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Archive for the ‘Alternative therapies’ Category

 

Proactive Use of Probiotics

Tuesday, October 28th, 2014

by Sarah Winey, PharmD candidate

According to the World Health Organization (WHO), two leading causes of death in young children, under the age of 5, are respiratory infections and diarrhea.1 Both respiratory tract infections (RTIs) and severe diarrhea are often caused by a bacterial infection, so an effective prevention therapy could reduce the incidence of these infections.  Currently, strategies are rarely employed for the prevention of these disease states, except avoidance of foods and conditions that may have an impact, such as fatty foods and environmental irritants. Avoidance of environment irritants can include avoidance of individuals who may carry infection and appropriate hygienic measures, such as hand washing. However, medical treatment frequently occurs only when the patient becomes symptomatic. The standard treatment for diarrhea involves fluid and electrolyte replacement or zinc supplementation, while the standard treatment for bacterial respiratory tract infections often involves antibiotic therapy.1 Probiotic therapy has been suggested as a potential preventative strategy for combating bacterial infections, including those associated with diarrhea and RTI’s.

Probiotics are live, healthy bacteria that are ingested in the form of a dietary supplement or cultured dairy products.2 The human body holds a significant amount of natural healthy bacteria in various locations, including the gastrointestinal (GI) tract.  When harmful bacteria enters the body, it competes for limited space with the healthy bacteria.  In the case of infection, the harmful bacteria overwhelms the system. The goal of probiotic supplementation is to overwhelm at risk areas, such as the GI tract, with healthy bacteria; in fact, the labeled dose is in terms of number of live cells or colonies, usually upward of one million.  In clinical testing, most patients do not experience side effects or experience only minor GI effects such as gas.3 According to current guidelines, probiotics have not been determined to replace standard treatment; nevertheless, the 2007 National Health Interview Survey found that probiotic-type products were the fifth most used natural product for children.3

In March 2014, the Pediatrics journal published a trial with the goal of determining whether a probiotic, Lactobacillus reuteri, had a significant impact on incidence of diarrhea in preschool children. The study was a forward-looking, random-sample, placebo-controlled trial (placebo- an identical substance to probiotic but has no effect) occurring from April 2011-June 2012 in four different day care centers in southeast Mexico City. The study population was comprised of healthy children aged six months to three years, born full term, and of similar socioeconomic status. The primary outcome, or goal, of the study was to determine if the number of days children experienced diarrhea was impacted by probiotic intervention. In addition, the number of days children experienced RTI’s, days of absence caused by diarrhea or RTI, days of antibiotic use, days of medical visits and cost impact due to intervention were studied. The study’s limitations included the possible lack of generalizability based on study location and choice of probiotic species.4

This study provided additional support to the theory that probiotic therapy can impact the prevention of bacterial infections, specifically diarrhea and RTI’s. The results showed that the intervention significantly reduced the incidence of both diarrhea and RTI.4 Additionally, the days of absence, number of medical visits, and antibiotic use were also significantly reduced as a result of probiotic intervention.4 Several other studies have found similar results. For instance, according to a Cochrane research review, probiotics were found to be a beneficial prevention strategy for infection; specifically, this study found that upper respiratory tract infection rate was reduced with probiotic use.5 Another research review of Randomized Control Trials (RCT’s) showed a decrease in duration and stool frequency as a result of probiotic intervention for diarrhea.6

In conclusion, probiotic therapy is a safe and seemingly effective for the prevention of respiratory infections and diarrhea.  This form of therapy may prove especially useful to parents of young children in daycare centers who are constantly in a crowded environment, which could lead to increased infection.  An additional option is the use of yogurt or other cultured dairy products, which also have the capability to reestablish normal, healthy bacteria in the GI tract. Currently probiotics are not an officially approved recommendation for children, should they be?

References:

  1. World Health Organization.Children: Reducing mortality. Media centre: Fact Sheets Web site. http://www.who.int/mediacentre/factsheets/fs178/en/. Updated 2014. Accessed September 20, 2014.
  2. EBSCO CAM Review B. Probiotics. Salem Press Encyclopedia Of Health [serial online]. January 2014;Available from: Research Starters, Ipswich, MA. Accessed August 31, 2014.
  3. National Center for Complementary and Alternative Medicine. Oral probiotics: An introduction. 2012.
  4. Gutierrez-Castrellon P, Lopez-Velazquez G, Parra M, et al. Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial. Pediatrics [serial online]. n.d.;133(4):E904-E909. Available from: Science Citation Index, Ipswich, MA. Accessed September 24, 2014.
  5. Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Of Systematic Reviews [serial online]. July 26, 2011;(9)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed September 20, 2014.
  6. Applegate J, Fischer Walker C, Ambikapathi R, Black R. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health [serial online]. October 2, 2013;13(Suppl 3):1-8. Available from: Academic Search Complete, Ipswich, MA. Accessed September 1, 2014.

The Coconut Oil Craze

Wednesday, October 22nd, 2014

By Danielle Grear, PharmD Student

Super-food, super-health, or super-hype? Coconut oil has been a trending topic in today’s society with its recent health claims for improving weight, fighting bacteria, treating Alzheimer’s, moisturizing skin, and the list goes on.1 Perhaps the most recent way coconut oil is being used today is in a process called “oil pulling,” which requires swishing a tablespoon of oil in the mouth for several minutes in order to detox the body and improve dental health. While the FDA has not yet approved the use of coconut oil for the treatment or prevention of disease, many consumers swear by the positive effects coconut oil has in improving their health.2

A recent article published by The Huffington Post explores the use of coconut oil pulling as a means to whiten teeth, reduce bacteria, strengthen the gums and jaw, and prevent bad breath.3 “It can be a good way to supplement recommended practices like tooth brushing, flossing, and regular dental visits,” says Michelle Hurlbutt, RDH, MSDH, an associate professor of dental hygiene at Loma Linda University in Southern California. Hurlbutt conducted a pilot study and found evidence that showed oil pulling can decrease the bacteria associated with dental cavities. Contrary to popular claims of coconut oil, however, she found that sesame oil had a 5-fold decrease in the level of Streptococcus mutans (a common bacteria associated with a high risk of cavities) compared to only a 2-fold decrease in the bacteria with coconut oil. Furthermore, after daily oil pulling stopped, the bad bacteria began to reemerge in both groups. While I believe that some may indeed have evidence supporting their experience of oil pulling’s benefits, I agree with Hurlbutt that the scientific evidence behind this process is lacking and needs further research to back these claims. The article does a good job in addressing that issue, and even states that oil pulling should not be used to replace regular oral health care.

