The Journal of Allergy and Clinical Immunology
Volume 123, Issue 2 , Pages 283-294.e10 , February 2009

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

  • Timothy Mainardi, MD, MS
    • ,
  • Simi Kapoor, MD
    • ,
  • Leonard Bielory, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Leonard Bielory, MD, Professor, Department of Medicine, Pediatrics, Ophthalmology and Visual Sciences, UMDNJ-New Jersey Medical School, Division of Allergy, Immunology and Rheumatology, Asthma and Allergy Research Center, 90 Bergen Street, Suite 4700, Newark, NJ 07103-2499.

Received 11 November 2008 ,Revised 18 December 2008 ,Accepted 19 December 2008.

References 

  1. Angell M, Kassirer JP. Alternative medicine—the risks of untested and unregulated remedies. N Engl J Med. 1998;339:839–841
  2. Resnick ES, Bielory BP, Bielory L. Complementary therapy in allergic rhinitis. Curr Allergy Asthma Rep. 2008;8:118–125
  3. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002.
  4. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569–1575
  5. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246–252
  6. WHO . Traditional medicine. Geneva, Switzerland: World Health Organization; 2003;
  7. Myers SP, Cheras PA, Myers SP, Cheras PA. The other side of the coin: safety of complementary and alternative medicine. Med J Aust. 2004;181:222–225
  8. Heimall J, Bielory L. Defining complementary and alternative medicine in allergies and asthma: benefits and risks. Clin Rev Allergy Immunol. 2004;27:93–103
  9. Studdert DM, Eisenberg DM, Miller FH, Curto DA, Kaptchuk TJ, Brennan TA. Medical malpractice implications of alternative medicine. JAMA. 1998;280:1610–1615
  10. Chen C, Biller J, Willing SJ, Lopez AM. Ischemic stroke after using over the counter products containing ephedra. J Neurol Sci. 2004;217:55–60
  11. Samenuk D, Link MS, Homoud MK, Contreras R, Theoharides TC, Wang PJ, et al. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clin Proc. 2002;77:12–16
  12. Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150–1155
  13. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007;297:842–857
  14. Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB, et al. Heavy metal content of Ayurvedic herbal medicine products. JAMA. 2004;292:2868–2873
  15. Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300:915–923
  16. Fugh-Berman A, Ernst E. Herb-drug interactions: review and assessment of report reliability. Br J Clin Pharmacol. 2001;52:587–595
  17. Ruschitzka F, Meier PJ, Turina M, Luscher TF, Noll G. Acute heart transplant rejection due to Saint John's wort. Lancet. 2000;355:548–549
  18. Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St John's wort. Lancet. 2000;355:547–548
  19. Wood B, Wishart J. Potent topical steroid in a Chinese herbal cream. N Z Med J. 1997;110:420–421
  20. Hon KL, Lee VW, Leung TF, Lee KK, Chan AK, Fok TF, et al. Corticosteroids are not present in a traditional Chinese medicine formulation for atopic dermatitis in children. Ann Acad Med Sing. 2006;35:759–763
  21. Hon KL, Leung TF, Ng PC, Lam MC, Kam WY, Wong KY, et al. Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol. 2007;157:357–363
  22. Critchley JA, Zhang Y, Suthisisang CC, Chan TY, Tomlinson B. Alternative therapies and medical science: designing clinical trials of alternative/complementary medicines—is evidence-based traditional Chinese medicine attainable?. J Clin Pharmacol. 2000;40:462–467
  23. Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocr Rev. 2005;26:662–687
  24. Rigby WF, Stacy T, Fanger MW. Inhibition of T lymphocyte mitogenesis by 1,25-dihydroxyvitamin D3 (calcitriol). J Clin Invest. 1984;74:1451–1455
  25. Thien R, Baier K, Pietschmann P, Peterlik M, Willheim M. Interactions of 1 alpha,25-dihydroxyvitamin D3 with IL-12 and IL-4 on cytokine expression of human T lymphocytes. J Allergy Clin Immunol. 2005;116:683–689
