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Preda M, Smolinska S, Popescu FD. Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1494. [PMID: 39336535 PMCID: PMC11433692 DOI: 10.3390/medicina60091494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024]
Abstract
Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)'s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks.
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Affiliation(s)
- Mariana Preda
- Faculty of Medicine, Department of Allergology "Nicolae Malaxa" Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, 022441 Bucharest, Romania
| | - Sylwia Smolinska
- Faculty of Medicine, Department of Clinical Immunology, Wroclaw Medical University, 51-616 Wroclaw, Poland
| | - Florin-Dan Popescu
- Faculty of Medicine, Department of Allergology "Nicolae Malaxa" Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, 022441 Bucharest, Romania
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Menon-Miyake MA, de Oliveira RC, Lorenzi-Filho G, Saldiva PHN, Butugan O. Luffa Operculata Affects Mucociliary Function of the Isolated Frog Palate. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Luffa operculata is a medicinal plant used in homeopathic and alternative medicine. In the United States, it is sold in a purified spray form, whereas a homemade L. operculata dry fruit infusion (DFI) is commonly used in Latin America. The L. operculata DFI is applied intranasally, inducing profuse mucous secretion and relieving nasal symptoms. Nevertheless, this medication may cause irritation of the nasal mucosa, as well as epistaxis or anosmia. Given the growing popularity of alternative medicine, a decision was made to evaluate the effects of this substance on mucous membranes. Methods The effects of L. operculata DFI on mucociliary transport velocity, ciliary beat frequency, and transepithelial potential difference (PD) were evaluated in an isolated frog palate preparation. We tested 46 palates immediately before immersion and again at 5 and 20 minutes after immersion. Four groups (n = 10) were tested in frog Ringer: control; L. operculata DFI, 60 mg/L; 600 mg/L; and 1200 mg/L. An additional group was tested using L. operculata DFI prepared with water (600 mg/L of H2O, n = 6). Epithelial samples were harvested for ultrastructural study. Results In treated palates, mucociliary transport velocity and ciliary beat frequency decreased significantly (p < 0.001 and p < 0.008, respectively). There was a dose-dependent decrease in PD modulus (p < .007). Our PD findings indicated ion-fluid transport abnormalities, which were confirmed by transmission electron microscopy that showed enlargement of interepithelial spaces. Conclusion In this ex vivo model, the L. operculata DFI infusion promoted significant changes in the mucociliary function of the epithelium, suggesting that it is potentially noxious to human nasal mucosa.
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Affiliation(s)
| | - Regiani Carvalho de Oliveira
- Laboratory of Experimental Air Pollution, Department of Pathology, University of São Paulo, São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratory of Experimental Air Pollution, Department of Pathology, University of São Paulo, São Paulo, SP, Brazil
- Department of Cardiology and Pneumology, University of São Paulo, São Paulo, SP, Brazil
| | | | - Ossamu Butugan
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, SP, Brazil
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Heffler E, Landi M, Quadrino S, Incorvaia C, Pizzimenti S, Vernero S, Crimi N, Rolla G, Canonica GW. Choosing wisely in Allergology: a Slow Medicine approach to the discipline promoted by the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Clin Mol Allergy 2015; 13:28. [PMID: 26594132 PMCID: PMC4653937 DOI: 10.1186/s12948-015-0034-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/28/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND One of the main problem health care systems are facis is the mis-use and over-use of medical resources (including useless exams, surgical interventions, medical treatments, screening procedures…) which may lead to high health care related costs without increased patients' benefit and possible harm to the patients themselves. The "Choosing wisely" campaign, in Italy denominated "Doing more does not mean doing better", tries to educate doctors and citizens at a correct use of medical resources. METHODS the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC) adhered to the "Doing more does not mean doing better" campaing and made a list of the 5 allergological procedures with the highest evidence of inappropriateness. RESULTS the 5 recommendations were: "Do not perform allergy tests for drugs (including anhestetics) and/or foods when there are neither clinical history nor symptoms suggestive of hypersensitivity reactions"; "Do not perform the so-called "food intolerance tests" (apart from those which are validated for suspect celiac disease or lactose enzymatic intolerance)"; "Do not perform serological allergy tests (i.e.: total IgE, specific IgE, ISAC) as first-line tests or as "screening" assays"; "Do not treat patients sensitized to allergens or aptens if there is not a clear correlation between exposure to that specific allergen/apten and symptoms suggestive of allergic reaction"; "Do not diagnose asthma without having performed lung function tests". CONCLUSIONS An important role scientific societies should play is to advise on correct diagnostic and therapeutical pathways. For this reason SIAAIC decided to adhere to the Slow Medicine Italy campaign "Doing more does not mean doing better" with the aim of warning the scientific community and the citizens/patients about some allergological procedures, which, when performed in the wrong clinical setting, may be not only useless, but unnecessarily expensive and even harmful for patients' health.
