Acupuncture for seasonal allergic rhinitis: a randomized controlled trial.

BACKGROUND: Seasonal allergic rhinitis (SAR) is a common condition with relatively high prevalence in Australia. It causes a significant impact on sufferers' quality of life (QoL). Meta-analysis has shown that the efficacy of acupuncture for SAR is uncertain. OBJECTIVE: To evaluate the efficacy and safety of 12 sessions of acupuncture treatment during 4 weeks for SAR in a randomized, subject- and assessor-blinded, sham-controlled trial conducted during the pollen seasons in 2009 through 2011 in Melbourne. METHODS: Patients diagnosed with SAR and confirmed allergic to rye grass pollen were randomly allocated to receive real acupuncture (RA) or sham acupuncture (SA) treatment. RA was delivered manually, whereas SA involved superficial needling at non-acupoints without additional stimulation. Severity of SAR symptoms was the primary outcome measurement. Secondary outcomes were QoL, global change, SAR-related medication usage, and adverse events. Analysis of covariance using pollen count as a covariate was used to analyze outcome data. RESULTS: A total of 175 participants were included in this trial. RA was significantly better than SA for decreasing SAR symptom severity (sneezing, mean difference -0.28, 95% confidence interval -0.51 to -0.05; itchiness of ears and palate, mean difference -0.40, 95% confidence interval -0.69 to -0.11) at the end of treatment and improving participants' QoL at the end of the treatment and follow-up phases. Furthermore, the acupuncture treatment was safe and well tolerated. CONCLUSION: Four weeks of acupuncture treatment is a safe and effective option for clinical management of SAR in the Melbourne area for patients' symptom relief and QoL improvement.

Traditional chinese medicine: an update on clinical evidence.

BACKGROUND: As an alternative medical system, Traditional Chinese Medicine (TCM) has been increasingly used over the last several decades. Such a consumer-driven development has resulted in introduction of education programs for practitioner training, development of product and practitioner regulation systems, and generation of an increasing interest in research. Significant efforts have been made in validating the quality, effectiveness, and safety of TCM interventions evidenced by a growing number of published trials and systematic reviews. Commonly, the results of these studies were inconclusive due to the lack of quality and quantity of the trials to answer specific and answerable clinical questions. OBJECTIVES: The methodology of a randomized clinical trial (RCT) is not free from bias, and the unique features of TCM (such as individualization and holism) further complicate effective execution of RCTs in TCM therapies. Thus, data from limited RCTs and systematic reviews need to be interpreted with great caution. Nevertheless, until new and specific methodology is developed that can adequately address these methodology challenges for RCTs in TCM, evidence from quality RCTs and systematic reviews still holds the credibility of TCM in the scientific community. CONCLUSIONS: This article summarizes studies on TCM utilization, and regulatory and educational development with a focus on updating the TCM clinical evidence from RCTs and systematic reviews over the last decade. The key issues and challenges associated with evidence-based TCM developments are also explored.

Chinese herbal medicine for Mild Cognitive Impairment and Age Associated Memory Impairment: a review of randomised controlled trials.

This review assesses the effectiveness and safety of Chinese herbal medicines (CHM) for Mild Cognitive Impairment (MCI) and Age Associated Memory Impairment (AAMI). Electronic searches of English and Chinese databases and hand searches of Chinese journal holdings were conducted. Randomised controlled trials comparing orally administered CHM with placebo, no intervention or other therapy were considered. Ginkgo biloba was excluded. Ten trials met inclusion criteria. Eight different CHM were investigated. Methodological quality was assessed using the Jadad scale and five studies scored three or above. Two studies compared CHM with placebo and eight with another intervention. This review found an overall benefit on some outcome measures for the eight CHMs involved in the 10 RCTs but methodological and data reporting issues were evident. Meta-analysis of three studies found the effects of the CHMs were at least equivalent to piracetam on Mini-Mental State Examination (MMSE) scores. No severe adverse events were reported.

Herbal medicine for dementia: a systematic review.

