Asthma Management Handbook

Providing information about the safety of complementary therapies

Recommendations

For patients who wish to use complementary therapies for asthma:

  • provide information about potential adverse effects or interactions with pharmaceutical medicines
  • advise them to avoid products that are not labelled with an AUST L or AUST R number.

Note: AUST L listing does not indicate that a product is effective; AUST L numbered products do not undergo efficacy assessment.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Advise patients that some complementary medicines have caused serious allergic reactions in some patients. These include:

  • Echinacea
  • bee products (pollen, propolis, royal jelly)
  • garlic supplements.
How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available), with particular reference to the following source(s):

  • Bielory, 20041
  • Bullock et al. 19942
  • Katayama et al. 20083
  • Leung et al. 19954
  • Moses and McGuire, 20105
  • Mullins and Heddle, 20026
  • National Asthma Council Australia, 20097
  • Pérez-Pimiento et al. 19998
  • Thien et al. 19939

Advise patients that some complementary therapies have caused other serious adverse effects in some patients. These include:

  • Ma huang (Ephedra sinica)
  • dietary elimination.

Advise patients not to try dietary elimination for themselves or their children, except under medical supervision of an allergist or accredited practising dietitian.

Note: The sale of Ephedra is prohibited in Australia.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available), with particular reference to the following source(s):

  • Department of Health and Ageing, 200710
  • National Drug Research Institute and Australian Institute of Criminology, 200711
  • Schulman, 200312

Advise patients that they should seek medical advice immediately if they suspect that a complementary medicine is aggravating their asthma symptoms or causing side effects.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

After adverse effects have been managed, advise the person to report the reaction to the Adverse Medicines Event Line (1300 134 237).

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Regulation of complementary medicines and therapies (AUST L & AUST R)

Under the Therapeutic Goods Act 1989 (Commonwealth), all products in Australia for which therapeutic claims are made must be on the Australian Register of Therapeutic Goods and must carry either an Australian Listing (AUST L) or Australian Registration (AUST R) number on their label.

An AUST L number issued by the Therapeutic Goods Administration indicates that the product ingredients have been assessed for quality and safety, and have not been associated with major toxicity or side effects. AUST L listing does not indicate that a product is effective; AUST L numbered products do not undergo efficacy assessment.

An AUST R number indicates that a medicine is registered by the Therapeutic Goods Administration and has been assessed for safety, quality and effectiveness. Registered medicines include all prescription-only medicines and many over-the-counter medicines.

A ‘complementary medicine’ is defined in the Australian Therapeutic Goods Regulations 1990 as a therapeutic good consisting principally of one or more designated active ingredients (listed in Schedule 14 of the Regulations), each of which has a clearly established identity and traditional use.13 Complementary medicines regulated under the Therapeutic Goods Act 1989 include medicinal products containing herbs, vitamins, minerals, nutritional supplements, homoeopathic and certain aromatherapy preparations.13

State governments regulate practitioners of complementary therapies. This means that the laws differ between states.

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Adverse effects of complementary medicines

Drug–drug interactions or overdosage of active ingredients may occur when complementary medicines are used with other medicines.5

Some complementary and alternative medicines may trigger an allergic response or exacerbate asthma. Clinically serious allergic reactions have been documented for:

  • Echinacea6
  • bee products (pollen, propolis, royal jelly)2349
  • garlic supplements. 1, 8

People with aspirin-exacerbated respiratory disease may be at risk if they use products that contain salicylates (e.g. willowbark) or salicin (e.g. meadowsweet).

Some complementary therapies may cause other serious adverse effects in some patients. These include:

  • Ma huang (Ephedra sinica)12
  • dietary elimination without medical supervision.
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References

  1. Bielory L. Complementary and alternative interventions in asthma, allergy, and immunology. Ann Allergy Asthma Immunol. 2004; 93: S45-54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15330011
  2. Bullock RJ, Rohan A, Straatmans JA. Fatal royal jelly-induced asthma. Med J Aust. 1994; 160: 44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8271989
  3. Katayama M, Aoki M, Kawana S. Case of anaphylaxis caused by ingestion of royal jelly. J Dermatol. 2008; 35: 222-4. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1346-8138.2008.00448.x/full
  4. Leung R, Thien FC, Baldo B, Czarny D. Royal jelly-induced asthma and anaphylaxis: clinical characteristics and immunologic correlations. J Allergy Clin Immunol. 1995; 96: 1004-7. Available from: http://www.jacionline.org/article/S0091-6749(95)70242-3/fulltext
  5. Moses GM, McGuire TM. Drug interactions with complementary medicines. Aust Prescr. 2010; 33: 177-80. Available from: http://www.australianprescriber.com/magazine/33/6/177/80
  6. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol. 2002; 88: 42-51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11814277
  7. National Asthma Council Australia. Aspirin/NSAID-intolerant asthma: pharmacy notes. National Asthma Council Australia, Melbourne, 2009. Available from: http://www.nationalasthma.org.au/health-professionals/primary-care-resources/pain-relievers-and-asthma
  8. Perez-Pimiento AJ, Moneo I, Santaolalla M, et al. Anaphylactic reaction to young garlic. Allergy. 1999; 54: 626-9. Available from: http://onlinelibrary.wiley.com/doi/10.1034/j.1398-9995.1999.00806.x/full
  9. Thien FC, Leung R, Plomley R, et al. Royal jelly-induced asthma. Med J Aust. 1993; 159: 639. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8123114
  10. Standards Australia. Australia New Zealand Food Standards Code: Standard 1.4.4 – Prohibited and Restricted Plants and Fungi (F2011C00580). Department of Health and Ageing, Canberra, 2011. Available from: http://www.comlaw.gov.au/Details/f2011c00580
  11. National Drug Research Institute, Australian Institute of Criminology. National Amphetamine-Type Stimulant Strategy background paper: monograph series no. 69. Department of Health and Ageing, Canberra, 2007. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono69
  12. Schulman S. Addressing the potential risks associated with ephedra use: a review of recent efforts. Public Health Rep. 2003; 118: 487-92. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497604/
  13. Department of Health, Therapeutic Goods Administration. An overview of the regulation of complementary medicines in Australia. Therapeutic Goods Administration, Canberra, 2013. Available from: http://www.tga.gov.au/industry/cm-basics-regulation-overview.htm