  26. van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol. 2005;97:93–101
  27. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296:2832–2838
  28. Munger KL, Zhang SM, O'Reilly E, Hernan MA, Olek MJ, Willett WC, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004;62:60–65
  29. Zingg JM. Vitamin E and mast cells. Vitam Horm. 2007;76:393–418
  30. Kempna P, Reiter E, Arock M, Azzi A, Zingg JM. Inhibition of HMC-1 mast cell proliferation by vitamin E: involvement of the protein kinase B pathway. J Biol Chem. 2004;279:50700–50709
  31. Wagner JG, Jiang Q, Harkema JR, Ames BN, Illek B, Roubey RA, et al. Gamma-tocopherol prevents airway eosinophilia and mucous cell hyperplasia in experimentally induced allergic rhinitis and asthma. Clin Exp Allergy. 2008;38:501–511
  32. Schuster GU, Kenyon NJ, Stephensen CB. Vitamin A deficiency decreases and high dietary vitamin A increases disease severity in the mouse model of asthma. J Immunol. 2008;180:1834–1842
  33. Ross AC. Vitamin A supplementation and retinoic acid treatment in the regulation of antibody responses in vivo. Vitam Horm. 2007;75:197–222
  34. Saxon A, Keld B, Braun J, Dotson A, Sidell N. Long-term administration of 13-cis retinoic acid in common variable immunodeficiency: circulating interleukin-6 levels, B-cell surface molecule display, and in vitro and in vivo B-cell antibody production. Immunology. 1993;80:477–487
  35. Zhang JG, Morgan L, Spickett GP. The effects of vitamin A derivatives on in vitro antibody production by peripheral blood mononuclear cells (PBMC) from normal blood donors and patients with common variable immunodeficiency (CVID). Clin Exp Immunol. 1997;107:57–60
  36. Karlowski TR, Chalmers TC, Frenkel LD, Kapikian AZ, Lewis TL, Lynch JM. Ascorbic acid for the common cold: a prophylactic and therapeutic trial. JAMA. 1975;231:1038–1042
  37. Dykes MH, Meier P. Ascorbic acid and the common cold: evaluation of its efficacy and toxicity. JAMA. 1975;231:1073–1079
  38. Bielory L, Gandhi R. Asthma and vitamin C. Ann Allergy. 1994;73:89–96quiz -100
  39. Bielory L, Lupoli K. Herbal interventions in asthma and allergy. J Asthma. 1999;36:1–65
  40. Fogarty A, Lewis SA, Scrivener SL, Antoniak M, Pacey S, Pringle M, et al. Oral magnesium and vitamin C supplements in asthma: a parallel group randomized placebo-controlled trial. Clin Exp Allergy. 2003;33:1355–1359
  41. Ram FS, Rowe BH, Kaur B. Vitamin C supplementation for asthma. Cochrane Database Syst Rev. 2004;CD000993
  42. Chen SC, Chang YL, Wang DL, Cheng JJ. Herbal remedy magnolol suppresses IL-6-induced STAT3 activation and gene expression in endothelial cells. Br J Pharmacol. 2006;148:226–232
  43. Tse AK, Wan CK, Zhu GY, Shen XL, Cheung HY, Yang M, et al. Magnolol suppresses NF-kappaB activation and NF-kappaB regulated gene expression through inhibition of IkappaB kinase activation. Mol Immunol. 2007;44:2647–2658
  44. Cho SY, Park SJ, Kwon MJ, Jeong TS, Bok SH, Choi WY, et al. Quercetin suppresses proinflammatory cytokines production through MAP kinases and NF-kappaB pathway in lipopolysaccharide-stimulated macrophage. Mol Cell Biochem. 2003;243:153–160
  45. Ruiz PA, Braune A, Holzlwimmer G, Quintanilla-Fend L, Haller D. Quercetin inhibits TNF-induced NF-kappaB transcription factor recruitment to proinflammatory gene promoters in murine intestinal epithelial cells. J Nutr. 2007;137:1208–1215
  46. Tan WF, Lin LP, Li MH, Zhang YX, Tong YG, Xiao D, et al. Quercetin, a dietary-derived flavonoid, possesses antiangiogenic potential. Eur J Pharmacol. 2003;459:255–262
  47. Wen MC, Wei CH, Hu ZQ, Srivastava K, Ko J, Xi ST, et al. Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma. J Allergy Clin Immunol. 2005;116:517–524
