Complementary and Alternative Medicine

Recent research suggests that one in ten of the UK population use some form of Complementary and Alternative Medicine (CAM) each year and about half of the population have used some CAM treatment during their lifetime. It is probable that more people than average with allergic illness will have used or considered the use of some form of CAM therapy.

In this fact sheet we intend to focus on the main allergic diseases (asthma, rhinitis and eczema) and wish to introduce some of the major forms of CAM treatments that you might consider if you have an allergic complaint. If you wish to seek advice from a complementary therapist about your allergic condition, it is important that you do so with the help of a competent and responsible practitioner. The initial sections of this leaflet deal with the therapies themselves, but considerable attention is paid to helping you choose a competent and professional therapist who can provide safe treatment in conjunction with your conventional doctor.

What is complementary medicine?

It is increasingly difficult to differentiate between conventional and complementary medicine. What we are all trying to achieve is the best possible medical approach for an individual's problem, and that may frequently involve some form of nutritional supplement combined with a conventional and symptomatic treatment for someone who suffers from an allergic disease like eczema.

It is also very difficult to define CAM; some people think of it as techniques that are not taught in medical school, although it is becoming increasingly popular in British medical schools to teach students about CAM so that they are better able to answer their patients' questions. Another definition is to consider them as therapies not thought of as mainstream in the context of a particular country's prevailing healthcare system.

Herbal medicine would therefore be thought of as complementary in the United Kingdom but mainstream in China. The first definition is perhaps more appropriate from a doctor's perspective, and the second perhaps takes more account of the patient's view.

In the United Kingdom, complementary medicine is mainly used for the treatment of chronic illness, particularly allergic conditions and conditions that involve the muscles, bones and joints, (e.g. osteopathy or chiropractic for back pain).

In general, complementary medicine does not claim to cure chronic conditions. The evidence available suggests that many people are drawn to the use of complementary medicine because it allows them to take a more active part in the management of their problem and to explore therapies that are usually safe and relatively side-effect free.

There are some simple principles which differentiate most complementary medical techniques from conventional treatments. In general, complementary medicine will not provide an immediate and swift response for the common allergies of asthma, eczema and rhinitis. Patients receiving homeopathy or acupuncture may find that there is an initial aggravation which will, with luck, be followed by a slow but sure improvement. We only have a limited amount of evidence about the value of complementary medicine in allergic disease; there are some areas where it may work quite effectively, for instance the use of homeopathy in rhinitis and evening primrose oil in eczema. However, because so little research has been done that it is usually very difficult to recommend a particular CAM treatment and the majority must be considered as unproven in the treatment of the vast majority of allergic conditions. If you therefore wish to try CAM treatments, please try and follow the simple guidelines we have laid out so that you will be able to select a safe therapist who can provide a proper and ethical approach to the treatment of your condition.

Acupuncture

Acupuncture is widely used in the treatment of allergic conditions. It involves the insertion of fine, stainless steel, single use, sterile needles into specific acupuncture points that are either on the body or the ear. The point prescriptions for allergic diseases are usually based on a traditional Chinese diagnosis. Acupuncture, for the treatment of allergic conditions, is usually practised privately and you will require 6-10 treatment sessions before you are likely to see clear clinical results. There is some evidence that acupuncture may be of help in asthma and rhinitis, but in general there is very limited research into how acupuncture may affect allergic diseases. It is therefore difficult to provide clear advice about its effectiveness beyond the sometimes enthusiastic reports from both practitioners and their patients. Acupuncture is generally a safe treatment with very few serious side effects, and can be used in conjunction with conventional medicine. Acupuncturists should only use single use, sterilised, disposable acupuncture needles.

The treatment of allergies should be provided by a competent practitioner; acupuncture is practised by professional

Acupuncturists:- British Acupuncture Council, 63 Jeddo Road, London, W12 9HQ Tel 020 8735 0400 www.acupuncture.org.uk)

Physiotherapists:- Acupuncture Association of Chartered Physiotherapists, Castleton House, Castle Street, Mere, Wiltshire, BA12 6JE

and Doctors:- British Medical Acupuncture Society, BMAS House, 3 Winnington Court, Northwich
CW8 1AQ Tel 01606 786782

All these professionals are registered and have their training approved by the relevant professional organisation; further information can be obtained by contacting them.

Herbal Medicine

Herbal medicine involves the use of plant extracts in the treatment of illness. It is almost exclusively provided in the context of private practice. Some herbal products are available over the counter, but in general the treatment of allergic conditions should be based on an individualised prescription after you have seen a registered and qualified medical herbalist.

