Hay Fever Tablets by Brauer

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Common cold. Although there is interest in using oral black mustard for the common cold, there is insufficient reliable information about the clinical effects of black mustard for this condition.
• Osteoarthritis. Although there is interest in using oral or topical black mustard for osteoarthritis, there is insufficient reliable information about the clinical effects of black mustard for this condition.
• Pain (acute). Although there is interest in using oral or topical black mustard for acute pain, there is insufficient reliable information about the clinical effects of black mustard for this purpose. More evidence is needed to rate black mustard for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there has been interest in using oral eyebright for allergic rhinitis, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Asthenopia (eye strain). Although there has been interest in using topical eyebright for asthenopia, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Blepharitis. Although there has been interest in using topical eyebright for blepharitis, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Cancer. Although there has been interest in using oral eyebright for cancer, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Common cold. Although there has been interest in using oral eyebright for the common cold, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Conjunctivitis. It is unclear if topical eyebright eye drops are beneficial in patients with conjunctivitis. Details: A small observational study shows that applying one drop of eyebright eye drops (WALA Heilmittel GmbH, Eck-walden/Bad Boll) up to five times daily results in complete recovery in about 82% of patients with conjunctivitis after two weeks of treatment (49391). However, due to the lack of a comparator group, it is not clear if this improvement is due to eyebright or to the natural resolution of conjunctivitis symptoms.
• Cough. Although there has been interest in using oral eyebright for cough, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Pharyngitis. Although there has been interest in using oral eyebright for pharyngitis, there is insufficient reliable information about the clinical effects of eyebright for this purpose.
• Rhinosinusitis. Although there has been interest in using oral eyebright for rhinosinusitis, there is insufficient reliable information about the clinical effects of eyebright for this purpose. More evidence is needed to rate eyebright for these uses.

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POSSIBLY EFFECTIVE

• Scarring. Clinical research in adults and children shows that topical application of onion extract, often as part of combination products, for 10 weeks to 6 months is beneficial for preventing scarring; however, the most effective combination of ingredients, dosage form, and dose are unclear. Details: Many small clinical trials show that using topical onion extract improves the appearance, as well as pain and itching, associated with postburn hypertrophic scars, keloidal scars, scars following tattoo removal, scars following Cesarean delivery, or scars following surgical removal of tissue when compared with control (66895,66918,66939,66951,66987,67089,67104,95151,95156,95159,104773). Products evaluated in clinical research have included gels containing a combination of onion extract, heparin, and allantoin (Contractubex, Merz Pharmaceuticals) (66895,66987,67089,67104,104773); a combination of onion extract and a silicone derivative (Cybele scagel, Bangkok Botanica) (95156,95159); a combination of onion extract, allantoin, pentaglycan, and a solution of glycosaminoglycans (Kaloidon gel, Laboratori Farmacologici Milanesi) (95151); and a transdermal patch containing a combination of onion extract and allantoin (104771). However, not all research agrees. A meta-analysis of randomized controlled trials using onion extract gel for scar management demonstrated mixed results when compared with control. However, the validity of the study is limited by high heterogeneity (109511). In addition, a specific product containing onion extract and allantoin (Mederma, Merz Pharmaceuticals) for 4-11 weeks does not appear to improve the appearance of new surgical scars (66742,66883). Similarly, observational research has found that a topical patch containing onion extract and allantoin is not associated with improved provider- or patient-assessed appearance of scars following cesarean-delivery after 4 weeks when compared with those using no scar treatment (104771). It is possible that the duration of treatment in these studies was inadequate to identify improvement.

