Rhinitis, sinusitis, and ocular diseases
ARIA update: I—Systematic review of complementary and alternative medicine for rhinitis and asthma

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Complementary-alternative medicines are extensively used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking. To provide evidence-based recommendations, the literature was searched by using MedLine and the Cochrane Library to March 2005 (Key words: Asthma [OR] Rhinitis, [AND] Complementary [OR] Alternative Medicine, [OR] Herbal, [OR] Acupuncture, [OR] Homeopathy, [OR] Alternative Treatment). Randomized trials, preferably double-blind and published in English, were selected. The articles were evaluated by a panel of experts. Quality of reporting was assessed by using the scale validated by Jadad. The methodology of clinical trials with complementary-alternative medicine was frequently inadequate. Meta-analyses provided no clear evidence for the efficacy of acupuncture in rhinitis and asthma. Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed. A limited number of studies of herbal remedies showed some efficacy in rhinitis and asthma, but the studies were too few to make recommendations. There are also unresolved safety concerns. Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.

Section snippets

Methods

To provide evidence-based recommendations, the available literature was searched with MedLine up to September 2005 (key words: Asthma [OR] Rhinitis, [AND] Complementary [OR] Alternative Medicine, [OR] Herbal, [OR] Acupuncture, [OR] Homeopathy, [OR] Alternative Treatment). Randomized trials, preferably double-blind and published in English, were selected, including all interventions in which CAMs were used. The Cochrane Library was also searched. The reference lists of all selected articles were

Acupuncture

Acupuncture is part of traditional Chinese medicine and is widely used for the treatment of chronic illnesses, including asthma. The theory behind the use of acupuncture is to restore the balance of “vital flows” by inserting needles at exact points of the body surface, where the “meridians” of these flows lie. Stimulation of the specific points can also be made with pressure or laser application. Acupuncture can be studied in a rigorous manner by using sham acupuncture as a control procedure.11

Herbal medicines (herbalism or phytotherapy)

Information on studies with herbal medicines can be found in Table IV.34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51

Drugs derived from plants and herbs are used commonly in medicine (eg, theophylline, ephedrine, digitalis, and morphine). Some medical systems (traditional Chinese medicine, Japanese, Kampo, and Ayurvedic) largely use herbs, often in fixed mixtures (eg, ma huang and saiboku-to) to treat diseases, including asthma and rhinitis.

There are some studies, done

Homeopathy

Homeopathy, founded by Hahnemann at the beginning of the 1800s, relies on the principle that symptoms of a disease can be cured by the same substances that provoke them when they are ultradiluted. Homeopathic remedies are selected according to symptoms and prepared with a special technique (repeated dilutions with “potentiation”). Homeopathy is a holistic approach to medicine, with particular attention to the homeopath-patient relationship. The scientific interest in homeopathy for treating

Physical techniques and other alternative treatments

Physical techniques (breathing control, breathing retraining, yoga, and chiropractic-spinal manipulation) are purported to relax the patient and improve the breathing pattern. There are several trials of physical techniques in asthma. (Table VI).74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85 Most of them failed to demonstrate a clinically relevant effect,74, 75, 81 or only marginal benefits were achieved, usually on nonspecific bronchial hyperresponsiveness.76, 77, 79 However,

Recommendations and conclusion

Data on the strength of the recommendations for CAMs in asthma and rhinitis are shown in Table VII.10

CAM is widely practiced, and many patients who use it appear to be satisfied. From a scientific viewpoint, there is no definitive or convincing proof of efficacy for most CAMs in rhinitis or asthma. In general, the methods used to study them are often inadequate (ie, not randomized, not controlled, and not blinded, with no quantitative measurement).94 Considering the randomized controlled

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    This article has been prepared by the International Board of ARIA (Allergic Rhinitis and its Impact on Asthma) in cooperation with GA2LEN (Global Allergy and Asthma European Network).

    Disclosure of potential conflict of interest: K. Carlsen has consultant arrangements with GlaxoSmithKline and is on the speakers' bureau for GlaxoSmithKline, AstraZeneca, and Merck. D. Price has consultant arrangements with Boehringer, GlaxoSmithKline, Pfizer, Ivax, and Viatris; has received grants from UK National Health Service, Abbot Laboratories, Altana Pharma, AstraZeneca, Boehringer, Pfizer, GlaxoSmithKline, Ivax, Merck, Sharpe and Dohme, Novartis, Schering Plough, Trinity Pharmaceuticals, and Viatris; and is on the speakers' bureau for Altana Pharma, AstraZeneca, Boehringer, Pfizer, GlaxoSmithKline, Ivax, Merck, Sharpe and Dohme, and Novartis. The rest of the authors have declared that they have no conflict of interest.

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