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Allergies and pregnancy

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Related Terms
  • Allergens, allergic, allergic asthma, allergic reaction, allergic response, allergic rhinitis, allergy, anaphylactic reaction, anaphylaxis, antibodies, antibody, antigens, antihistamines, asthma, asthma inhalers, dust mites, hay fever, hypersensitive, hypersensitivity, IgE, IgE-mediated, immune, immune defense system, immune system, immunoglobulin, immunoglobulin E, mold, nasal decongestant, nasal allergies, nasal spray, non-allergic rhinitis, pollen, pregnancy, radioallergosorbent test, RAST, rhinitis, rhinitis of pregnancy, seasonal allergic rhinitis, seasonal allergies, skin test, systemic allergic reaction.

Background
  • An allergy or hypersensitivity reaction occurs when the body's immune system overreacts to a substance that is normally harmless (allergen), such as mold, pollen, animal dander, or dust mites. Allergy symptoms may include runny nose, watery eyes, urticaria (hives), angioedema (swelling beneath the skin), and atopic dermatitis (red, itchy dry skin). The most severe allergic reaction, known as called anaphylaxis, can lead to low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal.
  • During pregnancy, women who have allergies may experience changes in the way they respond to allergens. Allergy symptoms may improve, worsen, or remain the same; there is no way to predict how an individual's allergies will change during pregnancy. Researchers estimate that about one-third of pregnant women who have allergies experience reduced allergy symptoms.
  • Allergic rhinitis and allergic asthma are the most common types of allergies that affect pregnant women. In addition, some pregnant women may experience non-allergic rhinitis (inflammation of the nose), also called rhinitis of pregnancy, which appears to be caused by an increase in pregnancy hormones (such estrogen and progesterone). Allergy symptoms are usually most severe between 29 and 36 weeks of pregnancy, according to researchers.
  • Minimizing exposure to known allergens may help reduce or prevent allergy symptoms. There are also many treatment options that are safe for pregnant women who have allergies. Certain asthma medications (like inhaled bronchodilators and beclomethasone), antihistamines (like diphenhydramine), and cromolyn sodium nasal sprays have been shown to be safe and effective for the treatment of allergies during pregnancy.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Allergy Asthma and Immunology. . Accessed May 4, 2009.
  2. American Lung Association. . Accessed May 4, 2009.
  3. Asthma and Allergy Foundation of America. . Accessed May 4, 2009.
  4. Centers for Disease Control and Prevention. . Accessed May 4, 2009.
  5. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 4, 2009.
  6. OB Focus. . Accessed May 4, 2009.

Causes
  • General: An allergy, or hypersensitivity reaction, occurs when the body's immune system overreacts to a substance that is normally harmless (allergen). Common allergy triggers include pollen, dust mites, molds, animal dander, latex, foods, and insect venom.
  • The white blood cells of an allergic individual produce an antibody called immunoglobulin E (IgE), which attaches to the allergen. This triggers the release of histamine and other inflammatory chemicals that cause allergic symptoms, such as runny nose, watery eyes, hives, angioedema, and atopic dermatitis. The most severe allergic reaction, known as called anaphylaxis, can lead to low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal.
  • Most allergies are inherited, which means they are passed on to children by their parents. Although people inherit a tendency to be allergic, they may not inherit an allergy to the same allergen. When one parent has allergies, each of his/her children has a 50% chance of developing allergies. That risk increases to 75% if both parents have allergies.
  • Allergic rhinitis: Pregnant women with allergies often suffer from seasonal allergic rhinitis, also called hay fever or nasal allergies, which occurs when airborne allergens like dust, dander, or pollen are inhaled. Allergic rhinitis is characterized by a collection of allergic symptoms, predominantly in the nose and eyes. When pollens cause the allergic symptoms, the allergic rhinitis is commonly referred to as hay fever. Perennial allergic rhinitis is an allergic reaction that has little or no seasonal variation. It is persistent, chronic, and generally less severe than seasonal allergic rhinitis.
  • Non-allergic rhinitis (rhinitis of pregnancy): Non-allergic rhinitis appears to be caused by an increase in pregnancy hormones, including estrogen and progesterone.
  • Allergic asthma: Pregnant women often suffer from allergic asthma, which occurs when allergens cause the airway to become inflamed. Asthma is one of the most common, potentially serious medical problems that occurs during pregnancy. According to some studies, asthma may complicate up to seven percent of all pregnancies. If asthma is not controlled, the mother has lower levels of oxygen in her blood. This may result in decreased oxygen in the fetal blood, which may also cause growth deficiencies in the fetus or death.
  • Pregnant women with asthma have an increased risk of delivering prematurely or giving birth to an infant with low birth weight. In addition, pregnant women with asthma are more likely to experience high blood pressure or a related condition called pre-eclampsia (swelling, high blood pressure, and kidney malfunction).
