Complementary Alternatives

By Christine Haran
|  Tuesday, Jun 30, 2009  |  Updated 3:43 PM PDT
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Today, people are almost as familiar with the herbal supplement echinacea as they are with aspirin. So it's no surprise that many Americans are turning to complementary and alternative (CAM) therapies to treat their allergy and asthma symptoms. When it comes to conditions for which people seek out nontraditional treatments, studies suggest that asthma and allergies are second only to lower back pain.

It's estimated that allergies affect 40 to 50 million Americans, and about 20 million have asthma. While herbal supplements and other complementary and alternative therapies, such as hypnosis and acupuncture, may ease some symptoms, experts say people have to be careful about which CAM treatment they choose. Not only are some people with allergies particularly susceptible to adverse drug reactions, but there is also a chance that some alternative remedies may interact with other medications.

Why Go Alternative?
You may wonder why people are turning to alternatives when there are many medications, both prescription and over-the-counter, that successfully treat asthma and allergies. Like many people with chronic medical conditions, those who suffer from asthma and allergies are often particularly interested in trying new, &natural& treatments. However, natural doesn't necessarily mean without side effects, and just like medications made by pharmaceutical companies, &natural& products can be powerful and toxic.

Another driving force behind the move toward alternative remedies may be the high cost of allergy and asthma medicines, says Dr. Gailen Marshall, a professor of medicine and director of the clinical immunology, asthma and allergy division at the University of Mississippi in Jackson. For example, some patients who have both allergies and asthma may choose to only treat their asthma to cut costs. But they may run into trouble quickly, because flaring allergies can worsen asthma symptoms. When this happens, Marshall says, people are more inclined to turn to CAM therapies, which are typically less expensive than prescriptions.

Safety Concerns
Unlike drug makers, manufacturers of herbal products and other dietary supplements do not have to demonstrate the safety and effectiveness of their products to the Food and Drug Administration (FDA). So little may be known about the true effects of a particular CAM product.

In a study published in a supplement devoted to CAM therapies in the Annals of Allergy, Asthma and Immunology, Dr. Leonard Bielory of the UMDNJ-New Jersey Medical School in Newark reviewed the medical literature to uncover the possible benefits as well as consequences of popular CAM therapies for asthma, allergies and immune system conditions.

"Many of my patients were taking complementary and alternative therapies," Bielory explains. "I wanted to learn more about what's real and not real. Physicians shouldn't downplay CAM if people feel better, even if it's a placebo effect. However, there are some herbal supplements that have adverse effects."

Bielory found that the most common side effects were various forms of allergic reaction like hives or contact dermatitis, which usually appears as an itchy rash.

Specific CAM Side Effects
But is the possibility of more serious side effects. Specifically, Bielory found that echinacea, used for the common cold and for upper respiratory tract allergies, carries some risk of liver toxicity. There have also been some reports linking echinacea to asthma attacks, life-threatening anaphylactic reactions, and worsening of asthma and allergies symptoms. People with pollen allergies or sensitivity to sunflower seeds or melons may be more likely to have an adverse reaction to echinacea.

Likewise, bee pollen, a CAM therapy sometimes used for asthma and allergies, has been shown to trigger sore throat and breathing problems. It should never be used by people who are allergic to bee pollen since it could lead to anaphylactic shock.

Ginkgo biloba, which has been shown to expand the air passages in the lungs, is sometimes recommended to people with asthma. But Bielory points out that ginkgo biloba interacts with warfarin (Coumadin), a blood-thinning medication, and can make it less effective. Physicians also caution people about using ginkgo biloba in combination with aspirin, or other non-steroid anti-inflammatories, since it can intensify the potency of these drugs and lead to serious complications.

Asthma sufferers specifically should be wary of St. John's wort, a supplement often recommended for anxiety and depression. It may interact with oral asthma medications such as theophylline.

Stress reduction techniques, such as biofeedback and hypnosis, are relatively safe and free of side effects. Some studies, including one conducted by Marshall, have demonstrated that chronic anxiety and depression play a role in asthma. So stress management, Marshall says, from counseling to CAM approaches, may help certain patients control their asthma and perhaps their allergy symptoms.

What Now?
According to Bielory, the next step for many of these herbal supplements is clinical trials. But that may never happen since companies don't have to submit trial data to the FDA; costly studies just aren't a good investment for them. In the meantime, allergists can familiarize themselves with CAM treatments, and patients need to be open with their doctors about which therapies they are taking.

"Patients with asthma and allergies should insist on an open-mindedness in their practitioners about discussing complementary and alternative therapies," Marshall says. "If their healthcare practitioner is not open-minded, the patient should find someone who is."

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