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December 18, 2006 — Complementary or alternative medicine (CAM) has increased tremendously in popularity in the United States. At a symposium held at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI), a team of experts discussed the safety and efficacy of CAM for the management of allergic diseases.
"As the United States has reached the 300 million person mark and with the world population approaching 7 billion, only 10 percent and at most to 30 percent of our health care is actually delivered by what we consider conventional or biomedical-oriented practitioners," said Leonard Bielory, M.D., professor of medicine, pediatrics & ophthalmology, and director, Asthma & Allergy Research Center at UMDNJ — New Jersey Medical School in Newark.
"The remaining 70 to 90 percent ranges from self-care according to folk principles to care given in an organized health care system based on an alternative tradition or practice," said Dr. Bielory.
Under the broad umbrella term of CAM fall a very wide and diverse number of modalities. These include the use of herbals, vitamins and other supplements, acupuncture and traditional Chinese medicine (TCM), homeopathy, naturopathy, chiropractic medicine, massage therapy, and Ayurveda. Often included into this mix are energy therapies such as Qi gong and bioelectromagnetic treatments, as well as mind-body practices that encompass prayer, meditation or even dance.
CAM for Allergic Diseases
This topic is of great importance to the subspecialty of allergy and immunology because one of the most common reasons that patients turn to CAM is for treating allergic diseases.
However, the possibility of more serious side effects exists, and some of the agents may have unfavorable interactions with prescription drugs. One survey found that 12 percent of asthmatic patients were using eucalyptus oil, which can reduce mucous membrane inflammation of the upper respiratory tract and act as a decongestant. However, eucalyptus oil can increase the effect on the central nervous system of drugs such as Ativan, Valium, barbiturates, narcotics, alcohol, and some antidepressants.
Echinacea is commonly used to treat allergic rhinitis and the common cold, but it can trigger an allergic reaction in patients who have allergies to plants in the Asteraceae or Compositae family (ragweed, chrysanthemums, marigolds, daisies). Anaphylaxis is also a potential side effect. The FDA has determined that there is no scientific evidence to support the use of Echinacea in the common cold.
Traditional Chinese Medicine
"There has been a recent surge of interest in TCM in Western countries, as it is low cost and has shown favorable safety profiles," said Xiu-Min Li, M.D., an associate professor of Pediatric Allergy & Immunology at the Mount Sinai School of Medicine in New York. She is also director of the Center of Excellence for Chinese Herbal Therapy for Allergy and Asthma funded by NIH.
Herbal therapy is in the mainstream of modern medical practice in China for treating asthma, although the role for TCM in Western countries has not been established as there are no FDA approved botanical drugs for treating asthma.
Dr. Li and colleagues have received a grant from the National Center for Complementary and Alternative Medicine to investigate a three-herb Chinese formula known as ASHMI, as a therapy for allergic asthma. Studies of the herbal formula first looked at its mechanism of action in an animal model, characterized the active components of the herbs, and have completed an investigation with asthma patients.
The study, conducted as a collaborative project with Weifang Asthma Hospital in China, investigated the efficacy and safety of ASHMI in 91 patients with asthma. In this randomized, double-blind active-controlled study, patients received either ASHMI or prednisone for four weeks.
"In the animal study, we found that ASHMI was effective in suppressing AHR, eosinophilic inflammation and airway remodeling, and had an immunomodulatory effect on Th1/Th2 responses," said Dr. Li.
"In our clinical trial, there was significantly improved lung function and symptom scores in patients who used ASHMI," said Dr. Li. "There was a beneficial immunoregulatory effect on Th1/Th2 balance. This study indicates that ASHMI may be an effective, safe, and well-tolerated botanical drug."
There is an ongoing FDA approved clinical trials at Mount Sinai School of Medicine to investigate whether ASHMI can reduce or replace corticosteroids in persistent moderate-to-severe asthma.
Probiotics
Another area of growing interest is in the use of probiotics to both treat and prevent allergic disorders. Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora.
"Microflora or healthy bacteria within the gut appear to be an important part of our mucosal protection while also supporting healthy bowel functions," said Renata J. M. Engler, M.D., from the Uniformed Service University of Health Sciences at Walter Reed Hospital in Washington, D.C. "When the healthy bacterial flora is disrupted as with antibiotic therapy, illnesses such as vaginitis and serious bowel infections may occur more easily. In addition, there is a growing body of evidence that the healthy bacteria may interact beneficially with the immune system overall.
"Although too early to translate into specific clinical recommendations, the evolving data suggest that probiotics may have a role in modulating the natural history of atopic dermatitis in the infant, particularly through the mother before the birth of the infant," she said.
Probiotics are currently proposed as beneficial for the treatment of acute diarrhea in both adults and children, the prevention of diarrhea caused by antibiotics, and to support remission of pouchitis.