Hypersensitivity Reactions to Complementary and Alternative Medicine Products

Abstract

Complementary and alternative medicine (CAM) is becoming increasingly popular, and is often used for treating hypersensitivity diseases. Virtually all alternative remedies can cause hypersensitivity reactions, but the most frequently involved ones are tea tree oil, members of the Compositae family, propolis, oils used in aromatherapy, substances responsible for photosensitization, and metal-containing compounds. The main target organ is skin, with manifestations ranging from contact dermatitis (the most common) to urticaria-angioedema, maculopapular eruptions, photosensitivity reactions, and the Stevens-Johnson syndrome. Other types of reactions are possible, including respiratory and anaphylactic ones. Different pathogenic mechanisms have been suggested for CAM product reactions, including immunologic ones. Basophils and mast cells participate in IgE-mediated reactions through the release of mediators like histamine and tryptase, whereas a T-cell-mediated pathogenic mechanism is involved in most delayed reactions, particularly contact dermatitis and maculopapular eruptions. Skin tests and serum specific IgE assays are carried out to diagnose immediate hypersensitivity reactions, while patch tests and lymphocyte transformation tests are usually performed to evaluate delayed hypersensitivity reactions. Thus clinicians should know about the potential of CAM products for causing adverse reactions. Our study is aimed at highlighting the risk of hypersensitive reactions to CAM remedies on the basis of the numerous cases reported in the literature. Because little is known about adverse reactions to CAM products, further systematic studies and an appropriate regulation by heath authorities are necessary.

Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?

“…However, in spite of this belief, 16.7% of users referred one or more adverse mucosal and/or cutaneous reactions to herbal products. This percentage was higher than previously observed . The reported adverse effects were described mainly as the occurrence or worsening of distressing symptoms, mainly itching and burning.…”

Importance of hypersensitivity in adverse reactions to drugs in the elderly

“…A recent study has also highlighted that the increased DNA methylation predisposes the elderly to respiratory allergic diseases, but could also predispose to HDRs [ 33 ]. The misuse of complementary and alternative medicine and polypharmacy during different degenerative diseases afflicting the elderly is another risk factor for the development of drug allergy [ 34 ]. A recent retrospective survey on 161 hospitalized patients (mean age 63 years) who had an HDR to medications during their hospital stay suggested that the administration of proton pump inhibitors (PPI), used in 83% of hospitalized patients, could favor the occurrence of HDRs, especially to NSAIDs.…”

Use of Complementary and Alternative Medicine in Patients with Autoimmune Bullous Dermatoses: A Cohort Study Analysis of a Rare Disease Group

“…Therefore, the disclosure of CAM use by patients to their healthcare providers is important, especially in the case of phytotherapy. Moreover, the topical use of phytotherapy shows a high potential to provoke type IV hypersensitivity reactions, particularly when using tea tree oil, Compositae, propolis, or metal-containing compounds [38,39]. Photosensitivity is another side effect of phytotherapy, which can appear after oral use (St. John's wort) or topical application, such as aromatherapy (essential oils and bergamot) [40].…”