Herbal interventions in asthma and allergy

Inhibition of TRPA1, Endoplasmic Reticulum Stress, Human Airway Epithelial Cell Damage, and Ectopic MUC5AC Expression by Vasaka (Adhatoda vasica; Malabar Nut) Tea

This study tested whether a medicinal plant, Vasaka, typically consumed as a tea to treat respiratory malaise, could protect airway epithelial cells (AECs) from wood smoke particle-induced damage and prevent pathological mucus production. Wood/biomass smoke is a pneumotoxic air pollutant. Mucus normally protects the airways, but excessive production can obstruct airflow and cause respiratory distress. Vasaka tea pre- and co-treatment dose-dependently inhibited mucin 5AC (MUC5AC) mRNA induction by AECs treated with wood smoke particles. This correlated with transient receptor potential ankyrin-1 (TRPA1) inhibition, an attenuation of endoplasmic reticulum (ER) stress, and AEC damage/death. Induction of mRNA for anterior gradient 2, an ER chaperone/disulfide isomerase required for MUC5AC production, and TRP vanilloid-3, a gene that suppresses ER stress and wood smoke particle-induced cell death, was also attenuated. Variable inhibition of TRPA1, ER stress, and MUC5AC mRNA induction was observed using selected chemicals identified in Vasaka tea including vasicine, vasicinone, apigenin, vitexin, isovitexin, isoorientin, 9-oxoODE, and 9,10-EpOME. Apigenin and 9,10-EpOME were the most cytoprotective and mucosuppressive. Cytochrome P450 1A1 (CYP1A1) mRNA was also induced by Vasaka tea and wood smoke particles. Inhibition of CYP1A1 enhanced ER stress and MUC5AC mRNA expression, suggesting a possible role in producing protective oxylipins in stressed cells. The results provide mechanistic insights and support for the purported benefits of Vasaka tea in treating lung inflammatory conditions, raising the possibility of further development as a preventative and/or restorative therapy.

Research hotspot and frontier analysis of traditional Chinese medicine in asthma using bibliometric methods from 1991 to 2021

Traditional Chinese medicine (TCM) has been successfully used to treat asthmatic conditions for centuries. Nevertheless, the current hotspots and research frontiers on TCM for asthma have not been systematically investigated on the basis of bibliometric analysis. In this study, a scientometric analysis (1991-2021) was carried out on 3081 journal articles obtained from the Web of Science Core Collection database to explore the basic characteristics, research hotspots, and frontiers of TCM in asthma research. The results revealed the following: (1) Research on TCM in asthma has received widespread attention since the beginning of the 21st century; perhaps 2009 was an important turning point. TCM in asthma research shows a trend of interdisciplinary development. (2) Well-known universities/institutions in China, the United States, and South Korea have conducted the main body of current TCM research in asthma. JingCheng Dong (Fudan University, China) and XiuMin Li (Mount Sinai School of Medicine, USA) are the top 2 leading authors in this field. However, there is still a lack of international cooperation in the field of TCM in asthma research, and the influence of researchers in China and South Korea still needs improvement. (3) The Journal of Allergy and Clinical Immunology ranks first in the research field on the influence of TCM in asthma. (4) Hotspots and frontiers of TCM in asthma are provided according to the timeline analyses of the research. In the former, complementary medicine, alternative treatment, allergic rhinitis, airway remodeling, Dietary Approach to Stop Hypertension diet, and eosinophilic esophagitis are in the exploratory stage. In the latter, pharmacology, essential oil, gut microbiota, and oxidative stress were investigated from 2006 until late 2021 as period B, which contradicts period A (1991-2005). Moreover, limitations of this bibliometric analysis and the study of TCM research in asthma still exist, which are sufficiently important to warrant further investigations. Finally, we propose the significant importance of the real quintessence and characteristics of TCM in clinical and future research.

3,4,5-Trihydroxycinnamic acid exerts anti-asthmatic effects in vitro and in vivo

3,4,5-Trihydroxycinnamic acid (THCA) has been reported to possess anti-inflammatory activity. However, the effect of THCA for treating allergic asthma was unknown. Therefore, in the present study, the anti-asthmatic effects of THCA were studied in both in vitro and in vivo studies. In phorbol 12-myristate 13-acetate (PMA)-stimulated A549 airway epithelial cells, THCA pretreatment decreased the mRNA expression and secretion of interleukin (IL)-8, monocyte chemoattractant protein-1 (MCP-1), and intercellular adhesion molecules 1 (ICAM-1), and reduced the mRNA expression of matrix metalloproteinase 9 (MMP-9). THCA also inhibited PMA-induced protein kinase B (AKT), mitogen-activated protein kinase (MAPK) and nuclear factor kappa B (NF-κB) activation in A549 cells. In lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages, THCA pretreatment suppressed the mRNA expression of ICAM-1 and MMP-9. In addition, THCA suppressed the adhesion of EOL and A549 cells. In ovalbumin (OVA)-administered asthmatic mice, THCA exerted inhibitory activity on IL-5, IL-13, and MCP-1 in bronchoalveolar lavage fluid (BALF) and on OVA-specific immunoglobulin E (IgE) in serum. THCA attenuated the numbers of inflammatory cells in BALF and the influx of inflammatory cell in lung tissues. Furthermore, THCA downregulated the levels of inducible nitric oxide (iNOS), cyclooxygenase-2 (COX-2), and leukotriene B4 (LTB4) expression, mucus production and CREB phosphorylation as well as Penh value. These effects were accompanied by suppression of AKT, extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and NF-κB activation. Therefore, the results of the current study suggest that THCA may be a valuable adjuvant or therapeutic in the prevention or treatment of allergic asthma.

Saibokuto as a Possible Therapy for Type B Insulin Resistance Syndrome: The Disappearance of Anti-insulin Receptor Antibody and a Marked Amelioration of Glycemic Control by Saibokuto Treatment

Type B insulin resistance syndrome is a rare autoimmune disease and no effective therapy has yet been established. On the other hand, it is known that Saibokuto, one type of Japanese Kampo medicine, may have beneficial effects on various symptoms associated with this disease and it is therefore occasionally prescribed for various immune disorders. We herein describe a case of type B insulin resistance syndrome in which anti-insulin receptor antibody disappeared and the patient's glycemic control markedly improved after the administration of Saibokuto. At first, we administered various anti-oral diabetic drugs and insulin therapy, but the patient's glycemic control became further aggravated. In addition, Helicobacter pylori eradication therapy was not effective, although its benefit has been reported. Interestingly, after the patient started taking Saibokuto, her glycemic control markedly improved. In addition, the patient's plasma insulin levels markedly decreased and anti-insulin receptor antibody became negative after taking Saibokuto. Taken together, there is a possibility that Saibokuto may one of the options for type B insulin resistance syndrome therapy.

