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.
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.
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.
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.
Regulation of Herbal Medicine
From April 2011, herbal medicine will only be available from practitioners regulated to supply unlicensed herbal medicines. In February 2011 the Government announced that practitioners of herbal medicine will need to register with the Health Professions Council but this has not yet come into effect. Until this takes place, contact one of the organisations listed below.
The organisations who register herbal practitioners (European Herbal Practitioners Association,
8 Lion Yard, Tremadoc Road, London SW4 7NQ Tel 020 7627 2680; Register of Chinese Herbal Medicine, Office 5, 1 Exeter Street, Norwich NR2 4QB www.rchm.co.uk) are responsible for their regulation and training andwould be happy to provide further information for you. Patients will usually take several visits to herbaliststo 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 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 (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 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 http://www.osteopathy.org.uk ; General Chiropractic Council, 44 Wicklow Street, LONDON WC1X 9HL, 020 7713 5155 www.gcc-uk.org )
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, contact the Complementary and Natural Healthcare Council (CNHC), which registers aromatherapists who have met nationally agreed standards of competence and practice. (The Complementary and Natural Healthcare Council (CNHC), 83 Victoria Street, London SW1H 0HW, Tel: 0203 178 2199. Enquiries to: firstname.lastname@example.org. To find a practitioner near you, use the ‘Check the Register’ facility on the CNHC’s website at: www.cnhc.org.uk).
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 dietitian with your doctor.
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 Complementary and Natural Healthcare Council (CNHC) registers Nutritional Therapists who have met nationally agreed standards of competence and practice. (The Complementary and Natural Healthcare Council (CNHC), 83 Victoria Street, London SW1H 0HW, Tel: 0203 178 2199. Enquiries to: email@example.com. To find a practitioner near you, use the ‘Check the Register’ facility on the CNHC’s website at: www.cnhc.org.uk ).
The members of the British Society for Ecological Medicine (formerly the Br Soc for Allergy, Environmental and Nutritional Medicine (www.ecomed.org.uk) are all medically qualified individuals. The organisation will providenames and addresses of doctors who can provide nutritional advice and support, the regulation of doctorsis the responsibility of the General Medical Council.
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.
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.
The Complementary and Natural Healthcare Council (CNHC) registers Reflexologistswho have met nationally agreed standards of competence and practice. (The Complementary and Natural Healthcare Council (CNHC), 83 Victoria Street, London SW1H 0HW, Tel: 0203 178 2199. Enquiries to: firstname.lastname@example.org. To find a practitioner near you, use the ‘Check the Register’ facility on the CNHC’s website at: www.cnhc.org.uk ).
To ensure the therapist you use has met national standards, check they are registered with one of the organisations listed above. Osteopaths and chiropractors have to be registered by law with the General Osteopathic Council or General Chiropractic Council.
The Complementary and Natural Healthcare Council (CNHC) was set up in 2008 to provide a register of practitioners from other complementary therapy disciplines. At the time of writing, the CNHC registers thirteen disciplines (listed below) with more to follow.
- Alexander Technique teaching
- Bowen therapy
- Massage therapy
- Microsystems acupuncture
- Nutritional therapy
- Sports therapy
- Yoga therapy.
Practitioners who are registered with the CNHC can display the CNHC Quality Mark (below).
So check for the CNHC quality mark which may be displayed on the practitioner’s publicity materials, certificate or website. If you have any doubt, check the CNHC’s online ‘Check the Register’ facility at www.cnhc.org.uk.
These regulatory bodies are independent from the professions concerned. Using a practitioner who is registered with one of the regulators means you are able to make a complaint to that organisation if necessary.
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? If they are registered with one of the organisations listed above, they will have completed training which meets the standards required in their field.
- If your practitioner is not registered with one of the regulatory bodies listed above, do they belong to a professional association? If so:
- What standards of training does that organisation require for membership?
- Does it hold a code of ethics which members must sign up to?
- Does that organisation employ a process of self-regulation and will it remove members from their list if they are not behaving ethically?
- Does the practitioner hold membership of most professonal organisations including professional indemnity insurance? but check if in doubt.
- Is the data they hold on you legally protected and will they treat the information you give them in a confidential manner?
- 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 practitioners 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 practitioners organisation one in 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.
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.
- Your 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.
- The Department of Health has recommended that referrals to practitioners who work in disciplines registered by the CNHC, such as aromatherapists, nutritional therapists and reflexologists, are made to CNHC-registered practitioners. If you have any doubt about whether your practitioner is registered, use the CNHC’s ‘Check the Register’ facility on its website at www.cnhc.org.uk or call 0203 178 2199.
- 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.
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.
Last updated: March 2012