This systematic review aimed to assess the effectiveness and safety of herbal medicines (HM) for treating dementia. Databases in English and Chinese were searched from their inceptions to February 2007. References in reviews and randomized controlled trials (RCTs) were screened by hand. Trials comparing orally administered HM with placebo, no intervention or other therapy were considered. Trials on Ginkgo biloba and its extracts were excluded to avoid duplication of existing reviews. Pairs of authors independently applied eligibility criteria, extracted data and assessed methodological quality using the Jadad Scale. Thirteen RCTs met the inclusion criteria of three or above on this scale. Six trials compared herbal medicine with placebo, one with no treatment, and the remainder with pharmaceutical intervention. Meta-analyses were performed on common cognitive performance outcome measures. All studies reported HM had significant effects in improving symptoms. In studies that employed active controls, HM was at least as effective as the pharmaceutical intervention. Meta-analyses found HM more effective than no treatment or placebo and at least equivalent to control interventions, although the overall effect was small. No severe adverse events were reported. These trials provide overall positive evidence for the effectiveness and safety of certain HMs for dementia management.

Acupuncture, chiropractic and osteopathy use in Australia: a national population survey.

BACKGROUND: There have been no published national studies on the use in Australia of the manipulative therapies, acupuncture, chiropractic or osteopathy, or on matters including the purposes for which these therapies are used, treatment outcomes and the socio-demographic characteristics of users. METHODS: This study on the three manipulative therapies was a component of a broader investigation on the use of complementary and alternative therapies. For this we conducted a cross-sectional, population survey on a representative sample of 1,067 adults from the six states and two territories of Australia in 2005 by computer-assisted telephone interviews. The sample was recruited by random digit dialling. RESULTS: Over a 12-month period, approximately one in four adult Australians used either acupuncture (9.2%), chiropractic (16.1%) or osteopathy (4.6%) at least once. It is estimated that, adult Australians made 32.3 million visits to acupuncturists, chiropractors and osteopaths, incurring personal expenditure estimated to be A$1.58 billion in total. The most common conditions treated were back pain and related problems and over 90% of the users of each therapy considered their treatment to be very or somewhat helpful. Adverse events are reported. Nearly one fifth of users were referred to manipulative therapy practitioners by medical practitioners. CONCLUSION: There is substantial use of manipulative therapies by adult Australians, especially for back-related problems. Treatments incur considerable personal expenditure. In general, patient experience is positive. Referral by medical practitioners is a major determinant of use of these manipulative therapies.

Desired Chinese medicine practitioner capabilities and professional development needs: a survey of registered practitioners in Victoria, Australia.

BACKGROUND: The State of Victoria in Australia introduced Chinese medicine practitioner registration in 2000 and issued its education guidelines in late 2002 for introduction in 2005. This study obtained practitioners' views on desired capabilities for competent Chinese medicine practice and to identify professional development needs. METHODS: A questionnaire, consisting of 28 predefined capabilities in four categories with a rating scale of importance from one to five, was developed and sent to all registered Chinese medicine practitioners in the State of Victoria, Australia in October, 2005. RESULTS: Two hundreds and twenty eight completed questionnaires were returned which represented a response rate of 32.5%. Of the four categories of capabilities, technical capabilities were considered to be the most important for clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In contrast, research and information management capabilities were considered the least important. The educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications than practitioners trained overseas valued communication as an important capability. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. CONCLUSION: Registered Chinese medicine practitioners viewed skills training as important but did not support the need for research and information management training. This represents a significant hurdle to developing Chinese medicine as a form of evidence-based healthcare.

Complementary and alternative medicine use by older Australians.

Complementary and alternative medicine (CAM) use by Australians is substantial and increasing, but little is known about its use by the elderly. We here present the findings for the elderly cohort in our recently conducted national survey on CAM use by adult Australians. In May and June 2005, computer-assisted telephone interviews, using random-digit telephone dialing, were employed to gather data on CAM use in the last 12 months. Of 1067 adult participants interviewed, 178 were 65 or older. More than half of these (57.8%; 95% CI, 50.7%-64.9%) had used at least one of 17 common forms of CAM and 60.4% of the CAM users had consulted CAM practitioners. Clinical nutrition, chiropractic, massage therapy, meditation, and herbal medicine were the most common forms of CAM used by the elderly. A higher proportion of the elderly had always used both CAM and conventional medical treatments (37.9%) than had those aged 18-34 (15.7%) and 35-64 (26.9%). Elderly CAM users (60.2%) were more likely than younger users to discuss their use with their doctors. Of those who did not do so, 24.1% were not asked by their doctors and 16.0% considered that their doctor would disapprove. In conclusion, we found that a substantial proportion of older Australians use CAM. The elderly are also more likely than younger adults to discuss their use of CAM with their doctors, but doctors need to play a more active role in initiating such communication.

