laboratory studies, and, in many cases, an oral food challenge to confirm a diagnosis. Novel diagnostic methods, including ones that focus on immune responses to specific food proteins or epitopes of specific proteins, are under study. Currently, management of food allergies consists of educating the patient to avoid ingesting the responsible allergen and to initiate therapy (eg, with injected epinephrine for anaphylaxis) in case of an unintended ingestion. Improved therapeutic strategies under study include oral and sublingual immunotherapy, Chinese herbal medicine, anti-IgE antibodies, and modified vaccines.

Pediatric asthma: an integrative approach to care

Asthma in children and young adults is a complex disease with many different phenotypic expressions. Diagnosis is often made based on history and lung function including measuring airway reversibility. However, in children younger than 6 years of age, the diagnosis is more difficult because many children wheeze in the first 4-6 years of life, especially with viral infections. For those children, asthma treatment is often started empirically. Those who go on to develop chronic asthma most likely have a genetic predisposition and exposure to various environmental factors resulting in chronic inflammation of the lower respiratory tract. There are established national guidelines for diagnosing and treating asthma in children and adults. For persistent asthma, it is recommended that medications be taken on a regular basis after identifying and avoiding environmental triggers. Because many factors play a role in developing asthma in children, many nonmedical approaches to asthma and asthma-like conditions have been promoted even when the diagnosis is at times uncertain. The nonmedical approaches and therapies are often referred to as complementary and alternative medicine (CAM). This review will discuss the conventional therapies recommended for children with asthma in addition to CAM therapies, some of which have supporting scientific evidence. Integrating conventional and CAM therapies can prove to be an effective way to treat pediatric asthma, a common and chronic childhood lung disorder. A case is provided to illustrate how such an integrative approach was used in the successful treatment of a child with moderate persistent asthma.

Safety and tolerability of an antiasthma herbal Formula (ASHMI) in adult subjects with asthma: a randomized, double-blinded, placebo-controlled, dose-escalation phase I study

BACKGROUND

Complementary and alternative medicines are increasingly used for the treatment of asthma in Western countries. A novel three-herb antiasthma herbal medicine intervention (ASHMI; Sino-Lion Pharmaceutical Company; Shan Dong China) was demonstrated to be effective and safe in a murine model of asthma and in a preliminary clinical study in China.

OBJECTIVE

The objective of this study was to evaluate the safety and tolerability of ASHMI in adult subjects with allergic asthma.

DESIGN

Randomized, double-blind, placebo-controlled, dose escalation, phase I trial aimed at developing a botanical drug under the United States Food and Drug Administration Investigational New Drug title.

INTERVENTIONS

Subjects received one of three doses of ASHMI or placebo: 600 mg (2 capsules); 1200 mg (4 capsules); or 1800 mg (6 capsules) twice daily for 1 week. Four (4) ASHMI and 2 placebo subjects were treated at each dose level. Subjects continued to use their conventional asthma medications for the duration of the study.

OUTCOME MEASURES

Vital signs, physical examination, laboratory data, and electrocardiogram data were monitored throughout the study to assess occurrence of adverse events (AEs). Immunomodulatory studies were performed to evaluate the effect of ASHMI on cytokine, chemokine, and growth factor levels.

RESULTS

Twenty (20) nonsmoking, allergic subjects with asthma were included in the study. Eight (8) subjects (4 ASHMI and 4 placebo) reported mild gastrointestinal symptoms. No grade 3 AEs were observed during the study period. Vital signs, electrocardiogram findings, and laboratory results obtained at pre- and post-treatment visits remained within normal range. No abnormal immunologic alterations were detected.

CONCLUSION

In this phase I study, ASHMI appeared to be safe and well tolerated by subjects with asthma. These findings allowed initiation of a larger phase II study to assess the efficacy of ASHMI.

Food allergy: recent advances in pathophysiology and treatment

Food allergies, defined as an adverse immune response to food proteins, affect as many as 6% of young children and 3%-4% of adults in westernized countries, and their prevalence appears to be rising. In addition to well-recognized acute allergic reactions and anaphylaxis triggered by IgE antibody-mediated immune responses to food proteins, there is an increasing recognition of cell-mediated disorders such as eosinophilic gastroenteropathies and food protein-induced enterocolitis syndrome. We are gaining an increasing understanding of the pathophysiology of food allergic disorders and are beginning to comprehend how these result from a failure to establish or maintain normal oral tolerance. Many food allergens have been characterized at a molecular level, and this knowledge, combined with an increasing appreciation of the nature of humoral and cellular immune responses resulting in allergy or tolerance, is leading to novel therapeutic approaches. Currently, management of food allergies consists of educating the patient to avoid ingesting the responsible allergen and initiating therapy if ingestion occurs. However, numerous strategies for definitive treatment are being studied, including sublingual/oral immunotherapy, injection of anti-IgE antibodies, cytokine/anticytokine therapies, Chinese herbal therapies, and novel immunotherapies utilizing engineered proteins and strategic immunomodulators.

