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Quality of Life of Allergic Rhinitis Patients treated with Ethanolic Benjakul Remedy Extract compared with Loratadine

  • January 2019
Authors:
Pannawat Chaiyawatthanananthn at Thammasat University
Pannawat Chaiyawatthanananthn
Arunporn Itharat at Thammasat University
Arunporn Itharat
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Abstract

Introduction: Benjakul scripture consists of 5 herbs i.e. Piper longum fruits, Piper sarmentosum roots, Piper interruptum vines, dried Zingiber officinale rhizomes and Plumbago indica roots. Previous study showed that 95% ethanol Benjakul extract reduced release of β-hexosaminidase in RBL-2H3 rat basophilic leukemia cells and indicated that the Benjakul extract could reduce allergic activity. Therefore, the ethanolic Benjakul extract could be used to replace synthetic drug and improve quality of life of patients with allergic rhinitis (AR) by decreasing rhinitis symptoms than conventional drugs are commonly used. Objective: To investigate quality of life of AR patients receiving ethanolic Benjakul extract compared with those treated with loratadine. Methods: This study was approved by the human ethics committee of Thammasat University No. I (Faculty of Medicine). In this study, 60 patients who were diagnosed with allergic rhinitis by otolaryngologist were recruited. The patients were divided into two groups. Experimental group received 300 milligrams (mg)/day of the Benjakul extract and Control group treated with 10 mg/day of loratadine for 6 weeks. All patients were measured quality of life follow as Rhinoconjuctivitis Quality of Life questionnaires (RCQ-36) at 0, 3 and 6 weeks and all data were analyzed with statistics. Results: After the group treated for 6 weeks, quality of life of the AR patients treated with the Benjakul extracts did not differ those receiving loratadine. Moreover, the patients receiving the Benjakul extract significantly improved quality of life by reducing Rhinitis symptoms (RS), Other symptoms (OS), Eye symptoms (ES), Physical functioning (PF), Role Limitation (RL), Sleep, Social functioning (SF), Emotions (E) and Overall health (OH) at 3 weeks and 6 weeks of treatment (p < 0.05). The results concluded that the Benjakul extract increased the quality of life of the AR patients. Conclusion: The Benjakul extract reduced rhinitis symptoms (RS) and improved quality of life of allergic rhinitis patients after treatment for 6 weeks. Thus, the ethanolic Benjakul extract could be a drug of choice for treating allergic rhinitis.
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36 Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019
นิพนธ์ต้นฉบับ
คุณภาพชีวิตของผูปวยโรคจมูกอกเสบจากภูมิแพที่ไดรบสารสกดตารบยา
เบญจกูลเทียบกบยาลอราทาดีน (Loratadine)
กตญชลี หวงเอี่ยม*, ไวพจน จนทรวิเมลือง**, อรุณพร อิฐรตน*, ***, ณิชมน มุขสมบติ***,
ปรรณณวชญ ไชยวฒนนนทน*, ***
บทคัดย่อ
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
 
 

37
Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019
 



 
38 Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019
บทน�ำ


 











  


Piper longum
 Piper sarmentosum
Piper interruptum
 Zingiber ofcinale
 Plum-
bago indica

β 





   



    
   




 
 







วิธีกำรศึกษำ















Piper
longum Piper sarmentosum
Piper interruptum(Zingiber ofcinale)
(Plumbago indica)









 

39
Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019

αβ2SD2/d2
 
 

 
αZα/2 β β
β 

 
 







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 
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 
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 
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  
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  
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 
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


  

  










40 Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019
 
 


  







   



 


U
 
 

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 
  
 

 
   





 
 
















  


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Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019
   p-value
 
    
   
   
    
   
   
    
    
   
    
    
   
    
   
   
    
   
   
    
     
     
    
     
     
    
     
     
 
 


42 Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019


 
  
 






 





    p-value
 
     
   
   
 
     
   
   
 
    
   
   
 
     
   
   
 
 
  

วิจำรณ์

 


 






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Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019



αα
ββ

αβ


β




  































 









กิตติกรรมประกำศ






 


เอกสำรอ้ำงอิง
 

 

  
 

 -


 
 

44 Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019
   
  

-


 



 

   
 
  

 

   
 


 



     

  
  

   