Acupuncture for persistent allergic rhinitis: a randomised, sham-controlled trial.

OBJECTIVE: To investigate the effectiveness and safety of acupuncture in persistent allergic rhinitis (PAR) DESIGN: Randomised, single-blind, sham-controlled trial conducted from May 2004 to February 2005. PARTICIPANTS AND INTERVENTION: 80 patients with PAR (age, 16-70 years) were randomly assigned to receive real or sham acupuncture. After a 1-week baseline period, participants were treated twice weekly for 8 weeks and followed up for another 12 weeks. MAIN OUTCOME MEASURES: Nasal obstruction, sneezing, rhinorrhoea and nasal itch were each self-assessed daily on a 5-point scale, and scores were aggregated weekly. The sum of the symptom scores (total nasal symptom score, TNSS) was also determined. A secondary outcome was use of PAR relief medication. RESULTS: After 8 weeks' treatment, the weekly mean difference in TNSS from baseline was greater with real (-17.2; 95% CI, -24.6 to -9.8) than with sham acupuncture (-4.2; 95% CI, -11.0 to 2.7) (P = 0.01). The decrease in individual symptom score was also greater with real acupuncture for rhinorrhoea (P < 0.01) but not the other symptoms. At the end of follow-up, the greater difference in TNSS from baseline in the real acupuncture group was still apparent: real, -21.0 (95% CI, -29.1 to -12.9) versus sham, - 2.3 (95% CI, -10.2 to 5.6) (P = 0.001). Moreover, the differences from baseline in all four individual symptom scores were greater for the real than for the sham group (P < 0.05). Real and sham acupuncture were both well tolerated. CONCLUSION: Our findings suggest that acupuncture is effective in the symptomatic treatment of PAR. TRIAL REGISTRATION: Australian Government Therapeutic Goods Administration CTN 034/2004.

Complementary and alternative medicine use in Australia: a national population-based survey.

OBJECTIVE: To investigate the use of and expenditure on 17 of the most popular forms of complementary and alternative medicine (CAM) by adult Australians, sociodemographic characteristics of CAM users, and communication between CAM users and their doctors. METHODS: In May-June 2005, a sample of 1067 adults, 18 years and older, from all Australian states and territories, was recruited by random-digit telephone dialing and interviewed about their CAM use in the previous 12 months. RESULTS: In the 12-month period, 68.9% (95% CI: 66.1%-71.7%) of those interviewed used at least one of the 17 forms of CAM and 44.1% (95% confidence interval: 41.1%-47.1%) visited a CAM practitioner. The estimated number of visits to CAM practitioners by adult Australians in the 12-month period (69.2 million) was almost identical to the estimated number of visits to medical practitioners (69.3 million). The annual "out of pocket" expenditure on CAM, nationally, was estimated as 4.13 billion Australian dollars (US $3.12 billion). Less than half of the users always informed their medical practitioners about their use of CAM. The most common characteristics of CAM users were: age, 18-34; female; employed; well-educated; private health insurance coverage; and higher-than-average incomes. CONCLUSIONS: CAM use nationally in Australia appears to be considerably higher than estimated from previous Australian studies. This may reflect an increasing popularity of CAM; however, regional variations in CAM use and the broader range of CAM included in the current study may contribute to the difference. Most frequently, doctors would not appear to be aware of their patient use of CAM.

Inhibition of release of inflammatory mediators in primary and cultured cells by a Chinese herbal medicine formula for allergic rhinitis.