To further investigate the use of coconut oil in oil pulling, a research study published in the Asia Journal of Public Health studied the effects of coconut oil pulling on oral microorganisms in biofilm models.4 A biofilm is a thin, slimy film of bacteria that adheres to a matrix. The bacteria that were used in this study on a saliva-coated plate were: Streptococcus Mutans, Lactobacillus Casei, and Candida Albicans, which are all predominately found in dental plaque and associated with infections. The study found that as coconut oil was exposed to the bacteria for one minute, it exhibited antimicrobial (anti-bacteria) activity on S. Mutans and C. Albicans. This allowed researchers to conclude that oil pulling therapy could be used as a preventative home therapy to maintain oral hygiene, especially in developing countries. However, while this article certainly shows the benefits of oil pulling, the study has its fair share of limitations. Predominately, because the mechanisms of oil pulling action are not known, further studies are needed to investigate the action of coconut oil on dental plaque and other microorganisms. Long-term effects in clinical trials on humans are also needed to provide significant data for its use in practice.

In addition, one of the main components of coconut oil is lauric acid. This saturated fat is a medium length fatty acid and has been shown in other studies to have an antimicrobial effect against certain bacteria (gram-positive) and yeasts.5 Even compared to other acids, lauric acid ultimately gave better results in fighting infections and inflammation.6 Because the bacteria Streptococcus mutans has been found in association with cavities3, there is a great possibility that further research can prove the benefits of lauric acid in oil pulling.

So what does this all mean? While the evidence for coconut oil in the use of oil pulling and treatment of various diseases is certainly unresolved, oil pulling has been found to have limited side effects as long as the technique is properly conducted.3 However, contrary to popular advertisements today, the articles studied showed that coconut oil is not a “means to cure all.” In fact, it should only be used as a supplement and not a way to treat serious conditions or infections. As a future pharmacist, I would inform patients inquiring about coconut oil pulling that while there have been reports of people experiencing benefits, this technique has not been fully researched and approved by the FDA. Patients must understand that while oil pulling will likely not harm them, it may not help them either. As research continues, hopefully more conclusive evidence will be produced, giving healthcare providers a better understanding of what to expect from the use of coconut oil in oil pulling.

Let’s hear from you. Have you had success with coconut oil pulling? Where else have you seen this product used to improve health?

References:

  1. Spera R. The best ways you’re probably not using coconut oil. ABC13 Eyewitness News Web site. http://abc13.com/society/the-best-ways-youre-probably-not-using-coconut-oil/315760/. Published September 29, 2014. Updated 2014. Accessed October 5, 2014.
  2. Select committee on GRAS substances (SCOGS) opinion: Coconut oil (packaging). U.S. Food and Drug Administration Web site. “Food.” Select Committee on GRAS Substances (SCOGS) Opinion: Coconut oil (packaging). N.p., 18 Apr. 2013. Web. 16 Oct. 2014. <http://www.fda.gov/Food/IngredientsPacka. Published April 18, 2013. Updated 2013. Accessed October 16, 2014, 2014.
  3.  Almendrala A. Oil pulling might be the next big thing–or not. The Huffington Post Healthy Living Web site.http://www.huffingtonpost.com/2014/03/12/oil-pulling_n_4943808.html. Published 3/12/2014. Updated 2014. Accessed October/16, 2013.
  4. Thaweboon S, Nakaparksin J, Thaweboon B. Effect of oil-pulling on oral microorganisms in biofilm models  . Asia Journal of Public Health. 2010;2(2).
  5. Salleh E, Muhamad II. Starch-based antimicrobial films incorporated with lauric acid and chitosan. AIP Conference Proceedings. 2010;1217(1):432-436.
  6. Huang W, Tsai T, Chuang L, Li Y, Zouboulis CC, Tsai P. Anti-bacterial and anti-inflammatory properties of capric acid against propionibacterium acnes: A comparative study with lauric acid. J Dermatol Sci. 2014;73(3):232-240.

 

Seeking relief when your child is coughing?

Wednesday, October 22nd, 2014

by Laura Farleman, PharmD candidate

Is your child’s nagging cough keeping you up at night? The honey in your kitchen may be the alternative to drug-laced syrups parents are searching for to calm their children’s coughs. The thick syrup nature of honey helps to soothe the throat and increase saliva, which can help reduce the urge to cough. Although not always severe, cough causes anxiety and disrupts sleep for parents and children. This drives many parents to seek immediate relief for their children. In recent years popular opinion has drifted toward the use of honey, but has research proven this golden nectar effective?

The current standard of care for cough in children under the age of 6 recommends talking to a doctor. In 2008, manufacturers voluntarily updated cough and cold product labels to state “do not use” in children under 4 years of age. There are few options available when treating cough in children under 4 years old without talking to a doctor. Main treatment options for children over the age of 4 have focused on cough syrups, such as Delsym or Benadryl containing dextromethorphan (DM) or diphenhydramine (DPH), respectively.1

Honey for acute cough in children, a Cochrane review published in June 2014 looked at the effectiveness of honey for cough in children compared to two commonly used cough medications. A Cochrane review is an organized review of primary research in human health care and health policy. It is recognized worldwide as the highest standard in evidence-based health care. In other words, Cochrane reviews provide the most reliable source for health care information. However, this Cochrane review is limited by only including two small studies each with high risk of bias. This review included two random-control trials involving 265 children (aged 2 to 18 years old) comparing the effect of honey to DM, DPH and ‘no treatment’ on cough relief.2 According to Honey for acute cough in children, researchers determined honey to be a better option than ‘no treatment’ and diphenhydramine (Benadryl) options. Honey was found to be equal to dextromethorphan (Delsym) for reducing frequency, severity, and impact of cough on sleep quality.2

The first study used for this review was published by Paul et al. in 2007, included 105 children (aged 2-18 years) and found honey to be a better option for treating cough than no treatment. Comparison of honey and DM did not show differences in the 2007 Paul study. 3 Compared to DM and no treatment, parents favored honey for relief of their child’s nighttime cough and sleep difficulty.3 The second study used for this review, Shadkam 2010, included 139 children (aged 2-5 years) with a cough and revealed that a 2.5-mL honey dose before sleep provided greater relief of cough compared to DM and DPH.1

A journal review by Dr. Ron Feise from 2008 about the Paul 2007 study stated that honey was better than no treatment for cough frequency, but DM was not a better treatment than ‘no treatment’.4 According to this journal review, DM used to treat childhood cough is not supported by the American Academy of Pediatrics (AAP)5 or the American College of Chest Physicians (ACCP)6. DM is associated with several adverse side effects in children, such as nausea, vomiting, constipation, and/or dizziness.7 In contrast, honey is generally recognized as safe with the exception of a severe form of food poisoning in children under the age of 1.8 Honey is not appropriate in this age group, because the bacteria in the stomach of infants (less than one year of age) has not fully developed.8 Honey provides a safe and effective option for children (1 year and older) over OTC cough and cold medications, which aren’t recommended for children younger than 6 years old.

