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Lee HG, Jeong H, Kwon CY, Kim KH, Sung SH, Han JE, Park M, Jang S. Adverse events of herbal decoction: A systematic review and meta-analysis over past 10 years. Complement Ther Med 2024; 83:103057. [PMID: 38830449 DOI: 10.1016/j.ctim.2024.103057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/22/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Herbal decoctions (HDs) are the oldest and most common herbal medicine formulations. Different HDs exist, and some consumers are concerned that they may become contaminated during manufacturing. Therefore, the need for a safety assessment of HDs has been raised. This study aimed to investigate the adverse events (AEs) associated with HDs by comprehensively analyzing randomized controlled trials (RCTs) using systematic reviews and meta-analyses. METHODS A systematic search was conducted on PubMed, Embase, and the Cochrane Library for articles published up to November 2022. The included RCTs compared HDs with other treatments published between 2013 and 2022, and the risk of bias was assessed using RevMan 5.4. Meta-analyses of the number of AEs associated with HDs reported in the included RCTs were also performed. RESULTS The systematic review included 26 RCTs, and the meta-analysis included 17 RCTs that reported AEs. The meta-analysis comparing HDs with active controls showed that both the number of AEs (14 studies; risk ratio (RR)= 0.50 cases, 95 % confidence interval (CI) [0.29, 0.88]; I2 = 42 %) and the number of patients who complained of AEs (seven studies; RR=0.51 patients, 95 % CI [0.28, 0.94]; I2 =9 %) were fewer in the HDs group than in the active control groups. CONCLUSION This study showed that HDs are safer than other conventional medications based on the results of qualitative and quantitative syntheses of RCTs.
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Affiliation(s)
- Han-Gyul Lee
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Republic of Korea
| | - Hyein Jeong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Republic of Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dongeui University, Republic of Korea
| | - Kyeong-Han Kim
- Department of Preventive Medicine, College of Korean Medicine, Woosuk University, Republic of Korea
| | - Soo Hyun Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Republic of Korea
| | - Ji Eun Han
- Department of Policy Development, National Institute of Korean Medicine Development, Republic of Korea
| | - Minjung Park
- Department of Public Health and Administration, Seoul Digital University, Republic of Korea
| | - Soobin Jang
- Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, 1 Haanydaero, Gyeongsan-si, Gyeongsangbuk-do 38610, Republic of Korea.
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Ai J, Guo S, Wang Y, Kang Y, Wang M, Zhao J, Huang S, Wang J. Clinical Effect Analysis of Fire-needle Acupuncture at Neiyingxiang Treating Persistent Allergic Rhinitis. Laryngoscope 2024. [PMID: 38841861 DOI: 10.1002/lary.31540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES We conducted the first trial to evaluate the effect that fire-needle acupuncture at Neiyingxiang (ExHN 9) in patients with moderate to severe persistent AR. METHODS This was a randomized, single-center, sham, and placebo-controlled rial. Patients were kept blinded to their group assignment. All participants were equally assigned to the fire-needle acupuncture (FA) treatment group, sham fire-needle acupuncture (SFA) group, or loratadine group. The trial was designed with an acupuncture intervention once a week for 4 weeks and follow-up 4 weeks. The Total Nasal Symptom Scores (TNSS), Total Non-Nasal Symptom Scores (TNNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Allergic Rhinitis Control Test (ARCT), and total nasal resistance of 150 Pa were evaluated as outcome measures. RESULTS A total of 180 participants were enrolled, and 175 participants completed the trials. At 2 and 4 weeks, the TNSS, TNNSS, and RQLQ scores of the FA and loratadine groups were significantly lower than those of the SFA group. At 8 weeks, the scores of loratadine group increased compared with the FA group (Cohen's d >0.80, p < 0.01). The ACRT score of the FA treatment group rose gradually. After treatment, the total nasal resistance of the FA group was significantly decreased and was lower than that of the other two groups (Cohen's d >0.80, p < 0.01). CONCLUSION Fire-needle acupuncture at Neiyingxiang (ExHN 9) is effective for improving nasal allergy symptoms and quality of life in patients with moderate and severe persistent AR, and the duration of its effects is long. LEVEL OF EVIDENCE 2 Laryngoscope, 2024.
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Affiliation(s)
- Jianwei Ai
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Suying Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Yaqin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Yuezhi Kang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Man Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Jingyi Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Shaoting Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
| | - Junge Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Hospital of Traditional Chinese Medicine Afliated with Capital Medical University, Beijing, China
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Son MJ, Kim S, Kim YE, Kim BY, Yeum CS, Lee JC, Cha JH, Kang S, Chang CH, Son S. Clinical effectiveness of decoction form of herbal medicine in primary care treatment of allergic rhinitis: A retrospective cohort study. Integr Med Res 2023; 12:100973. [PMID: 37637186 PMCID: PMC10448014 DOI: 10.1016/j.imr.2023.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background The decoction form of herbal medicine (D-HM) is mainly prescribed to patients with allergic rhinitis (AR) in Korean Medicine (KM) clinics in the Republic of Korea; however, it is difficult to conduct clinical trials of D-HM due to regulatory issues. This study investigated the clinical safety and effectiveness of D-HM combination therapy for the treatment of AR by analyzing the AR outpatient data from 17 KM clinics. Methods This retrospective cohort study included patients who visited KM clinics for AR treatment from January 1, 2021, to March 31, 2022. Cases were collated using structured case report forms and divided into the D-HM with KM usual care group (D-HM group) and the KM usual care group (UC group). Since D-HM therapy could not be randomly assigned to the study population, we used optimal propensity score (PS) matching to investigate the effectiveness and safety of D-HM combination therapy in the treatment of AR. Results Data from 228 patients were collected. After PS matching, 144 patients were finally analyzed. The total nasal symptom score (TNSS) and mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ) were significantly improved in the D-HM group compared with those in the UC group (TNSS: p=0.02; mini-RQLQ: p=0.04). Four patients in the D-HM group experienced minor adverse events that were mild and resolved within 15 days. Conclusions D-HM combination therapy may be beneficial in the management of symptoms and rhinitis-associated quality of life and potentially useful in clinical practice. However, randomized placebo-controlled clinical trials are required to confirm their effectiveness. Study registration This study has been registered at Clinical Research Information Service (KCT0007242).