  

  

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Thammasat Medical Journal, Vol. 19 No. 1, January - March 2019





 
 

 
 Piper longumPiper sarmentosumPiper
interruptumZingiber ofcinalePlumbago indica 
β
 



 

 

   


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
... Therefore, the mechanism by which Benjakul extract mediates the upregulation of CYP3A1 expression and activity may involve the activation of PXR. Recently, Benjakul has been used to treat patients with allergic rhinitis and lung cancer [25,26]. Herb-drug interactions may occur if Benjakul extract is combined with drugs metabolized by CYP3A4. ...
Modulatory effects of Benjakul extract on rat hepatic cytochrome P450 enzymes
Article
Full-text available
  • Nov 2021
Benjakul, a traditional Thai formulation, has been used as a carminative and adaptogenic drug. It consists of five plants, Piper chaba Hunter, Piper sarmentosum Roxb., Piper interruptum Opiz., Plumbago indica Linn., and Zingiber officinale Roscoe, in equal ratios. Some individual herbs present in Benjakul were reported to modulate cytochrome P450 (CYP) enzymes. This study aimed to investigate the effects of Benjakul extract on the activities and mRNA expression levels of hepatic CYP2C11 and CYP3A1 in rats. Adult male rats were orally administered 200, 400, or 600 mg/kg BW Benjakul extract for 28 days. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and creatinine levels were assayed. CYP2C11 and CYP3A1 activities were analyzed using cytochrome P450 assay kits. The mRNA expression of CYP2C11 and CYP3A1 was measured using a quantitative real-time PCR assay. Benjakul treatment significantly increased the serum ALT and BUN levels. At doses of 200, 400, and 600 mg/kg BW, Benjakul treatment increased hepatic CYP3A1 activity and CYP3A1 mRNA expression. CYP2C11 mRNA expression was unchanged by treatment with Benjakul extract; however, treatment with the high and middle doses of Benjakul extract increased CYP2C11 activity. Treament with Benjakul extract induced CYP2C11 and CYP3A1 activity in rats. Concurrent use of Benjakul with conventional drugs should be considered to potentially induce herb-drug interactions.
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Clinical Efficacy and Safety of Benjakul Remedy Extract for Treating Primary Osteoarthritis of Knee Compared with Diclofenac: Double Blind, Randomized Controlled Trial
Article
Full-text available
Background The purpose of this study was to investigate the clinical efficacy and safety of Benjakul (BJK) extract for treating primary osteoarthritis (OA) of the knee compared with diclofenac. Methods A phase 2, double blind, randomized, and controlled study was conducted. The BJK group received 300 mg of BJK extract per day, while another group received 75 mg of diclofenac per day. All patients were followed up at 14 and 28 days. The changing of visual analogue scale (VAS) for pain, 100-meter walking times, the modified Thai WOMAC index scores, and the global assessment were evaluated for efficacy. For safety issue, clinical signs and symptoms, complete physical examination, and renal and liver function were evaluated. Results 39 and 38 patients for BJK extract group and diclofenac group were evaluated. For efficacy, all patients from both groups reported a decrease in the VAS pain score and 100-meter walking times but only the diclofenac group showed significant reduction of both measurements when compared with day 0. The modified Thai WOMAC scores of both groups were significantly reduced from baseline. However, all efficacy outcomes were not significantly different for both groups. For safety outcomes, the patients from both groups had no severe adverse events reported and only BJK had no toxicity in renal and liver functions. Conclusions The BJK remedy extract showed equal clinical efficacy in relieving symptoms of OA knee when compared with diclofenac.
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Quality of life in patients with allergic rhinitis: a clinical trial comparing the use of bilastine versus loratadine
Article
Full-text available
  • Jul 2016