Management of Allergic Rhinitisand Sinusitis

Allergic rhinitis and sinusitis are chronic conditions of the airway and cause significant morbidity. Both can require pharmacotherapy with nonprescription products to relieve symptoms or with prescription products to treat the underlying pathophysiology. Because these diseases are prevalent conditions, the pharmacist is in the unique position of being the first health professional contact for many patients. The pharmacist can assist the patient in selection of nonprescription antihistamines, decongestants, and nasal saline sprays as well as provide instruction on the use of steam therapy, aromatic vapors, and warm compresses for the relief of symptoms. Equally important, the pharmacist can encourage patients to seek care from a physician when treatment with intranasal corticosteroids, antibiotics, and nonsedating antihistamines are needed.

BuShenYiQi Formula strengthens Th1 response and suppresses Th2-Th17 responses in RSV-induced asthma exacerbated mice

ETHNOPHARMACOLOGICAL RELEVANCE

The prevalence of allergic asthma has been increased rapidly in recent years. About 20% of all these sufferers have experienced asthma exacerbation. Although corticosteroids and β-agonists therapy improves serious asthma symptoms, they can׳t completely cure these allergic diseases. BuShenYiQi Formula (BSYQF) has been widely used to treat bronchial asthma and its exacerbation for decades in Huashan Hospital of Fudan University, China. Nevertheless, the mechanisms of BSYQF' anti-asthmatic effects haven׳t been fully elucidated. In this study, we evaluated the involvement of Th1, Th2 and Th17 cells in the anti-asthmatic effects of BSYQF in Respiratory Syncytial Virus (RSV)-induced asthma exacerbated mice.

MATERIALS AND METHODS

BALB/c mice were challenged with ovalbumin (OVA), followed by RSV infections for establishment of asthma exacerbated model. Airway hyperresponsiveness (AHR) was examined by direct airway resistance analysis. Bronchoalveolar lavage fluid (BALF) was assessed for inflammatory cell counts and secreted levels of cytokines. Lung tissues were detected for inflammatory cell infiltration and mucus hypersecretion. Subsequently, CD4(+)T cells and alveolar macrophages were sorted and purified from mice lungs in different groups. CD4(+)T cell subpopulations including the expression levels of important transcription factors in T lymphocyte polarization were examined. In asthma exacerbation group, the purified CD4(+)T cells and macrophages were co-cultured, and the changes of co-cultured cells with BSYQF treatment were further analyzed in vitro.

RESULTS

BSYQF significantly attenuated airway hyperresponsiveness and inhibited inflammatory cell infiltration, especially for excessive infiltration of eosinophils and neutrophils. Histopathological analysis showed that BSYQF could suppress airway inflammation and RSV replication. The decreases of antigen-specific IgE, IL-4, IL-5, IL-6, IL-17a and increases of IFN-γ, IL-12 were observed in BALF, lung homogenate or serum after BSYQF treatment. We further confirmed that BSYQF could down-regulate Th2-Th17 cell proportions with lower expressions of GATA3, STAT6 and RORγT, and up-regulate Th1 cell proportion with higher expression of T-bet. And as a result of strengthened Th1-response, activated macrophages were also observed by remarkable enhancement of signature gene expressions and phagocytosis.

CONCLUSIONS

BSYQF can significantly attenuate RSV-induced asthma exacerbation. These effects may be mediated at least partially by regulating the balance between Th1 and Th2-Th17 responses.

The Chinese Herbal Medicine Formula Sheng-Fei-Yu-Chuan-Tang Suppresses Th2 Responses and Increases IFN γ in Dermatophagoides pteronyssinus Induced Chronic Asthmatic Mice

Sheng-Fei-Yu-Chuan-Tang (SFYCT), a traditional Chinese medicine formula consisting of 13 medicinal plants, has been used in the treatment of asthma. This study demonstrated the immunoregulatory effect of SFYCT on chronic allergic asthma using the Dermatophagoides-pteronyssinus- (Der p-) challenged chronic asthmatic murine model. SFYCT decreased the airway hyperresponseness (AHR), pulmonary inflammatory cell infiltration, and airway remodeling in Der p mice. SFYCT treatment decreased Der p-induced total IgE and Der-p-specific IgG1 but not IgG2a/2b Ab titer in serum of Der p mice. SFYCT also decreased Th2 cytokines, IL-4, IL-5, and IL-13, but increased IFN-γ and IL-12 in the BALF of Der p mice. TGF-β1 and collagen production in the lung of mice were decreased by SFYCT. The mRNA expression of chemokine including Eotaxin, RANTES, and MCP-1 in the lung of Der p mice was decreased by SFYCT. In conclusion, the suppressed Der-p-induced airway inflammation, remodeling, and hyperresponseness in chronic asthma murine model are related to SFYCT inhibits Th2 responses, decreases chemokine expression and promotes IFN-γ and IL-12 production. SFYCT could show Der-p-induced Th2 responses to Th1 responses by increasing IFN-γ which is merit for clinical application on asthma patients.

Ocimum gratissimum Linn. and rosmarinic acid, attenuate eosinophilic airway inflammation in an experimental model of respiratory allergy to Blomia tropicalis

Allergic asthma has emerged as an important public health problem of urban populations in developed countries. Very often herbal medicine is used to treat this widespread disease, due to the lack of efficacy and the important side effects related to the classical drugs in use. Along this line, Ocimum gratissimum (Og) is a plant widely used in Brazilian folk medicine to treat inflammatory disorders, such as asthma. In the present study we evaluated the immunomodulatory effects of Og and rosmarinic acid (RA, a polyphenolic compound) in a murine model of respiratory allergy induced by the Blomia tropicalis (Bt) mite. The respiratory allergy was induced in A/J mice by administration of Bt extract and the treatment was done using 25, 50 or 100mg/kg of an Og methanolic extract or using 2, 20 or 200mg/kg of RA. We then evaluated the changes induced by these drugs on immunological parameters related to the allergic process, which are up-regulated in this allergic model. The treatment of animals with 100mg/Kg Og and 200mg/Kg RA led to a significant reduction in the numbers of leukocytes/eosinophils in bronchoalveolar lavage (BAL); eosinophil peroxidase activity in BAL; presence of mucus in respiratory tract, histopathological changes in the lung, and IL-4 in BAL. These results suggest that the methanolic extract of Og and the polyphenol RA have therapeutic potential in this murine model of respiratory allergy to a clinically relevant human sensitizer allergen.