  48. Srivastava K, Teper AA, Zhang TF, Li S, Walsh MJ, Huang CK, et al. Immunomodulatory effect of the antiasthma Chinese herbal formula MSSM-002 on TH2 cells. J Allergy Clin Immunol. 2004;113:268–276
  49. Jang M, Cai L, Udeani GO, Slowing KV, Thomas CF, Beecher CW, et al. Cancer chemopreventive activity of resveratrol, a natural product derived from grapes. Science. 1997;275:218–220
  50. Baur JA, Pearson KJ, Price NL, Jamieson HA, Lerin C, Kalra A, et al. Resveratrol improves health and survival of mice on a high-calorie diet. Nature. 2006;444:337–342
  51. Wood JG, Rogina B, Lavu S, Howitz K, Helfand SL, Tatar M, et al. Sirtuin activators mimic caloric restriction and delay ageing in metazoans. Nature. 2004;430:686–689
  52. Manna SK, Mukhopadhyay A, Aggarwal BB. Resveratrol suppresses TNF-induced activation of nuclear transcription factors NF-kappa B, activator protein-1, and apoptosis: potential role of reactive oxygen intermediates and lipid peroxidation. J Immunol. 2000;164:6509–6519
  53. Youn HS, Lee JY, Fitzgerald KA, Young HA, Akira S, Hwang DH. Specific inhibition of MyD88-independent signaling pathways of TLR3 and TLR4 by resveratrol: molecular targets are TBK1 and RIP1 in TRIF complex. J Immunol. 2005;175:3339–3346
  54. Mehendale SR, Bauer BA, Yuan CS, Mehendale SR, Bauer BA. Yuan C-S. Ephedra-containing dietary supplements in the US versus ephedra as a Chinese medicine. Am J Chin Med. 2004;32:1–10
  55. Schaneberg BT, Crockett S, Bedir E, Khan IA, Schaneberg BT, Crockett S, et al. The role of chemical fingerprinting: application to ephedra. Phytochemistry. 2003;62:911–918
  56. Schafer T. Epidemiology of complementary alternative medicine for asthma and allergy in Europe and Germany. Ann Allergy Asthma Immunol. 2004;93:S5–S10
  57. Sidora-Arcoleo K, Yoos HL, McMullen A, Kitzman H. Complementary and alternative medicine use in children with asthma: prevalence and sociodemographic profile of users. J Asthma. 2007;44:169–175
  58. Gupta S, George P, Gupta V, Tandon VR, Sundaram KR. Tylophora indica in bronchial asthma—a double blind study. Ind J Med Res. 1979;69:981–989
  59. Mathew K, Shipvuri D. Treatment of asthma with alkaloids of Tylophora indica: double blind study. Aspects Allergy Appl Immunol. 1974;7:166–178
  60. Shivpuri D, Menon M, Prakash D. A crossover double-blind study on Tylophora indica in the treatment of asthma and allergic rhinitis. J Allergy Clin Immunol. 1969;43:145–150
  61. Shivpuri DN, Singhal SC, Parkash D. Treatment of asthma with an alcoholic extract of Tylophora indica: a cross-over, double-blind study. Ann Allergy. 1972;30:407–412
  62. Rouhi H, Ganji F, Nasri H. Effects of ginger on the improvement of asthma [the evaluation of its treatmental effects]. Pak J Nutr. 2006;5:373–376
  63. Gabrielian E, Narimanian M, Aslanian G, Amroyan E, Panossian A. A placebo controlled double blind study with an Ayurvedic drug PulmoFlex in bronchial asthma. Phytomedica. 2004;5:113–120
  64. Juergens UR, Dethlefsen U, Steinkamp G, Gillissen A, Repges R, Vetter H. Anti-inflammatory activity of 1.8-cineol (eucalyptol) in bronchial asthma: a double-blind placebo-controlled trial. Respir Med. 2003;97:250–256
  65. Badria F, Mohammed E, El-Badrawy M, El-Desouky M. Natural leukotriene inhibitor from Boswellia: a potential new alternative for treating bronchial asthma. Alt Compl Ther. 2004;10:257–265
  66. Gupta I, Gupta V, Pariha RA, Gupta S, Ludtke R, Safayhi H. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. 1998;3:511–514
  67. Khayyal M, el-Ghazaly M, el-Khatib A, Hatem A, de Vries P, el-Shafei S. A clinical pharmacological study of the potential beneficial effects of a propolis food product as an adjuvant in asthmatic patients. Fund Clin Pharmacol. 2003;17:93–102
  68. Lau BH, Wong DS, Slater JM. Effect of acupuncture on allergic rhinitis: clinical and laboratory evaluations. Am J Chin Med. 1975;3:263–270
