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Facial flushing

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Related Terms
  • Alcohol, allergic, allergic reaction, allergic response, allergy, anger, antihistamines, anxiety, blood vessels, blush, blushing, cool compress, emotions, estrogen, evening primrose oil, exercise, food additives, hormone therapy, immune, immune defense system, immune reaction, immune response, immune system, menopausal symptoms, menopause, primrose oil, red face, rosacea, sex, skin condition, skin disorders, skin reaction.

Background
  • Facial flushing occurs when there is increased blood flow to the face causing the face to suddenly become red. This may also cause the face to feel warm or hot. Sometimes the neck and chest may also become red. Most people have experienced facial flushing when they have felt embarrassed (blushing) or angry.
  • There are hundreds of potential causes of facial flushing. Some of the most common causes of facial flushing include alcohol consumption, allergies, drug reactions, emotions (e.g. embarrassment or anger), reactions to food additives, menopause, exposure to extreme temperatures (hot and cold), and skin disorders (like rosacea).
  • The exact prevalence of facial flushing has not been established. This is because facial flushing is a common symptom of many illnesses, disorders, and reactions.
  • Symptoms of facial flushing may be treated with a cool compress or by drinking cool fluids. However, the only way to prevent facial flushing from returning is to treat the underlying cause. Once the cause is treated, symptoms may resolve.

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 & Immunology. . Accessed May 13, 2009.
  2. American Academy of Dermatology (AAD). . Accessed May 13, 2009.
  3. DermNet NZ. . Accessed May 13, 2009.
  4. Izikson L, English JC 3rd, Zirwas MJ. The flushing patient: differential diagnosis, workup, and treatment. J Am Acad Dermatol. 2006 Aug;55(2):193-208. .
  5. Graham-Brown R. Dermatologic problems of the menopause. Clin Dermatol. 1997 Jan-Feb;15(1):143-5. .
  6. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 13, 2009.
  7. Wines N, Willsteed E. Menopause and the skin. Australas J Dermatol. 2001 Aug;42(3):149-8; quiz 159. .
  8. Yale SH, Vasudeva S, Mazza JJ, et al. Disorders of flushing. Compr Ther. 2005 Spring;31(1):59-71. .

Causes
  • General: Facial flushing is usually a symptom of an underlying medical condition or reaction to certain substance. Below are some of the most common causes of facial flushing.
  • Alcohol: Facial flushing may occur after alcohol consumption. This is because alcohol causes the blood vessels to expand. As a result, more blood flows to the face. For unknown reasons, people of Asian decent are more likely to experience alcohol-induced facial flushing. Certain drugs, including disulfiram (Antabuse®), chlorpropamide (Diabinese®), metronidazole (Flagyl®), and cephalosporin antibiotics (like Keflex® or Pulvules®), may cause facial flushing when taken with alcohol.
  • Allergy: An allergic reaction may cause many symptoms, including facial flushing. An allergic reaction occurs when the body's immune system overreacts to a substance that is normally harmless. The immune system mistakenly identifies a substance (like pollen or dust mites) as a foreign invader, such as bacteria. When the immune system starts to fight off the foreign substance, allergy symptoms, which may include facial flushing, develop.
  • Facial flushing may be a symptom of a severe and potentially life-threatening allergic reaction called anaphylaxis. The most serious symptoms of anaphylaxis include low blood pressure, breathing difficulties, shock ,and loss of consciousness, all of which can be fatal. Patients should seek immediate medical treatment if these symptoms develop.
  • Drugs: Facial flushing is a side effect of many drugs, including vasodilators, calcium channel blockers, nicotinic acid, morphine, amyl nitrite and butyl nitrite, cholinergic drugs, bromocriptine, thyroid releasing hormone, tamoxifen, cyproterone acetate, systemic steroids, and ciclosporin.
  • Facial flushing may also be a sign of a severe allergic reaction to the medication. If flushing occurs in other areas of the body and is accompanied by other symptoms, such as difficulty breathing, chest pain, hives, or nausea, patients should seek immediate medical treatment.