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.

Bresol inhibits phosphodiesterase 4 gene expression and modulates the levels of select mediators of inflammation in human monocytic cells

Bresol-a poly-herbal formulation, has been reported to be effective against bronchial asthma and allergic rhinitis in children. In vivo studies have supported the anti-histaminic and anti-anaphylactic action of bresol. However, the mechanism of action of bresol in modulation of inflammation has not been studied at the cellular and molecular level. The present study was aimed to elucidate the mechanism(s) of action of bresol at the cellular and molecular levels, using human monocyte leukemia cells. The effects of bresol on phosphodiesterase 4B (PDE4B) gene expression were analyzed using human monocytic U937 leukemia cells. The ability of bresol to stimulate cAMP formation in these cells, as well as its effects on mediators of inflammation like tumor necrosis factor-α (TNFα), nitric oxide (NO), and cycloxygenase-2 (COX-2) in lipopolysaccharide (LPS)-stimulated U937 cells, were also studied. The results here indicated that bresol exhibited potential anti-inflammatory properties by inhibiting LPS-induced PDE4B gene expression in the cells. Bresol also dose dependently activated cAMP formation, and inhibited TNFα, NO, as well as COX-2 formation in the LPS-stimulated cells. Based upon the results, we concluded that the reported anti-inflammatory activity of bresol might be attributed to its abilities to inhibit PDE4B and thus elevate cAMP levels in human monocytes. The anti-inflammatory effects of bresol might also be a result of the capacity of bresol to modulate the formation of TNFα, NO, and COX-2 in monocytes.

Clinical efficacy of herbal Padmapatradi yoga in bronchial asthma (Tamaka Swasa)

Ayurveda refers to bronchial asthma as Tamaka Swasa and it is well explained in Charaka Samhita. It contributes several modalities of the treatment for Swasa roga(asthma). Among all modalities of treatment, polyherbal combinations are said to be well-accepted, safe and effective in asthma. A study was carried out in 40 patients of either sex in between the age of 15-65 years to assure the clinical response of Padmapatradi yoga in bronchial asthma (Tamaka Swasa) at P.G. department of Kayachikitsa, D.G.M. Ayurvedic Medical College, Gadag, Karnataka. The sum total properties of Padmapatradi yoga is tikta katu rasa, laghu and tikna guna (light and penetrating properties), ushna virya (hot potency) and vatakaphagna (decrease vata and kapha dosa) Padmapatradi yoga is effective in increased peak expiratory flow rate, breath holding time, and reduces the absolute eosinophil count of studied cases and also found statistically highly significant at p<0.001 level. The drug is quite safe and acts as a bronchodilator, antihistaminic and anti-inflammatory.

Anti-inflammatory, immunomodulatory, and heme oxygenase-1 inhibitory activities of ravan napas, a formulation of uighur traditional medicine, in a rat model of allergic asthma

Ravan Napas (RN) is a traditional formula used to treat pulmonary symptoms and diseases such as coughing, breathing difficulty, and asthma in traditional Uighur medicine. The purpose of this study was to investigate the anti-inflammatory, and immuno-modulatory activity of RN in a well-characterized animal model of allergic asthma. Rats were sensitized with intraperitoneal (ip) ovalbumin (OVA) and alum, and then challenged with OVA aerosols. The asthma model rats were treated with RN; saline- and dexamethasone- (DXM-) treated rats served as normal and model controls. The bronchoalveolar lavage fluid (BALF) cellular differential and the concentrations of sICAM-1, IL-4, IL-5, TNF-α, INF-γ, and IgE in serum were measured. Lung sections underwent histological analysis. The immunohistochemistry S-P method was used to measure the expression of ICAM-1 and HO-1 in the lung. RN significantly reduced the number of inflammatory cells in BALF and lung tissues, decreased sICAM-1, IL-4, IL-5, TNF-α, and IgE in serum, and increased serum INF-γ. There was a marked suppression of ICAM-1 and HO-1 expression in the lung. Our results suggest that RN may have an anti-inflammatory and immuneregulatory effect on allergic bronchial asthma by modulating the balance between Th1/Th2 cytokines.

Common respiratory diseases

The self-medication phenomenon in upper respiratory tract infections, rhinosinusitis, asthma, and chronic obstructive pulmonary disease are significant and will continue to increase. Current level of evidence is poor because of the small number of good quality studies, small sample size, short duration, and variation in the composition of the herbal interventions or therapies. The current review points to several potential therapies that could be effective either alone, or as adjuncts to conventional therapies.

Complementary/alternative medicines in allergic disease

Complementary/alternative medicines is a generic term that encompasses a variety of approaches, including homeopathy, acupuncture, phytotherapy and numerous holistic or behavioral techniques. Complementary/alternative medicines are widely used in a number of conditions, including asthma and rhinitis. The medical literature on complementary/alternative medicines is impressive, but there are few clinical studies conducted with an appropriate methodology, and their results are negative or conflicting. In general, the results are insufficient to provide recommendations for the use of complementary/alternative medicines in clinical practice. Regarding diagnostic techniques, none have demonstrated the capability of distinguishing between healthy and allergic subjects and none are able to identify sensitizations.

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.

Complementary and alternative medicine: herbs, phytochemicals and vitamins and their immunologic effects

Complementary and alternative medicines (CAMs) are used in more than 80% of the world's population and are becoming an increasing component of the US health care system, with more than 70% of the population using CAM at least once and annual spending reaching as much as $34 billion. Since the inception of the National Center for Complementary and Alternative Medicine, there has been an enormous increase in the number of basic science and therapy-based clinical trials exploring CAM. The subspecialty of allergy and immunology represents a particularly fertile area with a large number of CAM therapies that have been shown to affect the immune system. Recent work has uncovered potential biochemical mechanisms involved in the immunomodulatory pathway of many supplemental vitamins (A, D, and E) that appear to affect the differentiation of CD4(+) cell T(H)1 and T(H)2 subsets. Other research has shown that herbs such as resveratrol, quercetin, and magnolol may affect transcription factors such as nuclear factor-kappaB and the signal transducer and activator of transcription/Janus kinase pathways with resultant changes in cytokines and inflammatory mediators. Clinically, there have been hundreds of trials looking at the effect of CAM on asthma, allergic rhinitis, and atopic dermatitis. This article reviews the history of CAM and its use among patients, paying special attention to new research focusing on herbals, phytochemicals, and vitamins and their potential interaction with the immune system.

