Memorandum by the Faculty of Homeopathy
1. BACKGROUND
1.1 The Faculty of Homeopathy was incorporated
by an Act of Parliament 1950 and represents statutorily registered
healthcare professionals who have trained in and integrate homeopathy
into their practice. The majority of Faculty members are doctors
(specialists working in the five NHS homeopathic hospitals, GPs
or independent practitioners) though there are also growing numbers
of nurses, pharmacists, dentists, podiatrists and vets.
1.2 Homeopathy is the only complementary
therapy to have been part of the NHS since its inception in 1948.
Today there are five NHS homeopathic hospitals—Bristol,
Glasgow, Liverpool, London and Tunbridge Wells. These are consultant-led
services, which take referrals from GPs and specialists and are
staffed by doctors who have trained and qualified in homeopathy
and other CAM (Complementary and Alternative Medicine) therapies
such as acupuncture.
1.3 Clinical outcome studies from the hospitals
consistently demonstrate a high level of patient satisfaction
with patient-reported improvement rates of over 70 per cent even
though many of the patients referred have not improved with the
conventional treatment they have usually tried at length before
coming to homeopathy.
2. THE HOMEOPATHIC
TREATMENT OF
ALLERGIES
2.1 Homeopathy
In homeopathy there are a number of therapeutic
strategies for the treatment of allergic disorders. These are
commonly termed "local", "constitutional"
or "miasmatic" strategies. Local prescribing is a strategy
based on the patient's actual allergic symptoms. The advantage
of this strategy is that it can be achieved in a standard GP appointment
or even through self-prescribing. Constitutional prescribing is
based on a more in-depth consultation which takes into consideration
the patient's allergic symptoms and, additionally, their unique
patterns of coping with any disease. Miasmatic prescribing is
based on an elaboration of the patterns of allergic disease which
can be seen to run through certain whole families. This approach
can be particularly appropriate in complex allergic conditions.
2.2 Isopathy
Isopathy is similar to homeopathy but the main
difference is that the treatment is selected solely on the basis
of the patient's proven allergies (as shown, for example, by skin
testing). It involves giving a patient a substance to which they
are allergic in a homeopathic potency, usually orally, for a short
course of a few days in order to reduce the allergic response.
All the common allergens such as pollens and dusts are available
in potentised form from the specialist homeopathic pharmacies
and it is also possible to have customised medicines made.
2.3 All of these approaches involve prescribing
homeopathic or isopathic medicines which are safe, not addictive
and have no side effects. However in some cases there may be a
temporary worsening of symptoms immediately after the patient
receives the treatment—the phenomenon known as "aggravation".
This does not entail any risk of anaphylactic shock. Treatment
options are individually tailored and rely on sensitive history-taking
and a flexible response by the practitioner, including careful
consideration of diet and lifestyle.
3. WHY PATIENTS
CHOOSE HOMEOPATHY
3.1 The homeopathic approach differs from
conventional medicine in that rather than suppressing the allergic
symptoms, the medicines stimulate the body's ability to cope with
exposure to the allergens. The benefits are therefore longer-lasting
and free from the side effects associated with conventional treatments.
A homeopathic medicine taken before the hay fever season begins
can act prophylactically protecting the patient and so reducing
the need for medicines such as antihistamines.
3.2 Many patients and doctors are concerned
about the long-term use of conventional drugs such as corticosteroids
and anti-histamines and for some patients a conventional approach
has not helped so they seek more holistic advice and care.
4. SPECIALIST
ALLERGY SERVICES
AT THE
HOMEOPATHIC HOSPITALS
4.1 All the NHS homeopathic hospitals receive
referrals for patients with allergy problems. Glasgow and London
have special allergy clinics.
4.2 Glasgow Homeopathic Hospital, North
Glasgow University Hospitals NHS Trust
Dr Jacqueline M Mardon MBBS MPhil MRCGP MFHom
4.2.1 Allergy is a frequent reason for people
to be referred to Glasgow Homeopathic Hospital by their medical
practitioner. The Allergy Clinic has been running for many years
and is funded as 26 clinical sessions/year. Originally set up
on a research basis, it is currently run by one experienced medical
practitioner who is on the Faculty of Homeopathy specialist register
and who regularly attends conventional medical allergy seminars
and updates.
4.2.2 Children and adults are accommodated
in either a general out-patient clinic or, in particular if there
is a strong indication of atopy or a complicated history such
as anaphylaxis or multiple sensitivities, in the specialist allergy
clinic. Sometimes a patient is referred elsewhere in the homeopathic
service from the clinic, for example for in-patient care. A wide
range of allergic conditions and morbidity is seen.
4.2.3 The clinical approach includes an
emphasis on careful history taking and assessment may include
skin-prick testing to a wide range of allergens, performed in
the clinic. Treatment is with a variety of methods: homeopathic
constitutional prescribing, symptom alleviation using homeopathic
remedies and isopathy which can often be prophylactic or curative
where specific allergens are identified. Advice about preventative
measures and a supportive approach in complex cases in particular
is also a mainstay of treatment.
