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Allergy and integrative medicine—The role of acupuncture
Invited Lectures / European Journal of Integrative Medicine 2 (2010) 159–164
different underlying mechanisms will significantly add to this process. doi:10.1016/j.eujim.2010.09.207 Allergy and integrative medicine—The role of acupuncture B. Brinkhaus Charité University Medical Center, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany Patients frequently use acupuncture for the treatment of allergic rhinitis (AR). Results of our pilot study, the ALLERGY study, indicate that the use of a combination of acupuncture and Chinese herbal medicine is superior to sham acupuncture and placebo treatment in patients with seasonal allergic rhinitis. In addition, results of a large pragmatic trial with more than 5000 AR patients suggested that treating patients suffering from allergic rhinitis with adjunctive acupuncture therapy leads to clinically relevant benefits. Despite these results, authors of two recently published systematic reviews draw the conclusion, that there is currently insufficient evidence to support or refuse the use of acupuncture in patients with allergic rhinitis. They pointed out that previous studies on the efficacy of acupuncture in AR have suffered from a variety of methodological limitations, such as small patient numbers or the lack of a sham-acupuncture control group and they concluded, that a large well conducted RCT, which overcomes identified methodological problems would be required. We performed a three-armed randomised controlled multi-centre trial, the Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) trial to investigate the efficacy of acupuncture in the treatment of seasonal allergic rhinitis. SAR Patients with seasonal allergic rhinitis with clinical symptoms and test positive to both birch and grass pollen were randomised to a (a) semistandardized acupuncture plus rescue medication (Cetirizin); (b) penetrating sham acupuncture at non-acupuncture points plus rescue medication; or (c) rescue medication alone for 8 weeks (standard treatment group). The results of this large trial have a major impact on the decision of whether acupuncture should be considered as a therapeutic option in the treatment of SAR. The topics of my plenary talk will be to present the use of acupuncture in AR, the current evidence of the efficacy and effectiveness of acupuncture in AR and the methods and results of the ACUSAR trial. doi:10.1016/j.eujim.2010.09.208 Allergy—A pragmatic integrated approach G. Lewith Aldermoore Health Center, Southampton, United Kingdom This talk will present an integrated approach to allergy which will look at environmental medicine, food intolerance, masked sensitivity and the integration of conventional allergic approaches to the management of rhinitis. The diagnosis and
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investigation of food intolerance/sensitivity is a complex clinical area. This lecture will summarise these issues along with the development of both primary and secondary food intolerance, its diagnosis and clinical management. A patient centred holistic approach to allergy and intolerance will be presented that integrates convention and complementary medicine with other whole systems such as acupuncture and homeopathy in a coherent pragmatic and clinically based disease model. Specific reference and illustrations will be drawn from allergic rhinitis and illustrative examples of how this condition may be approached will be discussed. doi:10.1016/j.eujim.2010.09.209 In-hospital care M. Frass ∗ , H. Friehs, M. Müllner, K. Gärtner, K. Thieves, C. Marosi Medical University Vienna, Internal Medicine I, Vienna, Austria Aim: The purpose of the study was evaluation of quality of life (QoL) and subjective existential orientation of oncological patients making use of additive homeopathic treatment. Method: 90 patients with breast (35), colorectal (10), renal (7), cerebral (7), and pancreatic (6) cancer; sarcoma (5); bronchial (4) cancer; lymphoma (4); pharyngeal (3) cancer; and others (9) underwent an elaborate medical history including questions relating to social and private circumstances. Symptoms given by patients were correlated with the signs of homeopathic evaluation of remedies as recorded in repertories (Zandvoort, Complete Repertory; MacRepertory® ). Patients received individually selected homeopathic remedies in addition to regular conventional treatment. Patients were requested to complete visual analogue scales as well as a specially developed form evaluating subjective existential orientation and, finally, EORTC QLQ-C30 form version 3.0. With respect to the latter, the mean QoL improved by 0.31 points (4.33 ± 1.54 before vs. 4.64 ± 1.59 after additive homeopathic therapy; p = 0.008, Student’s t-test for paired data) between first and last registered consultation which lay apart by a mean of 24 weeks. This result corresponded to an improvement of 11.6% in a seven part-series. Similar results were found for the specially developed form: the visual analogue scale showed a difference of 0.71 (5.60 ± 2.06 before vs. 6.31 ± 2.3 at the third consultation, p = 0.043; corresponding to an improvement of 16.1% in a ten part-series), and a difference of 0.59 (5.56 ± 2.15 vs. 6.15 ± 2.31, p = 0.007; 13.3% improvement in a ten part-series) between first and last consultation. Following the fourth consultation, analysis in 45 participants revealed that 80% (n = 36) felt an improvement of the general condition, while 20% (n = 9) experienced no effect. All patients were interested in continuing homeopathic treatment. Conclusion: Homeopathy was well accepted by the investigated patients. Improvement in QoL as well as in subjective existential orientation warrants further investigations. Oncologists may want to receive information about the use of homeopathy and other forms of com-