The effects of Fructus Xanthii extract on cytokine release from human mast cell line (HMC-1) and peripheral blood mononuclear cells

In the present study, human mast cell line (HMC-1) and peripheral blood mononuclear cells (PBMNC) were pre-incubated with various concentrations of Fructus xanthii extract solution followed by being stimulated with phorbol myristate acetate and further incubated for 24 hours. The cytokines, in cell culture supernatants, of interleukin (IL)-4, IL-6, IL-8, GM-CSF, and TNF-alpha in the supernatant were measured by enzyme-linked immunosorbent assay. The results demonstrated that Fructus xanthii could modulate the mast cell-mediated and PBMNC-mediated inflammatory and immunological reactions modulated by cytokines. And our study supplied the evidence of the mechanisms of Fructus Xanthii in treating inflammatory and allergic diseases.

Herbal interventions for chronic asthma in adults and children

BACKGROUND

Herb and plant based preparations are a popular treatment for asthma, although there remain concerns as to their efficacy and safety. In Western societies, motivations for using such treatments may be both positive and negative, with their perceived safety and dissatisfaction with conventional medicine among them. In China such treatments are more commonly used and many compounds considered 'conventional' are derived from herbs or plants.

OBJECTIVES

To assess the efficacy and safety of herb and plant extracts in the management of chronic asthma.

SEARCH STRATEGY

The Cochrane Airways Group Trials Register, CENTRAL, MEDLINE, EMBASE and AMED were searched with pre-defined terms. Searches are current as of February 2007.

SELECTION CRITERIA

Randomised placebo controlled trials of any herb or plant extract were eligible. Study participants had to have a primary diagnosis of asthma. Studies in both adults and children were eligible for the review.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed studies for suitability. Data were extracted and double-checked.

MAIN RESULTS

Twenty-seven studies (29 experimental groups) met the review entry criteria, randomising a total of 1925 participants. The studies identified assessed the effects of 21 different herbal preparations. Study quality varied considerably, and the sample sizes were often small. For primary outcomes (exacerbations, steroids use and lung function measurements): Two out of six studies reporting change in FEV1 were positive, with very few data available on the frequency of exacerbations. One study which did report these data was negative. Health-related quality of life was only measured in one trial.

AUTHORS' CONCLUSIONS

The evidence base for the effects of herbal treatments is hampered by the variety of treatments assessed, poor reporting quality of the studies and lack of available data. The data that are available from the studies provide only a small insight into the long-term efficacy and harm profiles of these treatments. The absence of common endpoint measurements limits the validity of our findings further. Positive findings in this review warrant additional well-designed trials in this area.

Herbal treatments of asthma: a systematic review

BACKGROUND

Asthma is a condition, often chronic, characterized by respiratory symptoms, variable airflow limitation and/or airway hyper-reactivity with symptoms causally related to family history, environmental influences, exposure to viruses and allergens as examples. The high economic burden associated with asthma is associated primarily with health care costs, missed work or school days. This systematic review was conducted to determine the study quality of articles investigating ayurvedic/collateral herbs, the effectiveness/efficacy and safety profile, as reported in the studies.

METHODS

Literature searches were conducted using PubMed, EMBASE, Mantis, Ovid, Annotated Bibliography of Indian Medicine, and Cochrane library to identify published trials on herbal medicines for asthma of which Ayruvedic herbals are a subset. Randomized Controlled Trials (RCTs) and Quasi-Experimental Designs (QEDs) were included in this systematic review. The classic Jadad Scale, Singh RCT Scale with additional domains than Jadad, Safety Scoring Scale for clinical trials and the Singh QED Scale based on expanded features of QEDs were used to assess study quality. Herbs included in Traditional Chinese Medicine were excluded from this review. Forty-two articles were retrieved and 37 studies were ultimately reviewed utilizing 3 independent evaluators/1 arbitrator.

RESULTS

Articles reviewed indicated benefit from most of the herbs used either as a primary or adjunctive treatment for Asthma. Study quality was mixed and therefore caution in interpretation of findings of usefulness of these herbals must be suggested. Limited safety information was mixed and generally was related to GI symptoms, though one herbal investigated reported more serious side effects.

CONCLUSIONS

Herbs may be useful in treatment of asthma. There is insufficient evidence to make recommendations for or against the use of these herbals. Established effectiveness must be balanced with study quality and safety profile for the herb.

Traditional Chinese herbal remedies for asthma and food allergy

The increasing prevalence of allergic diseases in Westernized countries is a significant health problem. Curative therapies for these diseases are not available. There are also significant concerns regarding the potential side effects from the chronic use of conventional drugs such as corticosteroids, especially in children. Many patients with chronic allergic conditions seek complementary and alternative medicine therapies including traditional Chinese medicines. This trend has begun to attract interest from mainstream health care providers and scientific investigators and has stimulated government agencies in the United States to provide support and guidance for the scientific investigation of complementary and alternative medicine. This effort may lead to improved therapies and better health care/patient outcomes. This review presents an update on the most promising Chinese herbal remedies for asthma and food allergy.

Inhibition of mite-induced immunoglobulin E synthesis, airway inflammation, and hyperreactivity by herbal medicine STA-1

The availability of STA-1 in suppressing allergen-induced immunoglobulin E (IgE) synthesis, airway inflammation and hyperreactivity in a murine model was investigated. The mice were intraperitoneally sensitized with Dermatophagoides pteronyssinus group 5 allergen (Der p 5) and orally treated with 300 mg/kg of STA-1 every other day for 14 days. The Der p 5-specific immunologic responses including changes of specific immunoglobulin G and E, cells in the broncholarvage fluid, and airway hyperreactivity were measured when mice received inhalation challenge with Der p 5 after sensitization for 21 days. By comparing with sham-treated groups, the synthesis of Der p 5-specific IgE was downregulated while the influx of eosinophils and neutrophils in the airway were remarkably reduced. In addition, Der p 5-induced airway hyperreactivity also was significantly eliminated by STA-1 treatment. These results showed that STA-1 could effectively suppress the Der p 5-induced allergic reactions, and the availability of STA-1 for the treatment of allergic asthma was demonstrated in this study.

Immune response modulation by curcumin in a latex allergy model

Background

There has been a worldwide increase in allergy and asthma over the last few decades, particularly in industrially developed nations. This resulted in a renewed interest to understand the pathogenesis of allergy in recent years. The progress made in the pathogenesis of allergic disease has led to the exploration of novel alternative therapies, which include herbal medicines as well. Curcumin, present in turmeric, a frequently used spice in Asia has been shown to have anti-allergic and inflammatory potential.