Practically, what does this mean? The next time your child develops a cough you might consider grabbing some honey from the kitchen or local grocery store. When your child begins to develop a cough, start by giving your child (12 months or older) ½ teaspoon of honey (2.5 mL), or (if 2 years old or older) two teaspoons (10 mL) of honey. Honey may be taken/given as often as is needed to relieve coughing. The thick syrup of honey coats and soothes the back of the throat, while the sweet taste results in salivation, which thins mucus and reduces the urge to cough. Honey may also help the body fend off colds by alleviating cold symptoms and reducing the length of a cough or cold. In addition to honey, ensure your child drinks enough fluid and consider increasing your child’s intake of vitamin C.9

It is important though, to remember that coughing isn’t completely terrible. It’s the body’s way to clear mucus from the airway. If your child is otherwise healthy and sleeping relatively well, typically there is no reason to suppress a cough. If your child has a fever, prolonged or worsening cough, wheezing, or cold symptoms lasting longer than two weeks please talk to a doctor.10

Have you tried using honey for cough in the past? Did you find it effective? In the future, will you use honey to relieve coughing?

References

 

  1. Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010;16(7):787-793.
  2. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Evidence-Based Child Health: A Cochrane Review Journal. 2014;9(2):401-444.
  3. Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM,Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.
  4. Feise R. Journal review II. [commentary on] paul IM, beiler J, McMonagle A, shaffer ML, duda L, berlin CM jr. effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. arch pediatr adolesc med 2007. Journal of the American Chiropractic Association. 2008;45(8):20-1.
  5. Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99(6):918-920.
  6. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S.
  7. Kelly LF. Pediatric cough and cold preparations. Pediatrics in Review. 2004;25(4):115-123.
  8. Grant KA, McLauchlin J, Amar C. Infant botulism: Advice on avoiding feeding honey to babies and other possible risk factors. Community Practitioner. 2013;86(7):44-6.
  9. SCHARDT D. Cold front. Nutrition Action Health Letter. 2014;41(2):11-13.
  10. Teitze, JK. Cough. In: Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription drugs: an interactive approach to self-care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012:205-215

 

Are you “Pro” Probiotic Supplements?

Thursday, December 5th, 2013

by Heather Evankow, PharmD student

In recent years, the popularity of probiotic supplements has risen. Probiotics are bacteria that help maintain the natural balance of organisms (microflora) in the intestine.1 The idea of probiotics is not a new concept. The idea was first developed around 1900 by the Nobel Prize-winning recipient Elie Metchnikoff. Metchnikoff theorized that the fermented milk products Bulgarian citizens ingested were a major factor in their longer life spans when compared with other countries.2 It was not until the year 1989 when R. Fuller popularized the term “probiotics”.3 Today, probiotics can be seen in the news claiming to improve the immune system, aid in skin health, defend against depression, clear up a bloated gut, prevent urinary tract infections, and even delay allergies.4

The Daily Herald recently released the article, Probiotics are all the rage, and experts say there are results behind the hype. The author, Gabriella Boston, Boston combines the opinions of several healthcare professionals to emphasize the health benefits behind the evolving topic of probiotics.

The first healthcare provider, Megan McCusker, is a dermatologist who believes probiotics are an important treatment therapy for treatment of anything from acne to psoriasis.4 While the Federal Drug Administration (FDA) does not approve any health claims for this supplement, McCusker could recommend 5-20 billion units per day depending on the patient’s needs. There were no clinical research references to show how McCusker developed these recommendations.

A nutritionist Boston featured, Jared Rice, also believes in the benefits of probiotics. Rice has not observed any downsides with his patients taking probiotics, but still advises patients to seek medical attention before taking high doses. Rice believes it is essential to buy the healthiest probiotic supplement. Also, he believes it is important to create a probiotic-friendly body by eating whole grains, bananas, and onions while steering clear of nondigestible carbohydrates.4 Unfortunately, there was no data referenced to confirm the benefits of Rice’s claims.

Ebeth Johnson, a nutritionist and chef, also gave her expert advice for this article. She believes this probiotic trend is here to stay. She encourages incorporating probiotics into your diet by consuming unpasteurized miso, live cultured pickles, tempeh, unsweetened kefir and yogurt, and kombucha teas.5 It is unclear how Johnson came up with these supplement sources. In addition, she also did not mention any specific research to validate the quality of these sources.

While the experts in Boston’s article seem confident in their recommendations of probiotics supplements, the clinical research is still limited for probiotics. The varieties of strains make it problematic in understanding the health benefits.

One of the most researched probiotic strains is Lactobacillus rhamnosus GG (LGG). LGG has been proven to help pediatric patients with pain-related gastrointestinal (GI) disorders in many clinical studies.5 In a 2011 meta-analysis, researchers systematically searched for randomized controlled trials assessing LGG supplementations in children with functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine and functional abdominal pain (FAP).5 The major limitations for this analysis included incomplete outcome data and the number of trials with a small sample size. The results revealed a decrease in severity in pain with the overall study population and the IBS subgroup.5 The frequency was also decreased in the IBS subgroup.

Another hopeful probiotic strain is Streptococcus thermophilus VSL #3. A multicenter, randomized, placebo-controlled, double-blind, crossover study has shown VSL #3 to be successful and safe in helping the lives of children with IBS.6  59 patients from ages 4-18 years of age completed the study with no untoward adverse effects reported. Researchers found no significant difference was found in the stool pattern of patients, but abdominal pain, abdominal bloating, and family life disruption were all significantly more effective to the placebo.6

Have you had any encounters with probiotic supplements? Comment and share your experiences. Please include the main therapy goal, specific probiotic strains, and the dosage.

If you have had no experience with probiotics, based on the information above, would you personally try probiotic supplements? Share your rational.

References

1. “Probiotics – Topic Overview.” WebMD. Healthwise, 04 FEB 2011. Web. 29 Nov 2013. <http://www.webmd.com/digestive-disorders/tc/probiotics-topic-overview>.

2. Parvez, S. and Kang S. “Probiotics and their fermented food products are beneficial for health.” Volume 6. Web. 29 Nov. 2013. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/pdf>.