  69. Mellis CM. Is asthma prevention possible with dietary manipulation?. Med J Aust. 2002;177(suppl):S78–S80
  70. Theoharides TC, Bielory L. Mast cells and mast cell mediators as targets of dietary supplements. Ann Allergy Asthma Immunol. 2004;93:S24–S34
  71. Schuster GU, Kenyon NJ, Stephensen CB. Vitamin A deficiency decreases and high dietary vitamin A increases disease severity in the mouse model of asthma. J Immunol. 2008;180:1834–1842
  72. Arora P, Kumar V, Batra S. Vitamin A status in children with asthma. Pediatr Allergy Immunol. 2002;13:223–226
  73. Harik-Khan RI, Muller DC, Wise RA. Serum vitamin levels and the risk of asthma in children. Am J Epidemiol. 2004;159:351–357
  74. Riccioni G, Barbara M, Bucciarelli T, di Ilio C, D'Orazio N. Antioxidant vitamin supplementation in asthma. Ann Clin Lab Sci. 2007;37:96–101
  75. Riccioni G, D'Orazio N. The role of selenium, zinc and antioxidant vitamin supplementation in the treatment of bronchial asthma: adjuvant therapy or not?. Exp Opin Investig Drugs. 2005;14:1145–1155
  76. Nja F, Nystad W, Lodrup Carlsen KC, Hetlevik O, Carlsen K-H. Effects of early intake of fruit or vegetables in relation to later asthma and allergic sensitization in school-age children. Acta Paediatr. 2005;94:147–154
  77. Milner JD, Stein DM, McCarter R, Moon RY. Early infant multivitamin supplementation is associated with increased risk for food allergy and asthma. Pediatrics. 2004;114:27–32
  78. Moreira A, Kekkonen R, Korpela R, Delgado L, Haahtela T. Allergy in marathon runners and effect of Lactobacillus GG supplementation on allergic inflammatory markers. Respir Med. 2007;101:1123–1131
  79. Mizuno Y, Furusho T, Yoshida A, Nakamura H, Matsuura T, Eto Y. Serum vitamin A concentrations in asthmatic children in Japan. Pediatr Int. 2006;48:261–264
  80. Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008;121:116–121e11
  81. Ogden NS, Bielory L. Probiotics: a complementary approach in the treatment and prevention of pediatric atopic disease. Curr Opin Allergy Clin Immunol. 2005;5:179–184
  82. Stonemetz D. A review of the clinical efficacy of evening primrose. Holist Nurs Pract. 2008;22:171–174
  83. Lee HS, Kim SK, Han JB, Choi HM, Park JH, Kim EC, et al. Inhibitory effects of Rumex japonicus Houtt on the development of atopic dermatitis-like skin lesions in NC/Nga mice. Br J Dermatol. 2006;155:33–38
  84. Jackson CM, Lee DK, Lipworth BJ. The effects of butterbur on the histamine and allergen cutaneous response. Ann Allergy Asthma Immunol. 2004;92:250–254
  85. Choi JJ, Park B, Kim DH, Pyo M-Y, Choi S, Son M, et al. Blockade of atopic dermatitis-like skin lesions by DA-9102, a natural medicine isolated from Actinidia arguta, in the Mg-deficiency induced dermatitis model of hairless rats. Exp Biol Med. 2008;233:1026–1034
  86. Choi MS, Kim EC, Lee HS, Kim SK, Choi HM, Park JH, et al. Inhibitory effects of Saururus chinensis (LOUR.) BAILL on the development of atopic dermatitis-like skin lesions in NC/Nga mice. Biol Pharm Bull. 2008;31:51–56
  87. Donsky H, Clarke D. Relieva, a Mahonia aquifolium extract for the treatment of adult patients with atopic dermatitis. Am J Ther. 2007;14:442–446
  88. Klovekorn W, Tepe A, Danesch U. A randomized, double-blind, vehicle-controlled, half-side comparison with a herbal ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica for the treatment of mild-to-moderate atopic dermatitis. Int J Clin Pharmacol Ther. 2007;45:583–591
  89. Ukawa Y, Izumi Y, Ohbuchi T, Takahashi T, Ikemizu S, Kojima Y. Oral administration of the extract from Hatakeshimeji (Lyophyllum decastes sing.) mushroom inhibits the development of atopic dermatitis-like skin lesions in NC/Nga mice. J Nutr Sci Vitaminol. 2007;53:293–296
  90. Kimata H. Improvement of atopic dermatitis and reduction of skin allergic responses by oral intake of konjac ceramide. Pediatr Dermatol. 2006;23:386–389