Methods

We used a murine model of latex allergy to investigate the role of curcumin as an immunomodulator. BALB/c mice were exposed to latex allergens and developed latex allergy with a Th2 type of immune response. These animals were treated with curcumin and the immunological and inflammatory responses were evaluated.

Results

Animals exposed to latex showed enhanced serum IgE, latex specific IgG₁, IL-4, IL-5, IL-13, eosinophils and inflammation in the lungs. Intragastric treatment of latex-sensitized mice with curcumin demonstrated a diminished Th2 response with a concurrent reduction in lung inflammation. Eosinophilia in curcumin-treated mice was markedly reduced, co-stimulatory molecule expression (CD80, CD86, and OX40L) on antigen-presenting cells was decreased, and expression of MMP-9, OAT, and TSLP genes was also attenuated.

Conclusion

These results suggest that curcumin has potential therapeutic value for controlling allergic responses resulting from exposure to allergens.

Complementary and alternative medicine use in asthma: who is using what?

Consumer interest in complementary and alternative medicine (CAM) has grown dramatically in Western countries in the past decade. However, very few patients volunteer information about CAM use unless directly questioned by their health-care practitioner. Therefore, by being informed about the prevalence and modality of CAM use for asthma, as well as characteristics of users, health-care practitioners may be better able to identify patients who use CAM. In turn, this may facilitate proactive discussion and optimization of the patient's overall asthma management. This review aims to summarize the current knowledge about use of CAM by people with asthma, and to assess the applicability of the available studies to the broader asthmatic population. Computerized literature searches were conducted on Medline, Embase, Cochrane and Allied and Complementary Medicine (AMED) databases from their inception to 13 April 2005. Search terms included: complementary medicine/therapies, alternative medicine/therapies and asthma. The bibliographies of accessible articles were searched for further papers. Seventeen studies have examined the use of CAM by people with asthma. The reported level of use for adults ranged from 4% to 79%, and for children from 33% to 89%. Among the most commonly used CAMs were: breathing techniques, herbal products, homeopathy and acupuncture. There is no strong evidence for effectiveness for any of these modalities. There is little consistency among available prevalence studies making conclusions difficult. Nevertheless, the high rates of CAM use reported in some studies indicate that CAM use should be taken into account when managing patients with asthma.

The prescriptions frequencies and patterns of Chinese herbal medicine for allergic rhinitis in Taiwan

BACKGROUND

The evaluation of Chinese herbal medicines (CHM) to allergic rhinitis (AR) by large-scale pharmaco-epidemiological study is not ease found, although CHM had been reported to have potential effect for AR in some clinical trials.

AIMS OF THE STUDY

To explore the frequency and pattern of CHM prescriptions on AR, we have the study by analysing the population-based CHM database in Taiwan.

METHODS

The way for this study was linked and processed the complete traditional Chinese medicine database for Taiwanese recorded in the year 2002. The diagnosis of AR was extracted with the only single ICD-9 Code of 477 to calculate the frequency and pattern of prescriptions. Association rule was applied to analyse co-prescription of CHM for patients with AR.

RESULTS

In the year 2002, among the 22 520 776 valid beneficiaries of the National Health Insurance, Taiwan, 914 612 subjects (3.8% of the total valid beneficiaries) have diagnosed AR. There were 35.6% of AR patients been treated by CHM. The peak age of AR patients treated by CHM was at the first decade (0-10). For the AR patients, the most common Chinese herbal formula prescription was Shin-yi-qing-fei-tang, or Angelica dahurica (Bai-zhi) for the single Chinese herb. While for the combination treatments the most common prescription was the two formulae, Xiao-qing-long-tang and Shin-yi-san.

CONCLUSIONS

Because of the high utilization rate of the CHM treatment for AR, a large-scale randomized trial warrants further research for its efficacy and safety.

Viscolin, a new chalcone from Viscum coloratum, inhibits human neutrophil superoxide anion and elastase release via a cAMP-dependent pathway

The mistletoe Viscum coloratum is used in traditional Chinese medicine to treat inflammatory diseases. In this study, a cellular model in isolated human neutrophils, which are important in the pathogenesis of rheumatoid arthritis, chronic obstructive pulmonary disease, and other inflammatory diseases, was established to elucidate the anti-inflammatory functions of V. coloratum. The partially purified extract of V. coloratum (PPE-SVC) potently inhibited formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP)-induced superoxide anion generation and elastase release in a concentration-dependent manner with IC(50) values of 0.58+/-0.03 and 4.93+/-0.54 microg/ml, respectively. Furthermore, a new chalcone derivative, viscolin (4',4''-dihydroxy-2',3',6',3''-tetramethoxy-1,3-diphenylpropane), was isolated from PPE-SVC. Viscolin was demonstrated to inhibit superoxide anion generation and elastase release, as well as to accelerate resequestration of cytosolic calcium in FMLP-activated human neutrophils. Furthermore, the inhibitory effects of viscolin were reversed by protein kinase A (PKA) inhibitor, suggesting that PKA mediates the viscolin-caused inhibitions. Viscolin induced a substantial increase in cAMP levels, and that occurred through the inhibition of phosphodiesterase (PDE) activity but not an increase in adenylate cyclase function. Consistent with this, viscolin potentiated the PGE(1)-caused inhibition of superoxide anion release and calcium mobilization, as well as elevation of cAMP formation. These results demonstrate that inhibition of inflammatory responses in human neutrophils by viscolin is associated with an elevation of cellular cAMP through inhibition of PDE. Comparable results were also observed by PPE-SVC, indicating that the effect of PPE-SVC is at least partly mediated by viscolin. In summary, viscolin is a novel inhibitor of PDE and might be useful for treatment of neutrophilic inflammation.

Use of herbal preparations in the treatment of oxidant-mediated inflammatory disorders

Complementary and alternative medicine (CAM) use has increased in popularity in recent years and herbal therapy alone is now a billion dollar market. For centuries herbs have been used as food and for medicinal purposes. Various herbs have been identified as possessing anti-inflammatory and antioxidative properties, and they are currently being used to treat inflammatory disorders as well as those caused by reactive oxygen species (ROS). Asthma, Alzheimer's disease, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and atherogenesis are all disorders where inflammation and ROS are involved in their pathogenesis. This review examines the pathogenesis of the above mentioned ROS-mediated inflammatory disorders, as well as discusses the antioxidant and anti-inflammatory mechanisms of various herbs and the clinical trials where herbs have been used to treat these disorders.