Objectives: The aim of this study was to determine whether there were differences in health-related quality of life of patients with allergic rhinitis treated with bilastine 20 mg compared to those treated with loratadine 10 mg. Design: This was a prospective randomized double-blinded study. Setting: Otolaryngology outpatient clinics in Criciúma, state of Santa Catarina, Brazil. Participants: Seventy-three patients, aged between 18 and 63 years, of whom 36 were treated with loratadine 10 mg and 37 with bilastine 20 mg with medication administered once a day for ten days. Main outcome measures: The outcome was quality of life as assessed by the modified Rhinoconjunctivitis Quality of Life Questionnaire (RQLQm), which was applied at baseline and after 10 days of treatment. Results: The use of bilastine 20 mg or loratadine 10 mg significantly reduced RQLQm scores after 10 days of treatment (p <0.001); however, there was no statistically significant difference between the two treatment groups (p >0.05). Conclusions: Health-related quality of life in patients with allergic rhinitis improved significantly after 10 days of treatment with loratadine and bilastine, and the effectiveness of both was equivalent. This article is protected by copyright. All rights reserved.
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The prevalence of rhinosinusitis in allergic rhinitis
Article
Full-text available
  • Aug 2006
Objective: To study the prevalence of rhinosinusitis in allergic rhinitis patients Material and Methods: Sixty adult patients with allergic rhinitis were studied at the Allergy and Rhinology Clinic, Songklanagarind Hospital, between March 1st, 2000 and February 28th, 2006. All patients had a positive skin prick test to at least 1 common aeroallergen. Nasal endoscopy and sinus radiography were performed. The criteria for diagnosis of rhinosinusitis were a history of rhinitis symptoms and a positive nasal endoscopy (mucoid or mucopurulent discharge from middle meatus or superior meatus) and/or abnormal sinus radiography. Results: Of the 60 patients with allergic rhinitis, 59 (98.3%) demonstrated sensitivity to more than 1 aeroallergen – most prominently, Dermatophagoides pteronyssinus (80.4%) and Dermatophagoides farinae (71.4%). Thirty two (53.3%) had an abnormal sinus radiography and 14 (23.3%) had a positive nasal endoscopy. According to rhinosinusitis diagnostic criteria, 32 (53.3%) had rhinosinusitis. Conclusion: 53.3% of patients with allergic rhinitis had rhinosinusitis, showing association between these two common diseases.
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Nitidine chloride inhibits LPS-induced inflammatory cytokines production via MAPK and NF-kappaB pathway in RAW 264.7 cells
Article
Full-text available
  • Sep 2012
Zanthoxylum nitidium (Roxb.) DC. has long been used as a traditional herbal medicine for inflammatory diseases such as rheumatic arthritis and peridentitis. However, the anti-inflammatory mechanism of Nitidine chloride has not been fully elucidated. To determine the anti-inflammatory effects and mechanism of Nitidine chloride (NTD), a pentacyclic alkaloid is isolated from the root of Z. nitidium, in murine macrophages. Anti-inflammatory properties of NTD were investigated using lipopolysaccharide (LPS)-stimulated Raw 264.7 macrophages as in vitro model. The pro-inflammatory cytokines were evaluated by real-time RT-PCR and ELISA. Furthermore, intracellular signaling pathways were analyzed by Western blot and Immunofluorescence staining using specific antibodies. NTD significantly reduced the production of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), and IL-6 in both RNA and protein level. Moreover, transcriptional activity of NF-кB as well as the phosphorylation of mitogen-activated protein kinases (MAPKs) in LPS-treated RAW 264.7 was significantly inhibited by NTD in a dose dependent manner. These results suggested that NTD exerts an anti-inflammatory property by inhibiting TNF-α, IL-1β, and IL-6 production in association with reduced NF-κB and MAPK signaling pathways in RAW 264.7 cells. These results suggested that NTD exerts an anti-inflammatory property by inhibiting TNF-α, IL-1β, and IL-6 production in association with reduced NF-κB and MAPK signaling pathways in RAW 264.7 cells. Nitidine chloride inhibits LPS-induced TNF alpha, IL-1beta and IL-6 production via the suppression of phosphorylation of MAPK and the translocation of p65. In addition, these results revealed a novel role of NTD in regulation of inflammatory diseases.
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The anti-allergic and anti-inflammatory effects of Benjakul extract (a Thai traditional medicine), its constituent plants and its some pure constituents using in vitro experiments
Article
  • May 2017