4.2.4 Using this approach, one is able to
address complex emotional issues which are so often involved (aetiologically
and as a result of the disease). Patients often find it easier
to accept advice about allergy from the homeopathic hospital,
which can steer them away from the more extreme (and expensive)
fringes of untested alternative treatments. This can be of particular
benefit with food sensitivities and allergies or multiple sensitivities.
4.3 Royal London Homeopathic Hospital,
University College London NHS Trust
Dr Saul Berkovitz MRCP MFHom MCPP
4.3.1 Allergy clinics at the RLHH are run
by a consultant physician with a postgraduate diploma in Allergic
Disease from the University of Southampton. There are three consultant
sessions per week and two clinical assistant sessions. Classical
allergic diseases are managed with avoidance advice, conventional
treatment where appropriate, dietary advice, homeopathic medication,
Western Herbal Medicine, and also (uniquely in the NHS) with a
form of desensitisation treatment called enzyme-potentiated desensitisation
(EPD). The clinic is also one of the very few centres able to
effectively manage patients with "food intolerance"
in all its manifestations.
4.3.2 EPD is a therapeutic technique in
which low dose allergens (in concentrations of 10-12 molar, comparable
to skin prick test doses) are injected intradermally to desensitise
patients with atopic diseases. It was first introduced by McEwen
in the early 1970s. Mixed allergens (inhalants, foods or both)
are given intradermally after mixing with the enzyme beta-glucuronidase,
which is thought to enhance the desensitising effect of the low
dose allergen. Unlike conventional immunotherapy, EPD is an extremely
safe technique, with a very low rate of anaphylaxis and other
major adverse effects. Injections are given two- to three-monthly
instead of weekly. Thousands of injections have been given at
the RLHH over the last thirty years with no systemic allergic
reactions. It is not used for IgE-mediated food allergy.
4.3.3 Several clinical trials involving
small numbers of subjects, conducted mostly in Italy over the
last two decades, suggested safety and effectiveness of EPD in
hay fever and asthma and house dust mite allergy in children.
The results in hay fever, however, were not confirmed by a larger
clinical trial recently performed in the U.K. All the studies
used the same mixture of inhaled allergens. Positive results using
mixed food allergens have also been shown for childhood attention
deficit disorder and childhood migraine. Despite the conflicting
research evidence, many allergy patients continue to benefit from
this treatment. It is hoped to demonstrate this with a program
of prospective audit.
4.3.4 The clinic is fortunate to have a
dietician who is expert in food allergy and intolerance, a rarity
in such services. This enables patients to be treated who have
adopted an unnecessarily restricted diet on the basis of spurious
"food allergy tests" available on the high street, gradually
broadening such diets, offering authoritative advice, checking
nutritional status and advising on supplements. It is also possible
to effectively manage conditions known to be variably improved
by elimination dieting (including irritable bowel syndrome and
rheumatoid arthritis) without compromising overall nutrition.
4.3.5 The Royal London Homeopathic Hospital
hopes to expand its allergy services in the near future, with
an increased emphasis on conventional as well as complementary
management of allergy in order to provide a truly integrated service.
REFERENCES (NOT
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5. THE EVIDENCE
BASE FOR
HOMEOPATHY IN
THE TREATMENT
AND MANAGEMENT
OF ALLERGIC
CONDITIONS
5.1 Thirteen randomised controlled trials
(RCTs) published in the peer-reviewed literature have studied
the effect of homeopathy in allergic conditions. Clinical areas
of investigation have been limited to seasonal allergic rhinitis
(11 RCTs) and allergic asthma (two RCTs); 12 of them were placebo-controlled
studies, the other was an equivalence trial.
5.2 Nine of these trials reported statistical
analyses in favour of homeopathy, one found homeopathy to be inferior
to placebo, and three observed no significant differences between
patient groups. This overall positive conclusion from RCTs of
homeopathy in allergy has support in the findings of six systematic
reviews. Summary details of the nine RCTs with positive findings
are listed below:
| Authors and Date |
Main Results Reported in Publication |
| 1 | Aabel S, Laerum E, Dølvik S, Djupesland P (2000)
| Verum group had fewer and less serious symptoms during a certain period of the birch pollen season. Single-day P values ranged from 0.41 to 0.02, ie for some days the differences between verum and placebo were statistically significant.
|
| 2 | Kim LS, Riedlinger JE, Baldwin CM, et al. (2005)
| Significant positive changes from baseline to 4 weeks in the verum group compared with the placebo group (P = 0.032 for rhino-conjunctivitis symptoms, P = 0.031 for activity impairment, P = 0.04 for reported health transition).
|
| 3 | Reilly DT, Taylor MA (1985)
| Maximum clinical improvement in verum group in weeks 3 and 4, with maximum statistical significance in week 3 (P = 0.002). Substantial reduction in average consumption of antihistamine tablets in verum group compared with placebo at that time.
