Mainardi Timothy, Kapoor Simi, Bielory Leonard
University of Medicine and Dentistry New Jersey-New Jersey Medical School, Newark, NJ, USA.
J Allergy Clin Immunol. 2009 Feb;123(2):283-94; quiz 295-6. doi: 10.1016/j.jaci.2008.12.023.
Complementary and alternative medicines (CAMs) are used in more than 80% of the world's population and are becoming an increasing component of the US health care system, with more than 70% of the population using CAM at least once and annual spending reaching as much as $34 billion. Since the inception of the National Center for Complementary and Alternative Medicine, there has been an enormous increase in the number of basic science and therapy-based clinical trials exploring CAM. The subspecialty of allergy and immunology represents a particularly fertile area with a large number of CAM therapies that have been shown to affect the immune system. Recent work has uncovered potential biochemical mechanisms involved in the immunomodulatory pathway of many supplemental vitamins (A, D, and E) that appear to affect the differentiation of CD4(+) cell T(H)1 and T(H)2 subsets. Other research has shown that herbs such as resveratrol, quercetin, and magnolol may affect transcription factors such as nuclear factor-kappaB and the signal transducer and activator of transcription/Janus kinase pathways with resultant changes in cytokines and inflammatory mediators. Clinically, there have been hundreds of trials looking at the effect of CAM on asthma, allergic rhinitis, and atopic dermatitis. This article reviews the history of CAM and its use among patients, paying special attention to new research focusing on herbals, phytochemicals, and vitamins and their potential interaction with the immune system.
全球超过80%的人口使用补充和替代医学（CAM），并且它在美国医疗保健系统中所占比重日益增加，超过70%的人口至少使用过一次CAM，年花费高达340亿美元。自国家补充和替代医学中心成立以来，探索CAM的基础科学和基于疗法的临床试验数量大幅增加。过敏与免疫学亚专业是一个特别活跃的领域，有大量已被证明能影响免疫系统的CAM疗法。最近的研究发现了许多补充维生素（A、D和E）免疫调节途径中涉及的潜在生化机制，这些机制似乎会影响CD4(+)细胞T(H)1和T(H)2亚群的分化。其他研究表明，白藜芦醇、槲皮素和厚朴酚等草药可能会影响转录因子，如核因子-κB以及信号转导和转录激活因子/Janus激酶途径，从而导致细胞因子和炎症介质的变化。临床上，已经有数百项试验研究CAM对哮喘、过敏性鼻炎和特应性皮炎的影响。本文回顾了CAM及其在患者中的使用历史，特别关注聚焦草药、植物化学物质和维生素及其与免疫系统潜在相互作用的新研究。
