Reviewed: Badar V, Thawani V, Wakode P, et al. Efficacy of Tinospora cordifolia in allergic rhinitis. J Ethnopharmacol. 2005;96:445-449.

Allergic rhinitis (AR) is the sixth most prevalent medical condition in the United States, outranking cardiac disease. It is characterized by sneezing, runny nose, nasal congestion, and itchy, watery eyes. Conventional treatment for AR generally includes antihistamines, decongestants, and cromolyn sodium. However, many of the conventional therapies produce the unwanted side effect of drowsiness. Hence, there is a search for a natural alternative that is effective and better tolerated.

Indian tinospora (Tinospora cordifolia [Willd.] Miers, Menispermaceae) is a deciduous climbing shrub from the tropical Indian subcontinent. Extracts from Indian tinospora (commonly called guduchi in India) contain several compounds that have been shown to have anti-inflammatory and anti-allergic effects. In addition, Indian tinospora is known to be a powerful stimulant of the immune system. In one study, an herb-mineral preparation containing Indian tinospora as a major ingredient (plus Indian madder [Rubia cordifolia L., Rubiaceae] and 6 other ingredients), led to further research on Indian tinospora as a stand-alone ingredient, as the findings from the study showed no adverse reactions and suggested potential efficacy. Furthermore, there is no evidence of serious adverse side effects associated with the use of Indian tinospora even after long-term use. The purpose of this randomized, double blind, placebo controlled trial was to determine the safety and efficacy of Indian tinospora as a single ingredient in the treatment of AR.

Patients diagnosed to be suffering from AR were recruited from a hospital in Nagpur, India; 75 patients were randomized into the study. They received either placebo or Indian tinospora (Tinofend®; Geni Herbs, Noblesville, IN) (300 mg tablet, M/s Pharmanza, India) 3 times a day for 8 weeks. Throughout the trial, participants recorded the incidence of sneezing and nasal discharge, itchiness, and congestion. In addition, at baseline and at 8 weeks, a clinical examination was performed and nasal smears and blood samples were taken. Compliance was measured at 8 weeks by counting the number of pills remaining, with an 80onsumption considered compliant. The primary outcome measure was relief of the symptoms of AR.

Eighty-three percent of the patients treated with Indian tinospora reported a total relief from sneezing while 79% of those patients in the placebo reported no relief at all. In the case of nasal discharge, 69% of patients treated with Indian tinospora reported complete relief while only 1 patient in the placebo group reported such relief. Nasal congestion was totally cleared in nearly 61% of patients who had received Indian tinospora, while nearly 83% patients on placebo had no relief. In nasal itchiness, 71% patients of the Indian tinospora group had complete improvement whereas 88% of those in the placebo group had no relief from this symptom. On an overall comparison, the difference between Indian tinospora and placebo treated groups in all the symptoms of AR was found to be highly significant (P< 0.00001). These findings correlated well with clinical findings from the nasal smears and white blood cell count that demonstrated a significant decrease in inflammation (P<0.001) and allergic response (P<0.05) in those patients treated with Indian tinospora. Those patients who were treated with Indian tinospora were satisfied with the treatment and reported no serious adverse side effects. As compared to treatment with Indian tinospora, the patients from the placebo group constantly complained of no relief of symptoms and needed continuous counseling to continue with the study.

The authors suggested that the data from the nasal smears, blood samples, and clinical findings validate the effectiveness of Indian tinospora in the treatment of AR. Furthermore, they proposed that because Indian tinospora was highly effective and easily tolerated, due to the absence of serious adverse side effects, Indian tinospora could be an important alternative in the treatment of AR. Overall, this was an excellent study in terms of methodology and reporting.

—Heather S. Oliff, PhD