3. Ouwehand, A., S. Salminen, and E. Isolauri. “Probiotics: an overview of beneficial effects.” Vol 82.Issue 1-4 (2002): 279-289. Web. 29 Nov. 2013. <http://link.springer.com/article/10.1023

4. Boston, Gabriella. “Probiotics are all the rage, and experts say there are results behind the hype.” Daily Herald. N.p., 28 Oct 2013. Web. 29 Nov 2013. <http://www.dailyherald.com/article/20131028/entlife/710289977/>.

5. Horvath, A., P. Dziechciarz, and H. Szajewska. “Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood.” Alimentary Pharmacology & Therapeutics. Vol 6.Issue 12 (2011): 1302-1310. Web. 29 Nov. 2013. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04665.x/full>.

6. Guandalini S., G. Magazzu, and A. Chiaro. “VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.” J Pediatrics Gastroenterol Nutr. 2010 Jul;51(1):24-30. Web. 04 Dec. 2013. http://www.ncbi.nlm.nih.gov/pubmed/20453678.

Over the Counter Probiotics May Be Able to Sooth Baby’s Colic

Thursday, December 5th, 2013

by Mallory Martin, PharmD student

This article posted by the BBC, “Probiotics ‘soothe some babies with colic’”,1 explores an option into easing or possibly preventing your baby’s colic. The article describes an analysis of 12 studies looking into probiotics as a treatment for colic. The analysis was done by a team of scientists in Australia and reported in the Jama Pediatrics Journal. However the article didn’t cite where in the journal this article was found. This seemed uncharacteristic and it made it difficult to evaluate their findings. All this aside, their findings were quite exciting because although colic is not a harmful condition to babies and resolves itself after 3-4 months1, it can be quite stressful for caretakers. An option for soothing baby’s colic would be highly valued for this reason.

When attempting to sooth colic, parents can be scared away by ambiguity, not wanting to give something to their baby unless it is proven. “Research shows” is a phrase that may be thrown around a lot, but what people really want to know is whether a treatment is safe for their child and if it is effective. Taking these people into consideration and with the incomplete citation by the BBC article, I wanted to explore several articles published on this topic in an attempt to come to a conclusion on whether or not to recommend probiotics for colic.

Probiotics must first be understood on their own before exploring them as a treatment for colic. Probiotics are a mixture of different microorganisms that when orally ingested are considered to have several overall health benefits.1 The word itself means “promoting life”.2 They generally have very low risk in normal adults because the cultures so closely resemblethe natural flora of the gut. 3 Probiotics are also naturally present in food. Some foods that contain probiotics are fermented vegetable such as sour kraut and most commonly yogurt.2 Probiotics contain many different types of bacteria but among the most common is Lactobacillus reuteri. It is this strain of bacteria that is considered to have the most health benefits. 2

Certain health benefits have been discovered with probiotic use. Probiotics, L. reuteri specifically, has been shown to lower LDL levels, kill bacteria that causes tooth decay, lessen the harmful effects of gingivitis, and lower your likelihood of developing episodic diarrhea or traveler’s diarrhea. Some reports even show that this bacterium can lessen a child’s risk of developing eczema through probiotic-filled breast milk. Studies in women’s health showed that it may help balance the bacteria present in the vagina and lower the risk of yeast infections, bacterial vaginosis, and urinary tract infections. Some additional benefits include its ability to reduce upper respiratory infections when compared to placebo, provide relief to baby’s colic, and reduce bloating and gas.2

Although the results are promising, research in this area is not concrete. Probiotics may have both risks and benefits for different people. Risk for special populations, such as small children and older adults, is unclear since there is little to no research done on these groups.2 So far, healthy, full-term babies who have received high doses of probiotics have not presented with any negative effects.4 However there is some evidence that young children who are pre-term or not fully healthy, such as children with weakened immune systems, catheters or other medical devices inside them, may be at risk if taking probiotics.4 When considering L. reuteri in treatment of colic, one study by Savino concluded that it is inconclusive whether L. reuteri reduces colic but it appears to reduce levels of harmful E. coli. 5,6 Savino performed a follow up study after comparing L.reuteri with simethicone and compared the bacteria against a placebo in treatment of colic.7 This study had a better study design for its desired outcome because the infants involved were chosen based on Wessel’s Criteria, a more systematic approach than the first study. The results concluded that L. reuteri DSM 17 938 at a dose of 108 colony-forming units per day in early breastfed infants improved symptoms of baby’s colic and was well tolerated and safe.7 Some factors that could contribute to the varying results in these studies include the differences in the care the infants received in different homes and different study designs. An article put out by Fox News article reported on this as well. The conclusion was that probiotics may not be effective. However in young infants, they can potentially reduce risk of asthma and eczema.4 This positive effect, while unrelated, is something to consider when evaluating probiotics for your child.

Considering all this information, I would recommend probiotics as a means of treatment for infantile colic. The best option would be for a nursing mother to start a regimen of daily probiotics and allow the probiotics to transfer through the breast milk. However, L. reuteri is available for infants to ingest. Gerber has a colic relief drop that specifically has L. reuteri in it which includes sunflower oil. Gerber also has a powder for formula around 30 dollars for 24 ounces. BioGaia has a straight L. reuteri drop for around 20 dollars for 5 mLs. There are options. Even if it may not be 100% guaranteed to be effective, if your colicky baby is becoming too much to handle and you have tried many other options, I would say it is worth a try. Especially considering no bad effects have been found and several unrelated positive effects have been suggested. Probiotics would be a safe and natural way to go in your attempt to soothe your baby and get a good night’s rest yourself. Some may not agree with me. With the lack of research and uncertainty, risks could exist. Just because no negative effects have been found does not mean that it is completely safe. Would you take that risk with your own child?

References

1. Roberts, M. Probiotics ‘soothe some babies with colic’. The BBC. October 7, 2013. http://www.bbc.co.uk/news/health-24426623. Accessed December 3, 2013.

2. Maier, R. Surprising Benefits of Probiotics. Healthine Web site. April 13, 2013. http://ask.healthline.com/health-slideshow/surprising-benefits-probiotics. Accessed December 3, 2013.

3. Probiotics – Topic Overview. Webmd Web site. February 04, 2011. http://www.webmd.com/digestive-disorders/tc/probiotics-topic-overview. Accessed September 15, 2013.

4. Rettner, R. Are Probiotics Safe for Kids?. Livescience Web site. October 06, 2011. http://www.livescience.com/16426-probiotics-safe-kids.html. Accessed December 3, 2013.