  • Proper treatment and management of asthma symptoms may help reduce the risk of complications, according to research.

Symptoms
  • Allergic rhinitis: Most cases of allergic rhinitis are generally mild, and do not cause complications during pregnancy. Common symptoms include cough, headache, itchy nose, itchy mouth, itchy throat, itchy skin, nosebleeds, impaired smell, watery eyes, sore throat, wheezing, fever, cross-reactivity allergy to some fruits, conjunctivitis (pinkeye), nasal congestion, post-nasal drip, runny nose, and swelling of the nasal tissues.
  • Non-allergic rhinitis (rhinitis of pregnancy): Symptoms of non-allergic rhinitis are the same as allergic rhinitis.
  • Allergic asthma: Common symptoms include: bronchospasms (abnormal contraction of the bronchi resulting in airway obstruction), coughing (constantly or intermittently), wheezing or whistling sounds when exhaling, shortness of breath or rapid breathing, chest tightness or chest pain, and fatigue. Infants may have trouble feeding and may grunt during suckling.

Diagnosis
  • Skin testing: While skin testing is the most common method of allergy testing, it is generally not performed in pregnant women because there is a slight risk of anaphylaxis, a severe allergic reaction. Anaphylaxis is a rapid, allergic reaction that affects the whole body. Anaphylaxis is a medical emergency that requires immediate medical treatment, as well as follow-up care with an allergist or immunologist. Symptoms of anaphylaxis can vary from mild to severe and may be potentially life threatening. The most dangerous symptoms are low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal. Epinephrine is a medication used to treat anaphylaxis.
  • Radioallergosorbent test (RAST®): A radioallergosorbent test (RAST®) is considered a safe alternative for pregnant women. A RAST® is a type of blood test that can determine whether a patient is allergic to particular substances. During the procedure, a sample of the patient's blood is exposed to suspected allergens (like dust mites, pollen, or animal dander) to determine whether the patient has developed allergen-specific immunoglobulin E (IgE) antibodies. Antibodies are proteins that recognize and bind to specific antigens. A qualified healthcare provider will interpret the results of the test. In general, the sensitivity of these tests ranges from 50-90%, with the average being about 70-75%. The patient will receive test results in about seven to 14 days.

Treatment
  • Safety: The U.S. food and Drug Administration (FDA) evaluates the safety of medications during pregnancy, and grades them on a scale of A through D and X. Class A is considered the safest. These medications have proven to be safe for use in pregnant women. Class B medications are considered safe during pregnancy, but definitive evidence from human trials is lacking. Class C medications are potentially harmful, according to animal studies, although no human studies are available. Class D medications should be avoided during pregnancy because they have been shown to be harmful to the human fetus. Class X drugs are considered teratogenic because the risks outweigh the benefits in pregnant women. Studies in animals or humans have shown that these drugs cause fetal abnormalities.
  • If allergies are severe, and the patient is not responding to current treatment, a healthcare provider may recommend class C medications like pseudoephedrine decongestants (Sudafed®) or corticosteroid nasal sprays like fluticasone (Flonase®). Since there are risks associated with these treatments, healthcare providers will only recommend class C medications when the benefits clearly outweigh the risks. Class D and X are not recommended during pregnancy, even if allergies are severe.
  • Pregnant women should not take any medication (prescription or over-the-counter), herb, or supplement without first consulting their obstetricians because they may interact with other agents or cause harm to the fetus. Patients should carefully read the packaging labels on medications and they should take the medication exactly as directed by their healthcare providers.
  • Asthma medications: Asthma can potentially cause harm to the fetus if the condition is uncontrolled. The safety of asthma inhalers varies. Most are assigned to Class B or Class C. Studies show that most asthma inhalers are safe during pregnancy. The risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications. However, oral medications should be avoided unless necessary to control symptoms.
  • Medications that have been used in pregnant women include inhaled bronchodilators, cromolyn sodium nasal spray (Nasalcrom®), and beclomethasone nasal spray (Beconase® or Vancenase®), all of which have a local effect. Theophylline (Bronkodyl®, Elixophyllin®, Slo-bid®, Slo-Phyllin®, Theo-24®, Theo-Dur®, Theolair®, Uniphyl®) has also been taken orally during pregnancy if the asthma is not adequately controlled by the other medications. Oral steroid medications, such as prednisone, should only be used when necessary for severe asthma during pregnancy.
  • Antihistamines: Most, but not all, antihistamines are Class B rated for pregnancy safety. Commonly used antihistamines that are considered safe (Class B) for pregnancy include chlorpheniramine (Chlor-Trimeton®), diphenhydramine (Benadryl®), and loratadine (Claritin®). In addition, cetirizine (Zyrtec®) is a commonly prescribed antihistamine that is considered safe for pregnancy. Pregnant women should avoid the popular antihistamine fexofenadine (Allegra®) because it is a Class C drug.
