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Braunwalder C, Ertl J, Wullschleger M, Timm E, Wolf U. Efficacy and Safety of Phytotherapy and Anthroposophic Medicine in Seasonal Allergic Rhinitis: A Systematic Review. Int Arch Allergy Immunol 2024:1-12. [PMID: 39084196 DOI: 10.1159/000539645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Seasonal allergic rhinitis (SAR) is a common health condition that is associated with an increased risk for bronchial asthma. Besides conventional medicine, treatments from traditional, complementary and integrative medicine are widely used by individuals with SAR. This review aims to systematically summarize evidence on the efficacy, effectiveness, and safety of European/Western phytotherapy (PT) and medications from anthroposophic medicine (AM) in individuals with SAR. METHODS Four electronic databases were screened for clinical studies published between January 1990 and March 2023. The results were qualitatively synthesized and the study quality was assessed. RESULTS In total, 14 studies were included, 11 from European/Western PT and three from AM. About half of the studies were rated as being of sufficient quality. The most frequently studied plant was Petasites hybridus (butterbur), showing beneficial effects on immunological parameters, subjective symptoms, and nasal airflow. Beneficial immunological and clinical effects were also shown for an herbal preparation combining Citrus limonis (lemon) and Cydonia oblonga (quince). The medications examined by studies of sufficient quality were judged to be safe. CONCLUSION In summary, this systematic review highlights two herbal preparations, one from European/Western PT and one from AM, that appear to be promising options in the treatment of SAR.
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Affiliation(s)
- Céline Braunwalder
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Jana Ertl
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Matteo Wullschleger
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Eliane Timm
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
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Baars EW, Kienle GS, Heusser P, Pedersen PA, van Wietmarschen HA, Kiene H, von Schoen-Angerer T, Hamre HJ. Anthroposophic Medicinal Products: A Literature Review of Features, Similarities and Differences to Conventional Medicinal Products, Scientific and Regulatory Assessment. Glob Adv Health Med 2022; 11:21649561211073079. [PMID: 35281956 PMCID: PMC8915225 DOI: 10.1177/21649561211073079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Regulatory assessment of anthroposophic medicinal products (AMPs) can be challenging due to their specific features. Objective The aim of this paper is therefore to provide adequate scientific information on AMPs for regulatory purposes. Methods A literature review was executed with database searches in PubMed, Cinahl, Merkurstab, Anthromedics, and https://iaap-pharma.org/. Search terms were: anthroposophic medicinal products, anthroposophic medicines, anthroposophic pharmacy. There was no language restriction; searches were executed from onset until June 11, 2020. In addition, experts were invited to suggest relevant literature. Results Eighty-seven of 660 identified publications were included. The system of anthroposophic medicine (AM) with its conceptual background and various aspects of AMPs was described: definition, pharmaceutical properties, an example of AMP development, use in clinical practice, similarities with and differences to conventional medicinal products, societal aspects, scientific and regulatory assessment. Conclusion AMPs are part of the integrative whole medical system of AM. AMPs are manufactured according to Good Manufacturing Practice and national drug regulations and have an excellent safety status; the limited available evidence suggests clinical benefits. Current drug regulation of AMPs in the EU and most European countries does not take the special properties of AMPs into account. Future research should focus on appropriate methodologies for the evaluation of effects of AMPs as part of the AM whole medical system, the scientific quality of its non-atomistic holistic ontological position, and the integration of AM and conventional medicine in clinical practice. Future policies should focus on appropriate ways of addressing regulatory challenges to AMPs.
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Affiliation(s)
- Erik W Baars
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands.,Faculty of Healthcare, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Gunver S Kienle
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Faculty of Medicine, Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Heusser
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Peter A Pedersen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Independent Pharmaceutical Consultant, Søborg, Denmark
| | - Herman A van Wietmarschen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | | | - Harald J Hamre
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
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Baars EW, Kiene H, Kienle GS, Heusser P, Hamre HJ. An assessment of the scientific status of anthroposophic medicine, applying criteria from the philosophy of science. Complement Ther Med 2018; 40:145-150. [PMID: 30219440 DOI: 10.1016/j.ctim.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The objective was to evaluate the scientific status of anthroposophic medicine (AM) according to demarcation criteria proposed in contemporary philosophy of science. DESIGN Criteria for what is science were retrieved from eight publications in the philosophy of science, focusing either on science in medicine or on the demarcation between science and pseudoscience or non-science. Criteria were combined, redundancies were excluded, and the final set of criteria was ordered in a logical sequence. The analysis yielded 11 demarcation criteria (community, domain, problems, goals, axiomatic basis, conceptual basis, quality of concepts, methodology, deontic basis, research products, tradition). RESULTS Assessing the scientific status of AM according to the 11 criteria, all criteria were fulfilled by AM. DISCUSSION AM is grounded on the notion that specific non-atomistic holistic formative forces exist and can be empirically and rationally assessed. From a position claiming that such holistic forces cannot possibly exist or cannot be empirically and rationally assessed, the axiomatic and conceptual basis of AM can be contested. However, such an a priori rejection is problematic in the presence of empirical evidence supporting the validity of holistic concepts, as discussed in the paper. Future research should therefore focus on the tenability of the ontological reductionist position in science and on the further validation of AM non-atomistic holistic concepts, methods and practices. CONCLUSION In this analysis, using criteria from philosophy of science, AM fulfilled all 11 criteria for what is science.