5. Woznicki, K. Probiotics May Reduce Crying From Colic. Webmd Web site. August 16, 2010. http://www.webmd.com/parenting/baby/news/20100816/probiotics-may-reduce-crying-from-colic. Accessed October 15, 2013.

6. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-33.

7. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. 2007;119(1):e124-30.

Are e-cigarettes a good option for smoking cessation?

Monday, December 2nd, 2013

by Tiffany Zehel, PharmD student

In 2011, an estimated 43.8 million U.S. adults were current cigarette smokers,[i] and currently, estimates of over one billion people worldwide are smokers.[ii] Cigarette smoking is a global epidemic that can give rise to several serious diseases with nearly 6 million deaths annually.[iii] The risk of serious diseases is significantly reduced after one quits smoking and maintains life-long abstinence. Unfortunately many nicotine replacement therapies (NRT’s), such as the patch or gum, have a low efficacy rate in real life practice.[iv] Many studies evaluating the use of nicotine replacement therapies find that while traditional NRT’s provided the chemical need for the individual, the behavioral and psychological needs of the individual were not being met.[v],[vi],[vii]

 The electronic cigarette (e-cigarette) was introduced to the U.S. market in 2007 to provide smokers with more freedom to smoke as well as a safer alternative compared to tobacco cigarettes.[viii] The standard e-cigarette is a battery powered electronic nicotine delivery device (ENDD) that resembles a cigarette, and delivers nicotine in a vaporized solution. The acceptance of the e-cigarette is attributed to the similarities of smoking, including the hand-to-mouth repetitive motion and the visual cue of the vapor, addressing the psychological and behavioral aspects of the addiction.[ix]

According to an article published in The Lancet, E-cigarettes were not shown to have a statistically significant difference in individuals that quit. However, they significantly reduced the amount of traditional cigarettes an individual used in a given day compared to the patch.[x] In this news article e-cigarettes are celebrated based on the fact that they show promise to eliminate tobacco smoking completely in the future, but not so much for the promise of helping people break their addiction. Smoking tobacco is very harmful and traditional cigarettes contain toxins that are carcinogenic. In that respect, e-cigarettes should be admired for their ability to replace cigarettes. The issue is that e-cigarettes are not regulated by the FDA like other NRT’s, and their safety has not been extensively researched, due to the recent emergence of the product.

The article also had several limitations. First, the study was underpowered, meaning any effect could have gone undetected, so the results may not be reliable. Another limitation is that there was a high drop out rate in the group given the nicotine patch; this is speculated to be due to the participants wanting to try e-cigarettes but instead where randomly assigned to receive the patch. A third limitation is that the e-cigarette, that this particular study group used, contained less than optimal amounts of nicotine and delivered nicotine inefficiently. As technology advances and e-cigarettes become more efficient in nicotine delivery, e-cigarettes may be proven more effective. The final limitation is that this study was over six months while the amount of time to quit cigarettes can be much longer depending on the individual.x The short amount of time also provided little ability to evaluate adverse effects that the e-cigarette may cause. Due to these obstacles, it is difficult to say whether e-cigarettes would or would not be better than the nicotine patch.

In an article published in the journal of Addiction Science and Clinical Practice (ASCP), a group of people that regularly used e-cigarettes were followed through a forum and interviewed regularly. One repetitive theme in the article was that the subjects, who identified themselves as “vapers,” drew a line between smoking cessation and nicotine cessation. They claimed that they wished to stop smoking because of the health ramifications, but because of the convenience and perceived safety of the e-cigarettes, they had no desire to quit their nicotine addiction.[xi] Up to this point, smoking cessation and nicotine cessation went hand-in-hand. NRT’s were prescribed to step the patient down from their nicotine addiction; currently e-cigarettes are not set up in this way. So now that we have this unique delivery system on our hands, we need to decide if nicotine cessation is as important as smoking cessation. We also need to do further studies on the long-term effects of e-cigarettes to evaluate their benefits over the alternative.

I do not think that replacing one addiction with a modified version of it is the best idea. While it does reduce the health risk, it does not solve the issue of nicotine addiction, the possible long-term effects, and the cost of feeding the addiction. However, I think that e-cigarettes can be beneficial for smoking cessation and nicotine cessation with proper monitoring from healthcare professionals and social support.

 Do you think that smoking cessation is more important than nicotine cessation? Do you think e-cigarettes should be utilized for nicotine-cessation?

References

[i] Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(44):889–94 [accessed 2013 Nov 29]

[ii] Available at: http://ash.org/resources/tobacco-statistics-facts/. Accessed November 29, 2013.

[iii] Polosa R. Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal 2013;10(19)1-11 [accessed 2013 Nov 29].

[iv] Casella G, Caponnetto P, Polosa R: Therapeutic advances in the treatment of nicotine addiction: Present and Future. Ther Adv Chronic Dis 2010, 1(3):95-106 (accessed Nov 29).

[v] Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, William J, Walker N. Electronic cigarettes for smoking cessation: a randomized controlled trial. The Lancet. 2013;382(9905)1629-1637 [accessed Nov 29).

[vi] Barbeau A, Burda J, Siegel M.  Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. ASCP Journal 2013;8(5):1-7 (accessed 2013 Nov 29).

[vii] Cahn Z and Siegal M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? Journal of Public Health Policy 2011;32(1)16-31 (accessed 2013 Nov 29)

[viii] Pozin I. Electronic cigarettes : booming industry or health fiasco?; Forbes.com; http://www.forbes.com/sites/ilyapozin/2013/04/11/electronic-cigarettes-booming-industry-or-health-fiasco/; (accessed 2013 Nov 29)

[ix] Polosa R. Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal 2013;10(19)1-11 [accessed 2013 Nov 29].

[x] Kelland K. E-cigarettes as good as nicotine patches in helping smokers quit. http://news.yahoo.com/e-cigarettes-good-nicotine-patches-helping-smokers-quit-220346477.html (accessed 2013 Nov 29)

[xi] Barbeau A, Burda J, Siegel M.  Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. ASCP Journal 2013;8(5):1-7 (accessed 2013 Nov 29).