Benjakul (BJK), a Thai traditional medicine preparation, has long been used for balanced health, controlled abnormal of element in the body, carminative, and relief of flatulence. It is composed of five plants: Piper interruptum Opiz., Piper longum L., Piper sarmentosum Roxb., Plumbago indica L., and Zingiber officinale Roscoe. The ethanolic extracts of BJK, its five individual plants, and pure constituents of BJK were investigated for their anti-allergic activity using immunoglobulin E (IgE)-sensitized β-hexosaminidase in the rat basophilic leukemia-2H3 (RBL-2H3) cells and anti-inflammatory activity using lipopolysaccharide (LPS)-induced nitric oxide (NO) and tumor necrosis factor-alpha (TNF-α) in the murine macrophage (RAW 264.7) cells. The ethanolic extracts of BJK showed anti-allergic activity (IC50 = 12.69 μg/ml) and exhibited potent NO inhibitory effect (IC50 = 16.60 μg/ml), but inactive on TNF-α release. Moreover, 6-shogaol and plumbagin, two pure compounds from BJK, showed higher anti-allergic activity than the ethanolic BJK extract with IC50 values of 0.28 and 4.03 μg/ml, respectively. These compounds were significantly higher than chlorpheniramine (CPM), standard drug, with IC50 value of 17.98 μg/ml. Determination of the anti-inflammatory activity by measuring the inhibition of NO production presented that plumbagin and 6-shogaol exhibited higher than crude BJK extract with IC50 values of 0.002 and 0.92 μg/ml, respectively. In particular, plumbagin also showed higher anti-inflammatory than prednisolone, positive control, with IC50 value of 0.59 μg/ml. 6-Shogaol also showed inhibitory effect on TNF-α release (IC50 = 9.16 μg/ml). These preliminary results may provide some scientific support for the use of BJK for the anti-allergic treatment and inflammatory disorders through the inhibition of NO production.
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Development of a health-related quality of life questionaire for Thai patients with rhinoconjunctivitis
Article
The objective of this study was to develop a disease-specific questionnaire for patients with rhinoconjunctivitis. All patients were recruited at the Out-Patient Clinic at Siriraj Hospital. Related topics were gathered from several sources, and a list of 63 items was produced. In phase I, the first version of the questionnaire was completed by 363 patients. Forty-eight items were identified by clinical impact analysis during the item removal process, two more questions were then added, giving a total of 50. Two hundred and forty-three patients completed the second version questionnaire in phase II. The average time taken to complete the questionnaire was 6.38 minutes. The item removal process in phase II was achieved by a multi-step process. There were 36 items in the third version questionnaire which consisted of six dimensions and two independent items as follows: symptoms (17 items), physical functioning (3 items), role limitations (3 items), sleep (3 items), social functioning (3 items), emotions (5 items), general health (1 item), and absenteeism (1 item). The scores of each item ranged from 1 to 5; a lower score indicating a better quality of life. Data from the selected 36 items was extracted to test the validity and reliability of the final version. The floor and ceiling effects of the scores for each dimension were low. Multitrait multi-item analysis was conducted to examine construct validity. The scaling success of convergent and divergent validity was 100% and 94%, respectively. Internal consistency determined by Cronbach's alpha coefficient, was satisfactory (0.79-0.87). The study indicates that the questionnaire is suitable for use in clinical settings. While the test results are encouraging, further work needs to be done on the test-retest reliability and on responsiveness.
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Comparison of the SF-36 and the rhinoconjunctivitis of life (Rcq-36) questionnaire in thai patients
  • Jan 2005
  • 189-192
  • C Bunnag
  • W Leurmarnkul
  • P Jareoncharsri
  • P Tunsuriyawong
  • P Assanasen
  • R Pawankar
Bunnag C, Leurmarnkul W, Jareoncharsri P, Tunsuriyawong P, Assanasen P, Pawankar R. Comparison of the SF-36 and the rhinoconjunctivitis of life (Rcq-36) questionnaire in thai patients. Allergy Clin Imminol Int-J World Allergy Org. 2005;17:189-92.
Inflammatory suppressive effect of Benjakul, a Thai traditional medicine on intestinal epithelial cell line
  • Jan 2013
  • J MED PLANTS RES
  • 3286-3291
  • A Burodom
  • A Itharat
Burodom A, Itharat A. Inflammatory suppressive effect of Benjakul, a Thai traditional medicine on intestinal epithelial cell line. J Med Plants Res 2013;7:3286-91.