My father recently asked me about black cumin seed oil. He emailed me (as I think so many of our friends and family do!): “Kara, I’m taking black cumin seed oil capsules daily. Should I?” I haven’t been using it in practice, and his question prompted a review of literature by me- which was immediately interesting- and then a good dialogue with our Clinical Development tribe. I was thrilled that Dr. Gereau not only had some experience using it in her functional otolaryngology practice, but wanted to dive into the literature around allergic disease- a focus at our clinic as well. We will be incorporating Nigella Sativa in conjunction with a full functional approach. Are you?
Thank you Sezelle, for this well thought-out and researched blog! DrKF
Sezelle Gereau MD, CDP participant
Allergy and allergic-related diseases are some of the most common conditions for which patients seek medical care. Starting early in life the allergic march can present as food allergy and progress to eczema. Soon after, patients develop seasonal and perennial allergies, which unfortunately can later lead to asthma. Thus, medical practitioners of all types require good treatment strategies for allergy. The most effective treatments are those that help to reverse the course or prevent progression of the disease, not just eliminate symptoms. It is also essential to start such therapies early so that children will not bear the lifelong burden of the atopic skin conditions and asthma.
The use of nutraceuticals in the allergic patient is tricky as patients can be allergic to the supplement itself, or be on a number of other medications that could cause interactions. Having a therapy that can easily be combined with medications, herbals, or used topically instead of taken orally, can minimize the risk of side effects and ultimately improve patient outcomes. Our goal should always be to reduce the use of antihistamines and steroids, and not to contribute to poly-pharmacy. Better yet if that herbal can be used as a food and still provide therapeutic effect.
It isn’t often that a powerhouse herb such as Nigella Sativa comes to our attention. In Arab countries it is widely used as a regular part of the diet for general wellness. There are many clinical studies that support its use as a dietary supplement to treat a variety of illnesses. This research looks especially promising for conditions such as eczema, asthma, and to enhance the effects of immunotherapy. The safety profile is impeccable, and many of its pharmacological properties suggest that it could be an ideal adjunct to other anti-allergy protocols. As an otolaryngologist, I believe it is worthy of a closer look.
A Plant with a Long, Esteemed History
Nigella sativa (NS), an annual flowering plant of the Ranunculaceae family, is native to South Asia. It is also cultivated and used in different parts of the Mediterranean, southern Europe, and Northern Africa. Also known as black cumin seed, nigella sativa has a long history of use in traditional foods and folk medicine.
While the seeds can be eaten plain, they are also heated or ground and mixed with honey, water or milk. They are often sprinkled on bread or pastries. Sometimes, they are burnt as incense. In Islamic medicine it has been touted as “a cure for all diseases except death” and the variety of ailments that it has been used for extend across many organ systems. A Pub Med literature search over the past 5 years revealed in vitro and in vivo research, examining NS for a number of disorders, including:
- Diabetes, hypertension and dyslipidemia
- Asthma, allergies and eczema
- Milk production in nursing mothers, mastitis and mastalgia
- Improvement in semen quality and production in infertile men
- Generalized oxidative stress
- Alcohol induced liver injury
- Neuropathic pain
- Mood, anxiety and cognition
- MRSA
- Cancer of various types, including cervical, lung, neuroblastoma, cholangiocarcinoma and leukemia
- Hashimoto’s thyroiditis
There was even one article that cited sero-conversion of an HIV+ patient who used a “concoction” containing NS. One might think that this “wonder herb” is just too good to be true!
Plant Pharmacology and Research Relevant to Atopic Disease
The seeds are the pharmacologically active portion of the plant. While NS has over 100 active constituents, 50% of the seed is composed of essential fatty acids (linoleic, oleic, palmitic, di-homolinoleic). Within this, thymoquinone (TQ) appears to be the active ingredient.