Effect of a Chinese herbal formula, Shi-Bi-Lin, on an experimental model of allergic rhinitis

BACKGROUND

Jia Wei Cang Er Zi San, a traditional Chinese herbal formula, has been used to treat allergic rhinitis (AR) for several centuries. However, its effect on experimental animal models and its therapeutic mechanism remain unclear.

OBJECTIVE

To study the effect of Shu-Bi-Lin, a modified Jia Wei Cang Er Zi San, on an animal model of AR.

METHODS

Shu-Bi-Lin was administered to the guinea pig model of AR. Meanwhile, an antihistamine-treated group for the treatment control, an ovalbumin-sensitized and untreated group for the positive control, and a sham-sensitized, sham-challenged group for the sham control were studied in parallel. Symptomatic and some pathophysiologic variables were evaluated.

RESULTS

Sneezing and nasal scratching after challenges were significantly ameliorated in the Shu-Bi-Lin-treated group compared with the ovalbumin-sensitized and untreated group, but rhinorrhea volume was not reduced. Shu-Bi-Lin significantly suppressed the production of IgG1 in the passive cutaneous anaphylaxis test. The thromboxane B2 level in nasal lavage fluid was significantly deceased in the Shu-Bi-Lin-treated group; however, the reduction in histamine and peptide leukotriene levels did not reach statistical significance. In addition, eosinophil infiltration and endothelial nitric oxide synthase immunoreactivity in the nasal tissues were reduced in the Shu-Bi-Lin-treated group.

CONCLUSIONS

Shu-Bi-Lin could alleviate the nasal symptoms of AR, and its mechanism might be related to its inhibitory effect on type I anaphylaxis reactions and eosinophil infiltration in the nasal tissues, as well as the inhibition of some mediators related to AR.

Clinical evaluation of the Chinese herbal medicine formula STA-1 in the treatment of allergic asthma

Although some formulae of traditional Chinese medicines (TCM) have been used for antiasthma treatment, few of them have had sufficient discussion on their efficacy, safety and mechanisms. In this study, the availability of the TCM formula STA-1 for the treatment of allergic asthma was investigated by conducting a double-blind, placebo-controlled and randomized trial. One hundred and twenty patients between the ages of 5 to 20 years with mild-to-moderate asthma were included. These patients were treated with either STA-1 or placebo in a dose of 80 g/kg/day and were administered twice daily for 6 months. The main outcome measures were a daily diary record of symptoms, supplementary bronchodilator and glucocorticoid treatment, changes of pulmonary function (forced expiratory volume in 1 s), changes of total and Dermatophagoides pteronyssinus (DP)-specific IgE and side effects. The results showed a statistically significant reduction of symptom scores, systemic steroid dose, total IgE and specific IgE in the STA-1 group. Furthermore, STA-1 also improved the pulmonary lung function FEV(1) compared with the placebo group and only minimal side effects were shown. These results suggested that STA-1 is available for the treatment of mild-to-moderate chronic asthma.

Nigella sativa (black seed) oil does not affect the T-helper 1 and T-helper 2 type cytokine production from splenic mononuclear cells in allergen sensitized mice

Nigella sativa Linn. (Ranunculaceae) is known to have beneficial effects on a wide range of diseases including asthma. However, the mechanism of action in asthma and other allergic diseases is not entirely clear. The present study was planned to evaluate the effects of Nigella sativa on cytokine production of splenic mononuclear cells in ova-sensitized mice. Nineteen two-month-old BALB/c mice were given 0.3 mL of Nigella sativa oil by oro-eosophageal cannula once a day for a month. The control group consisting of 10 mice took 0.3 mL of 0.9% saline solution by the same route for the same period. In the third week of the study, all mice were sensitized by means of intraperitoneal injections of 20 microg of ovalbumin (OVA-Grade VI, Sigma). Ova injections were repeated three times with 7-day intervals. After another week, all mice were sacrificed by means of cervical dislocation. Then the splenic mononuclear cells (MNCs) of mice were cultured with OVA or Concavalin A (Con-A). From the culture supernatants, IL-4, IL-10 and IFN-gamma were assessed by means of ELISA. The cytokine production of splenic MNCs of mice that were given Nigella sativa for 30 days was not significantly different than those who took saline solution instead. In conclusion, Nigella sativa oil seems not to have an immunomodulatory effect on Th1 and Th2 cell responsiveness to allergen stimulation.

Effects of the Chinese herbal formula Shi-Bi-Lin on cytokine release from the human mast cell line

BACKGROUND

The traditional Chinese herbal formula Cang Er Zi San has been used for the treatment of rhinitis, paranasal sinusitis, and allergic rhinitis for several centuries. However, its therapeutic mechanisms remain largely unclear.

OBJECTIVE

To study the effects of Shi-Bi-Lin (SBL), a modified Cang Er Zi San formula, on cytokine release from and expressions in the human mast cell line (HMC-1).

METHODS

The HMC-1 was preincubated with different concentrations of SBL extract solution 1 hour before being stimulated with 25 ng/mL of phorbol myristate acetate plus 2.5 x 10(-7)M calcium ionophore A23187 and then further incubated for 6, 12, and 24 hours, respectively. The cell culture supernatants were harvested, and the cytokines of interleukin 4 (IL-4), IL-6, IL-8, and tumor necrosis factor alpha (TNF-alpha) in the supernatants were measured by enzyme-linked immunosorbent assay. Furthermore, the total RNA of the cells was extracted, and the cytokines' messenger RNA expressions were examined using semiquantitative reverse transcriptase-polymerase chain reaction.

RESULTS

After different incubation periods at different concentrations, SBL could potently inhibit the cytokines of IL-4 and TNF-alpha and modestly affect IL-6 but not obviously affect IL-8 release from the HMC-1. However, no inhibitory effects were detected on the messenger RNA expressions of these cytokines.

CONCLUSIONS

These results demonstrate that SBL could modulate the mast cell-mediated hypersensitivity reaction in allergy. Inhibition of mast cell-derived IL-4 and TNF-alpha might explain the efficacy of SBL in treating allergic disease.

Beyond allergen avoidance: update on developing therapies for peanut allergy

PURPOSE OF REVIEW

Food allergy has emerged as a significant health problem. Peanut allergy is a major cause of food-induced fatal and near fatal anaphylactic reactions, and the incidence in children is increasing. Attempts to manage peanut allergy by strict avoidance are often unsuccessful. The purpose of this review is to highlight the most promising novel approaches for treating peanut allergy beyond allergen avoidance.

