Lee Alice N, Werth Victoria P
Section of Dermatology, University of Chicago, IL, USA.
Arch Dermatol. 2004 Jun;140(6):723-7. doi: 10.1001/archderm.140.6.723.
Evidence for the scientific basis of purported therapeutic effects and adverse effects of herbal supplements continues to grow. Many herbal supplements are touted for their immunostimulatory properties, and both in vitro and in vivo experiments have supported this claim. Although this explains their beneficial effects in preventing or curtailing disease, to our knowledge, no immunostimulatory herbal supplements have been reported to exacerbate disorders of immune system overactivity.
We describe 3 patients whose autoimmune disease onset and/or flares correlated with ingestion of herbal supplements with proven immunostimulatory effects. Echinacea and the alga Spirulina platensis are implicated in 2 patients' flares of pemphigus vulgaris, and a supplement containing the algae Spirulina platensis and Aphanizomenon flos-aquae was ingested by a third patient days before both onset and a severe flare of dermatomyositis. The third patient showed heterozygosity for a tumor necrosis factor alpha (TNF-alpha) promoter polymorphism (-308A), leading to increased production of TNF-alpha, which may have predisposed her to developing dermatomyositis.
Immunostimulatory herbal supplements may exacerbate preexisting autoimmune disease or precipitate autoimmune disease in persons genetically predisposed to such disorders. Increased production of TNF-alpha may play a role, although more research is needed to clarify the mechanisms of such phenomena.
草药补充剂所谓治疗作用和不良反应的科学依据的证据不断增加。许多草药补充剂因其免疫刺激特性而受到吹捧，体外和体内实验均支持这一说法。虽然这解释了它们在预防或减轻疾病方面的有益作用，但据我们所知，尚无免疫刺激草药补充剂会加剧免疫系统过度活跃紊乱的报道。
我们描述了3例自身免疫性疾病的发病和/或发作与摄入已证实具有免疫刺激作用的草药补充剂相关的患者。紫锥菊和钝顶螺旋藻与2例寻常型天疱疮患者的发作有关，第三例患者在皮肌炎发作和严重发作前数天摄入了一种含有钝顶螺旋藻和水华束丝藻的补充剂。第三例患者肿瘤坏死因子α（TNF-α）启动子多态性（-308A）呈杂合性，导致TNF-α产生增加，这可能使她易患皮肌炎。
免疫刺激草药补充剂可能会使已有的自身免疫性疾病恶化，或在遗传上易患此类疾病的人群中引发自身免疫性疾病。TNF-α产生增加可能起了作用，不过需要更多研究来阐明此类现象的机制。