In the UK there are two main types of herbal practice: European and Traditional Chinese. The organisations who register herbal practitioners are:

European Herbal Practitioners Association, 8 Lion Yard, Tremadoc Road, London SW4 7NQ Tel 020 7627 2680;

and

Register of Chinese Herbal Medicine, Office 5, 1 Exeter Street, Norwich NR2 4QB www.rchm.co.uk

The organisations are responsible for their regulation and training and would be happy to provide further information for you. Patients will usually take several visits to herbalists to obtain a clear clinical result.

There is growing evidence from randomised controlled trials that herbal medicine may be effective in both eczema and asthma, there is also some evidence that herbs may interact with conventional medications and that herbs themselves may be responsible for some adverse reactions. A registered and qualified herbalist will be aware of these dangers and will liaise with your general practitioner in order to produce a safe and rational treatment plan that takes account of both your individual needs and your conventional medication.

Homeopathy

Homeopathy involves the use of very dilute preparations, sometimes so dilute that there is no molecule of the original substance in the medicine. Homeopathic medicine may be derived from animal, mineral or plant product. Its manufacture involves dilution and shaking or succussion, a process that is supposed to potentise or strengthen the remedy the more dilute it gets. A C potency is a 1 in 100 dilution and a D potency is a 1 in 10 dilution. In order to prescribe a homeopathic remedy, a full history is required and the homeopath will try to match the remedy to the patients' general constitutions and their specific complaints. Consequently, there is no particular homeopathic remedy for any disease, but there are remedies that are thought to be effective in specific individuals with allergic disease. There is some evidence that homeopathy may help rhinitis, but limited scientific evidence that it helps asthma and eczema. It is, however, widely used by allergic people and many homeopaths claim great success in allergic conditions. Homeopathy is available via the NHS, either through qualified general practitioners or through the various homeopathic hospitals in England and Scotland, although probably the greatest volume of homeopathic practice occurs in the private sector.

The Faculty of Homeopathy registers medically qualified homeopaths at Hahnemann House, 29 Park St West, Luton LU1 3BE 0870 444 3950 www.trusthomeopathy.org.

Non-medically qualified professional homeopaths can be found through the Society of Homeopaths, 11 Brookfield, Duncan Close, Moulton Park, Northampton NN3 6WL Tel 0845 450 6611.

There are no serious adverse reactions to homeopathy, although in the short term homeopathy may aggravate your existing allergic condition. You will usually need to visit a homeopath on several occasions to obtain a clear clinical result for your condition.

You should not stop your conventional medicine and replace it with homeopathy without discussing a safe process for this transition with your own general practitioner. Some non-medically qualified homeopaths claim that vaccinations should be avoided in allergic individuals and that they cannot treat allergic individuals if they continue to receive conventional medication, such as inhaled steroids for asthma; not only could this be dangerous, but there is no evidence for these claims.

The manipulative treatments

The manipulative therapies, such as osteopathy and chiropractic, are usually used in the treatment of diseases of muscle, bones and joints. There is little evidence that they are of value in allergic conditions, although some osteopathic techniques do claim to be beneficial for asthma, particularly childhood asthma. These two professions are now effectively statutorily registered in much the same manner as nursing, physiotherapy and medicine.

If you wish to obtain further information about osteopathy or chiropractic, please contact the relevant registering bodies

General Osteopathic Council, 176 Tower Bridge Road, London SE1 3LU Tel 0207 357 6655;

British Chiropractic Association, Blagrave House, 17 Blagrave Street, Reading RG1 1QB Tel 01189 505950.

Aromatherapy

Aromatherapy involves using essential oils extracted from plants. A French chemist, Gattefosse, burned his hand in a laboratory accident and then plunged it into a vat of lavender oil; he found that the wound healed remarkably quickly without any scarring and coined the term 'aromatherapy' in 1931 to describe this new treatment. In fact the use of aromas to treat illness appears to have originated with the Australian Aborigines; they had already identified that tea tree oil, an essential oil used in modern aromatherapy, was an excellent antiseptic.Aromatherapy oils can be taken simply as a "smell" or they may be dropped into a hot bath and absorbed through the skin. It is important when using the oils to remember that they should be diluted, neat oils may damage the skin.