RECENT FINDINGS

In the past 5 years much effort has been devoted to developing a treatment for peanut allergy. A recent clinical trial showed that monthly injections of humanized recombinant anti-IgE antibodies increased the threshold for allergic responses of peanut-sensitive individuals, at least to small amounts of peanut protein. However, this treatment cannot cure peanut allergy, and continuous monthly injections are necessary to maintain protection. Developing new therapies for the treatment of peanut allergy is essential. In reviewing publications between 2003 and 2005, several novel therapeutic approaches, tested in the murine model of peanut anaphylaxis appeared promising. Immunotherapy with engineered recombinant peanut protein and bacterial adjuvant significantly protected peanut allergic mice from anaphylaxis. It was also found that a Chinese herbal medicine formula called Food Allergy Herbal Formula-2 completely blocked anaphylaxis up to 5 weeks following therapy. These potent therapeutic effects are associated with immunoregulation of Th1 and Th2 responses.

SUMMARY

Although there is no effective and safe therapy for food allergy, many novel approaches are under investigation. Some of these approaches may provide allergists with effective treatments in the near future.

RETRACTED: Promising treatments in development for food allergies

Up to 6% of young children and 2% of adults suffer from food allergy. Among them many have IgE-mediated food allergy, a condition with potentially fatal allergic reactions. The only proven treatment is avoidance of the offending food, which can be identified using standardised allergic tests. However, several studies have addressed possible definite treatment options for food allergy. Immunotherapy, administered orally or by systemic injections, shows promising preliminary results, but these therapeutics are based on studies with insufficient scientific support, or are associated with a high risk of severe side effects. At present, no studies can support pharmacotherapy. However, promising results were recently published with anti-IgE antibodies in a human trial, and various approaches in a mouse model of food allergy (chinese herbal medicine, specific modulation of the T-cell response). Rapidly evolving findings might provide hope for a cure for food allergy in the near future.

Efficacy and safety of modified Mai-Men-Dong-Tang for treatment of allergic asthma

The aim of this study was to evaluate the efficacy and safety of a Chinese herbal formula modified Mai-Men-Dong-Tang (mMMDT) for treatment of persistent, mild-to-moderate asthma. A total of 100 asthmatic patients were enrolled and assigned to three treatment groups in this double-blind, randomized, placebo-controlled clinical trial. Over a period of 4 months, patients in groups A and B received 80 and 40 mg/kg/day of mMMDT, while those in group C received a placebo. Efficacy variables included changes in forced expiratory volume in 1 s (FEV1), symptom score, serum total immunoglobulin E (IgE), and dust mite-specific IgE. Safety assessments included complete blood count, and liver and kidney function. Relative to baseline, significantly greater increases in FEV1 were demonstrated for both A and B groups in comparison with the placebo-treated analog (both p <0.05). Further, similar improvements in symptom score were observed for both mMMDT treatment groups. The serum total IgE for group A showed a decreasing tendency after treatment but no statistical difference was noted. Furthermore, no drug-related adverse effects were reported. Blood test, and liver and kidney function were within normal range during the study, with no marked changes demonstrated over time. In conclusion, the Chinese herbal formula mMMDT provided improvements in lung function and relieved asthma symptoms in our sample of patients. Given its efficacy and safety, we consider mMMDT a credible treatment regimen for persistent, mild-to-moderate asthma.

Food allergy therapy

Novel approaches to the treatment and prevention of IgE-mediated food allergy include anti-IgE, food allergy vaccines, herbal preparations, and probiotics. They bring real hope to the patients for whom no specific therapy is available. These immunomodulatory therapies have to be evaluated carefully for potential side effects, such as overstimulation of T helper cell type 1 immune antibodies. Animal models of food allergy are invaluable in testing new therapies for food allergy.

Herbal remedies in a Nicaraguan barrio

To become more culturally competent, nurses need to increase their knowledge of the health practices of their immigrant clients. With the growing Latino immigrant community, it is imperative that nurses learn more about the cultures from which the immigrants come. This article examines the use of herbal remedies in treating common illnesses in a barrio in Managua, Nicaragua. Data were collected in a random sample of households in an impoverished community of more than 1,600 persons. The use of herbal remedies occurred in 78% of the households. Herbal remedies were used for a variety of symptoms. There was no difference in herbal remedy use based on age or education. The discussion focuses on the availability and functionality of these herbal remedies for this vulnerable population. Implications are addressed for incorporating this information into nursing practice with Central American immigrants, thereby increasing cultural competence.

Complementary and alternative interventions in asthma, allergy, and immunology

OBJECTIVE

To review which herbs are most commonly used as complementary and alternative medicine (CAM) for treatment of asthma, allergy, and immunologic conditions.

DATA SOURCES

A review of the literature was performed using the PubMed and OVID databases searching the keywords asthma, allergy, and CAM to identify studies published between 1980 and 2003 that focused on Echinacea (Echinacea augustifolia, Echinacea pallida, and Echinacea purpurea); garlic (Allium); angelica; chamomile; ephedra; gingko; grape seed extract; licorice root (Glycyrrhiza); St. John's wort (Hypericum); kava kava (Piper); peppermint oil and leaf (Mentha); stinging nettle (Urtica); and ginseng (Panax) published in the English and German literature.

STUDY SELECTION

Studies included in vitro and in vivo clinical trials and case reports selected according to the expert opinion of the author.

RESULTS

Echinacea is one of the most common herbs used to treat symptoms of the "common cold" or upper respiratory tract allergies. Although no common drug interactions have been reported, there is a risk of hepatotoxicity, exacerbation of allergies and asthma, and anaphylactic reactions. Garlic is primarily used for cardiovascular health and relief of cough, colds, and rhinitis. Adverse effects commonly include gastrointestinal disturbances, change in body odor through the sweat and breath, and rarely allergic reactions or hypoglycemia. Other CAM agents, including angelica, German chamomile flower, ephedra, gingko, grape seed extract, licorice root, St. John's wort, kava kava rhizome, peppermint, stinging nettle, and ginseng, are also associated with significant adverse effects.

CONCLUSION

The specialty of allergy and immunology has seen the second largest increase in the popularity of CAM (second only to practitioners who treat lower back pain). Almost all of the CAM interventions have displayed adverse effects, usually in the form of a hypersensitivity reaction. Allergists and clinical immunologists need to become more knowledgeable about CAM so that they can inform patients about the use and possible abuse of these modalities.

The potential use of Chinese herbal medicines in treating allergic asthma

OBJECTIVE

To discuss the potential use of the Chinese herbal formula MSSM-002 in treating asthma based on its effects on a murine model of allergic asthma, immunoregulatory actions on T(H)2 cells in vitro, and the means of standardization for herbal formula quality control.