  • Emotions: Certain emotions, including embarrassment (blushing), anxiety, anger, stress, and guilt, may cause facial flushing. When patients experience such emotions, the body releases a large amount of hormones, such as adrenaline, under pressure. The blood vessels in the face respond by releasing chemicals that cause them to dilate (expand). This may lead to a reddening in color in the face (facial flushing), sometimes called adrenaline flushing.
  • Exercise: Some patients may develop facial flushing after exercising. This is because exercise increases blood flow throughout the body, including the face. This causes the face to become red.
  • Food additives: Food additives are substances or chemicals that are added to food to make it last longer, taste better, or look more appealing. Patients can read the labels of food to determine the food additives that may be present in the product. Consuming large amounts of certain food additives, including MSG (monosodium glutamate), sodium nitrate, and sulphites (such as potassium metabisulfite), may cause facial flushing. MSG is used to enhance the flavor of some foods. Sulfites occur naturally in some foods and they are sometimes added to food to prevent mold growth or enhance crispness. They also form when wine ferments. Sulphites are present in beer, cider, wine, desserts, fried and frozen vegetables, fruit juices, frozen prawns, and shrimp and milk products.
  • Foods and beverages: Spicy foods and hot beverages may cause facial flushing.
  • Menopause: Facial flushing is a common symptom of menopause (when a woman stops menstruating). In fact, an estimated 80% of menopausal women experience facial flushing. The decreased levels of hormones, such as estrogen and progesterone, may lead to facial flushing, as well as hot flashes (sudden feeling of warmth that causes sweating) and facial tingling.
  • Sex: Facial flushing may also occur after sex and/or orgasm. This is because there is an increase in blood flow throughout the body, including the face. This causes the face to become red.
  • Skin disorders: Certain skin disorders, including rosacea, may cause facial flushing.
  • Weather: Exposure to hot or cold temperatures may cause facial flushing.

Symptoms
  • Patients who have facial flushing experience a sudden reddening of the face. In some patients, the face may also feel hot. Sometimes the neck and upper chest may also become red.
  • Depending on the underlying cause, additional symptoms may also be present. For instance, if facial flushing is triggered by an allergic reaction, symptoms, such as sneezing, runny nose, or hives, may also be present. If menopause is causing facial flushing, symptoms such as hot flashes, difficulty sleeping, night sweats, and irritability may also occur.

Diagnosis
  • A healthcare provider can diagnose flushing after a physical examination and medical history. Since facial flushing may be a symptom of an underlying medical condition or allergy, additional tests may be necessary to determine the cause of symptoms.
  • In order to determine the tests that are necessary, a healthcare provider will ask the patient several questions about his/her symptoms. For instance, the healthcare provider may ask whether symptoms affect the whole body or if the face feels hot. It is important to determine how often flushing occurs and whether symptoms are becoming more frequent or severe. A physician will also ask whether symptoms worsen after alcohol consumption and if the patient is going through menopause. It is important to know whether other symptoms, such as wheezing, hives, diarrhea, or difficulty breathing, are also present because this usually indicates an allergy.

Treatment
  • General: Symptoms of facial flushing may be treated with a cool compress or by drinking cool fluids. However, the only way to prevent facial flushing from returning is to treat the underlying cause. Once the cause is treated, symptoms may resolve. If flushing occurs after a patient feels embarrassed or angry or after exercise or sex, symptoms will resolve without any treatment.
  • Avoiding triggers: If alcohol, certain foods, beverages, or food additives are causing the reaction, symptoms will resolve on their own, unless it is a symptom of a severe allergic reaction called anaphylaxis; this condition is a medical emergency that requires immediate treatment with epinephrine. Avoiding or minimizing exposure to these products helps prevent symptoms from recurring. If a drug is causing the reaction, a healthcare provider may recommend an alternative medication or dose.
  • Allergy medications: Allergy medications like diphenhydramine (Benadryl®) may be used if facial flushing is a symptom of an allergic reaction. However, unless the patient avoids exposure to substances that trigger the allergic reaction, symptoms will return once the medication wears off.
  • Epinephrine: A medication called epinephrine is used to treat a severe allergic reaction called anaphylaxis. Epinephrine is injected into the skin at a hospital. Patients with a history of anaphylaxis should carry an auto-injectable epinephrine (EpiPen®) with them at all times. If symptoms of anaphylaxis appear after exposure to an allergen, the patient uses the device to inject the epinephrine into his/her thigh. Epinephrine acts as a bronchodilator because it opens the patient's airway. It also constricts the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may also be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support.
