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The complementary and the questionable

There is inevitable medical scepticism about the use of unorthodox techniques for allergy diagnosis and complementary treatments for allergic disease. Despite this, a significant percentage of allergy sufferers resort to various forms of complementary medicine. The profession has been very circumspect in responding to a proliferation of unorthodox practices and has hesitated to make any pronouncements. However, as long ago as 1992 the Royal College of Physicians in the UK produced a report Allergy: conventional and alternative concepts (1). This report drew attention to the dangers of relying on practitioners of complementary and alternative medicine to deliver an appropriate allergy service. This did not deter continued proliferation of such practices. We should always remain open to convincing evidence and we have published within our own journal two papers on Chinese herbs which appear to have some beneficial effect on, in the first case, mild to moderate asthma (2) and in the second, in a double blind placebo controlled trial an impact on airway hyper responsiveness, symptoms and medication requirements in children with persistent asthma (3). A Cochrane review of 17 trials of herbal treatment for asthma predominantly of Chinese origin identified nine studies that had reported some improvement on lung function (4). However, the great difficulty is disentangling the effects of multiple ingredients. It is also not clear how generalizable the observations are likely to be given the enormous variations in the herbal mixtures. However, it is at least probable that there are pharmacologically active ingredients in the mixtures that perhaps warrants further investigation. Notwithstanding the information on herbal treatments many other approaches have been investigated and found wanting. The time has therefore come to be much more emphatic about those approaches which are inappropriate, ineffective and conceivably even dangerous. This could even be true of herbal treatments which, if pharmacologically active, would be predicted to sometimes produce untoward side effects. We now live in an era of evidence-based medicine. While lack of evidence does not necessarily mean that a diagnostic practice or treatment is ineffective it should not be used until submitted to high quality research conducted with the same rigour and objectivity as that required by conventional medicine. The asthma management guidelines produced by the British Thoracic Society in collaboration with the Scottish Intercollegiate Guidelines Network has now made rather more emphatic statements about some complementary and alternative therapies based on a systematic review of the literature. This has led to authoritative statements rejecting the use of acupuncture, air ionisers, homeopathy, chiropracty, physical exercise training and hypnotherapy. The review of breathing exercises including yoga and Buteyko breathing technique suggests there may be some benefits on symptoms. This will facilitate at least some authoritative advice that can be given to the families of asthma sufferers. The Australasian Society of Clinical Immunology and Asthma (ASCIA) has produced an excellent position statement on non-conventional approaches to allergy testing which can be read in full on their website. I would strongly recommend it to all our readers. The important issue is the highlighting of the danger of inappropriate allergy diagnosis perhaps leading to damaging dietary restrictions, increased costs and the danger of missed allergy diagnoses. Furthermore if the complementary therapies result in failure to use approaches of proven efficacy long-term suffering and the potential for acute exacerbation is increased. While complementary practitioners who do not have any medical qualifications seem able to advertise unsubstantiated claims the medical profession is restricted by its professional codes and seems relatively impotent in responding. We should all therefore commend ASCIA for its position paper. Pediatr Allergy Immunol 2008: 19: 473–474