|
| 4 | Reilly DT, Taylor MA, McSharry C, Aitchison T (1986)
| Mean change of VAS scores was -17.2 in verum group and -2.6 mm in placebo group (P = 0.02). Doctor-assessed scores showed similar reduction: -27.7 in verum group vs. -12.2 in placebo group (P = 0.05). Use of antihistamines lower in the verum group than in controls: total 11.2 cf. 19.7 tablets (P = 0.03).
|
| 5 | Reilly D, Taylor MA, Beattie NGM, et al. (1994)
| Difference in visual analogue score in favour of homeopathic immunotherapy appeared within one week of starting treatment and persisted for up to 8 weeks (P = 0.003). Similar trends in respiratory function and bronchial reactivity tests.
|
| 6 | Taylor MA, Reilly D, Llewellyn-Jones RH, et al. (2000)
| Homeopathy group had significant objective improvement in nasal airflow compared with placebo group (mean difference 19.8 l/min, 95 per cent CI 10.4 to 29.1 (P = 0.0001).
|
| 7 | Wiesenauer M, Häussler S, Gaus W (1983)
| After observation time of 17 days, Galphimia was more effective than placebo (P = 0.01). Significant benefit in 34 of 41 (83 per cent) patients in verum group and in 21 of 45 (47 per cent) patients in placebo group; 3 weeks later in 30 of 37 (81 per cent) patients in verum group, in 20 of 35 (57 per cent) patients in placebo group.
|
| 8 | Wiesenauer M, Gaus W, Häussler S (1990)
| After 5 weeks of treatment, significant improvement of ocular symptoms in 75 of 98 (77 per cent) patients in verum group and 52 of 103 (51 per cent) patients in placebo group (P < 0.01). Improvement of nasal symptoms: 75 of 98 (77 per cent) patients in verum group and 48 of 103 (46 per cent) in placebo group (P < 0.01).
|
| 9 | Weiser M, Gegenheimer LH, Klein P (1999)
| Rhino-conjunctivitis Quality of Life Questionnaire score changed significantly in the course of treatment. VAS scores increased by 24 per cent in verum group and by 29 per cent. in controls. Global assessments of therapeutic efficacy did not markedly differ with respect to treatments or the rating person. Therapeutic non-inferiority of homeopathic vs. cromolyn sodium treatment was demonstrated.
|
5.3 Evidence is also available from non-randomised studies
that homeopathy can be an effective treatment in allergic conditions.
An international, prospective, multi-centre study compared homeopathic
treatment with conventional medical care in 456 patients with
respiratory tract complaints including allergies. The primary
outcome measure was the number of patients who were cured or had
"major improvement" after 14 days of treatment; homeopathy
was found to be at least as effective as conventional treatment.
A similar study carried out in Germany on 178 children with mostly
allergic conditions reported significantly greater improvement
after homeopathic than conventional treatment. Large-scale clinical
observational studies in primary or secondary care in Europe have
indicated a high proportion of follow-up patients with allergic
complaints achieve good outcome from homeopathy. A report from
a single clinic in Israel showed that homeopathic intervention
led to modest economic savings and reductions in the use of medicines
commonly used to treat allergies and their complications. Finally,
high dilutions of two homeopathic medicines used for the treatment
of allergic diseases (Lung histamine and Apis mellifica)
were observed to have a significant effect on human basophil degranulation
in-vitro.
6. IS THE
LEVEL OF
UK RESEARCH ADEQUATE?
6.1 One of the arguments levelled against homeopathy
is that its evidence base is weak. Problems with inappropriate
study design and a lack of funds mean that there is strong but
not unequivocal evidence to demonstrate the effectiveness of homeopathy
in clinical trials and much more research is needed. Homeopathic
medicines do not attract pharmaceutical funding because they cannot
be patented and there is consequently very little financial impetus.
Non-commercial funding is extremely limited and good research
proposals often fall by the wayside due to lack of resources,
often relying on small charities with an interest in CAM. This
situation needs to be addressed.
6.2 The Science & Technology Committee's report on
CAM in 2000 recommended the creation of a stronger research infrastructure
for CAM and the DH allocated limited funds. None of these has
been directed towards research into the homeopathic treatment
of allergies.
6.3 The homeopathic approach has much to offer but at
present is limited to a smaller number of centres of excellence
and individual practitioners. A great opportunity is being missed,
particularly in view of the potential for savings on allopathic
medicines with potentially serious side-effects, such as corticosteroids.
7. MOST PROMISING
AREAS OF
RESEARCH INTO
PREVENTING OR
TREATING ALLERGY
7.1 Research is needed to confirm unequivocally whether
specific homeopathic medicines are more effective than placebo
in the treatment of particular allergic conditions. It is also
important to demonstrate convincingly with further pragmatic RCTs
that homeopathy has clinical effectiveness at least as good as
conventional medical care. Since the mechanism of homeopathy's
in-vivo effects remains to be elucidated, the study of allergy
might afford an opportunity for hypothesis-driven clinical research
in this area: it has been proposed, for example, that homeopathy
may help to regulate the Th1/Th2 lymphocyte imbalance that characterises
allergic disorders.
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