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Affiliation(s)
- Enrico Heffler
- />Department of Clinical and Experimental Medicine, Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | | | - Silvana Quadrino
- />“Change” Institute, Turin, Italy
- />“Slow Medicine Italy”, Turin, Italy
| | | | - Stefano Pizzimenti
- />ASL-TO3, Allergy Outpatients’ Clinic, “Edoardo Agnelli” Hospital, Pinerolo, TO Italy
| | | | - Nunzio Crimi
- />Department of Clinical and Experimental Medicine, Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - Giovanni Rolla
- />Department of Medical Sciences, Allergy and Clinical Immunology, University of Torino, Turin, Italy
| | - Giorgio Walter Canonica
- />Allergy and Respiratory Diseases Clinic, DIMI-Department of Internal Medicine, IRCCS AOU S.Martino-IST, Genoa, Italy
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The patient with rhinitis in the pharmacy. A cross-sectional study in real life. Asthma Res Pract 2015; 1:4. [PMID: 27965758 PMCID: PMC4970378 DOI: 10.1186/s40733-015-0002-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/05/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the practical management of allergic rhinitis (AR), pharmacists are usually the first-line contact, also because some medications are available as over the counter. Therefore, pharmacists may represent an important resource, in mediating the interaction between patients and physicians. We evaluated the clinical/demographic characteristics of patients with respiratory allergies who consulted their pharmacists as first-line contact. A patient-oriented questionnaire was developed by a scientific committee including pharmacists, GPs, allergists, pulmonologists and ENT specialists. METHODS The questionnaire consisted of items covering the general aspects of AR. Allergic Rhinitis and its Impact on Asthma guidelines were assumed as reference for diagnosis and therapy. The questionnaire was distributed to pharmacies, and pharmacists were asked to deliver the questionnaire to all patients referring for nasal symptoms. RESULTS 30 pharmacies were involved during the pollen season 2011, and 410 patients (55 % male) participated. The most frequent complaints were 20 rhinitis (49 %) and conjunctivitis (29 %), followed by lower respiratory symptoms (cough and/or dyspnea). Isolated conjunctival symptoms were present in only 22 % of patients. Among patients with lower respiratory symptoms, cough was the most frequent, variously associated with upper respiratory symptoms or overt dyspnea. Dyspnea alone was present in 16 % of patients. 39 % of patients had no physician-based diagnosis. Oral antihistamines were the most used self-medication, followed by intranasal decongestants. 30 % of respondents had used alternative medicines. CONCLUSION According to these data, AR is still considered a trivial disease, frequently self-managed, with over the counter medications, not in line with guidelines. A physician-based diagnosis is present in about 60 % of patients.
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Kim CY, Park HW, Ko SK, Chang SI, Moon HB, Kim YY, Cho SH. The financial burden of asthma: a nationwide comprehensive survey conducted in the republic of Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2010; 3:34-8. [PMID: 21217923 PMCID: PMC3005317 DOI: 10.4168/aair.2011.3.1.34] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/02/2010] [Indexed: 11/24/2022]
Abstract
Purpose Asthma-related morbidity and mortality are increasing, and the financial burden imposed by this condition will substantially increase. Nevertheless, little information is available regarding the nature and magnitude of the burden due to asthma at the national level. This study was conducted to characterize the financial burden imposed by asthma in the Republic of Korea at the national level. Methods The overall prevalence of asthma and the costs of related medical services were determined using data from the National Health Insurance Corporation, which is responsible for the National Health Insurance scheme. Indirect costs, including expenditures on complementary and alternative medicines, and the economic impact of an impaired quality of life (intangible costs) were estimated by surveying 660 asthmatics, and these estimates were transformed to the national level using the prevalence of asthma. Results The prevalence of asthma and total costs related to the disease in 2004 were 4.19% and $2.04 billion, respectively. Direct costs and indirect costs contributed equally to total costs (46.9% and 53.1%, respectively). However, when intangible costs were included, total costs rose to $4.11 billion, which was equivalent to 0.44% of the national gross domestic product in 2004. Conclusions The results provide evidence that asthma is a major health cost factor in the Republic of Korea and that intangible costs associated with asthma are significant cost drivers.