Insomnia: Not just about sleep

Monday, December 2nd, 2013

by Chelsae Ward, PharmD student

Insomnia is one of the most common patient complaints for Americans, third only to headache and the common cold. It is estimated that 33 percent of the United States population experiences insomnia.1 As defined by the CDC, insomnia “is an inability to initiate or maintain sleep.” 2 While the symptoms of insomnia are similar and easily identifiable, the causes can be vast and often hard to determine. Many times insomnia is not the primary condition but the effect of an underlying problem. One of the major causes of insomnia is emotional unrest due to either excitement or stress/worry. Therefore, insomnia is often a tell sign of depression or other emotional disorder. Pain or physical disturbances are also a common cause of insomnia. Other times, sleep disorders, such as sleep apnea cause insomnia.3

Rxdaily.com, a pharmacy news website, reviewed a study on the effects of insomnia in the article, It’s More Than Beauty Sleep.”4 The study was conducted by the CDC and looked at the correlation between insomnia causing diabetes and/or heart disease. Specifically, they focused on insomnia caused by mental distress and obesity. The study used over 50,000 participants who were 45 years and older. It concluded that a majority of people (64.8 percent) were optimal sleepers in terms of amount of time spent sleeping each night. Those who were short sleepers (31.1 percent) were more likely to develop heart disease, stroke, mental disorders, obesity, and diabetes. The authors of the study point out limitations in that it is difficult to determine which of the factors are the cause and which are the effect. For example, does insomnia cause diabetes or does diabetes cause insomnia? Sleep expert, Robert S. Rosenberg, states that the former has been most evidenced in recent studies.4 Another limitation was that the study was open to recall bias because the participants gave their own opinions on their sleep habits. The Rxdaily article concludes that medical professionals need to be more attentive to patients sleep patterns and habits.4

I agree with the Rxdaily article that health care professionals, including pharmacists, need to be attentive to a patient’s sleeping habits. Recognizing insomnia in patients can help identify a possible disease state since insomnia can be either a cause or effect of many disorders.5 Based on this knowledge it would make sense that Health Care Professionals would be attentive to a patient’s insomnia. One way in which this process can be easily implemented is to begin asking patients with a known medical history of heart disease, diabetes, obesity, or stroke of their sleeping habits. Along with this step, health care professionals can stress the importance of quality sleep to all patients, and thus the patient can address insomnia if/when it becomes a problem for them.

Not only is it important to pinpoint insomnia in patients due to its ability to cause medical issues, but many patients attempt to self-treat insomnia with over-the-counter medication (9 percent) or alcohol (11 percent).1 Pharmacists, being the best patient contact for over-the-counter medication, need to be aware of their patient’s insomnia. The pharmacist can then appropriately guide the patient on the best way to treat their insomnia. Benadryl, the most common over-the-counter sleep aid, may be used beneficially in short-term insomnia; but its use is not recommended long term.1 Many patients believe that alcohol will help to solve their sleep insomnia. It is important that alcohol users are aware that while alcohol may initially cause drowsiness and help one get to sleep, it will be more difficult to stay asleep. Many people will wake up more frequently throughout a night with alcohol use.6

The best way that has been found to treat chronic insomnia is through sleep training (also known as sleep hygiene), in which the patient trains themselves in proper sleeping habits.7 Sleep training are basic steps to take in order for one’s body to be in a suitable sleeping environment. It is important to keep a steady sleep schedule in which the patient will go to bed at the same time every night and wake at the same time every morning. The bedroom should be quiet, dark, and a place where the patient feels they can relax. The temperature of the room should not be too hot or too cold. The bed should be comfortable to the patient, neither too soft nor too firm. The bed should only be used for sleeping, making sure activities like reading, watching TV, or completing work, are done outside the bedroom. It would also be helpful to avoid large meals two hours before bedtime. Avoid taking naps throughout the day. If still unable to fall asleep, it is recommended to, instead of trying to force sleep, carry out a relaxing activity away from the bedroom.1,2

With the new evidence linking chronic illness and insomnia as found in the research study reviewed by rxdaily.com, and the high rate of self-treatment for insomnia, it would seem, not only important, but also necessary for health care professionals to be aware of patients sleeping difficulties. Do you think the health benefits of sleep are being under-rated in today’s health system?

 

References

1) Melton, C. K. Insomnia, Drowsiness, and Fatigue. In: R. R. Daniel L. Krinsky, Handbook of Nonprescription Drugs An Interactive Approach to Self-Care. Washington, DC: American Pharmacists Association; 2012: 867-876.

2) Sleep and Sleep Disorders. Centers for Disease Control and Prevention. http://www.cdc.gov/sleep/index.htm. May, 2012.

3) Staff, M. C. Insomnia. Mayo Clinic. http://www.mayoclinic.com/health/insomnia/DS00187. Janurary, 2011.

4) Robert S. Rosenberg, D. F. It’s More Than Beauty Sleep. Rxdaily.com. http://www.dailyrx.com/chronic-illnesses-may-be-associated-poor-sleeping-habits-study-suggests. October, 2013.

5) Lawrence Robinson, G. K. Sleeping Pills & Natural Sleep Aids. helpguide.org. http://www.helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm. May, 2013.

6) Szalavitz, Maia. Sleeping It Off: How Alcohol Affects Sleep Quality. Time: Health and Family. http://healthland.time.com/2013/02/08/sleeping-it-off-how-alcohol-affects-sleep-quality/. February 8, 2013.

7) Reinberg, S. Prescription Sleep Aids Common Choice for Insomnia. WebMD. http://www.webmd.com/sleep-disorders/news/20130829/prescription-sleep-aids-a-common-choice-for-american-insomnia. August 29, 2013.

Exercise to Save Your Knees

Monday, December 2nd, 2013

by Jeniffer George, PharmD student

An estimated 27 million adults in the United States suffer from osteoarthritis of the knee or hip which is commonly seen in patients 65 and older.1 Osteoarthritis is the breakdown in cartilage that covers the ends of the bone to where they meet and form a joint to allow movement.1 As of today, researchers have not found a set cure for arthritis, however, mild pain relief can be found from the use of NSAIDS, acetaminophen and combination products such as glucosamine and chondroitin. In addition, with the increase in obesity in the United States, exercise can relieve stress that is placed on the knees for patients with osteoarthritis. A survey conducted by the Centers for Disease Control and Prevention showed 53% of patients with arthritis didn’t walk at all for exercise, and 23% meet the current recommendation for activity—walking for at least 150 minutes a week.2 So the question I pose is: as future pharmacists, should we recommend glucosamine and chondroitin or exercise to patients with osteoarthritis?