  • Cromolyn sodium: Cromolyn sodium nasal spray (Nasalcrom®) is another option with a Class B rating that can be used to control nasal allergy symptoms during pregnancy. The spray is used to treat and prevent allergy symptoms, such as stuffy or runny nose and sneezing. It may take up to four weeks for the spray to take effect. Eye drop versions of cromolyn sodium are also available for itchy, bloodshot eyes.

Integrative therapies
  • Note: Many integrative therapies are considered unsafe for use during pregnancy and lactation. Specific safety data for pregnancy and lactation may also be unavailable in some cases. Patients should always consult with their healthcare providers and licensed obstetrician/gynecologist before using integrative therapies for any indication.
  • Good scientific evidence:
  • Boswellia: Boswellia has been proposed as a potential therapy for asthma. Future studies are needed to assess the long-term efficacy and safety of boswellia and to compare the efficacy of boswellia to standard therapies. Boswellia should not be used for the relief of acute asthma exacerbations.
  • Boswellia is generally believed to be safe when used as directed, although safety and toxicity have not been well studied in humans. Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble medications, agents metabolized by the liver's cytochrome P450 enzymes, or sedatives. Use cautiously with impaired liver function or liver damage or lung disorders. Use cautiously in children. Avoid if pregnant due to potential abortifacient effects or if breastfeeding.
  • Bromelain: Bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation/swelling. Studies report mixed results, although overall bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a firm conclusion can be made.
  • Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour or other members of the Bromeliaceaefamily. Use cautiously with history of bleeding disorders, stomach ulcers, heart disease, liver disease or kidney disease. Use cautiously before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Buteyko breathing technique: The Buteyko breathing technique (BBT) consists of breathing techniques, relaxation exercises, and asthma education. The technique aims to reduce hyperventilation. Studies have shown reduced use of rescue inhalers among patients receiving BBT. Improvements in other measures of asthma severity have not been shown. Additional study is warranted.
  • BBT is generally considered safe. Avoid with asthma that changes suddenly ("brittle asthma"). BBT may interact with asthma medications and should be used with caution when decreasing asthma medication. Asthma should be treated by a qualified healthcare professional and patients should always carry a rescue inhaler. Avoid if pregnant or breastfeeding.
  • Butterbur: Good scientific evidence suggests that butterbur may be effective for allergic rhinitis prevention in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra®) and cetirizine (Zyrtec®), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (like ragweed, marigolds, daisies and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney, damage or cancer. Avoid if pregnant or breastfeeding.
  • Choline: Choline is possibly effective when taken orally for asthma. Choline supplements seem to decrease the severity of symptoms, number of symptomatic days and the need to use bronchodilators in asthma patients. There is some evidence that higher doses of 3 grams daily might be more effective than lower doses of 1.5 grams daily.
  • Choline is generally regarded as safe and appears to be well-tolerated. Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Coleus: There is a lack of sufficient data to recommend for or against the use of coleus in the treatment of bronchial asthma. Preliminary data appears to be promising. However, larger, randomized, controlled trials are needed to confirm the safety and efficacy of coleus for this use.
  • Coleus is generally regarded as safe, as very few reports have documented adverse effects. However, only a few short-term trials have assessed its safety in a small sample size of patients. Avoid if allergic to Coleus forskohlii and related species or with bleeding disorders. Avoid if pregnant or breastfeeding.
  • Ephedra: Ephedra contains the chemicals ephedrine and pseudoephedrine, which are bronchodilators (expand the airways to assist in easier breathing). It has been used and studied to treat asthma and chronic obstructive pulmonary disease, such as asthmatic bronchoconstriction, in both children and adults. Other treatments such as beta-agonist inhalers (for example, albuterol) are more commonly recommended due to safety concerns with ephedra or ephedrine.
  • The U.S. Food and Drug Administration (FDA) has collected thousands of reports of serious toxicity linked to ephedra (including over 100 deaths). Ephedra products are banned from dietary supplements because of serious health risks, including heart attack, heart damage, breathing difficulties and fluid retention in the lungs. Avoid ephedra if pregnant or breastfeeding.
  • Nasal irrigation: Good scientific evidence suggests that nasal irrigation may effectively treat allergies and chronic sinusitis. Well conducted clinical study is needed to make a conclusion in this area.
  • Nasal irrigation is generally well tolerated. Use cautiously with a history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
  • Probiotics: Use of probiotic Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce frequency of relapses and the need for antibiotic therapy.
  • Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Pycnogenol: Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster spp. atlantica), which is grown in coastal south-west France. Pycnogenol may offer clinical benefit to both children and adults with asthma. Additional study is needed before a conclusion can be made.
  • Avoid if allergic/hypersensitive to pycnogenol, its components, or members of the Pinaceae family. Use cautiously with diabetes, hypoglycemia, or bleeding disorders. Use cautiously if taking hypolipidemics, medications that may increase the risk of bleeding, hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if pregnant or breastfeeding.
