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- Red Ginseng (Panax ginseng)
- Allergic Rhinitis
| Date:
05-31-2011 | HC#
051161-425
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Re: Therapeutic Effects of Fermented Red Ginseng on Allergic Rhinitis Symptoms
Jung
J-W, Kang H-R, Ji G-E, et al. Therapeutic effects of fermented red ginseng in
allergic rhinitis: a randomized, double-blind, placebo-controlled study. Allergy Asthma Immunol Res. April
2011;3(2):103-110.
"Red"
ginseng (Panax ginseng) is produced
by steaming raw ginseng root, which generates the caramel-colored end product after
drying, while "white" ginseng is usually peeled or scraped raw main
root, which is then either sun-dried or oven-dried without further processing.
Steaming ginseng leads to transformation of some original ginsenosides, mainly
by partial deglycosylation, resulting in enhancement of biological activity. (Editor's
Note: This process has…not been
found to increase the content of…ginsenosides.) The authors of the paper
summarized here stated that, "Fermented red ginseng has been treated with
microorganisms and enzymes that enhance
the saponin content of the red ginseng for maximum efficacy." They
meant to say that: Red ginseng is treated with microorganisms and enzymes to
produce "fermented" red ginseng, which has further enhanced
biological activity, as evidenced by the protective effect of lipopolysaccharide
(LPS)-inflammation in RAW 264.7 cells.
Ginsenoside
Rh1, produced from metabolic biotransformation of protopanaxatriol ginsenosides,
has been reported to be anti-allergenic and anti-inflammatory.1 The authors
cite a previous study showing that fermented red ginseng worked better in
suppressing allergy-related inflammation than non-fermented red ginseng.2
In this randomized, double-blind, placebo-controlled study, the authors
evaluate the therapeutic effects of fermented red ginseng against the symptoms
of allergic rhinitis.
Patients
included in this study were between 18-55 years old suffering from at least 2
of the 4 major allergic rhinitis symptoms of itching, sneezing, runny nose, or
congestion for the past 2 years. Included patients also had positive skin prick
tests for more than 1 perennial allergen such as house dust mites, fungi,
cockroaches, and animal hair. Patients already taking medication for allergic
symptoms or having taken antihistamines or H2-blockers within 2 weeks prior to
the study were excluded. Those suffering from asthma, hypertension, diabetes,
or who were pregnant or planning on becoming pregnant within 3 months of the
study were also excluded. Lastly, the authors did not include patients with
abnormal blood test results.
The
experimental material was a capsule of 250 mg of dried, fermented red ginseng
powder provided by Bifido Inc., Hongcheon, Korea. The powder per gram was
characterized as containing 236.7 mg of crude saponin, 2.3 mg of Rb2, 0.01 mg
of Rb3, 0.6 mg of Rc, 9.5 mg of Rd, 0.5 mg of Re, 0.6 mg of Rg1, 8.2 mg of Rg2,
27.7 mg of Rg3, 12.1 mg of Rh1, and 3.1 mg of Rh2 ginsenosides, with 61.0 mg of
compound K. Placebo capsules containing starch were the same size and shape as
the experimental capsules. The dosage regimen was 3 capsules twice daily for 4
weeks.
Patients
were randomly placed in either the experimental or control groups and received
either the fermented red ginseng or placebo, respectively. The authors administered
a Rhinitis Quality of Life (RQoL) survey before and after the 4-week study.
This survey assessed quality of life with a 5-point scale of 28 subjects
related to allergic rhinitis including practical problems, sleep, nasal
symptoms, non-nose/non-eye symptoms, activity state, emotional state, and eye
symptoms. In addition, a daily total nasal symptom score (TNSS) addressed the 4
symptoms of itching, sneezing, runny nose, and congestion using a 4-point scale
ranging from 0 to 3, with 0 being no symptoms and 3 being severe symptoms.
Symptom duration during each day was also measured using a range from 0 for
none to 3 for symptoms lasting more than 2 hours. A skin prick test was also
conducted before and after the study measuring 14 allergens including the
perennial allergens of house dust mites, fungi, cockroaches, animal hair, and
the seasonal allergens of trees, grass, and weeds. Patients were also monitored
for adverse effects.