BACKGROUND: We demonstrated that a Chinese herbal formula, which we refer to as RCM-101, developed from a traditional Chinese medicine formula, reduced nasal and non-nasal symptoms of seasonal allergic rhinitis (SAR). The present study in primary and cultured cells was undertaken to investigate the effects of RCM-101 on the production/release of inflammatory mediators known to be involved in SAR. METHODS: Compound 48/80-induced histamine release was studied in rat peritoneal mast cells. Production of leukotriene B4 induced by the calcium ionophore A23187 was studied in porcine neutrophils using an HPLC assay and lipopolysaccharide-stimulated prostaglandin E2 production was studied in murine macrophage (Raw 264.7) cells by immune-enzyme assay. Expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) was determined in Raw 264.7 cells, using western blotting techniques. RESULTS: RCM-101 (1-100 microg/mL) produced concentration-dependent inhibition of compound 48/80-induced histamine release from rat peritoneal mast cells and of lipopolysaccharide-stimulated prostaglandin E2 release from Raw 264.7 cells. Over the range 1-10 microg/mL, it inhibited A23187-induced leukotriene B4 production in porcine neutrophils. In addition, RCM-101 (100 microg/mL) inhibited the expression of COX-2 protein but did not affect that of COX-1. CONCLUSION: The findings indicate that RCM-101 inhibits the release and/or synthesis of histamine, leukotriene B4 and prostaglandin E2 in cultured cells. These interactions of RCM-101 with multiple inflammatory mediators are likely to be related to its ability to reduce symptoms of allergic rhinitis.

Does acupuncture or Chinese herbal medicine have a role in the treatment of allergic rhinitis?

PURPOSE OF REVIEW: Complementary medicines, including acupuncture and Chinese herbal medicine, are being used increasingly for the management of allergies such as allergic rhinitis. Until relatively recently, however, evidence for the efficacy and safety of these therapies in allergic conditions has been lacking. RECENT FINDINGS: A limited number of well conducted studies, all with small sample sizes, have demonstrated the promising therapeutic potential of acupuncture and Chinese herbal medicine for allergic rhinitis. The possible additional benefit of combining the two therapies, however, is yet to be confirmed. There are concerns about the appropriateness of the sham/placebo controls that have been used in acupuncture studies and also about the safety evaluation of individual herbs and herbal formulations. In addition to well established symptom scores and specific quality of life questionnaires, the concurrent use of conventional anti-allergy medications has been utilized as an outcome measure in a number of trials that have evaluated the effectiveness of acupuncture and Chinese herbal medicine for allergic rhinitis. SUMMARY: Tentatively, it appears that acupuncture and Chinese herbal medicine can be effective treatments for allergic rhinitis. Confirmatory evidence, however, is needed from large and, ideally, multi-centre trials.

Cromakalim inhibits transmitter acetylcholine release in rat trachea by an action on epithelial cells and a diffusible factor.

The present study was undertaken to investigate further the effects of the potassium channel opening drug cromakalim on the release of transmitter acetylcholine from cholinergic nerves of rat isolated trachea by using two tracheal preparations superfused in series. In all experiments, the lower chamber contained an epithelium-denuded preparation which had been incubated with [3H]-choline to incorporate [3H]-acetylcholine into cholinergic transmitter stores, whereas the upper chamber contained an unlabelled, epithelium-intact or epithelium-denuded preparation. When the upper chamber contained an epithelium-intact tracheal preparation, cromakalim (1-100 micro M) significantly reduced the stimulation-induced (S-I) efflux of [3H]-acetylcholine from the radiolabelled, epithelium-denuded tracheal preparation in the lower flow chamber. In contrast, when the upper flow chamber contained an epithelium-denuded preparation, cromakalim (10 micro M) was without effect on the S-I efflux. Glibenclamide (1 micro M), an ATP-sensitive potassium channel blocker, was without effect on the S-I efflux when the upper chamber contained an unlabelled, epithelium-intact tracheal preparation. However, glibenclamide (1 micro M) prevented the inhibition of the S-I efflux by cromakalim (10 micro M). When the upper chamber contained an epithelium-intact tracheal preparation and the lower chamber contained an epithelium-denuded tracheal preparation, cromakalim (10 micro M), when infused through the side-arm of the T-piece, such that only the lower radiolabelled epithelium-denuded tracheal preparation was exposed to the drug, was without effect on the S-I efflux. The findings of the present study have provided evidence of an inhibitory action of the potassium channel opener cromakalim on transmitter acetylcholine release in rat trachea which is dependent on the functional integrity of the tracheal epithelium. The findings suggest that cromakalim may inhibit transmitter acetylcholine release by opening ATP-sensitive potassium channels, probably, on cells in the epithelial layer to release a putative epithelial factor, which in turn acts prejunctionally to mediate the inhibitory effect of cromakalim.