  • Yoga: Multiple human studies report benefits of yoga (such as breathing exercises), when added to other treatments for mild-to-moderate asthma (such as standard drug therapy, diet, or massage). Better research is needed before a firm conclusion can be drawn.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
  • Unclear or conflicting scientific evidence:
  • Acupressure, shiatsu: Preliminary research suggests that acupressure may be of benefit in improving quality of life in asthma. Further well-designed studies are needed before firm conclusions can be drawn.
  • With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
  • Acupuncture: There is currently insufficient available evidence on which to base recommendations for acupuncture in non-allergic rhinitis. However, studies suggest that it may offer possible benefits. Additionally, more studies are needed of stronger design to determine whether or not acupuncture offers benefit in sinusitis.
  • Acupuncture should be avoided in patients with heart disease, pulmonary disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Pregnant women, the elderly, diabetics, people with a history of seizures, and those receiving radiation therapy and/or taking drugs increasing bleeding risks should also avoid acupuncture.
  • Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures, with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. There is currently not enough scientific evidence to make a strong recommendation for the use of the Alexander technique in chronic asthma patients. More study is needed in this area.
  • Serious side effects have not been reported with use of the Alexander technique. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
  • Applied kinesiology: Applied kinesiology is commonly used for food allergy diagnosis. However, there is conflicting scientific evidence as to whether applied kinesiology is an effective diagnostic tool. Study results are also mixed in regards to bronchial asthma. Further research is needed before conclusions can be drawn.
  • Applied kinesiology techniques in themselves are generally considered to be safe. However, medical conditions should not be treated with AK alone, and should not delay appropriate medical treatment.
  • Aromatherapy: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form). The available studies are of poor quality, and have used combination therapies or 1,8-cineole (eucalyptol), which is a component of eucalyptus. Further studies are needed before a firm conclusion can be made.
  • Skin rash (dermatitis) from direct contact with various essential oils has been reported in humans, and skin irritation and allergies may develop with regular use. Peppermint and eucalyptus oils may burn the skin if applied at full strength. Severe skin sensitivity to light may occur. Aromatherapy vapors may irritate the eyes, and affect breathing. There are reports of agitation, drowsiness, nausea, and headache with the use of aromatherapy. Some oils may have toxic effects on the brain, liver and kidney; long-term use may also increase cancer risks. Caution is advised in people who are driving or operating heavy machinery. Essential oils may be toxic if taken by mouth, and should not be swallowed. Fragrances may contain unknown and potentially toxic contaminants. The use of these oils is discouraged during pregnancy, and infants and young children may be especially sensitive.
  • Ayurveda: There is early evidence that daily supplementation with gum resin of Boswellia serrata, known in Ayurveda as Salai guggal, may reduce dyspnea (shortness of breath), rhonchi, and the number of attacks in bronchial asthma. Another herb, Devadaru (Cedrus deodara), may have antispasmodic effects and reduce symptoms in bronchial asthma, particularly for patients with shorter histories of asthma and lower frequencies of attacks. Further research is needed in this area before a recommendation can be made.
  • Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before use of any herbs or supplements. Use guggul cautiously with peptic ulcer disease. Avoid sour food, alcohol, and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Black seed: Studies in patients with allergies found that black seed decreased allergic disease severity, slightly decreased plasma triglycerides (levels of fat within the blood), and slightly increased HDL cholesterol. The effect of black seed for allergies is still not clear and further study is required.
  • Avoid with a known allergy/hypersensitivity to black seed, its constituents, black seed oil, or to members of the Ranunculaceae family. Allergic contact dermatitis has been reported after topical use of black seed or the oil from the seed.
  • Black tea: Research has shown caffeine to cause improvements in airflow to the lungs (bronchodilation). However, it is not clear if caffeine or tea use has significant clinical benefits in people with asthma. Better research is needed in this area before a conclusion can be drawn.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use caution if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism, and irritability.
  • Borage seed oil: The flowers and leaves of borage (Borago officinalis) are often pressed to produce oil very high in gamma-linolenic acid (GLA). Preliminary evidence suggests that gamma linolenic acid (GLA) may have some immunosuppressant activity that may be helpful in reducing asthma symptoms.
  • Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid in pregnant patients as borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as borage oil's GLA. Avoid if breastfeeding.
  • Butterbur: Historically, butterbur has been used to treat asthma. Pre-clinical studies report anti-inflammatory and leukotriene inhibitory properties, which may lead to clinical effects. Initial human research suggests possible benefits. However, controlled trials with adequate sample sizes are necessary in order to clarify whether there are true benefits in humans.
  • Use caution if allergic or sensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (like ragweed, marigolds, daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
  • Cat's claw: It has been suggested that cat's claw may help treat respiratory diseases involving allergies. However, there is limited scientific evidence to support this claim. More well-designed trials are needed to determine whether cat's claw is a beneficial treatment.
  • Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, lupus). Use cautiously with bleeding disorders or a history of stroke, or if taking drugs that may increase the risk of bleeding. Discontinue use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic, Texan grown plant, Acacia gregii being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
  • Chiropractic: Several studies report the effects of chiropractic spinal manipulative therapy on breathing indices and quality of life in children and adults with asthma. Results are variable, and in the studies with positive results, mostly subjective but not objective (lung function test) changes are reported. Due to methodological problems and variable results, clear conclusions cannot be drawn at this time.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
  • Coenzyme Q10: CoQ10 may benefit asthma patients when added to other therapies. Further research is needed.
  • Allergy has not been associated with Coenzyme Q10 supplements, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs, or blood pressure, blood sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Choline: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis symptoms in limited available study. However, further research is needed before a firm conclusion can be made.
  • Choline is generally regarded as safe and appears to be well tolerated. Avoid if allergic to choline, lecithin, or phosphatidylcholine.
  • Cordyceps: Cordyceps may reduce some asthma symptoms. Additional studies are needed to make a firm conclusion.
  • Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes or bleeding disorders or if taking anticoagulant medications. Use cautiously with prostate conditions, if taking immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives. Avoid with myelogenous-type cancers. Avoid if pregnant or breastfeeding.
  • Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Better studies are needed in which danshen is compared with more proven treatments for asthmatic bronchitis before a clear conclusion can be drawn.
  • Avoid if allergic or hypersensitive to danshen. Use cautiously with altered immune states, arrhythmia, compromised liver function or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin or hypotensives including ACE inhibitors such as captopri, or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders, low blood pressure and following cerebal ischemia. Avoid if pregnant or breastfeeding.
  • Elderberry and elder flower: Elder may offer benefits for bacterial sinusitis, such as reducing excessive mucus secretion.
  • Herbal preparations containing elder may result in less swelling of mucus membranes, better drainage, milder headache, and decreased nasal congestion. Cyanide toxicity is possible. Avoid if allergic to elder or to plants related to honeysuckle. Some reports exist of allergies from contact with fresh elder stems. Use caution with diabetes, high blood pressure or urinary problems, or with drugs used for any of these conditions. Use caution with anti-inflammatories, diuretics ("water pills" for high blood pressure), or laxatives. Avoid if pregnant or breastfeeding.
  • Ephedra: Preliminary study suggests that a nasal spray containing ephedrine, a chemical in ephedra, may help treat symptoms of nasal allergic rhinitis. Additional research is needed before a firm conclusion can be made.
  • The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths. Avoid use in individuals younger than 18 years old. Avoid use for prolonged periods (longer than seven days) due to risk of abuse or toxicity. Discontinue use at least one week prior to major surgery or diagnostic procedures. Use cautiously with cardiovascular disease, including structural heart disease, arrhythmia, coronary artery disease, high blood pressure, cerebrovascular disease, or a history of stroke or transient ischemic attack. Use cautiously with depression, anxiety disorders, anorexia/bulimia, a history of suicidal ideation, insomnia, tremors, urinary retention, enlarged prostate, diabetes, kidney disease, glaucoma, thyroid disease, and peptic ulcer disease. Use cautiously with monoamine oxidase inhibitor (MAOI) or stimulant use. Avoid if pregnant or breastfeeding.
  • Eucalyptus oil: Despite widespread use in multiple over-the-counter agents and inhalation vapors, there is currently insufficient available evidence to recommend either for or against use of eucalyptus oil as a decongestant-expectorant (in oral or inhaled form) and for upper and lower airway diseases, such as asthma.
  • Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of actue intermittent porphyria. Avoid during pregnancy or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
  • Gingko: Ginkgo biloba has been used medicinally for thousands of years and is currently one of the top selling herbs in the United States. Ginkgo may reduce symptoms in patients with asthma. More study is needed to make a conclusion.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergy to mango rind, sumac, poison ivy or oak or cashews exists, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.
  • Ginseng: Limited research suggests that ginseng has positive effects on breathing, such as its proposed role as a bronchodilator. More research is needed in this area.
  • Avoid ginseng with a known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Goji: In traditional Chinese medicine (TCM), herbs are almost always administered in combination formulas consisting of several herbs that balance each other's effects and enhance the success of the treatment. A case study provides some initial objective data on the formula "Invigorating Kidney," which includes wolfberry together with six other herbs. This herbal decoction showed that it may be possible to reverse airway obstruction for patients convalescing from asthma.
  • Use cautiously in patients who are taking blood-thinning medications, such as warfarin. Use cautiously in asthma patients and in patients with sulfite sensitivities. The New York Department of Agriculture has detected the presence of undeclared sulfites, a food additive, in two dried goji berry products from China. Avoid in patients who are allergic to goji, any of its constituents, or to members of the Solanaceae family.
  • Green-lipped mussel: Limited evidence suggests that green-lipped mussel supplementation may help allergic diseases, such as atopic asthma. Additional research is needed before a recommendation can be made.