POSSIBLY INEFFECTIVE

• Obesity. Clinical research does not support the use of dietary onion or onion supplements for weight loss. Details: Clinical research in overweight patients shows that taking capsules containing steamed onion (Oniro, Kunpoong Bio Co., Ltd) 300 mg orally three times daily for 12 weeks does not reduce body mass index (BMI), fat distribution, or fat mass when compared with placebo (101747). In addition, one clinical study in overweight and obese patients with polycystic ovary syndrome (PCOS) shows that eating raw red onion 80-120 grams daily can actually increase BMI by 0.36 kg/m2 when compared with eating 20-30 grams of raw red onion (95155). Clinical studies have also used onion products standardized by quercetin content. Preliminary clinical research in overweight and obese patients shows that taking onion peel extract providing quercetin 100 mg orally daily for 12 weeks reduces body weight by up to 1.1 kg and BMI by up to 0.4 kg/m2 when compared to baseline, but not when compared with placebo (95152,101748). Another small clinical study in healthy, overweight Japanese adults shows that taking an onion powder containing quercetin 60 mg orally daily for 12 weeks does not reduce body weight, BMI, abdominal circumference, or abdominal fat when compared with the same quantity of quercetin-free onion powder (104772).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alopecia areata. It is unclear if topical onion is beneficial in patients with alopecia areata. Details: Preliminary clinical research in children and adults with alopecia areata shows that topical application of raw onion juice twice daily for 8 weeks improves hair growth when compared with placebo. Hair regrowth was demonstrated in 74% of subjects using onion juice, compared with 13% using placebo (66797).
• Angina. Although there has been interest in using oral onion for angina, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Asthma. Although there has been interest in using oral onion for asthma, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Atherosclerosis. Although there has been interest in using oral onion for atherosclerosis, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Bruises. Although there has been interest in using topical onion for bruises, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Diabetes. It is unclear if oral onion is beneficial in patients with diabetes. Details: Preliminary clinical research in adults with type 2 diabetes shows that taking fresh onion 20 grams orally three times daily, in addition to consuming a controlled diet, for 8 weeks decreases blood glucose levels by 5% when compared with a controlled diet alone (67072).
• Dyspepsia. Although there has been interest in using oral onion for dyspepsia, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Gastric cancer. It is unclear if oral onion is beneficial for preventing gastric cancer. Details: Population research has found that the highest dietary intake of onion is associated with a 48% reduced odds of gastric cancer when compared with the lowest intake (51460).
• Hypertension. It is unclear if oral onion is beneficial in patients with hypertension. Details: Preliminary clinical research in overweight or obese adults with prehypertension or hypertension shows that taking onion skin extract 132 mg orally three times daily for 6 weeks reduces 24-hour systolic blood pressure by 4 mmHg, but does not affect diastolic blood pressure, when compared with placebo (95149). Other preliminary clinical research in patients with hypertension shows that taking a specific product (Campo di mele formula, Phyt-Immun) containing onion 2.5 grams, olive oil 5 mL, grape skin extract 50 mg, L-carnitine 30 mg, vitamin E 3 mg, vitamin C 2 mg, lycopene 1 mg, and folic acid 44 mcg, once daily for one week, decreases systolic and diastolic blood pressure by 5 mmHg and 2 mmHg, respectively, when compared with placebo (66766). It is unclear if this effect is due to onion, other ingredients, or the combination.
• Hypothyroidism. It is unclear if oral onion is beneficial for preventing hypothyroidism. Details: Population research in females has found that high dietary intake of onion is associated with a lower risk of subclinical hypothyroidism when compared with low dietary intake, However, this association was not identified in males. The association of dietary onion intake with symptomatic hypothyroidism was not evaluated (109512).
• Insect bite. Although there has been interest in using topical onion for insect bites, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Insomnia. It is unclear if oral onion is beneficial in patients with poor sleep quality. Details: Preliminary clinical research in healthy adults that were unsatisfied with their current sleep quality shows that taking onion extract 500 mg orally three times daily for 5 days may slightly improve sleep latency and waking after sleep onset, but does not change self-rated sleep quality, when compared with placebo (104774).
• Polycystic ovary syndrome (PCOS). It is unclear if oral onion is beneficial in patients with PCOS. Details: Clinical research in overweight or obese adults with PCOS shows that eating 80-120 grams of raw red onion daily does not improve levels of fasting blood glucose, cholesterol, triglycerides, or lipoprotein (a), and can increase body mass index (BMI) by 0.36 kg/m2, when compared with eating 20-30 grams of raw red onion daily (95155).
• Prostate cancer. It is unclear if oral onion is beneficial for preventing prostate cancer. Details: Population research has found that high dietary intake of onion is not associated with a lower odds of developing prostate cancer when compared with low dietary intake of onion (88410).
• Respiratory tract infections. Although there has been interest in using oral onion for respiratory tract infections, including the common cold, there is insufficient reliable information about the clinical effects of onion for this purpose.
• Stretch marks (striae gravidarum). Topical onion has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adult females shows that applying a specific cream (Mederma For Stretch Marks, Merz Pharmaceuticals) containing onion extract, gotu kola, and hyaluronic acid to striae rubra twice daily for 12 weeks improves stretch mark scores, including color, softness, and texture, when compared with no treatment (95154).
• Warts. Although there has been interest in using topical onion for warts, there is insufficient reliable information about the clinical effects of onion for this purpose. More evidence is needed to rate onion for these uses.

(Read more about ONION)

LIKELY SAFE ...when used orally in the amounts commonly found in foods. Black mustard has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of black mustard when used orally or topically for medicinal purposes.

PREGNANCY: LIKELY UNSAFE
when used orally for medicinal purposes. Black mustard might have abortifacient and menstrual stimulant effects (19). There is insufficient reliable information available about the safety of black mustard for its other uses during pregnancy; avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when used orally in amounts commonly found in foods. Eyebright is listed by the Council of Europe as a natural source of food flavoring (4).