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Affiliation(s)
- Chang-Yup Kim
- Graduate School of Public Health, Seoul National University, Seoul, Korea
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Awareness of allergy patients about herbal remedies: a cross-sectional study of residents of Ankara, Turkey. Allergol Immunopathol (Madr) 2010; 38:78-82. [PMID: 20188453 DOI: 10.1016/j.aller.2009.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/19/2009] [Accepted: 07/19/2009] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The use of herbs in patients with allergic diseases is a special problem and still controversial. The objective of this questionnaire-based study was to determine the rate of herbal use in allergy clinic outpatients as well as to explore patient knowledge. METHODS Patients with respiratory and/or skin disease, either atopic or non-atopic were assigned to a prospective questionnaire study conducted in allergy clinic outpatients. RESULTS Three hundred and ninety-five patients enrolled in the study. The mean age was 33.50+/-12.14 years. Participants generally had a high educational level (40.5% college and 39% university graduated). The rate of herbal use was 14.2%. All characteristics were similar within herbal user and non-user patients, except gender and age. The number of female patients who use herbal products was greater than for males (p=0.043). Herbal use was common in patients in their late thirties (p=0.024). Three main rationales for herbal use were revealed: (i) acting upon advice of someone (41.1%); (ii) the belief that "herbals are always more beneficial than chemicals" (37.5%); and (iii) the trust that "herbals are always safe" (21.4%). Most of the participants have "no idea" (41.5%) or are "not sure" (33.7%) about potential harmful effects of herbs to allergic people. CONCLUSION People will continue to use herbals for one reason or another. Allergists and clinical immunologists need to become more knowledgeable about herbal therapies so that they can inform patients about either the benefits or possible harmful effects of herbs.
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Schäfer T. Epidemiology of complementary alternative medicine for asthma and allergy in Europe and Germany. Ann Allergy Asthma Immunol 2004; 93:S5-10. [PMID: 15330007 DOI: 10.1016/s1081-1206(10)61481-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe and discuss the epidemiologic characteristics and determinants of the use of complementary alternative medicine (CAM) from a European, particularly German, perspective. DATA SOURCES An unrestricted literature search using the keywords alternative, allergy, complementary, epidemiology, and medicine was performed in PubMed (National Library of Medicine). In addition, background literature and the opinion of the author contributed to the article. STUDY SELECTION European studies that provided data on the epidemiology of the use of CAM were selected and discussed in more detail. RESULTS Approximately 30% of patients with allergies report experiences with CAM in Europe. In selected in-patient populations, the prevalence reaches 50%. Users of CAM tend to be younger women with a higher educational background. Furthermore, users and nonusers differ in terms of psychomedical characteristics, such as health locus of control or health-related quality of life. Although a larger number of different CAM modalities are provided, only a few techniques account for the majority of use (eg, acupuncture, homeopathy, herbalism, bioresonance, autologous blood injection). The use of CAM is associated with considerable costs, reaching an estimated amount of 0.9 billion Euro (approximately 1 billion US dollars) in Germany. CONCLUSIONS CAM is widely used by the public to treat allergies. National peculiarities concerning the individual methods, providers, or reimbursement must be considered. The economic and public health implications should be discussed in context with the limited evidence of efficacy.
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Affiliation(s)
- Torsten Schäfer
- Institute of Social Medicine, Medical University of Schleswig-Holstein, Lübeck, Germany.
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Semizzi M, Senna G, Crivellaro M, Rapacioli G, Passalacqua G, Canonica WG, Bellavite P. A double-blind, placebo-controlled study on the diagnostic accuracy of an electrodermal test in allergic subjects. Clin Exp Allergy 2002; 32:928-32. [PMID: 12047441 DOI: 10.1046/j.1365-2222.2002.01398.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many unconventional diagnostic procedures based on bioelectrical skin responses are presently widely used for allergic diseases, but rigorous experimental evaluations of their accuracy are still lacking. AIM We assessed whether an electrodermal device can correctly diagnose respiratory allergy. METHODS The diagnostic accuracy of the electrodermal device was assessed in double-blind fashion in 72 allergic patients and 28 healthy volunteers. A random sequence of substances in sealed vials, including histamine, allergens, immunoglobulins at various dilutions and physiological saline, were tested in duplicate in each subject. RESULTS A wide variability of the measurements was found in most patients irrespective of their allergy status and of the substance tested. Allergic patients showed more negative skin electrical response at the second trial, compared to normal controls, independent of the tested substance. No significant difference in skin electrical response between allergens and negative controls could be detected. CONCLUSION We conclude that the studied bioelectrical method, under blind testing, cannot correctly detect respiratory allergy.
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Affiliation(s)
- M Semizzi
- Department of Morphological and Biomedical Sciences, University of Verona, Verona, Italy
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Senna G, Passalacqua G, Bonadonna P, Agostinis F, Lombardi C, Cocco G, Zanon P, Canonica GW. Is alternative medicine acceptable in allergology? Allergy 2000; 55:1200. [PMID: 11117282 DOI: 10.1034/j.1398-9995.2000.00925.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- G Senna
- Allergy and Respiratory Diseases, DIMI Pad Maragliano, Genoa, Italy
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