Monthly Archives: March 2005

Rituximab is a laboratory manufactured antibody that targets the cells in our bodies that produce antibodies. This was genetically engineered and is the first monoclonal antibody to be approved by the FDA for the treatment of cancer. The current indication for its use is in the treatment of non-Hodgkin’s lymphoma. It has become an important tool for patients with that disease.

The function of the immune system was critical to survival of our species. Prior to the 20th century man’s greatest killers were, in fact, infectious diseases. It is important to note that not everyone’s immune system functions in the same way because genetic diversity determines how one individual will react to a given infection. Diversity in the immune response has protected us from devastating events. For example, not everyone who got the bubonic plaque died. Some individual had a genetically programmed immune response that was more effective than others and they were able to survive. There are many examples of that throughout history of our species.

Herbal supplements are used widely, and some of these supplements may stimulate the immune system in ways that could be harmful for people who have or are prone to autoimmune diseases. 
There are a number of herbal medications that have been studied and have immunostimulatory effects.  Among these are Echinacea, the algae Spirulina platensis and Aphanizomenon flos-aquae.  We recently reported three patients with autoimmune disease, two of whom had pemphigus vulgaris, whose disease exacerbated shortly after beginning one of these herbal medications (Lee and Werth, Arch Dermatol 140:723, 2004).  In one case of dermatomyositis, the patient re-flared several months later after rechallenging herself with the same herbal product. 

These herbs seem to affect the immune system by increasing pro-inflammatory proteins produced by inflammatory cells, and their effects have been studied in a number of experimental models.  Studying the potential mechanisms and effects of these herbs in humans has been done in only a few studies, and much more work will be needed in order to document their potential toxicity in patients with autoimmune diseases.  Until these studies are performed, it would be prudent for patients with pemphigus vulgaris to avoid potentially immunostimulatory herbal medications.

Potential Adverse Effects of Some Herbal supplements on Patients with Autoimmune Diseases 

By Victoria P. Werth, M.D.

Herbal supplements are used widely, and some of these supplements may stimulate the immune system in ways that could be harmful for people who have or are prone to autoimmune diseases.

There are a number of herbal medications that have been studied and have immunostimulatory effects.  Among these are Echinacea, the algae Spirulina platensis and Aphanizomenon flos-aquae.  We recently reported three patients with autoimmune disease, two of whom had pemphigus vulgaris, whose disease exacerbated shortly after beginning one of these herbal medications (Lee and Werth, Arch Dermatol 140:723, 2004).  In one case of dermatomyositis the patient re-flared several months later after rechallenging herself with the same herbal product.

These herbs seem to affect the immune system by increasing pro-inflammatory proteins produced by inflammatory cells, and their effects have been studied in a number of experimental models.  Studying the potential mechanisms and effects of these herbs in humans has been done in only a few studies, and much more work will be needed in order to document their potential toxicity in patients with autoimmune diseases.  Until these studies are performed, it would be prudent for patients with pemphigus vulgaris to avoid potentially immunostimulatory herbal medications.