Complementary and alternative medicine in pediatric allergic disorders

PURPOSE OF REVIEW

Allergic disorders represent a serious public health problem in children. The chronic nature of these diseases and the fear of known side effects of synthetic drugs influence many families to seek complementary and alternative medicine. This review focuses on traditional Chinese medicine (TCM) herbal products and acupuncture for treating pediatric allergies.

RECENT FINDINGS

Given the general safety profile and reputed efficacy, TCM are well received by the general population. However, compared with the long human history and popularity of the use of TCM, research into its efficacy and safety is still in its infancy. In the last 2-3 years, there have been more controlled studies of TCM for allergic asthma and allergic rhinitis. Several publications including ours indicate that some TCM herbal formulas are well tolerated and produce some level of efficacy. Some herbal formulas also showed beneficial immunomodualtory effects. Several preclinical studies demonstrated that the food allergy herbal formula-2 was effective in protecting against peanut anaphylaxis in animal models. Two TCM products have entered clinical trials in the United States for treating asthma and food allergy, respectively. Both of these trials include children.

SUMMARY

Recent studies indicate that TCM therapy including herbal medicines and acupuncture for allergic disorders in children is well tolerated. There are also promising clinical and objective improvements. More controlled clinical studies are encouraged.

Modulation of antigen-induced anaphylaxis in mice by a traditional chinese medicine formula, Guo Min Kang

A traditional Chinese Medicine (TCM) formula, Guo Min Kang (GMK), has been used in clinics in China for allergic diseases, including type I immediate hypersensitivity, a potentially fatal disease, but its modulatory mechanism remains elusive. The aim of this study was to investigate the modulatory mechanisms of GMK in a mouse model of Ag-induced anaphylaxis. Ag (conalbumin) sensitized mice were treated with either PBS (sham) or GMK before (schedule A) or during (schedule B) sensitization, and various anaphylactic parameters were measured following Ag challenge, including symptom score, cutaneous hypersensitivity response, mast cell degranulation, plasma histamine levels and the levels of specific IgE and T-cell responses. Systemic anaphylaxis was investigated in mice immediately following Ag challenge, and the results showed that GMK-treated mice from both treatment schedules A and B showed significantly reduced symptom scores when compared with the sham-treated group. The reduction in symptom score was associated with a significant reduction in the level of Ag-induced cutaneous immediate hypersensitivity. Also, GMK was able to suppress Ag-induced IgE production and T-cell responses, while it spares mitogen (Con A)-induced T-cell response. Further, treatment of mice with GMK abrogated the levels of Ag-induced histamine release and significantly reduced the number of degranulated mast cells. No effect of GMK was observed on the levels of total IgE and plasma histamine in naive mice. These results provide a basis for the modulation effect of GMK and suggest a potential utility of GMK as a prophylactic and therapeutic agent.

Efficacy and mechanisms of action of traditional Chinese medicines for treating asthma and allergy

BACKGROUND

Although corticosteroids and beta(2)-agonists are effective in managing asthma symptoms, a curative therapy for asthma is lacking. Traditional Chinese medicine (TCM), used in Asia for centuries, is beginning to play a role in Western health care as a complementary and alternative medicine modality. There is increasing scientific evidence supporting the use of TCM for asthma treatment.

OBJECTIVE

This review article discusses promising TCM interventions for asthma and explores their possible mechanisms of action.

METHODS

We first reviewed 5 clinical studies of antiasthma TCM herbal remedies published between 2005 and 2007. We then summarized possible mechanisms underlying their effects on the basis of data in the original articles, published abstracts, and available databases. Possible mechanisms include anti-inflammation, inhibition of airway smooth muscle contraction, and immunomodulation. Research on TCM herbal therapy for food allergy is rare, and we therefore focused on the effect and mechanism of action of food allergy herbal formula-2 on a murine model of peanut allergy and preliminary clinical study results.

CONCLUSION

Evidence from clinical studies supports beneficial effects of TCM herbal therapy on asthma. A number of mechanisms may be responsible for efficacy of these agents. Strong preclinical study data suggest the potential efficacy of food allergy herbal formula-2 for food allergy.

Complementary and alternative medicine for the allergist-immunologist: where do I start?