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Affiliation(s)
- Erik W Baars
- ESCAMP, Zechenweg 6, D-79111 Freiburg, Germany; Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, The Netherlands; University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, The Netherlands.
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Zechenweg 6, D-79111 Freiburg, Germany
| | - Gunver S Kienle
- ESCAMP, Zechenweg 6, D-79111 Freiburg, Germany; Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Zechenweg 6, D-79111 Freiburg, Germany; Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Heusser
- ESCAMP, Zechenweg 6, D-79111 Freiburg, Germany; Witten/Herdecke University, Gerhard-Kienle-Weg 4, D-58313 Herdecke, Germany
| | - Harald J Hamre
- ESCAMP, Zechenweg 6, D-79111 Freiburg, Germany; Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Zechenweg 6, D-79111 Freiburg, Germany
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Hoffmann A, Klein SD, Gründemann C, Garcia-Käufer M, Wolf U, Huber R. Efficacy of a Nasal Spray from Citrus limon and Cydonia oblonga for the Treatment of Hay Fever Symptoms-A Randomized, Placebo Controlled Cross-Over Study. Phytother Res 2016; 30:1481-6. [PMID: 27282490 DOI: 10.1002/ptr.5649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/30/2016] [Indexed: 11/12/2022]
Abstract
Nasal spray from lemon and quince (LQNS) is used to treat hay fever symptoms and has been shown to inhibit histamine release from mast cells in vitro. Forty-three patients with grass pollen allergy (GPA) were randomized to be treated either with placebo or LQNS for one week, respectively, in a cross-over study. At baseline and after the respective treatments patients were provoked with grass pollen allergen. Outcome parameters were nasal flow measured with rhinomanometry (primary), a nasal symptom score, histamine in the nasal mucus and tolerability. In the per protocol population absolute inspiratory nasal flow 10 and 20 min after provocation was higher with LQNS compared to placebo (-37 ± 87 mL/s; p = 0.027 and -44 ± 85 mL/s; p = 0.022). The nasal symptom score showed a trend (3.3 ± 1.8 in the placebo and 2.8 ± 1.5 in the LQNS group; p = 0.070) in favor of LQNS; the histamine concentration was not significantly different between the groups. Tolerability of both, LQNS and placebo, was rated as very good. LQNS seems to have an anti-allergic effect in patients with GPA. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Hoffmann
- Center for Complementary Medicine, University Medical Center Freiburg, Germany
| | - S D Klein
- Institute of Complementary Medicine, University of Bern, Switzerland
| | - C Gründemann
- Center for Complementary Medicine, University Medical Center Freiburg, Germany
| | - M Garcia-Käufer
- Center for Complementary Medicine, University Medical Center Freiburg, Germany
| | - U Wolf
- Institute of Complementary Medicine, University of Bern, Switzerland
| | - R Huber
- Center for Complementary Medicine, University Medical Center Freiburg, Germany
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Baars EW, Nierop AF, Savelkoul HF. Development of systems biology-oriented biomarkers by permuted stepwise regression for the monitoring of seasonal allergic rhinitis treatment effects. J Immunol Methods 2012; 378:62-71. [DOI: 10.1016/j.jim.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 01/23/2012] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
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A comparative in vitro study of the effects of separate and combined products of Citrus e fructibus and Cydonia e fructibus on immunological parameters of seasonal allergic rhinitis. Mediators Inflamm 2012; 2012:109829. [PMID: 22315506 PMCID: PMC3270462 DOI: 10.1155/2012/109829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 10/10/2011] [Indexed: 11/17/2022] Open
Abstract
This paper examined the effects of the combined product, Citrus e fructibus/Cydonia e fructibus (Citrus/Cydonia; Citrus and Cydonia: each 0.01 g/mL), and separate products of Citrus (0.01 g/mL) and Cydonia (0.01 g/mL) on the immunological pathways involved in seasonal allergic rhinitis (SAR). Peripheral blood mononuclear cells (PBMCs) from five healthy and five grass pollen-allergic donors were isolated and analyzed in vitro after polyclonal and allergen-specific stimulation of T cells in the presence of the three extracts. The analyses demonstrated acceptable cell survival with no signs of toxicity. Citrus mainly had a selective effect on reducing allergen-specific chronic inflammatory (TNF-α; Citrus compared to Cydonia and Citrus/Cydonia: −87.4 (P < 0.001) and −68.0 (P < 0.05), resp.) and Th2 pathway activity (IL-5; Citrus compared to Cydonia: −217.8 (P < 0.01); while, both Cydonia and Citrus/Cydonia mainly affected the induction of the allergen-specific Th1 pathway (IFN-γ; Cydonia and Citrus/Cydonia compared to Citrus: 3.8 (P < 0.01) and 3.0 (P < 0.01), resp.). Citrus and Cydonia demonstrated different working mechanisms in the treatment of SAR and the combination product did not demonstrate larger effects than the separate preparations. Further effectiveness and efficacy studies comparing the effects of the products on SAR in vivo are indicated.