  • Topical antibiotics: Patients who experience facial flushing as a symptom of rosacea typically receive antibiotics that are applied to the skin. These medications are used for their anti-inflammatory effects rather than their antimicrobial (ability to kill bacteria) effects. Antibiotics like metronidazole (Metrocream®, Metrogel®, or Noritate®) or azelaic acid (Azelex® or Finacea®) have been used to reduce redness and inflammation associated with the skin disorder.
  • Cool compress: Patients can soak a clean cloth under cool water and apply it to the face. This helps relieve symptoms of facial flushing. This treatment is especially beneficial if exercise, spicy foods, hot beverages, extreme temperatures, or sex/orgasm triggers symptoms.
  • Cool fluids: Drinking cool fluids or eating ice chips may help alleviate symptoms of flushing. This treatment is especially beneficial if exercise, spicy foods, hot beverages, extreme temperatures, or sex/orgasm triggers symptoms.
  • Estrogen: Patients experiencing menopause may benefit from hormone therapy with estrogen to help alleviate symptoms, including facial flushing. However, according to research, patients who receive estrogen have an increased risk of stroke. Patients should consult their healthcare providers to determine the potential health benefits and risks associated with hormone therapy.

Integrative therapies
  • Good scientific evidence:
  • Sage: Sage (Salvia officinalis) may contain compounds with mild estrogenic activity. In theory, estrogenic compounds may decrease menopausal symptoms. Sage has been tested against menopausal symptoms with promising results.
  • Avoid if allergic or hypersensitive to sage species, their constituents, or to members of the Lamiaceae family. Use cautiously with hypertension (high blood pressure). Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid with previous anaphylactic reactions to sage species, their constituents, or to members of the Lamiaceae family. Avoid if pregnant or breastfeeding.
  • Soy: Soy (Glycine max) products containing isoflavones have been studied for the reduction of menopausal symptoms such as hot flashes. The scientific evidence is mixed in this area, with several human trials suggesting reduced number of hot flashes and other menopausal symptoms, but more recent research reporting no benefits. Overall, the scientific evidence does suggest benefits, although better quality studies are needed in this area in order to make a conclusion.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
  • Unclear or conflicting scientific evidence:
  • Acupuncture: Although some studies report beneficial results, currently there is not adequate available evidence to recommend for or against the use of acupuncture in the treatment menopausal symptoms such as hot flashes. High quality clinical research is needed to make a conclusion.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.
  • Belladonna: Bellergal® (a combination of phenobarbital, ergot, and belladonna) has been used to treat menopausal symptoms like hot flashes. However, in human studies belladonna supplements have not shown effectiveness. More studies are needed.
  • Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (bell peppers, potatoes, eggplants). Avoid with history of heart disease, high blood pressure, heart attack, abnormal heartbeat (arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren's syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular disorders such as myasthenia gravis, or Down's syndrome. Avoid if pregnant or breastfeeding.
  • Black cohosh: Black cohosh (Actaea racemosa, formerly known as Cimicifuga racemosa) is popular as an alternative to hormonal therapy in the treatment of menopausal symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness. Several studies have reported black cohosh to improve symptoms for up to six months, although the current evidence is mixed. The mechanism of action of black cohosh remains unclear and the effects on estrogen receptors or hormonal levels (if any) are not definitively known. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy. Safety and efficacy beyond six months have not been proven, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated. Nonetheless, caution is advisable until better-quality safety data are available.
  • Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional. Use cautiously if allergic to members of the Ranunculaceaefamily such as buttercups or crowfoot. Avoid if allergic to aspirin products, non-steriodal anti-inflammatories (NSAIDs, Motrin®, ibuprofen, etc.), blood-thinners (like warfarin) or if history of blood clots, stroke, seizures, or liver disease. Stop use before surgery/dental/diagnostic procedures with bleeding risk and avoid immediately after these procedures. Avoid if pregnant or breastfeeding.
  • 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.
  • Butterbur: Preliminary research suggests that butterbur may not suppress allergic skin disease reactions when compared to the prescription drug fexofenadine (Allegra®), which does suppress these reactions. Additional study is needed.
