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Wise et al.

Page 118

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Benefits-Harm Assessment: Balance of benefit and harm.

Author Manuscript Author Manuscript Author Manuscript Author Manuscript

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Value Judgments: Studies are inconclusive and heterogeneous.

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Policy Level: No recommendation due to inconclusive evidence.

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Intervention: None.

IX.B.11.c. Herbal therapies.: Like acupuncture and honey, herbal remedies have been used for the treatment of various physical ailments, including AR, world-wide for thousands of years. This area of complementary/alternative medicine is an attractive alternative to mainstream medicine for patients who wish to avoid traditional pharmacotherapy or who have not tolerated various anti-allergic medications in the past. There are a vast number of studies looking at the effectiveness of numerous herbs and herbal supplements in the treatment of AR; however, most are small and of poor quality. Those herbal remedies that have been subjected to more rigorous study are summarized in Table IX.B.11.C Given the lack of robust and repeated large double-blind randomized placebo-controlled trials on any 1 herbal remedy, no evidence based recommendations can be made supporting the routine use of any 1 herb or compound; this should be considered an area requiring further research before any such recommendations can be made. • Aggregate Grade of Evidence: Uncertain. • Benefit: Unclear, but some herbs may be able to provide symptomatic relief. • Harm: Some herbs are associated with mild side effects. Also, the safety and quality of standardization of herbal medications is unclear. • Cost: Cost of herbal supplements; variable. • Benefits-Harm Assessment: Unknown. • Value Judgments: The authors determined that there is a lack of sufficient evidence to recommend the use of herbal supplements in AR. • Policy Level: No recommendation. • Intervention: None. AR is a medical disease, but at times may become refractory to medical management. Surgery for AR is primarily aimed at reducing nasal obstruction and/or rhinorrhea, with the contributing structures being the nasal septum and turbinates. 1551 Vidian neurectomy is historically a surgical technique that seeks to overcome chronic and intractable rhinitis. No Cochrane review of septoplasty or vidian neurectomy for allergic patients currently exists. A Cochrane review of turbinate reduction in allergic patients refractory to medical management was explored, but was unable to identify any qualifying studies (selection criteria stringently required randomized controlled trials of inferior turbinate surgery vs continued medical treatment for proven AR, or comparisons between 1 technique of inferior turbinate surgery vs another technique, after maximal medical treatment). 1552 Physicians

IX.C. Surgical treatment

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.