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Baars EW, Jong M, Nierop AFM, Boers I, Savelkoul HFJ. Citrus/Cydonia Compositum Subcutaneous Injections versus Nasal Spray for Seasonal Allergic Rhinitis: A Randomized Controlled Trial on Efficacy and Safety. ISRN ALLERGY 2011; 2011:836051. [PMID: 23724234 PMCID: PMC3658594 DOI: 10.5402/2011/836051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/27/2011] [Indexed: 11/29/2022]
Abstract
Background. Clinical experiences in vitro and clinical studies have demonstrated the curative potency and safety of Citrus/Cydonia compositum in seasonal allergic rhinitis treatment. Objectives. To compare the efficacy and safety of two routes of administration (nasal spray versus subcutaneous injections). Methodology: Design. a national, randomised, comparative clinical trial with two parallel groups. Participants. 23 patients fulfilled the study requirements. Intervention. after a one- or two-week wash-out period, 23 patients were randomized, to a 6-week treatment period. Outcomes. immunological and symptom severity changes and safety. Immunologic outcome assessments were blinded to group assignment. 23 patients were randomized and from 22/23 patients (11 in each group) blood samples were analyzed before and after treatment. Conclusion. Both routes of administration demonstrate immunological and clinical effects, with larger inflammatory and innate immunological effects of the nasal spray route and larger allergen-specific clinical effects of the subcutaneous route, and are safe.
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Affiliation(s)
- Erik W Baars
- Department of Healthcare and Nutrition, Louis Bolk Institute, Hoofdstraat 24, 3972 LA Driebergen, The Netherlands
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Gründemann C, Papagiannopoulos M, Lamy E, Mersch-Sundermann V, Huber R. Immunomodulatory properties of a lemon-quince preparation (Gencydo®) as an indicator of anti-allergic potency. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2011; 18:760-768. [PMID: 21256726 DOI: 10.1016/j.phymed.2010.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/08/2010] [Accepted: 11/24/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Gencydo®, a combination of lemon (Citrus limon) juice and aqueous quince (Cydonia oblonga) extract has been used traditionally in anthroposophical medicine for treating patients with allergic rhinitis or asthma. Because there are no reports about the mode of action, we investigated the anti-allergic effects of this preparation in vitro by using cell lines and primary cells in various biological and immunological endpoints. MATERIALS AND METHODS The release of soluble mediators from basophilic cells, mast cells and lung epithelial cells, which are essential for the initiation of early- and late-phase allergic reactions, was analyzed in relation to the synthetic anti-allergic drugs azelastine and dexamethasone. In addition, the impact of Gencydo® on the viability and activation of GM-CSF-activated eosinophil granulocytes was investigated. RESULTS AND DISCUSSION Gencydo® reduced the degranulation and histamine release of IgE-activated basophilic cells and mast cells and inhibited the IgE- and PMA/A23187-induced increases in IL-8, TNF-α and GM-CSF production in mast cells. The effects were comparable to that of the used concentration of azelastine and dexamethasone. Furthermore, Gencydo® partially blocked eotaxin release from human bronchial epithelial cells, but has no impact on the viability and activation of GM-CSF-activated eosinophil granulocytes. In conclusion, these results give a rational base for the topical use of Gencydo® in treatment of allergic disorders through the down regulation of soluble mediators, which are essential for the initiation and maintenance of allergic reactions.
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Affiliation(s)
- Carsten Gründemann
- Center for Complementary Medicine, Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany.
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Citrus/Cydonia comp. can restore the immunological balance in seasonal allergic rhinitis-related immunological parameters in vitro. Mediators Inflamm 2008; 2008:496467. [PMID: 19079587 PMCID: PMC2590663 DOI: 10.1155/2008/496467] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 11/05/2008] [Indexed: 11/18/2022] Open
Abstract
In two in vitro studies, we examined the immunological (pathways of the) effects of Citrus/Cydonia comp. from, respectively, a healthy and an allergic donor; peripheral blood mononuclear cells (PBMCs) were isolated out of peripheral blood and analyzed in vitro after polyclonal stimulation of T-cells. The differentiation capacity and the influence with regard to Th1 (IFN-gamma) and Th2 (IL-5) cells were examined. Citrus/Cydonia comp. has a selective effect on the differentiation of T-cells by producing relatively more IL-10 than IL-12. By that, it also seems to have an effect on the induction of regulatory (IL-10 producing) T-cell subsets. It is in vitro capable of neutralizing (to some extent) the changes, characteristic to allergic rhinitis, with regard to the maturation, differentiation, and activity of the immune system. Thus, Citrus/Cydonia comp. can potentially restore the disturbed immune state of rhinitis patients, which essentially could be sufficient to make allergic symptoms disappear permanently.
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