  • 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.
  • Calendula: Limited early research suggests that calendula extracts may reduce skin inflammation. Human studies are lacking in this area.
  • Avoid if allergic to plants in the Aster/Compositae family such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
  • Cat's claw: Cat's claw may have anti-inflammatory effects, which has led to research of this herb for conditions such as allergies. Large, high-quality human studies are needed comparing effects of cat's claw alone vs. placebo.
  • 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.
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone made in the human body and secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). Many different aspects of menopausal disorders have been studied using DHEA as a treatment, such as vaginal pain, hot flashes or emotional disturbances such as fatigue, irritability, anxiety, depression, insomnia, difficulties with concentration, memory, or decreased sex drive (which may occur near the time of menopause). Study results disagree and additional study is needed in this area.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or with anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Flaxseed: Flaxseed (Linum usitatissimum) and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which is a biologic precursor to omega-3 fatty acids such as eicosapentaenoic acid. There is preliminary evidence from randomized controlled trials that flaxseed oil may help decrease mild menopausal symptoms. Additional research is necessary before a clear conclusion can be drawn.
  • Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil or other plants of the Linaceae family. Avoid large amounts of flaxseed by mouth and mix with plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that cause bleeding risk (like anticoagulants and non-steroidal anti-inflammatories (like aspirin, warfarin, Advil®)), high triglyceride levels, diabetes, mania, seizures or asthma. Avoid if pregnant or breastfeeding. Avoid with breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods.
  • Gamma linolenic acid (GLA): Gamma linolenic acid (GLA) is a dietary omega-6 fatty acid found in many plant oil extracts. Limited available study has examined the effect of GLA on menopausal hot flashes. No improvement in the number of hot flashed was noted as compared with placebo.
  • Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
  • Gamma oryzanol: Gamma oryzanol is a mixture of ferulic acid esters of sterol and triterpene alcohols, and it occurs in rice bran oil at a level of 1-2%, although it has been extracted from corn and barley oils as well. It is theorized that some of the health benefits from rice bran oil, namely its cholesterol-lowering effects, may be due to its gamma oryzanol content. Gamma oryzanol may reduce menopausal symptoms. However, these results must be viewed cautiously as a high placebo effect is associated with the treatment of menopausal symptoms. Additional study is needed in this area to better determine gamma oryzanol's effect on menopausal symptoms.
  • Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormone, drugs or herbs that alter blood sugar levels, immunomodulators, luteinizing hormone or luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering or thyroid drugs, or herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia, hyperglycemia and high cholesterol. Avoid if pregnant or breastfeeding.
  • Ginseng: Although ginseng (Panax ginseng) has been used for menopausal symptoms, evidence from a small amount of research is unclear in this area. Some studies report improvements in depression and sense of well-being, without changes in hormone levels.
  • Avoid with 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.
  • Green tea: Green tea supplements are made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant. A study conducted in healthy postmenopausal women showed that a morning/evening menopausal formula containing green tea was effective in relieving menopausal symptoms including hot flashes and sleep disturbances. Further studies are needed to confirm these results.
  • Green tea supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease. Caffeine-free green tea supplements are available.
  • Hops: When used in combination with other products, hops may help alleviate menopausal symptoms, such as hot flashes and difficulty sleeping, because it has estrogen-like activity. However, until more well-designed studies are performed, a strong recommendation cannot be made.
  • Hops may cause drowsiness, therefore, caution is advised when operating an automobile or heavy machinery. Hops supplements are not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.
  • Hypnotherapy: Early evidence shows that hypnotherapy may be beneficial in the treatment of hot flashes and may improve quality of life in women with menopausal disorders. Further research is needed.
  • It has also been suggested that hypnotherapy may be effective for allergies. However, further research is necessary to determine whether it is an effective treatment for this indication.
  • Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
  • Jewelweed: Jewelweed has been used traditionally as a treatment for various types of contact dermatitis, including poison ivy/oak rashes and allergic dermatitis, however, human study indicates that it may not be effective for this use.