While there is some evidence that aromatherapy may help sleep disturbance and one or two other conditions, there is no evidence (because there have been no studies) that it is of any benefit in common allergic conditions. If you wish to consult an aromatherapist, the governing organisation is:

The Aromatherapy Organisations Council (PO Box 6522, Desborough, Kettering NN14 2YX tel 0870 7743477) represents all the different professional registered aromatherapists.

Dietary avoidance and advice

There are some general pieces of advice that fall largely within the remit of conventional rather than complementary medicine. If you have a known food allergen (for instance, peanuts), these must be avoided. We know that food additives, such as preservatives and colourants, have a tendency to make allergic conditions such as asthma worse. In addition, there is now overwhelming evidence that allergic individuals have reduced anti-oxidant status; this means that supplementation with vitamins, such as vitamins E and C, and a diet that is rich in fresh fruits and vegetables, is advantageous to asthmatics.

If you are aware that you have specific allergens or that you are following a dietary restriction, then it is important that you seek appropriate nutritional advice to make sure that your diet is adequately balanced. In these instances you should discuss referral to a qualified dietician with your doctor.

Nutritional Medicine

Nutritional medicine usually involves the use of food supplements, vitamins or minerals, given orally, in the form of tablets or liquids. Food supplements include the use of glucosamine sulphate in the treatment of arthritis and essential fatty acids, such as evening primrose oil, for the treatment of eczema. The importance of vitamins and minerals was first identified by James Lind in 1753. He noticed that sailors on long voyages developed scurvy and that this was a disease of nutritional deficiency as it could be remedied by the addition of lime juice to a sailor's diet. Vitamin C was not chemically isolated until the 20th Century. Nutritional medicine can therefore be used to treat or prevent diseases of deficiency.

It can also be used to help manage chronic illness where the body's nutritional demand may be distorted by the disease process. For instance, many asthmatics are deficient in magnesium, so the addition of magnesium may help in the management of asthma. We know that the addition of evening primrose oil helps many people with eczema, and some of those involved in nutritional medicine claim that the inflammatory process of eczema means that zinc and vitamin B supplements are frequently required in this condition. The evidence for the use of nutritional medicine in allergic conditions is patchy but encouraging.

If you wish to consult a nutritional practitioner, there are a number of people you can contact:

The members of the British Society for Ecological Medicine (formerly the Br Soc for Allergy, Environmental and Nutritional Medicine (www.ecomed.org) are all medically qualified individuals. The organisation will provide names and addresses of doctors who can provide nutritional advice and support.

Tthe regulation of doctors is the responsibility of the General Medical Council. The General Council and Register of Naturopaths, 2 Goswell Road, Street, Somerset, BA16 0JG - Telephone: 01458 840072; email: admin@naturopathy.org.uk) and the British Association of Nutritional Therapists (BCM BANT, London, WC1N 3XX - Telephone: 0870 606 1284) are organisations primarily for non-medically qualified individuals. Both these organizations act as educational and regulatory bodies.

Reflexology

Reflexology, or reflex zone therapy, can in theory be applied to almost any area of the body, in practice it is usually applied to the feet. The feet are said to have various zones on them which represent the whole structure of the body. While there is some good evidence that reflex zones exist in the ear, there is no evidence that they also exist in the feet. Having said this, many reflexologists are able to make surprising diagnoses based on these specific "tender areas". However, a diagnosis based on reflexology may not be accurate and should never be assumed to correlate directly with a conventional medical diagnosis.

Reflexology became popular in the 1960s through the efforts of Doreen Bailey who met one of Joseph Reilly's assistants and developed and popularised the technique.

The reflexologist massages the tender areas in the feet, sometimes inducing quite a lot of pain, in order to treat and rebalance dysfunction. Unfortunately, there is no evidence (because there have been no clinical trials) that reflexology is effective in the treatment of common allergic conditions.

There are no specific organisations for reflexologists; the two largest organisations within the reflexology world are:

Tthe Association of Reflexologists (27 Old Gloucester Street, London, WC1N 3XX - telephone: 0870 567 3320)

The International Federation of Reflexologists (76-78 Edridge Road, Croydon, Surrey, CR0 1EF - telephone: 020 8667 9458).

How do I know my therapist is competent?

If you are thinking of choosing a complementary therapist yourself, then there are certain questions that you might like to discuss with them. These form the foundation of good clinical practice but do not guarantee competence.