POSSIBLY UNSAFE ...when applied into the eyes. Avoid using due to hygienic concerns; eyebright ophthalmic products may be subject to contamination (8,11). There is insufficient reliable information available about the safety of eyebright when used orally in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about EYEBRIGHT)

LIKELY SAFE ...when consumed in amounts commonly found in foods. Onion has Generally Recognized as Safe (GRAS) status in the US (4912). ...when onion extract is used topically (66742,66883,66895,66903,67089,95151,95154,95156).

POSSIBLY SAFE ...when onion extract is used orally and appropriately (2). Onion extract has been used safely in doses of 300 mg three times daily for up to 12 weeks (95149,101747).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in amounts greater than used in foods.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, black mustard seed might increase the risk of hypoglycemia when used with antidiabetes drugs.  Details Animal research shows that some extracts of black mustard seeds can reduce blood glucose levels, possibly by regulating the release of insulin and the metabolism of glucose (64176,64207).

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, eyebright might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research suggests that eyebright lowers blood glucose levels (49393).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of anticoagulant or antiplatelet drugs with onion might increase the risk of bleeding.  Details In vitro research shows that onion inhibits platelet aggregation (19,66898).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Concomitant use of antidiabetes drugs with onion may increase the risk of hypoglycemia.  Details Animal research and clinical research shows that taking onion can lower blood glucose levels (19,66800,66812,66859,66982,67033,67043,67053,67072,95148,95160). Monitor blood glucose levels closely.

ASPIRIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Concomitant use of aspirin with onion may worsen onion allergy.  Details In one case report, a patient with a mild onion allergy reported worsening allergy, including swelling and severe urticaria, after taking aspirin (5054).

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, taking onion might increase the levels and clinical effects of drugs metabolized by CYP2E1.  Details Animal research shows that taking onion powder inhibits CYP2E1 (19653). However, this interaction has not been reported in humans.

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General ...Orally, black mustard is generally well tolerated when used in amounts found in foods. Very large amounts of black mustard seed can cause serious adverse effects.

Cardiovascular ...Orally, taking very large amounts of black mustard seed can lead to cardiac failure and possibly death (18).

Dermatologic ...Topically, black mustard oil or powder containing allyl isothiocyanate can cause skin irritation or burns, especially if applied for an extended period of time (6,11,12,18).

Endocrine ...Orally, the isothiocyanate constituents contained in black mustard have been linked to endemic goiters (6,11).

Gastrointestinal ...Orally, taking very large amounts of black mustard seed can lead to vomiting, stomach pain, and diarrhea (18).

Neurologic/CNS ...Orally, taking very large amounts of black mustard seed can lead to somnolence and coma (18).

Pulmonary/Respiratory ...Orally, taking very large amounts of black mustard seed can lead to breathing difficulties and possibly death (18). In a case report, a 15 month-old male developed acute, severe respiratory distress after ingesting and aspirating ground black mustard seeds (64387).

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General ...Orally, eyebright is generally well tolerated when used in food amounts. Topically, eyebright might be unsafe due to the potential for contamination.

Gastrointestinal ...Orally, eyebright has been reported to cause nausea and constipation (4).

Genitourinary ...Orally, eyebright has been reported to cause polyuria (4).

Neurologic/CNS ...Orally, eyebright has been reported to cause confusion and headache (4).

Ocular/Otic ...Topically, eyebright has been reported to cause increased ocular pressure, lacrimation, pruritus, redness, swelling of eyelid margins, vision changes, and photophobia when applied to the eyes (4). Ophthalmic eyebright products should be used with caution due to the potential for contamination (8,11).

Pulmonary/Respiratory ...Orally, eyebright has been reported to cause cough, dyspnea, and nasal congestion (4).

(Read more about EYEBRIGHT)

General ...Orally, onion is well tolerated. Topically, onion is generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, heartburn.
Topically: Eczema, irritation.
Serious Adverse Effects (Rare):
All ROAs: Anaphylaxis in sensitive individuals.

Dermatologic ...Topically, frequent contact with onions can result in hand eczema, pemphigus, sensitization, and irritation (18,5004,51303,67066,67093).

Gastrointestinal ...The consumption of large quantities of onions or onion powder can cause stomach distress or heartburn (18,95155,104772). Stomach distress from onion powder appears to be transient (104772). In one case report, consumption of raw onions led to esophageal spasm (66841).

Immunologic ...Allergy to onion is rare, although there are reports of symptoms to both oral and topical exposure (41752,101743). In one case, oral exposure or the aroma of onions caused the sensation of throat closing in an allergic woman (88404). In a 35-year-old man, cooked onion ingestion triggered anaphylaxis (101742). In another case, the smell of onion was identified as a trigger for migraines in a 32-year-old female. Because the patient had a positive allergy skin test for onion, allergenic or immunogenic mechanisms were considered to be the origin of the migraines (88404).

Ocular/Otic ...Exposure to onion aroma can cause excessive tearing (67049).

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