  • Green-lipped mussel is generally considered safe. Use cautiously with anti-inflammatory agents. Use cautiously with asthma. Avoid in patients with liver disease. Avoid with allergy or sensitivity to green-lipped mussel or other shellfish. Avoid if pregnant or breastfeeding.
  • Green tea: Research has shown caffeine to cause improvements in airflow to the lungs (bronchodilation). However, it is not clear if caffeine or tea use has significant benefits in people with asthma. Better research is needed in this area before a conclusion can be drawn.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.
  • Honey: Currently there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis. Poor quality study reported no benefit of the use of honey for the treatment of rhinoconjunctivitis. Further research is necessary before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Horseradish: Studies have indicated that some horseradish constituents have antibiotic activity. Clinical study has used a combination product that contained nasturtium herb and horseradish root to treat sinusitis. Although the treatment had similar results as the standard antibiotic therapy control, the effect of horseradish alone cannot be isolated due to the use of a combination product. Additional high-quality clinical studies are needed before a conclusion can be made.
  • Avoid if allergic or hypersensitive to horseradish (Armoracia rusticana), its constituents, or members of the Brassicaceae family. Large oral doses may provoke allergic reactions. Use cautiously with clotting disorders, hypotension (low blood pressure), thyroid disorders, kidney disorders, kidney inflammation, gastrointestinal conditions, skin ulcers, and stomach ulcers. Use cautiously if taking anticoagulants or antiplatelets (blood thinning agents), antihypertensives (blood pressure-lowering agents), anti-inflammatory agents, or thyroid hormones. Use cautiously if undergoing treatment for cancer. Avoid medicinal amounts of horseradish if pregnant or breastfeeding, as glucosinolates from horseradish are considered a toxin that can be excreted through breast milk and may pose a toxicity hazard. Also, based on herbal textbooks and folkloric precedent, horseradish has been used to induce abortion.
  • Hypnotherapy, hypnosis: It has been suggested that hypnotherapy may be effective for allergies and may help treat hay fever. Preliminary research for the use of hypnosis for the management of asthma symptoms does not provide clear answers. Anxiety associated with asthma may be relieved with hypnosis. Further research is necessary to determine whether it is an effective treatment.
  • Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
  • Kiwi: Currently, data on the therapeutic benefit of kiwi as a preventative for lung and other respiratory problems is lacking. More research is warranted before a recommendation can be made.
  • Avoid if allergic or hypersensitive to kiwi, latex, birch pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame seeds, and related substances. Kiwi is generally considered safe when taken in amounts naturally found in foods. Use cautiously with anti-platelet drugs like aspirin, cilostazol, or clopidogrel. Use cautiously with hormone therapies or serotonergic drugs. Avoid if pregnant or breastfeeding because clinical trials testing safety in supplemental doses are currently lacking. The amount found in foods appears to be safe in most people.
  • Lactobacillus acidophilus: Limited available study suggests that the Lactobacillus acidophilus (L. acidophilus) strain L-92 (L-92) may be effective for the treatment of Japanese cedar-pollen allergy. Lactobacillus acidophilus has also been suggested as a possible treatment for asthma. However, further research is necessary before a firm conclusion can be made.
  • L. acidophilus may be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid with history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid with prescription drugs, such as corticosteroids, because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy L. acidophilus. Therefore, it is recommended that L. acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals may use antacids, such as famotidine (Pepcid®) and esomeprazole (Nexium®), to decrease the amount of acid in the stomach one hour before taking L. acidophilus.
  • Massage: Promising initial evidence suggests that massage therapy may improve lung function in children with asthma. Additional research is necessary before a firm conclusion can be drawn.
  • Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously if history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Preliminary research of transcendental meditation® for asthma reports benefits. However, due to unclear design or study description, these results cannot be considered definitive.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Melatonin: Based on preliminary research, melatonin may improve sleep in asthma. Further studies that evaluate the long-term effects of melatonin on airway inflammation and bronchial hyper-responsiveness are needed before a firm conclusion can be made.
  • Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. Available trials report that overall adverse effects are not significantly more common with melatonin than placebo. However, case reports raise concerns about risks of blood clotting abnormalities (particularly in patients taking warfarin), increased risk of seizure, and disorientation with overdose.
  • MSM: According to preliminary clinical study, MSM reduces symptoms associated with seasonal allergic rhinitis (SAR). However, larger controlled trials are needed to confirm these findings.
  • Avoid if allergic or hypersensitive to MSM. Long-term effects of supplementation with MSM have not been examined. Avoid if pregnant or breastfeeding.
  • Omega-3 fatty acids, fish oil, alpha linolenic acid: Several studies do not provide enough reliable evidence to form a clear conclusion on the use of fish oil for asthma. Because most studies have been small without clear descriptions of design or results, the results cannot be considered conclusive.
  • Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).