• Do you think the practitioner is technically competent? This usually means that they are a member of an appropriate organisation and therefore have adequate training in the field in which they practice? Membership of most professional organisations includes professional indemnity insurance, but check this if in doubt.
• Might they advise you to change your conventional medical treatment without seeking the advice of your doctor, e.g. asking you to stop your inhaled steroids? In general terms it is a very bad idea for one person treating you to change treatments without communicating and informing the other individuals who are involved in your care. Ideally your GP should be communicating with your complementary practitioner and vice versa.
• Can the proposed treatment be provided safely? For instance, if you are seeing a herbalist, are you sure they are aware of the potential cross-reaction between herbal medicine and the conventional medicine you may be taking?
• Will the complementary practitioner set guidelines with you, at the first appointment, for how they think the treatment should progress? For instance, should you expect a response to treatment after 3 or 4 acupuncture sessions or would it be more reasonable to assess whether the treatment is worthwhile after 8 or 10 treatments? This helps to focus both your own and your practitioner's mind about whether the treatment is working. It would also be ideal for you to come to your consultation with a clear list of symptoms and problems, this can then be used to refer back to at a later stage as symptoms may change during treatment.
• The main organisations for you to contact are listed under each therapy.
• Does your practitioner's organisation have a code of ethics? Is the data they hold on you legally protected and will they treat the information you give them in a confidential manner?
• Is your practitioner's organisation one which employs a process of self-regulation and will remove members from their list if they are not behaving ethically?
• Are they aware of and do they have a process of reporting any adverse reaction to the treatment that they provide?

It would certainly be wise for anybody thinking of having a CAM treatment to consider whether their therapist is competent and whether the therapy itself can be provided in a proper and professional manner. Ideally you should discuss this with your own general practitioner and the complementary therapist you are thinking about consulting. If you are unsure or concerned about any of these issues, ask again and do not go and see anybody until you are happy that they are a safe and competent practitioner.

How can I be referred to a complementary practitioner?

Many people find their route to complementary medicine through the recommendation of a friend or somebody who has been successfully treated. It is impossible to lay down absolute guidelines for when such referrals should take place, but in general terms both you and your GP may wish to consider the following issues:

• Has a clear diagnosis of your problem been made? If such a diagnosis cannot be made, then have other common conditions been excluded so that both you and your GP know that you are not missing out on appropriate conventional medical treatment.
• If you have got a chronic condition which is relatively stable then it may be reasonable to try a complementary medical approach, either to help symptoms or to minimise the use of potentially damaging long-term conventional medicines, e.g. steroids for eczema. However, before you reduce your conventional medications, this must be discussed with your GP.
• Our GP may know a competent complementary therapist to whom they regularly refer. If this is the case then your GP will have assured themselves that the person to whom they are referring is a competent and safe individual.
• Your GP may wish to refer you to another doctor practising some form of complementary medicine. This kind of referral should be exactly the same as a referral to any medically qualified specialist, as the person to whom your GP is referring will be a registered medical practitioner.
• Because we have so little information about where complementary medicine may work best it is quite reasonable to try a treatment (providing it is safe) for a limited period of time and agree with both your GP and your complementary practitioner, at the outset, as to when you would expect to see some beneficial effects.

Finding the right practitioner with so little information about whether CAM works for allergic conditions is a difficult process. People seeking CAM often take advice from satisfied customers and, while this may be of real help in finding a competent complementary therapist, it is not always reliable. Sometimes individual therapy organisations can provide useful guidelines, but in general terms both you and your GP need to be assured that seeking complementary medical help is both appropriate and safe, as well as both you and the practitioner developing a clear understanding of what you both might see as a reasonable investment of time and effort so that you can get some improvement from the treatment that you have had.

Will I need to pay privately?

The homeopathic hospitals have been part of the NHS since its inception in 1948 and offer a service that is largely homeopathic but also involves a comprehensive approach to a variety of CAM therapies, usually including acupuncture and manipulative medicine. Complementary practitioners are increasingly forming part of the primary care team, and particularly during the whole process of general practitioner fund-holding there were growing numbers of osteopaths, chiropractors and acupuncturists who were actually employed by general practices to offer a service to their patients.

However, the reality is that if you wish to seek some form of complementary medical treatment, the likelihood is that you will need to pay for it privately, although it is certainly worthwhile discussing this with your general practitioner as there may be an NHS referral route which is not widely publicised. You can usually obtain more information from the individual therapy organisations; for instance the Faculty of Homeopathy gives clear guidance to general practitioners as to how they may refer patients through the NHS for homeopathy.

Written by Dr George Lewith MA,DM, FRCP, MRGCP, Senior Research Fellow, Complementary Medicine Research Unit Royal South Hants Hospital, November 2001 - Checked 4/2009