  • Avoid if allergic or hypersensitive to jewelweed (Impatiens biflora), its constituents, or members of the Balsaminaceae family. Use cautiously if taking calcium supplements and with kidney stone disorders. Avoid consuming excess amounts of jewelweed due to reports of high mineral content, particularly calcium oxalate. Avoid if pregnant or breastfeeding.
  • Kudzu: Kudzu (Pueraria lobata) originated in China and was brought to the United States from Japan in the late 1800s. It is distributed throughout much of the eastern United States and is most common in the southern part of the continent. Kudzu contains chemicals called isoflavones, which are reported to have estrogenic activity. There is conflicting evidence regarding the effects of kudzu on menopausal symptoms. Additional study is needed to clarify these results.
  • Avoid if allergic or hypersensitive to Pueraria lobata or members of the Fabaceae/Leguminosae family. Use cautiously if taking anticoagulants/anti-platelet and blood pressure lowering agents, hormones, antiarrhythmics, benzodiazepines, bisphosphonates, diabetes medications, drugs that are metabolized by the liver's cytochrome P450 enzymes, mecamylamine, neurologic agents, or methotrexate. Well-designed studies on the long-term effects of kudzu are currently unavailable. Avoid if pregnant or breastfeeding.
  • Marshmallow: Marshmallow extracts have traditionally been used to treat inflammatory skin conditions. Several laboratory experiments, mostly in the 1960s, reported marshmallow to have anti-inflammatory activity but limited human study is available. Safety, dosing, and effectiveness compared to other anti-inflammatory agents have not been examined.
  • Historically, marshmallow is generally regarded as being safe in healthy individuals. However, since studies have not evaluated the safety of marshmallow, proper doses and duration in humans are not known. Allergic reactions may occur. There is not enough scientific evidence to support the safe use of marshmallow during pregnancy or breastfeeding.
  • Milk thistle: An herbal preparation containing milk thistle may be effective in decreasing menopausal symptoms. However, milk thistle alone has not been researched.
  • Use cautiously if allergic to plants in the aster family (Compositea or Asteraceae), daisies, artichoke, common thistle, or kiwi. Use cautiously with diabetes. Avoid if pregnant or breastfeeding.
  • Onion: Early research shows that topical application of an alcoholic onion extract significantly reduced responses to allergies, such as wheals (hives) and flares. More research is needed.
  • 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: Para-aminomethylbenzoic acid (PABA) may be useful in the treatment of lichen slerosus, a benign, progressive dermatologic condition characterized by inflammation, pruritus (itching), and pain, especially in the anogenital region (involving the anus and genitals). Additional investigations are needed regarding the use of PABA for inflammatory skin disorders.
  • Avoid with known hypersensitivity to PABA or its derivatives. Discontinue use if rash, nausea, or anorexia occurs. Avoid oral use in children and pregnant or nursing women. Use cautiously in patients with renal or liver disease. PABA should not be given concurrently with sulfonamides. Use cautiously in patients with bleeding disorders or taking anticoagulants. Use cautiously in patients with diabetes or hypoglycemia.
  • Peony: Peony root may have beneficial effects on immune function. These effects may help decrease inflammation associated with allergic skin reactions such as allergic dermatitis. There is currently not enough evidence to recommend for or against the use of peony in allergic skin conditions.
  • Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
  • Perilla: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. 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.
  • Pomegranate: There is currently not enough evidence to support the use of pomegranate in the reduction of menopausal symptoms.
  • Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under supervision of a qualified healthcare professional. Use cautiously with liver damage or disease. Pomegranate supplementation can be unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind can cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data.
  • 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.
  • Red clover: Red clover (Trifolium pratense) is a legume, which like soy, contains "phytoestrogens" (plant-based chemicals that are similar to estrogen, and may act in the body like estrogen or may actually block the effects of estrogen). Laboratory research suggests that red clover isoflavones have estrogen-like activity. However, there is no clear evidence that isoflavones share the possible benefits of estrogens (such as effects on bone density). Red clover isoflavones are proposed to reduce menopausal symptoms (such as hot flashes) and to serve as a possible alternative to hormone replacement therapy (HRT). However, most of the available human studies are poorly designed and short in duration. As results of published studies conflict with each other, more research is needed before a clear conclusion can be drawn.