DATA SOURCES

Information presented at the 2002 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting International Symposium on Complementary Alternative Medicine in San Antonio, TX.

STUDY SELECTION

All presentations from the ACAAI meeting that discussed MSSM-002 were considered for this review.

RESULTS

The Chinese herbal formula MSSM-002 suppressed airway hyperreactivity and eosinophilic inflammation in a murine model of allergic asthma. These effects were comparable to dexamethasone but were not accompanied by the suppression of T(H)1 responses seen with dexamethasone. In vitro studies demonstrated that MSSM-002 significantly decreased antigen-induced T(H)2 cytokine secretion by murine T(H)2 polarized splenocytes and human mucosal T(H)2 cell lines, which in contrast to dexamethasone did not cause apoptosis and was not cytotoxic but was associated with decreased GATA-3 expression. Chromatographic fingerprints of MSSM-002 and evaluation of in vivo actions showed that the quality of several batches of MSSM-002 was consistent.

CONCLUSION

MSSM-002 has a therapeutic effect on allergic asthma and immunoregulatory actions on established T(H)2 cells and may prove to be of potential clinical benefit to asthma patients.

Understanding pediatric inner-city asthma: an explanatory model approach

Explanatory models (EMs) for asthma among inner-city school-age children and their families were examined as a means of better understanding health behaviors. Children and parents were interviewed about their concepts of asthma etiology, asthma medications, and alternative therapies. Drawings were elicited from children to understand their beliefs about asthma. Nineteen children with 17 mothers from a variety of cultural backgrounds were interviewed. Among children, contagion was the primary EM for asthma etiology (53%). Twenty-five percent of children reported fear of dying from asthma, while fear of their child dying from asthma was reported by 76% of mothers. Mothers reported a variety of EMs, some culturally specific, but the majority reported biomedical concepts of etiology, pathophysiology, and triggers. Although 76% of mothers knew the names of more than one of their children's medications, 47% thought their child's medications all had similar functions. Thirty-five percent of families used herbal treatments and 35% incorporated religion into asthma treatment. Seventy-one percent of families had discontinued medications and 23% reported currently not giving anti-inflammatory medication. Reasons for discontinuing daily medications included fears of unknown side effects (53%), addiction (18%), tachyphylaxis (18%), and feeling that their child was being given too much medicine (23%). The traditional focus of asthma education is not sufficient to ensure adherence. Asthma education for children should address their views of etiology and fears about dying from asthma. Conversations with parents about their EMs and beliefs about medications and alternative therapies could assist in understanding and responding to parental concerns and choices about medications and help achieve better adherence.

Complementary and alternative medicine for bronchial asthma: is there new evidence?

PURPOSE OF REVIEW

Complementary and alternative medicine is widely used in bronchial asthma. Data on efficacy of these treatment modalities are lacking.

RECENT FINDINGS

Studies published since June 2002 on complementary and alternative medicine in bronchial asthma were systematically reviewed.

SUMMARY

Studies do not support the use of homeopathy, air ionizers, manual therapy, or acupuncture for asthma. These methods bear some risks to patients related to undertreatment and side effects. There might be a possible, but so far not clearly established, role for antioxidant dietary supplementation, and some natural antiinflammatory and immunomodulatory remedies. However, their effect size compared with the classical treatment and side-effect profile is not clearly established. Strategies influencing breathing technique or perception, such as breathing or retraining exercises, need to be studied over the next few years to establish their additive role in the treatment of asthma. Breathing exercises could improve lung function and quality of life in different studies. Psychotherapy-related methods such as relaxation, hypnosis, autogenic training, speleotherapy, and biofeedback might have a small effect in selected cases, but have not proven to be superior to placebo. Nevertheless, more randomized controlled trials of good methodological quality are required to allow firm conclusions.

Review of complementary and alternative medicine in treatment of ocular allergies

PURPOSE OF REVIEW

Ocular allergy is a common complaint of allergy sufferers, many of whom may choose to use complementary and alternative medicine in the treatment of these symptoms. In this review major complementary and alternative medicine modalities including herbal therapies, acupuncture, homeopathy, alternative immunotherapy and behavior modification are assessed for evidence of their effectiveness in the treatment of ocular allergy symptoms.

RECENT FINDINGS

Certain herbs including Euphrasia officinalis, Petasites hybridus and Argemone mexicana have been evaluated in control studies in the treatment of ocular allergy. Honey is no more effective than placebo in the treatment of ocular allergy. Acupuncture used regularly has demonstrated some positive trends in ocular allergy sufferers. Homeopathy has shown conflicting results in the treatment of ocular allergy, while alternative forms of immunotherapy have been shown to develop immunologic tolerogenic effects in the control of the condition.

SUMMARY

Several forms of complementary and alternative medicine have been studied for their effectiveness in treatment of ocular allergy symptoms. Further research is needed to assess mechanisms of action and to establish practice guidelines for the use of these modalities

Complementary and alternative medicine in children with asthma

BACKGROUND

The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children.

OBJECTIVE

To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma.

METHODS

The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM.

RESULTS

Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mother's and father's education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their child's asthma in the future (P = 0.001).

CONCLUSIONS

Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.

Complementary and alternative medicine herbal therapies for atopic disorders

More than 42% of patients with atopic disorders use some type of complementary or alternative medicine, underscoring the importance of determining the scientific validity of such treatments. This review summarizes herbal therapies from China, Japan, Korea, and India, and provides an introduction to some Western preparations. Although well-controlled scientific studies of many of the Asian herbal therapies have been carried out, and some basic studies have been performed for various herbal components (active ingredients), additional research is needed to assess the composite effects of many of these remedies.

Herbal antitussives

The mechanisms of actions of cough medicines are not always known. The problem is exacerbated for herbal medicines, where the effectiveness of the plant or its phytochemicals have rarely been carefully evaluated. Moreover, the most active phytomedicinal constituent is difficult to identify, and the expense and difficulty of such studies discourages sponsors who may not be able to benefit by subsequent exclusive marketing of the herbal remedy. Most popular herbs used as cough medicines appear to be demulcents whose action is confined to the oropharynx. It is probable that the vast majority of allegedly effective herbal cough medicines act as non-specific emetic-expectorants. The proof of activity of even marketed herbal derivatives such as guaifenesin and codeine is difficult to obtain. It is therefore likely that herbal cough medications will never be shown to be more active than placebos. Nevertheless, these plant products will continue to be popular remedies for patients and their health care advisors.