  91. Schempp CM, Windeck T, Hezel S, Simon JC. Topical treatment of atopic dermatitis with St. John's wort cream—a randomized, placebo controlled, double blind half-side comparison. Phytomedicine. 2003;10(suppl 4):31–37
  92. Matsumoto T, Shibata T. The ex vivo effect of the herbal medicine sho-saiko-to on histamine release from rat mast cells. Eur Arch Otorhinolaryngol. 1998;255:359–364
  93. Lee DKC, Carstairs IJ, Haggart K, Jackson CM, Currie GP, Lipworth BJ. Butterbur, a herbal remedy, attenuates adenosine monophosphate induced nasal responsiveness in seasonal allergic rhinitis. Clin Exp Allergy. 2003;33:882–886
  94. Schapowal A. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res. 2005;19:530–537
  95. Urtica dioica; Urtica urens (nettle). [monograph] Alt Med Rev. 2007;12:280–284
  96. Kobayashi S, Tanabe S. Evaluation of the anti-allergic activity of Citrus unshiu using rat basophilic leukemia RBL-2H3 cells as well as basophils of patients with seasonal allergic rhinitis to pollen. Int J Mol Med. 2006;17:511–515
  97. Shin TY, Kim SH, Suk K, Ha JH, Kim I, Lee MG, et al. Anti-allergic effects of Lycopus lucidus on mast cell-mediated allergy model. Toxicol Appl Pharmacol. 2005;209:255–262
  98. Kim S-H, Lee S, Kim IK, Kwon TK, Moon J-Y, Park W-H, et al. Suppression of mast cell-mediated allergic reaction by Amomum xanthiodes. Food Chem Toxicol. 2007;45:2138–2144
  99. Bernstein DI, Bernstein CK, Deng C, Murphy KJ, Bernstein IL, Bernstein JA, et al. Evaluation of the clinical efficacy and safety of grapeseed extract in the treatment of fall seasonal allergic rhinitis: a pilot study. Ann Allergy Asthma Immunol. 2002;88:272–278
  100. Yoshimura M, Enomoto T, Dake Y, Okuno Y, Ikeda H, Cheng L, et al. An evaluation of the clinical efficacy of tomato extract for perennial allergic rhinitis. Allergol Int. 2007;56:225–230
  101. Mao TK, Van de Water J, Gershwin ME. Effects of a spirulina-based dietary supplement on cytokine production from allergic rhinitis patients. J Med Food. 2005;8:27–30
  102. Josling P, Steadman S. Use of cellulose powder for the treatment of seasonal allergic rhinitis. Adv Ther. 2003;20:213–219
  103. Saxena VS, Venkateshwarlu K, Nadig P, Barbhaiya HC, Bhatia N, Borkar DM, et al. Multicenter clinical trials on a novel polyherbal formulation in allergic rhinitis. Int J Clin Pharmacol Res. 2004;24:79–94
  104. Badar VA, Thawani VR, Wakode PT, Shrivastava MP, Gharpure KJ, Hingorani LL, et al. Efficacy of Tinospora cordifolia in allergic rhinitis. J Ethnopharmacol. 2005;96:445–449
  105. Yang SH, Yu CL. Antiinflammatory effects of Bu-zhong-yi-qi-tang in patients with perennial allergic rhinitis. J Ethnopharmacol. 2008;115:104–109
  106. Hu G, Walls RS, Bass D, Ramon B, Grayson D, Jones M, et al. The Chinese herbal formulation biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12-week clinical trial. Ann Allergy Asthma Immunol. 2002;88:478–487
  107. Zhao Y, van Hasselt CA, Woo JK, Chen GG, Wong YO, Wang LH, et al. Effects of the Chinese herbal formula Shi-Bi-Lin on cytokine release from the human mast cell line. Ann Allergy Asthma Immunol. 2005;95:79–85
  108. Ikeda Y, Kaneko A, Yamamoto M, Ishige A, Sasaki H. Possible involvement of suppression of Th2 differentiation in the anti-allergic effect of sho-seiryu-to in mice. Jpn J Pharmacol. 2002;90:328–336
  109. Denny SI, Thompson RL, Margetts BM. Dietary factors in the pathogenesis of asthma and chronic obstructive pulmonary disease. Curr Allergy Asthma Rep. 2003;3:130–136

 Series editors: Donald Y. M. Leung, MD, PhD, and Dennis K. Ledford, MD

PII: S0091-6749(08)02439-1

doi: 10.1016/j.jaci.2008.12.023

The Journal of Allergy and Clinical Immunology
Volume 123, Issue 2 , Pages 283-294.e10 , February 2009

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