Among herbal supplements, elderberry poses greatest risks in autoimmune skin disease
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Key takeaways:
- Herbal supplement use was reported by 30% of patients with dermatomyositis and 36% of patients with CLE.
- Elderberry preceded exacerbation in 62% of those with DM and 50% of those with CLE.
Use of elderberry as an herbal supplement preceded disease exacerbation in 62% of patients with dermatomyositis, and in 50% of those with cutaneous lupus erythematosus, according to data published in ACR Open Rheumatology.
In all, nearly one-third of patients with autoimmune skin diseases reported using herbal supplements despite the risks for immune dysregulation, the researchers added.
“Autoimmune diseases have a genetic predisposition, but that there are triggers such as immunostimulatory herbs that can induce the disease or exacerbate the disease,” Victoria P. Werth, MD, of the Corporal Michael J. Crescenz Veterans Affairs Medical Center and the University of Pennsylvania, in Philadelphia, told Healio. “This is relevant to both patients and their family members who are at increased risk because of genetics. Immunostimulatory herbs are being used much more since the pandemic and are in many supplements. The week before the lock-down, the use of elderberry went up 400%.
“We have previously studied one weight loss powder and spirulina in terms of the ability to activate blood cells from patients with dermatomyositis,” she added. “In the case of spirulina, it is clear that cells from dermatomyositis patients are activated much more than from healthy controls. We are now interested in looking at a broader range of herbal supplements in autoimmune dermatology patients in terms of their use, and also any exacerbations that patients might have seen when they used them.”
To examine which herbal supplements are most common, and the risks they entail, in autoimmune skin disease, the researchers analyzed data from 673 adults (mean age, 49 years) with either dermatomyositis or CLE who visited the University of Pennsylvania’s rheumatology-dermatology clinic between January 2007 and February 2024. Patients reported their herbal supplement use in a systematic, stepwise manner to minimize recall bias, with handouts listing common options.
The researchers assessed the impact of herbal supplements through retrospective chart review, while demographic factors associated with supplement use were analyzed with chi-square tests.
According to the researchers, the overall prevalence of herbal supplement use was 32%, and reported among 30% of patients with dermatomyositis and in 36% of those with CLE. Herbal supplement use was reported by 44% of patients aged 18 to 29 years, 29% of those aged 50 to 64 years (P = .02) and 23% of those aged older than 65 years (P = .003). Herbal supplement use was also significantly more common among patients characterized as “Hispanic/Latino” (58%) vs. white patients (31%).
Overall, disease onset or exacerbation followed supplement use in 31% of patients with dermatomyositis, but only 10% of patients with CLE. In both groups, the greatest risk for exacerbation was seen with elderberry use, impacting 62% of users with dermatomyositis and half of users with CLE, according to the researchers.
“The amount of use and associated exacerbations are not surprising to my team, since we regularly see patients who go to the gym, want to increase their ‘healthy behavior by taking green drinks with spirulina, green algae, or chlorella, and then come down with dermatomyositis,” Werth said. “I believe the number of immunostimulatory herbs is large and more work is needed to define their role epidemiologically and in the lab.
“This is an unregulated industry and although many supplements are healthy, there are a host of them that are not,” she added. “People need to read the fine print on the back of their herbal supplements, and be careful about taking ingredients that ‘boost the immune system’ or ‘improve immune support’ to avoid potentially taking supplements that may make them sick.”
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