Complementary and alternative medicine (CAM) therapies present a growing information management challenge for physicians because nearly 40% of their patients may be using and another 50% may be considering use of CAM as part of their healthcare regimen. The National Health Statistics Reports for 2007 described the most commonly used nonvitamin, nonmineral therapy as natural products (eg, herbals at 17.7%). More than 5% of children under the age of 18 years used CAM for allergic conditions including asthma. The amount and quality of information available and concerns about liability risk represent a challenge for most physicians. This review focuses on considerations for approaching a CAM-related consultation, incorporating legal and logistic factors affecting how such an encounter should be approached. A 10-step process is presented that addresses different components of CAM consultations and what should be documented. Access to timely, high-quality information regarding product specific efficacy and safety data, as found in the Natural Medicines Comprehensive Database, is needed to support CAM consultation efficiently. Understanding of serious adverse events associated with CAM is limited; an international need exists for improved safety surveillance and information sharing. Allergy-immunology, as a specialty with expertise in adverse drug reaction evaluation and management, has a unique opportunity to support enhanced CAM-related adverse events evaluations, reporting, and research.

Licorice flavonoids inhibit eotaxin-1 secretion by human fetal lung fibroblasts in vitro

Glycyrrhiza uralensis (Gan-Cao), commonly called "licorice", is one of the most commonly used herbs in traditional Chinese medicine (TCM). In the United States, licorice products are most often consumed as flavoring and sweetening agents in food products. The licorice triterpenoid glycyrrhizin has several biological activities, including anti-inflammatory activity. Other potential anti-inflammatory constituents in G. uralensis have not been fully investigated. Airway eosinophilic inflammation is a major feature of allergic asthma. Eotaxin-1 (eotaxin) is involved in the recruitment of eosinophils to sites of antigen-induced inflammation in asthmatic airways. Because human lung fibroblasts are the major source of eotaxin, inhibition of eosinophil recruitment by suppression of fibroblast eotaxin production is a potentially valuable approach for the pharmacological intervention in asthma. A systematic bioassay-guided purification of G. uralensis yielded five flavonoids: liquiritin, liquiritigenin, isoliquiritigenin, 7,4'-dihydroxyflavone, and isoononin. The structures of the compounds were established by (1)H and (13)C nuclear magnetic resonance (NMR) and liquid chromatography-mass spectrometry (LC-MS) studies. The potential ability of these isolated pure compounds and glycyrrhizin to inhibit secretion of eotaxin-1 by human fetal lung fibroblasts (HFL-1) was tested. Liquiritigenin, isoliquiritigenin, and 7,4'-dihydroxyflavone were more effective than liquiritin, isoononin, and glycyrrhizin in suppressing eotaxin secretion. A concentration-response study showed the IC(50) concentrations of liquiritigenin, isoliquiritigenin, and 7,4'-dihydroxyflavone were 4.2, 0.92, and 0.21 microg/mL, respectively, demonstrating that Glycyrrhiza flavonoids inhibit eotaxin-1 secretion in vitro.

Patients' beliefs and preferences regarding doctors' medication recommendations

BACKGROUND

An estimated 20-50% of patients do not take medications as recommended. Accepting a doctor's recommendation is the first step in medication adherence, yet little is known about patients' beliefs and preferences about how medications are prescribed.

OBJECTIVE

To explore patients' beliefs and preferences about medication prescribing to understand factors that might affect medication adherence.

METHODS

Fifty members from 2 health plans in Massachusetts participated in in-depth telephone interviews. Participants listened to an audio-vignette of a doctor prescribing a medication to a patient and were asked a series of questions related to the vignette. Responses were reviewed in an iterative process to identify themes related to participants' beliefs and preferences about medication prescribing.

RESULTS

Participants' beliefs and preferences about medication prescribing encompassed 3 major areas: patient-doctor relationships, outside influences, and professional expertise. Important findings included participants' concerns about the pharmaceutical industry's influence on doctors' prescribing practices and beliefs that there is a clear "best" medication for most health problems.

CONCLUSIONS

Patients' beliefs and preferences about medication prescribing may affect medication adherence. Additional empiric studies that explore whether doctors' relationships with pharmaceutical representatives impact medication adherence by affecting trust are indicated. In addition, it would be worthwhile to explore whether discussions between patients and doctors regarding equipoise (no clear scientific evidence for 1 treatment choice over another) affect medication adherence.

Integrative medicine and asthma

Childhood asthma is a spectrum of symptoms and clinical presentations. The treatment begins with developing goals of therapy for a child by the health care provider, the family, and the child as a team. The primary objective is to reduce symptoms and exacerbations using therapies that include conventional medications, environmental controls, and lifestyle modification while reducing the potential for adverse effects of medications and the disease. Complementary and alternative medicine (CAM) may play a role in meeting these objectives, and through the integration of conventional and CAM therapies, an integrative medicine approach may facilitate reaching these objectives in a more effective manner.