Initially,
66 patients were enrolled in the study with 7 dropping out before completion.
Overall, 59 patients completed the study with 30 in the experimental group and
29 in the control group. At baseline, there were no significant differences in positive
reactions to allergens, TNSS, or RQoL between experimental and control groups.
Throughout the study, both the experimental and control groups significantly
improved in the itchy nose, runny nose, and sneezing TNSS and duration scores
from baseline to control (P<0.05); however, the nasal congestion TNSS of the
experimental group significantly improved at weeks 2, 3, and 4 (P<0.05)
while the control group did not. Also, the experimental group's duration TNSS for
nasal congestion improved at weeks 1, 2, 3, and 4 of treatment (P<0.05),
while the control group's score did not significantly change until week 4
(P<0.05). The endpoint TNSS and duration scores were not significantly
different between the experimental and control groups (1.16 ± 0.55 vs. 1.46 ±
0.75 and 1.22 ± 0.54 vs. 1.42 ± 0.76, respectively).
The
experimental group significantly improved in the RQoL activity and emotional
state categories while the control group did not (P<0.05); however, in all
other RQoL categories, both groups significantly improved (P<0.05), and
there were no significant differences between the experimental and control
groups' RQoL at the end of the study (9.38 ± 2.45 vs. 10.14 ± 3.34,
respectively). Also, the experimental group had significantly reduced skin
discoloration in response to 8 tested perennial allergens while the control
group showed no change (P<0.05). Lastly, the authors observed a significant
increase in the allergy-associated antibody immunoglobulin E (IgE) levels in
the control group between baseline and endpoint (507.38 ± 45.67 U/ml vs. 522.34
± 50.75 U/ml, P=0.025). No significant increase was seen in the experimental
group.
Mild
hepatic dysfunction was reported from 3 patients, with 1 in the experimental
group and 2 in the control group. The patient in the experimental group had
elevated levels of alanine aminotransferase (ALT), a liver enzyme used to
detect liver problems, but showed normal levels after 2 weeks. The other
patients had increased levels of ALT and bilirubin; however, no other adverse
effects were reported.
The
authors conclude that the positive results observed with the nasal congestion TNSS
in the experimental group indicate fermented red ginseng as a possible
substitute for antihistamine use. The authors argue that conventional
medication for nasal decongestion such as decongestants and steroids may be
ineffective and even harmful if used over a long period of time. The data
presented in this study support the use of fermented red ginseng, along with
liver function monitoring, for this allergy symptom as it is more effective
than the placebo in this study. One notable aspect was the parallel improvement
of TNSS and RQoL in both the experimental and placebo groups throughout the
study. This suggests that overall, with the exception of nasal congestion,
fermented red ginseng was not more effective in treating allergic rhinitis
symptoms than the placebo.
A
serious issue with this study is the lack of any details about the preparation
and fermentation of the red ginseng; also informative would be a comparison of
the ginsenoside profiles of red ginseng and the fermented red ginseng product.
(Editor's Note: The authors address a timely and important avenue of research
into the potential impacts of fermented foods and herbal medicine; however,
without specifics on the microbes used and the fermentation process, it is hard
to make any definitive assessment about the bioactivity observed. As microbes'
effects on medicinal plants are only starting to be a focus of investigation,
studies such as the one presented here will become increasingly paramount.)
—Amy
C. Keller, PhD
References
1Park E-K, Choo M-K,
Han MJ, Kim D-H. Ginsenoside Rh1 possesses antiallergic and anti-inflammatory
activities. Int Arch Allergy Immunol.
February 2004;133(2):113-120.
2Hyun MS, Hur JM, Shin
YS, Song BJ, Mun YJ, Woo WH. Comparison study of white ginseng, red ginseng,
and fermented red ginseng on the protective effect of LPS-induced inflammation
in RAW 264.7 cells. J Appl Biol Chem. March 2009;52(1):21-27.
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