  • Avoid if allergic to red clover or other isoflavones. Use caution with hormone replacement therapy (HRT) or birth control pills. Use caution with history of a bleeding disorder, breast cancer, or endometrial cancer. Use caution with drugs that thin the blood. Avoid if pregnant or breastfeeding.
  • Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet that are believed to correspond to other parts of the body. Currently, there is not enough evidence to support the use of reflexology for treating hot flashes and other menopausal symptoms.
  • 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: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus. There is promising early evidence from human trials supporting the use of relaxation techniques to reduce menopausal symptoms,although effects appear to be short-lived. Better quality research is necessary before a firm conclusion can be drawn.
  • 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.
  • St. John's wort: Extracts of St. John's wort (Hypericum perforatum) have been recommended traditionally for a wide range of medical conditions. The most common modern-day use of St. John's wort is the treatment of depression. Although St. John's wort supplements have been used with effectiveness in treating depression associated with menopause, there is a lack of high quality human studies supporting the use of St. John's wort for peri-menopausal symptoms.
  • St. John's wort interferes with the way the body processes many drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood in the short-term (causing increased effects or potentially serious adverse reactions) and/or decreased in the blood in the long-term (which can reduce the intended effects). Examples of medications that may be affected by St. John's wort in this manner include carbamazepine, cyclosporin, irinotecan, midazolam, nifedipine, birth control pills, simvastatin, theophylline, tricyclic antidepressants, warfarin, or HIV drugs such as non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs). The U.S. Food & Drug Administration (FDA) suggests that patients with HIV/AIDS on protease inhibitors or non-nucleoside reverse transcriptase inhibitors avoid taking St. John's wort. Avoid if allergic or hypersensitive to plants in the Hypericaceae family. Rare allergic skin reactions like itchy rash have been reported. Avoid with organ transplants, suicidal symptoms, or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with diabetes or with history of mania, hypomania (as in Bipolar Disorder), or affective illness. Avoid if pregnant or breastfeeding.
  • Tea tree oil: Small studies show that tea tree oil applied to the skin may reduce allergic skin reactions caused by histamine-induced inflammation. Further research is needed to confirm these results.
  • Avoid allergic or hypersensitive to tea tree oil (Melaleuca alternifolia), any of its constituents, balsam of Peru, benzoin, colophony (rosin) tinctures, eucalyptol, or members of the Myrtle (Myrtaceae) family. Avoid taking tea tree oil by mouth. Avoid if taking antineoplastic agents. Use tea tree oil applied to the skin cautiously in patients with previous tea tree oil use. Avoid if pregnant or breastfeeding.
  • Thyme: Historically, thyme has been used topically for a number of inflammatory skin disorders. Results are mixed. Additional study is needed in this area.
  • Avoid with known allergy/hypersensitivity to members of the Lamiaceae (mint) family or to any component of thyme, or to rosemary (Rosmarinus officinalis). Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury, or in atopic patients, due to multiple reports of contact dermatitis. Use cautiously in patients with gastrointestinal irritation or peptic ulcer disease due to anecdotal reports of gastrointestinal irritation. Use cautiously in patients with thyroid disorders due to observed anti-thyrotropic effects in animal research of the related species Thymus serpyllum. Avoid if pregnant or breastfeeding.
  • Thymus extract: Thymus extract may reduce allergy symptoms due to its potential immune stimulating effects. More clinical trials are required before recommendations can be made involving thymus extract for this use.
  • 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.
  • Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) herbs are commonly used for menopausal symptoms such as hot flushes. Evidence is mixed. More studies are needed to explore the possible benefit of TCM herbs in menopausal symptoms.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ephedra (ma huang). Avoid ginseng if pregnant or breastfeeding.
  • Valerian: Valerian root (Valerian officinalis) has been used as a sedative and anti-anxiety treatment for more than 2,000 years. There is currently not enough available scientific evidence on the use of valerian for menopausal symptoms.
  • Caution is advised when taking valerian supplements, as numerous adverse effects including drowsiness and drug interactions are possible. Caution is also advised when operating heavy machinery or an automobile if taking valerian supplements. Valerian is not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.
  • Vitamin E: Vitamin E is a fat-soluble vitamin with antioxidant properties. A study of oral vitamin E reports a very small reduction in frequency of breast cancer-related hot flashes (approximately one less hot flash per day), but no preference among patients for vitamin E over placebo.
