Complementary and alternative interventions in atopic dermatitis.

The burden of atopic diseases, including atopic dermatitis (AD), is significant and far-reaching. In addition to cost of care and therapies, it affects the quality of life for those affected as well as their caretakers. Complementary and alternative therapies are commonly used because of concerns about potential adverse effects of conventional therapies and frustration with the lack of response to prescribed medications, be it due to the severity of the AD or the lack of appropriate regular use. Despite the promising results reported with various herbal medicines and biologic products, the clinical efficacy of such alternative therapies remains to be determined. Physicians need to be educated about alternative therapies and discuss benefits and potential adverse effects or limitations with patients. A systematic approach and awareness of reputable and easily accessible resources are helpful in dealing with complementary and alternative medicine (CAM). The use of CAM interventions is common among individuals with AD. Epidemiologic data have been a motivating drive for better elucidation of the efficacy of CAM interventions for allergic disease. Herbal medicines and biologics for AD treatment and, more recently, prevention comprise a major area of clinical investigation. Potential mechanisms of therapeutic effect elucidated by animal models and human clinical studies implicate modulation of TH2-type allergic inflammation and induction of immune tolerance. Population-based research regarding the use of CAM for allergic diseases underscores the increasing challenge for care providers with respect to identifying CAM use and ensuring safe use of allopathic and complementary medicines in disease management. Copyright 2010. Published by Elsevier Inc.