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Affiliation(s)
- Mi Ju Son
- R&D Planning Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungha Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young-Eun Kim
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bo-Young Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | | | - Jong Cheol Lee
- 365 Cha Korean Medicine Clinic, Yeosu, Republic of Korea
| | - Jae Hoon Cha
- 365 Cha Korean Medicine Clinic, Yeosu, Republic of Korea
| | - Soonsik Kang
- Moa Korean Medicine Clinic, Seoul, Republic of Korea
| | | | - Seokho Son
- I-Bone Korean Medicine Clinic, Asan, Republic of Korea
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Herbal Medicines for Allergic Rhinitis: a Systematic Review and Meta-analysis. Curr Allergy Asthma Rep 2021; 21:25. [PMID: 33768322 DOI: 10.1007/s11882-021-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW To assess the effects of herbal medicine (HM) therapy in various durations and analyze the effects of HM separately by mechanism of action in the treatment of allergic rhinitis (AR). RECENT FINDINGS Thirty-two studies were included (2,697 patients, mean age 34.6 years). For the ≤ 4 weeks of treatment duration, HM brought greater benefits over placebo in reduction of total nasal symptoms score (standardized mean difference (SMD) -0.68; 95% confidence interval (CI) -0.98, -0.38; p <0.01) and improvement in Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.53; 95% CI -0.81, -0.25; p <0.01). For the 4-12 weeks duration, total nasal symptoms score (SMD -0.22; 95%CI -0.4, -0.05; p =0.01) and Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.48; 95% CI -0.89, -0.06; p =0.03) favored the HM. However, HM therapy for longer than 12 weeks was related to tachyphylaxis and showed no benefit over placebo in any outcomes. There was no difference between the HM and standard treatment on symptoms improvement. Anti-allergic effect, anti-inflammatory effect, anti-leukotriene effect, and anti-histaminic effect of HM were revealed. HM was safe and their adverse effects were comparable placebo. HM therapy is safe and provides better results than placebo in improving nasal symptoms and disease-specific quality of life in patients with AR. Its beneficial effects are demonstrated only in less than 12 weeks of treatment. TRIAL REGISTRATION PROSPERO ID: CRD42020168367.
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Li H, Kreiner JM, Wong AR, Li M, Sun Y, Lu L, Liu J, Yang AWH. Oral application of Chinese herbal medicine for allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials. Phytother Res 2021; 35:3113-3129. [PMID: 33533107 DOI: 10.1002/ptr.7037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/15/2020] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
Chinese herbal medicine (CHM) has long been used for allergic rhinitis (AR). This systematic review aimed to investigate the clinical effects and safety of oral CHM for AR by comparing it to Western medications (WM). Nineteen databases were searched up to May 27, 2020. Randomized controlled trials (RCTs) assessing the effects of CHM on the primary or secondary outcomes comparing to WM, in any age of the patients, were included. The pooled results were expressed as mean difference, standardized mean difference, or odds ratio with 95% confidence intervals. Eighteen RCTs were included and 17 of them were evaluated in the meta-analysis. CHM may improve total nasal symptom scores, individual symptom scores (rhinorrhea, nasal congestion, sneezing, and nasal itching), quality of life, and recurrence rate, compared to antihistamines (loratadine and chlorpheniramine). Only mild and transient adverse events of CHM were reported. However, there were no significant differences in some subgroup analyses in total nasal symptom scores, rhinorrhea, nasal obstruction, sneezing, nasal itching, and SF-36. Due to the small number of included studies, poor quality of trial design, and substantial heterogeneities, the potential of CHM for AR should be validated in large, multicenter, and well-designed RCTs in the future.
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Affiliation(s)
- Hong Li
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Jenny Manuela Kreiner
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ann Rann Wong
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Mingdi Li
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Yue Sun
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Leyao Lu
- School of Life Sciences, Guangzhou University, Guangzhou, China
| | - Jianping Liu
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Angela Wei Hong Yang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Fried J, Yuen E, Li A, Zhang K, Nguyen SA, Gudis DA, Rowan NR, Schlosser RJ. Rhinologic disease and its impact on sleep: a systematic review. Int Forum Allergy Rhinol 2020; 11:1074-1086. [PMID: 33275331 DOI: 10.1002/alr.22740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). METHODS A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea-hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease-specific patient-reported outcome measures (PROMs; 22-item Sino-Nasal Outcome Test [SNOT-22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. RESULTS The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). CONCLUSION Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.
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Affiliation(s)
- Jacob Fried
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Erick Yuen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Andraia Li
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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