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Allergies > Doctors: Alternative medicines

Alternative Medicines

Various alternative medicines for allergies are available, including:

- Chinese herbal medicine
- Homeopathy
- Herbal remedies
- Nutritional supplements
- Food avoidance
- Saline nasal washes
- Acupuncture

There is no proven clinical value of most alternative medicines in treating allergic rhinitis. In those studies that have found a benefit, there is frequently poor methodology, or the results can be attributed to a placebo effect.

However, if a patient perceives an improvement in their symptoms whilst using an alternative medicine, and is satisfied with the treatment, then they probably should not be dissuaded from taking it, unless it is considered a health risk.

There are few estimates of the extent of use of alternative treatment in allergic rhinitis, but it appears that it may be common.

- A survey in the US reported that in 300 adults with asthma or rhinosinusitis, 127 (42%) reported using alternative medicine. Of these, 24% reported herbal use, 18% reported caffeine use, and 22% had used other alternative therapies; 26% were not current prescription medication users

Many people may prefer to try natural remedies rather than use pharmacological treatments, or may turn to them if pharmacological treatments are ineffective. Primary care practitioners should be aware of the range of natural remedies available to allergic rhinitis patients.

Chinese Herbal Medicine

Chinese medicine typically comprises 10 or more herbs boiled in water and used as a soup. Chinese herbal formulations available for allergic rhinitis include Turtle shell, Cistanche combination, and Jade Screen powder]. The efficacy of Chinese herbal medicine in allergic rhinitis has not been rigorously tested.

Homeopathy

Classical homeopathy is based on the concept that a substance that evokes certain symptoms in healthy individuals may be effective in the treatment of illnesses with similar symptoms, if given in very small doses.

Traditionally, the patient visits a homeopathic practitioner who evaluates their symptoms, personality, and daily living. A suitable homeopathic preparation is then selected (typically consisting of herbs diluted into a solution). Homeopathic remedies can also be bought over the counter.

There is no conclusive evidence for a beneficial effect of homeopathic remedies in allergic disease, particularly as trials assessing their use often use sub-standard methodology. Any benefits reported in studies can usually be attributed to a placebo effect. Indeed, patients tend to be equally satisfied by treatment prescribed by a trained practitioner, or bought over-the-counter. However, a few small randomised, controlled studies have shown a beneficial effect of homeopathy over placebo in the treatment of allergic rhinitis, and so the debate continues.

However, homeopathy is completely safe. Therefore, if a patient believes that their symptoms have improved whilst using it, they should be allowed to continue with the treatment.

Homeopathic remedies used in the treatment of allergic rhinitis include: Allium cepa (common onion), Euphrasia (eyebright), Nux vomica (poison nut), Pusatilla (windflower), Histaminium, Kalic bic, Natrum mur, Sabadilla, Solidago, and Wyethia.

Herbal Remedies

Nettle leaf (Urtica dioica)

In a double-blind, placebo-controlled, randomised study, patients with allergic rhinitis were given freeze-dried Urtica dioica for 1 week. Urtica dioica was rated higher than placebo in global assessments of disease, but this was not significant. Allergic and gastric side effects are rare.

Quercetin

Quercetin is a flavonoid aglycone of rutin that is found in vegetables and herbs. It has been found to inhibit inflammatory processes eg it reduces antigen stimulated histamine release, and prevents mast cell and basophil degranulation. There have been no clinical outcome studies on the use of quercetin in allergic rhinitis.

Others

Other herbal supplements that are available for allergic rhinitis include bromelain, chamomile, Echinacea angustifolia (coneflower), Hydrastis canadensis (goldenseal), Gallium aparine (cleavers), Zingiber officinalis (ginger root), Sambucus nigra (elderberry), and Euphrasia officinalis (eyebright). There is no clinical evidence for their efficacy

Nutritional Supplements

Vitamin C

Vitamin C appears to have several anti-histamine effects. A small, placebo-controlled study found that 2 g of vitamin C significantly decreased bronchial responsiveness to histamine challenge in patients with allergic rhinitis.

Others

Other supplements that are available for allergic rhinitis include N-acetylcysteine, vitamins A, B, and E, and zinc. There is no clinical evidence for their efficacy.

Avoidance of Food Allergens

People allergic to pollen may also have adverse reactions to certain foods.

- In 102 children monosensitized to grass pollen, 60% had positive skin tests to food allergens (mainly tomato, peanut, green peas, and wheat) compared with 9% of 117 children monosensitised to Dermatophagoides [10]. These results suggested the presence of cross-reacting IgE to grass pollen, tomato and peanut antigens.

Patients allergic to pollen may also have intolerance to certain foods, and therefore they should therefore be advised to avoid any food that may trigger their allergies.

Saline Washes

Irrigation of the nasal passages with warm saline is thought to remove allergens from the nasal passages and thus relieve the symptoms of allergic rhinitis. There is only anecdotal evidence for the benefits of this procedure. One study found that simple saline irrigation and large-particle vapour treatment reduced inflammatory mediators in the nasal secretions of 30 symptomatic patients with allergic rhinitis.

Acupuncture

There is no good evidence for the use of acupuncture in allergic rhinitis or asthma.

References

Ziment I, Tashkin DP. Alternative medicine for allergy and asthma. J Allergy Clin Immunol 2000;106:603–614.

Blanc PD, Trupin L, Earnest G, Katz PP, Yelin EH, Eisner MD. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis. Data from a population-based survey. Chest 2001;120:1461–1467.

Merrell WC, Shalts E. Homeopathy. Med Clin North Am 2002;86:47–62.

Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997;350:834–843.

Reilly DT, Taylor MA, McScharry C, Aitchison T. Is homeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as model. Lancet 1986;2:881–886.

Taylor MA, Reilly DT, Llewellyn-Jones RH, McScharry C, Aitchison T. Randomised controlled trial of homeopathy versus placebo in perennial allergis rhinitis with overview of four trial series. BMJ 2000;321:471–476.

Thornhill SM, Kelly AM. Natural remedies of perennial allergic rhinitis. Altern Med Rev 2000;5:448–454

Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care 2002;29:231.

Mittman P. Randomized, double-blind study of freeze-dried Urtica dioica in the treatment of allergic rhinitis. Planta Med 1990;56:44–47.

de Martino M, Novembre E, Cozza G, de Marco A, Bonazza P, Vierucci A. Sensitivity to tomato and peanut allergens in children monosensitised to grass pollen. Allergy 1988;43:206–213.

Boccafogli A, Vicentini L, Camerani A, Cogliati P, D'Ambrosi A, Scolozzi R. Adverse food reactions in patients with grass pollen allergic respiratory disease. Ann Allergy 1994;73:301–308.