  • Onion: Research shows that topical application of an alcoholic onion extract significantly reduced responses to allergies. Although intriguing, more research is needed in this area to establish the efficacy and dosing of topical onion extracts.
  • Avoid if allergic or hypersensitive to onion (Allium cepa), its constituents, or members of the Lilaceae family. Use cautiously with hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), and hypotension (low blood pressure). Use cautiously if taking anticoagulants or antiplatelets (blood thinners). Avoid medicinal doses if pregnant or breastfeeding.
  • Para-aminobenzoic acid: Although limited available clinical study suggested that oral PAMBA (para-aminomethylbenzoic acid) administration helped to prevent asthma exacerbation following bronchoprovocation challenge, further studies are needed to confirm this effect.
  • Avoid oral use in children and pregnant or nursing women. PABA must be used with caution in patients with renal disease because of its predominantly renal route of excretion. Abnormalities of liver function tests have been noted in patients taking PABA. Monitoring may be indicated for higher doses (>8g per day). Blood sugar monitoring may be warranted in diabetics or patients at risk for hypoglycemia who are taking PABA systemically. Discontinue use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its derivatives should only be taken under appropriate medical supervision.
  • Peppermint: There is currently not enough available scientific evidence on the use of peppermint for asthma.
  • Use cautiously in patients with gastroesophageal reflux disease or achlorhydria due to lower esophageal sphincter relaxing effects and reports of dyspepsia. Peppermint oil should be used cautiously by people with G6PD deficiency or gallbladder disease. Use cautiously in patients with hiatal hernia or kidney stones. Avoid injection of peppermint oil, as it may result in pulmonary edema and acute lung injury. Avoid topical use of peppermint oil around the facial or chest areas of infants and young children, especially around the nose, because the menthol constituent can induce apnea, laryngeal and bronchial spasm, acute respiratory distress with cyanosis, or respiratory arrest if applied directly to these areas.
  • Perilla: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies as well as asthma. Further clinical trials are required before conclusions can be made.
  • Avoid if allergic/hypersensitive to perilla or members of the Lamiaciae/Labiatae family. Use cautiously with cancer, low HDL-cholesterol, and immune disorders. Use cautiously if taking NSAIDS or barbiturates. Avoid if pregnant or breastfeeding.
  • Physical therapy: Chest physical therapy and physiotherapy breathing retraining have been studied in both children and adults to improve quality of life and improve lung function in severe and acute asthma. Early evidence is mixed. Studies often include combination treatment with drug therapy or are not well-designed, which make it difficult to assess the magnitude of benefit, if any, of physical therapy alone. More research is warranted.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Probiotics: Only a few types and combinations of probiotics have been studied as a possible allergy treatment. They have been studied mostly in children, teenagers, and young adults. Further research is necessary before a firm conclusion can be made.
  • Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. Some research suggests that the regular practice of internal Qi gong over several months may improve breathing in asthma. Further research is needed to confirm these results.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Reflexology: Preliminary data suggests that self-applied reflexology may be as beneficial as self-applied nasal irrigation in the treatment of chronic sinusitis. However, data are insufficient for making definitive conclusions. More studies are needed.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Relaxation therapy: Preliminary studies of relaxation techniques in individuals with asthma report a significant decrease in asthma symptoms, anxiety and depression, along with improvements in quality of life and measures of lung function. Further large trials in humans are needed to confirm these results.
  • Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.
  • Sanicle: Sanicle (Sanicula europaea, Sanicula europa), a perennial plant in the Apiaceae family, has been studied for use in asthma. More evidence is needed before a recommendation can be made.
  • Avoid if allergic or sensitive to sanicle. Use cautiously with stomach problems. Use cautiously if taking blood pressure-lowering or diuretic drugs. Avoid if pregnant or breastfeeding.
  • Selenium: Preliminary research reports that selenium supplementation may help improve asthma symptoms. Further research is needed to confirm these results.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Shea butter: Studies show that shea butter may have nasal decongestant effects. More research is needed before a conclusion can be made.
  • Shea butter may be unsafe in patients taking anticoagulants (blood-thinners), and in those with latex allergies.
  • Sorrel: Research suggests that an herbal combination preparation containing sorrel, Sinupret®, may have beneficial effects in improving symptoms of sinusitis when used with antibiotics. It is not clear if these same effects would be seen with sorrel alone or what dose may be safe and effective. For allergic rhinitis, there is not enough evidence to make a conclusion at this time. More research of sorrel alone is needed.
  • Avoid sorrel with a known allergy to sorrel or any of its constituents. Avoid large doses of sorrel because there have been reports of toxicity and death. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
  • Spiritual healing: It is not clear whether spiritual healing has any effect on symptoms or quality of life in asthma patients. Further research is needed.
  • Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
  • Spirulina: Anti-inflammatory properties of spirulina may help improve symptoms of allergic rhinitis. However, further high-quality studies are needed to confirm these findings.
  • Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; of if consuming a high-protein diet. Avoid in children or if pregnant or breastfeeding.
  • Stinging nettle: For many years, a freeze-dried preparation of Urtica dioica has been prescribed by physicians and sold over-the-counter for the treatment of allergic rhinitis. Clinical trials demonstrating statistical significance over placebo and/or equivalence with other available treatments are needed to support the use of nettle in the treatment of allergic rhinitis.
  • Avoid if allergic or hypersensitive to nettle, the Urticaceae family or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, and/or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
  • Thymus extract: Thymus extract may reduce allergy symptoms due to its potential immune stimulating effects. Preliminary evidence suggests that thymus extract may be useful for asthma symptom reduction. More clinical trials are required before recommendations can be made involving thymus extract for these uses.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Tylophora: Available studies of Tylophora for asthma show conflicting results. Methodologically weak trials make extrapolation to clinical practice difficult. Therefore, efficacy remains unproven.
  • Avoid if allergic or hypersensitive to tylophora.
  • Vitamin B6: Preliminary research suggests that children with severe asthma may have inadequate pyridoxine status. Theophylline, a prescription drug used to help manage asthma, seems to lower pyridoxine levels. Studies of pyridoxine supplementation in asthma patients taking theophylline yield conflicting results. Further research is needed before a conclusion can be drawn.
  • Avoid vitamin B6 products if sensitive or allergic to any of ingredients in product formulations. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Use cautiously if pregnant or breastfeeding.
  • Vitamin C: It has been suggested that low levels of vitamin C (or other antioxidants) may increase the risk of developing asthma. The use of vitamin C for asthma has been studied since the 1980s (particularly exercise-induced asthma), although the evidence in this area remains inconclusive. Additional research is necessary before a clear conclusion can be drawn.
  • Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than Dietary Reference Intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.
  • Vitamin E: Although thought to aid in reducing the nasal symptoms of allergic rhinitis, vitamin E intake may not be effective. Current evidence is limited, however, and more studies are needed before a firm conclusion can be drawn.
  • Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams; for breastfeeding women of any age, the recommended dose is 19 milligrams. Use beyond this level in pregnant women is not recommended.
  • Fair negative scientific evidence:
  • Applied kinesiology: Applied kinesiology (AK) has been used for diagnosis of allergies, but scant research has been done in this area. There is preliminary evidence suggesting that AK is not a reliable means of wasp venom allergy diagnosis. There is currently insufficient evidence on which to base recommendations for or against use of AK in this application.
  • Applied kinesiology techniques in themselves are considered to be safe. However, medical conditions should not be treated with AK alone, and should not delay appropriate medical treatment.
  • Evening primrose oil: Small studies do not show evening primrose oil to be useful in the treatment of asthma. Further research is needed to confirm this conclusion.
  • Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
  • Grape seed: Grape seed has been used to treat immune system disorders due to its antioxidant effects. However, a well-designed human study of allergic rhinitis sufferers showed no improvement in allergy symptoms with administration of grape seed extract ingredients.
  • Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed using the liver's "cytochrome P450" enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid with disorders that increase the risk of bleeding or with active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.
  • Reflexology: Reflexology is based on the concept that areas of the feet correspond to other parts of the body, and stimulation of these areas on the feet can affect the associated body part. In addition to the feet, some practitioners perform reflexology of the ears and hands. So far, studies have shown that reflexology is no better than placebo at treating asthma.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Vitamin E: There is preliminary evidence that vitamin E does not provide benefits in individuals with asthma.
  • Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams; for breastfeeding women of any age, the recommended dose is 19 milligrams. Use beyond this level in pregnant women is not recommended.
  • Strong negative scientific evidence:
  • L-arginine: Although it has been suggested that arginine may be a treatment for asthma, studies in humans have actually found that arginine worsens inflammation in the lungs and contributes to asthma symptoms. Therefore, taking arginine by mouth or by inhalation is not recommended in people with asthma.
  • Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.

Prevention
  • Avoid exposure to known allergens, such as dust mites, mold, pet dander, and pollen, and irritants, such as tobacco smoke and strong chemical odors, which may worsen symptoms.
  • Pregnant women who suffer from allergic asthma should avoid allergen triggers that cause attacks.
  • Keep windows closed, and if possible, use the air conditioner in the house and car.
  • Do not dry clothes outside.
  • Regularly wash the hands and face to remove pollen.
  • An air purifier or high-efficiency particulate air (HEPA) filter may help remove some of the allergens out of the air.
  • Consider using a humidifier, which adds moisture to the air, to help keep the nasal passages open.
  • Vacuum carpets and fabric-covered furniture regularly to remove indoor allergens. Use a vacuum cleaner with a double-layered microfilter bag or HEPA filter.
  • Cover the bed mattress and pillows in dust-proof or allergen-impermeable covers. Regularly change bed linens, including sheets and pillow covers.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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