NS seeds are thought to exhibit anti-histaminic, anti-inflammatory and immune enhancing effects. TQ is believed to account for the antioxidant and anti-inflammatory properties, partially through inhibiting inducible nitric oxide in response to oxidative stress. TQ can inhibit 5-lipoxygenase (especially relevant to asthma), and works synergistically with glutathione, NAD and NADPH.
Animal studies have shown that TQ and other constituents of NS oil can alter cytokine production, inhibiting TNF-a, interleukin (IL)-6 and IL-1b. Nigellone, a polymer of TQ, has been shown to prevent the release of histamine from mast cells, thus having applications in asthma, bronchitis and allergies. Nigellone also appears to have antileukotriene effects .
Numerous studies have shown improvement in allergic disorders with the use of oral NS. When .5ml of oil was administered to allergic patients orally for 30 days there was a significant decrease in sneezing and itch, turbinate hypertrophy and congestion, and mucosal pallor.
It has also been shown to cause a decrease in blood eosinophils.
When administered alongside subcutaneous immunotherapy, NS helps to preserve polymorphonucleocyte (PMN) function. A very small study looked at 30 asthmatic children who were also sensitized to house dust mite and were receiving sublingual immunotherapy. When NS in powder form was administered with probiotics and multivitamins, there was a greater improvement in symptoms than with immunotherapy alone.
One study looked at 1 gram of NS oil administered topically twice daily for 4 weeks to patients with hand eczema. Subjects were 18-60 years old. The study found equivalence to betamethasone cream utilized similarly for an equivalent time. Eczema often heralds the start of the allergic march for many children and sometimes requires topical steroids for treatment. It would be interesting to see a similar study in a younger population, or even NS oil used alongside placebo without the betamethasone limb as it could offer a new, safe and effective alternative to topical steroid use in the pediatric population.
A double blind crossover study looked at topical use of NS oil for nasal symptoms in the elderly. They compared 2 weeks of NS oil to topical saline spray. Both were used as 3 sprays 3 times daily. While there was no difference in muco-ciliary transport there was a difference in patients’ reports of nasal obstruction, dryness and crusting. No difference was noted in burning and itch. One drop of NS oil used intranasally 3 times daily for 6 weeks alleviated symptoms of allergy. more effectively than placebo.
Koshak studied a group of 80 asthmatic patients. He found that 4 weeks of NS oil (.7% TQ, 500 mg twice daily) significantly decreased asthma symptoms. Improvement in FEV1 approached clinical significance. Blood eosinophils were reduced while there was no difference in total serum IgE.
Caveats for Clinical Use
Many of the studies had methodological constraints, including small sample sizes, unclear endpoints, and use of non-validated quality-of-life questionnaires. While most studies looked at skin testing results prior to administering the instrument, none looked at skin prick testing post. Despite these issues, overall the research looks promising – well worth recommending it to patients as an adjunct to our integrative protocols.
NS appears to be safe used in recommended dosages. It can inhibit cytochrome P450 and so should be used with caution in patients who are on drugs similarly metabolized. Side effects are rare. There are some reports of nasal dryness when used topically; nausea, headache and insomnia when taken orally.
Dosages vary from 40-80mg/kg a day with usual dosages at around 50 mg/kg/d. Many studies used 500mg of the oil taken 3 times daily. If taken as the whole seed, dosage is 1-3 grams daily. Intranasal use is 1-3 sprays 3 times daily. For eczema 1 gram should be used topically for 4 weeks. It is recommended to look for .7% or greater TQ content.
How I Use Nigella Sativa in Practice
I have used Nigella Sativa rarely in my practice, and only to augment the effectiveness of sublingual immunotherapy. Now, having reviewed the research and learned of the many other uses for this herb, I am eager to share this information with my patients. I am particularly interested in it for topical nasal use, as there are so few options for patients other than nasal steroids or nasal antihistamines. It’s nice to have new tricks up one’s sleeve for the allergically prone patient. I am hopeful that this will lead to better patient outcomes overall – truly the best use for integrative therapies that there is!
If you have clinical experience with using NS in your practice, please share in the comments below.