  • Vitamin E supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe if taken at doses lower than the recommended dietary allowance (RDA). Avoid with retinitis pigmentosa (loss of peripheral vision).
  • Wild yam: It has been hypothesized that wild yam (Dioscorea villosa and other Dioscorea species) possesses dehydroepiandrosterone (DHEA)-like properties, and acts as a precursor to human sex hormones such as estrogen and progesterone. Based on this proposed mechanism, extracts of the plant have been used to treat menopausal symptoms such as hot flashes and headaches. However, these uses are based on a misconception that wild yam contains hormones or hormonal precursors - largely due to the historical fact that progesterone, androgens, and cortisone were chemically manufactured from Mexican wild yam in the 1960s. It is unlikely that this chemical conversion to progesterone occurs in the human body. The hormonal activity of some topical wild yam preparations has been attributed to adulteration with synthetic progesterone by manufacturers, although there is limited evidence in this area.
  • Avoid wild yam if allergic or hypersensitive to wild yam or any member of the Dioscorea plant family. Use cautiously with a history of hormone-sensitive conditions (e.g. breast cancer or endometrial cancer), asthma, blood clots, stroke, or diabetes. Avoid if pregnant or breastfeeding.
  • Yoga: Early evidence showed mixed results regarding yoga's effect on menopausal symptoms. Although early results are promising, more research is needed in this area.
  • 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, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided 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. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
  • Fair negative scientific evidence:
  • Boron: It has been proposed that boron affects estrogen levels in post-menopausal women. However, preliminary studies have found no changes in menopausal symptoms.
  • Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate or glycinate. Avoid with history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions like breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.
  • Dong quai: Dong quai (Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and is used primarily for health conditions in women. Dong quai is used in traditional Chinese formulas for menopausal symptoms. It has been proposed that Dong quai may contain "phytoestrogens" (chemicals with estrogen-like effects in the body). However, it remains unclear from laboratory studies if Dong quai has the same effects on the body as estrogens, blocks the activity of estrogens, or has no significant effect on estrogens.
  • Dong quai supplements may increase the risk of bleeding in sensitive individuals, such as those taking medications to reduce blood clotting, including aspirin and warfarin (Coumadin®). Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae / Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with diabetes, glucose intolerance or hormone sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
  • Evening primrose oil: Available studies do not show evening primrose (Oenothera biennis) oil to be helpful with flushing or bone metabolism during menopause. Larger, well-designed study is needed.
  • 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.
  • Traditional or theoretical uses lacking scientific evidence:
  • Oregano: Traditionally, oregano has been used to treat symptoms of rosacea. However, human studies that evaluate the safety and efficacy of this treatment are currently unavailable.
  • Research suggests that oregano is well tolerated in recommended doses. Avoid if allergic or hypersensitive to oregano. Use cautiously if allergic or hypersensitive to other herbs from the Lamiaceae family, including hyssop, basil marjoram, mint, sage, and lavender. Use caution with diabetes and bleeding disorders.Pregnant or breastfeeding women should not consume oregano at doses higher than those normally found in food.
  • Perilla: Although perilla has been traditionally used to treat rosacea, scientific evidence is lacking in this area. Until scientific research is conducted, it remains unknown whether perilla is an effective treatment for rosacea.
  • 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.
  • Relaxation therapy: Relaxation therapy has been suggested as a possible treatment for rosacea. However, scientific studies on the safety and efficacy of this treatment are currently lacking.
  • 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.

Prevention
  • Avoid exposure to known allergens.
  • Avoid or minimize exposure to hot or cold temperatures if they are known to trigger symptoms.
  • Do not consume alcohol with drugs that are known to cause facial flushing.
  • If alcohol has caused facial flushing, patients can avoid or limit their alcohol intake to prevent symptoms from occurring.
  • If menopausal, speak to a healthcare provider about therapeutic options to reduce facial flushing and hot flashes.
  • Individuals with a history of anaphylaxis should carry an autoinjectable epinephrine device (known as an EpiPen®) with them at all times. A trained family member or friend may help the patient administer the epinephrine, if necessary.
  • Try to avoid hot drinks, spicy foods, or food additives if they are known to trigger symptoms.

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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