For almost 20 years, the nutritional supplement glucosamine and chondroitin has been marketed to the public for joint health. Glucosamine is an amino sugar that can help renew cartilage while chondroitin is thought to be a complex carbohydrate that helps cartilage retain water.3 Glucosamine and chondroitin are found as natural substances in and around the cells of cartilage.3

NPR recently released an article that presented a study published by the New England Journal of Medicine (NEJM) and another study by the Journal of American Medical Association (JAMA). The study found in NEJM, involved 1,583 randomly selected patients receiving glucosamine and chondroitin with placebo.4 They found that glucosamine/chondroitin, in comparison with placebo seemed to show no effect on patients with osteoarthritis, however, a smaller subgroup characterized with moderate to severe pain showed a significant reduction of knee pain after the use of glucosamine. The study was conducted well, however, patients measured at baseline reported having mild knee pain, as compared with that in classic studies of osteoarthritis, in which a criterion for entry was a disease flare after the discontinuation of NSAIDs.4 In general, the evidence on glucosamine/chondroitin is varied, leaving it difficult to answer if the use of supplements are proven to be effective.

The second study presented in JAMA, included 399 participants that are overweight and presented with knee osteoarthritis. Participants in the study endured 18 months of combined intense diet and exercise modifications to see if there would be an increase in knee function and reduction in pain. Participants in the diet and exercise and diet groups had greater reductions in Interleukin 6 (used to measure inflammation) levels than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group.5 The article does a great job on emphasizing the importance of exercise, however, patients with moderate to severe osteoarthritis, who may have difficulty exercising were excluded from the study.

I agree with most of the content in the article and seem to agree with the studies associated with the material. As a future pharmacist, I would recommend using glucosamine and chondroitin in conjunction with exercise while living a healthy dietary lifestyle to help patients with osteoarthritis. It is human nature to avoid doing things when you are in pain. Patients with osteoarthritis may avoid exercise when a hip, knee, or other joints hurt. As shown in the NEJM study, patients with moderate-to-severe pain saw a reduction in pain after using glucosamine and chondroitin. Recommending glucosamine and chondroitin can help patients have temporary relief in pain, which can enable them to engage in low impact activities, get the heart rate up and burn calories. If exercise is not an option for the patient, guiding the patient in dietary modifications can help in weight reduction. Other treatment options include: rest which helps reduce stress and tension that is put on the knees, hot and cold therapy to help increase blood flow and reduce inflammation near the joint area, and to avoid standing in one position for an extended time.

With studies like these, would you suggest glucosamine and chondroitin as a form of therapy? How can you advise a patient that is adamant on not losing weight due to the pain they are experiencing?

 

References

 

  1. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/research/results/gait/qa.htm. Published May 2002. Updated October 2008. Accessed November 1, 2013.
  2. Skerrett PJ. Exercise is good, not bad, for arthritis. Harvard Health Publication Web site. http://www.health.harvard.edu/blog/exercise-is-good-not-bad-for-arthritis-201305086202. Published May 8,2013. Accessed November 21, 2013.
  3. Patti Neighmond. National Public Radio. National Public Radio Website. http://www.npr.org/blogs/health/2013/10/14/231451187/exercise-may-help-knees-more-than-glucosamine-and-chondroitin?utm_content=socialflow&utm_campaign=nprfacebook&utm_source=npr&utm_medium=facebook. Published October 14, 2013. Accessed November 1, 2013
  4. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. N Engl J Med. 2006;354(8):795-808.
  5. Messier SP, Mihalko SL, Legault C, et al. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis: The IDEA Randomized Clinical Trial. JAMA. 2013;310(12):1263-1273. doi:10.1001/jama.2013.277669.Accessed November 1, 2013.

 

Can Probiotics Help Prevent the Common Cold?

Monday, December 2nd, 2013

by Andrea Bashore, PharmD student

There are many types of illnesses caused by respiratory tract infections. One that we are all familiar with is the common cold. About 22 million school days are lost in America due to this sickness, and it is the leading cause of doctor’s visits and missed days of work.1 It is common for adults to contract three to four colds each year, while the elderly and young have a higher risk of catching four to six colds annually.1 An article on Natural Standard has proposed that probiotics, or “good” bacteria, can help reduce the risk for upper respiratory tract infections.2 Common ways to prevent a cold may be washing one’s hands frequently, getting plenty of rest, or dressing appropriately for cold weather. In addition to these things, it has now been found that probiotics can be an added measure against catching a cold. Most of us have probably seen probiotics advertised on yogurt such as Activia. There have been several health benefit claims about these good bacteria, and one of the most common uses is for gastric and intestinal illnesses.3 Other benefits are alleviation of lactose intolerance and food allergies, blood pressure control, and control of inflammation in arthritis.3 Along with these benefits, research has found a new use for probiotics.

The article “Probiotics May Reduce the Risk of Respiratory Tract Infections” discusses a study with new findings. Researchers recruited 465 people to participate in the study.3 They separated the participants into three different groups with the first receiving a probiotic, the second receiving a different probiotic, and the third receiving a placebo.3 The group who took probiotic BI-04 showed a significantly lower risk for an upper respiratory illness compared to the placebo group.3 Because of this comparison the researches concluded that it was an effective supplement for preventing colds.

Along with this research, there has been more evidence that supports this idea of cold prevention with probiotics. Bacteria in the nasal cavity cause upper respiratory infections, and a study in Switzerland took this into account when testing probiotics.4 They concluded that probiotics decrease the amount of this potentially illness causing bacteria.4 Another study focused on children in day care centers. They tested the same probiotics as the Switzerland study, and their results showed that use of the probiotics substantially reduced the number of respiratory tract infections in the study’s population.1

Though the conclusions from each of these articles support the claim of probiotics preventing respiratory tract infections, they cannot make the claim that probiotics directly cause this prevention. This is what the evidence shows, but we cannot say that this is a cause and effect since the articles do not give a full explanation of how this kind of good bacteria is working to prevent infection. The probiotics do not make any direct contact with the nasal cavity, though the results showed prevention of bacteria in this area.1 Even with this limitation, I would agree that probiotics are helpful and would suggest this to others. A meta-analysis done on probiotic therapy for diarrhea reported that out of four different studies no serious adverse effects were reported.5 While I believe that more studies need to be done on the safety and adverse effects of probiotics, they have not been reported to be harmful. If simply eating yogurt everyday or taking a probiotic supplement can help someone’s health through the cold season, I would gladly suggest this. I don’t think it is necessary for every person to do this, but it is something that I would recommend. There are many other ways to help prevent colds, and this is simply and additional preventative measure. Encouraging patients to take probiotics to prevent colds also opens the door to inform them of other health benefits that they may not have known.

The common cold puts a damper on our everyday lives, and using probiotics to prevent respiratory tract infections is a step towards a healthier population. This is such a simple way that we can help our communities fight the cold season.3 As pharmacists, we can easily encourage our patients to take probiotics to help prevent a cold. Can we confidently tell patients that this will be effective? How as pharmacist can we properly inform patients on probiotics and the benefits they provide? Through research and educating ourselves on this topic we can hope to better the health of our community.

