Some decades back I had hay fever of epic proportions one weekend. I’d never heard of Chlor-trimeton® but the label sounded good, and the drug worked wonders immediately. That was my one and only real success with it. It didn’t do much later for allergy flare-ups.
Fast-forward twenty years, and someone recommended Echinaceae when I had a cold. Sure, why not? At the time nobody had a better idea (zinc salts weren’t on the horizon yet for colds). Bang! Echinacea was amazing … but only for that one cold.
Now don’t confuse this with bacterial resistance to antibiotics. Resistance happens when drug overuse favors the tiny minority of bacteria that tolerate it. By contrast, colds are viral, and hay fever is an immune response, so those drugs must lose their strength by other mechanisms.
That irreproducibility – and the difficulty of disproving mere coincidence – shows why anecdotal data on drugs meets scientific apathy. No doubt other people have also had one-bout experiences, but any articles on the topic would be an anthology of merely anecdotal data. Even so, the issue may account for the uneven reputations of natural and synthetic drugs.
What does get studied is the gradual fading of efficacy. For instance, biologics lose potency after 6 months of continuous use for psoriasis. Sometimes that is due to flawed protocols: drug doses that are sporadic, too low, or unable to reach the blood effectively. More troublesome is immunogenicity: the immune system sidelines the anti-psoriasis drug.
In other words, a drug allergy arises. When the public hears that term, anyphylaxis and fatalities come to mind, yet in most cases the allergy only marginalizes the compound. Biologics are a special case because their molecules or arrays are big enough to be recognized by the immune system. However smaller drugs can be haptens, that is, they bind to some protein, and then the affected protein is attacked by antibodies and purged.
There’s research on workarounds. Co-administering psoriasis biologics with etanercept (Enbrel®) limits the immune response. Of course, biologic drugs are high-dollar products, so the R&D can afford immunogenicity testing. Not so for over-the-counter natural drugs: we’re lucky if an academic group undertakes a study for a popular plant extract. Yet cosmetic markets find that scores of widely-used plant extracts can trigger allergic reactions in some users.
Few fans of natural medicine would use etanercept or comparable synthetics if they could avoid it, but they may have received similar benefits by serendipity. Herbal compositions often include an immunomodulator such as ginseng root or astragalus root or holy basil. This is typically explained as rebalancing the immune system. I doubt most of those formulators contemplate that the body might treat their product as an insult otherwise. Meaning, instead of correcting defective immunity, those herbs may only ensure the body’s acceptance of the drug.
This gives me hope. All my life I’ve battled with allergies, and several leading hay fever meds have lost their potency. So, I’ll try to find a mild botanical immunomodulator that can work in parallel with antihistamines. Maybe the one-bout wonders can be wonderful again.
***
- Cichoric acid (aka chicoric acid): a compound of Echinaceae purpurea thought to assist relief from colds.
- It is chemically interesting because of its rotational symmetry and its relationship to cinnamic acid.
- The compound was first isolated from chicory (hence the name), but is found in many species, including basil, lemon balm, dandelion leaves, lettuce, ferns, horsetails, and aquatic plants.
- Other medicinal effects of cichoric acid: anti-arthritic (anti-inflammatory; also inhibits breakdown of hyaluronic acid in nerves, surface tissue and connective tissue); protects collagen proteins (in skin, nails and hair) from radical-induced damage; and inhibits the integration of HIV genetic code into human code.
Food for Thought
Y.Y.M. Huang, J.S. Ruth and S. Hsu, “Loss of efficacy of secukinumab for psoriasis at 24 to 32 weeks,” Journal of the American Academy of Dermatology, 75(4):e169. (October 2016). https://www.jaad.org/article/S0190-9622(17)30236-0/pdf
Y.Y.M. Huang and S. Hsu, “Loss of efficacy of secukinumab for psoriasis at 24 to 32 weeks: Update and commentary,” Journal of the American Academy of Dermatology, 76(6):e221. (June 2017). https://www.jaad.org/article/S0190-9622(17)30236-0/pdf
Bruce E. Strober, “Why biologic therapies sometimes lose efficacy,” Seminars in Cutaneous Medicine and Surgery, 35(supp. 4):S78-S80 (2016). https://www.globalacademycme.com/cme/dermatology-skin-disease-education-foundation/highlights-skin-disease-education-foundations-12th/why-biologic-therapies-sometimes-lose-efficacy
***
Circling-V ™ 