different underlying mechanisms will significantly add to this process. doi:10.1016/j.eujim.2010.09.207 Allergy and integrative medicine—The role of acupuncture B. Brinkhaus Charité University Medical Center, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany Patients frequently use acupuncture for the treatment of allergic rhinitis (AR). Results of our pilot study, the ALLERGY study, indicate that the use of a combination of acupuncture and Chinese herbal medicine is superior to sham acupuncture and placebo treatment in patients with seasonal allergic rhinitis. In addition, results of a large pragmatic trial with more than 5000 AR patients suggested that treating patients suffering from allergic rhinitis with adjunctive acupuncture therapy leads to clinically relevant benefits. Despite these results, authors of two recently published systematic reviews draw the conclusion, that there is currently insufficient evidence to support or refuse the use of acupuncture in patients with allergic rhinitis. They pointed out that previous studies on the efficacy of acupuncture in AR have suffered from a variety of methodological limitations, such as small patient numbers or the lack of a sham-acupuncture control group and they concluded, that a large well conducted RCT, which overcomes identified methodological problems would be required. We performed a three-armed randomised controlled multi-centre trial, the Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) trial to investigate the efficacy of acupuncture in the treatment of seasonal allergic rhinitis. SAR Patients with seasonal allergic rhinitis with clinical symptoms and test positive to both birch and grass pollen were randomised to a (a) semistandardized acupuncture plus rescue medication (Cetirizin); (b) penetrating sham acupuncture at non-acupuncture points plus rescue medication; or (c) rescue medication alone for 8 weeks (standard treatment group). The results of this large trial have a major impact on the decision of whether acupuncture should be considered as a therapeutic option in the treatment of SAR. The topics of my plenary talk will be to present the use of acupuncture in AR, the current evidence of the efficacy and effectiveness of acupuncture in AR and the methods and results of the ACUSAR trial. doi:10.1016/j.eujim.2010.09.208 Allergy—A pragmatic integrated approach G. Lewith Aldermoore Health Center, Southampton, United Kingdom This talk will present an integrated approach to allergy which will look at environmental medicine, food intolerance, masked sensitivity and the integration of conventional allergic approaches to the management of rhinitis. The diagnosis and
163
investigation of food intolerance/sensitivity is a complex clinical area. This lecture will summarise these issues along with the development of both primary and secondary food intolerance, its diagnosis and clinical management. A patient centred holistic approach to allergy and intolerance will be presented that integrates convention and complementary medicine with other whole systems such as acupuncture and homeopathy in a coherent pragmatic and clinically based disease model. Specific reference and illustrations will be drawn from allergic rhinitis and illustrative examples of how this condition may be approached will be discussed. doi:10.1016/j.eujim.2010.09.209 In-hospital care M. Frass ∗ , H. Friehs, M. Müllner, K. Gärtner, K. Thieves, C. Marosi Medical University Vienna, Internal Medicine I, Vienna, Austria Aim: The purpose of the study was evaluation of quality of life (QoL) and subjective existential orientation of oncological patients making use of additive homeopathic treatment. Method: 90 patients with breast (35), colorectal (10), renal (7), cerebral (7), and pancreatic (6) cancer; sarcoma (5); bronchial (4) cancer; lymphoma (4); pharyngeal (3) cancer; and others (9) underwent an elaborate medical history including questions relating to social and private circumstances. Symptoms given by patients were correlated with the signs of homeopathic evaluation of remedies as recorded in repertories (Zandvoort, Complete Repertory; MacRepertory® ). Patients received individually selected homeopathic remedies in addition to regular conventional treatment. Patients were requested to complete visual analogue scales as well as a specially developed form evaluating subjective existential orientation and, finally, EORTC QLQ-C30 form version 3.0. With respect to the latter, the mean QoL improved by 0.31 points (4.33 ± 1.54 before vs. 4.64 ± 1.59 after additive homeopathic therapy; p = 0.008, Student’s t-test for paired data) between first and last registered consultation which lay apart by a mean of 24 weeks. This result corresponded to an improvement of 11.6% in a seven part-series. Similar results were found for the specially developed form: the visual analogue scale showed a difference of 0.71 (5.60 ± 2.06 before vs. 6.31 ± 2.3 at the third consultation, p = 0.043; corresponding to an improvement of 16.1% in a ten part-series), and a difference of 0.59 (5.56 ± 2.15 vs. 6.15 ± 2.31, p = 0.007; 13.3% improvement in a ten part-series) between first and last consultation. Following the fourth consultation, analysis in 45 participants revealed that 80% (n = 36) felt an improvement of the general condition, while 20% (n = 9) experienced no effect. All patients were interested in continuing homeopathic treatment. Conclusion: Homeopathy was well accepted by the investigated patients. Improvement in QoL as well as in subjective existential orientation warrants further investigations. Oncologists may want to receive information about the use of homeopathy and other forms of com-