 

References

  1. Snovak N, Abdović S, Szajewska H, Mišak Z, Kolaček S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition. 2010; 29: 312-316. Available at: http://www.clinicalnutritionjournal.com/article/S0261-5614(09)00203-9/fulltext. Accessed November 2, 2013.
  2. Probiotics May Reduce the Risk of Respiratory Tract Infections. Natural Standard. 2013. Available at: http://www.naturalstandard.com/news/news201310010.asp. Accessed November 2, 2013.
  3. Parvez S, Malik KA, Kang A, Kim Y. Probiotics and their fermented food products are beneficial for health. Journal of Applied Microbiology. 2006; 100: 1171-1185. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/full. Accessed November 2, 2013.
  4. Glück U, Gebbers J. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and hemolytic streptococci). The American Journal of Clinical Nutrition. 2003;77: 517-520. Available at: http://ajcn.nutrition.org/content/77/2/517.short. Accessed November 2, 2013.
  5. Nandini D, Costa V, MacGregor M, Brophy J. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review. Canadian Medical Assiciation Journa. 2005; 173: 167-179. Available at: http://www.cmaj.ca/content/173/2/167.full. Accessed November 25, 2013.

Effectiveness of Acupuncture on Allergy Treatment

Sunday, November 24th, 2013

By Yeseul Kim, PharmD student

Many people in the world are suffering from allergies and they want some relief from the symptoms whether they are mild or serious. Some are using OTC allergy medications, such as Allegra, Benadryl, and Claritin, for treatment. However, these OTC allergy medications can cause some side effects, such as drowsiness, dizziness, constipation, or dry mouth.1 Therefore, people often try another treatment like acupuncture which may have fewer side effects than OTC medications. According to National Center for Complementary and Alternative Medicine (NCCAM), this therapy originally came from Asian countries and has been studied for over a thousand years for a wide range of conditions.2

The article, “Acupuncture may be antidote for allergies”, from CNN Health, deals with treating allergy patients with the therapy of acupuncture.3 Since some patients have already adopted the acupuncture method for relieving pain, one study tried to evaluate the effect of acupuncture on patient’s allergies. The researchers divided allergy patients into three groups.4 The first group received acupuncture treatments with antihistamines as needed, the second group received fake acupuncture treatments with antihistamines as needed, and the third group did not receive any acupuncture, and only took antihistamines for treatment.4

The study results showed some effectiveness of acupuncture for allergy treatment. The first group took less antihistamines and showed improvement in symptoms.4 There is a placebo effect also as shown in second group, in which some patients improved with fake acupuncture.4 Based on improvement seen in this study, I agree with and support the use of acupuncture in addition to antihistamines for allergy treatment. Another study found similar results and helps increase the validity of this study. The 2008 Berlin allergic rhinitis acupuncture study concluded that “the result of this trial suggests that treating patients with allergic rhinitis in routine care with additional acupuncture leads to clinically relevant and persistent benefits.”5

Although the study reported a higher quality of life for allergy patients after acupuncture treatment, there are some limitations to the study. The researchers noted, “We found that acupuncture led to statistically significant improvements in disease-specific quality of life and antihistamine use after eight weeks of treatment compared with sham acupuncture and with antihistamine alone, but the clinical significance of the findings remains uncertain.”6 Also, acupuncture was less effective on severe allergy symptoms. If patients with severe allergies do not get relief from OTC medication or acupuncture, they may want to try prescription products for their allergies.

Another study, Effect of Acupuncture in the Treatment of Seasonal Allergic Rhinitis: A Randomized Controlled Clinical Trial, found a significant improvement in nasal and non-nasal symptoms between the two types of acupuncture treatments.7 The study concluded at the end that “no side effects were observed for both groups. The results indicate that acupuncture is an effective and safe alternative treatment for the management of Seasonal Allergic Rhinitis.”7

I want to recommend acupuncture therapy with use of antihistamines for allergy patients, even though this is different from the standard of care. The current standard of care is taking antihistamines only for treatment. Several studies have found a positive result in treating allergies and acupuncture is a safe treatment as reported side effects are rare. Acupuncture treatment also contains some placebo effect which I believe is another important mechanism in patient treatment. A positive state of mind largely influences the improvement of symptoms  

Through various research, the efficacy of acupuncture on allergies is proven, but some are still questioning the exact scientific mechanism of how the acupuncture works. Some patients will get better with acupuncture but others will not.  We should think about “What are the factors that can lead to less effectiveness?” and “Should we recommend an acupuncture treatment for a patient before recommending OTC medications to a patient?”

References

 

1. Berardi RR, Kroon LA, McDermott JH et al. Handbook of nonprescription drugs, an interactive approach to self-care. APhA Publications; 2006.

2. Acupuncture: An Introduction. National Center for Complementary and Alternative Medicine Web Site. http://nccam.nih.gov/health/acupuncture/introduction.htm. Updated 2012. Accessed October 30, 2013.

3. Sifferlin A. Acupuncture may be antidote for allergies. CNN.com Web Site. http://www.cnn.com/2013/02/19/health/acpuncture-allergies/. Updated 2013. Accessed October 29, 2013.

4. Benno Brinkhaus, Miriam Ortiz, Claudia M. Witt, Stephanie Roll, Klaus Linde, Florian Pfab, Bodo Niggemann, Josef Hummelsberger, András Treszl, Johannes Ring, Torsten Zuberbier, Karl Wegscheider, Stefan N. Willich; Acupuncture in Patients With Seasonal Allergic RhinitisA Randomized Trial. Annals of Internal Medicine. 2013 Feb;158(4):225-234.

5. Louis PF. Banish allergies with acupuncture: Here’s how. Naturalnews.com Web Site. http://www.naturalnews.com/040305_allergies_acupuncture_studies.html. Updated May 13, 2013. Accessed October 30, 2013.

6. Radford B. Acupuncture for Allergies? Jury’s Still Out. Discovery.com Web Site. http://news.discovery.com/human/health/acupuncture-for-allergies-jurys-still-out-130222.htm. Updated 2013. Accessed October 30, 2013.

7. Xue C, English R, Zhang J, da Costa C, Li C. Effect of Acupuncture in the Treatment of Seasonal Allergic Rhinitis: A Randomized Controlled Clinical Trial. American Journal Of Chinese Medicine [serial online]. January 2002;30(1):1. Available from: Academic Search Complete, Ipswich, MA. Accessed October 31, 2013.