-IBIS-1.7.6-
tx
respiratory system
asthma
Nutrition

dietary guidelines

eating principles:
Decrease consumption of foods with arachidonic acid (red meats and dairy products). Amino acids are the major substrate for lipoxygenase which results in increased levels of leukotrienes. It should be noted that safflower, sunflower, and other oils contain high levels of linoleic acid and small amounts can get converted to arachidonic acid (via D 5 desaturase in the presence of stress) after their conversion to DHGLA. (Marz, 321, 1997.)
Increase consumption of foods containing flavonoids and carotenes. Both inhibit the action of lipoxygenase. Yellow vegetables and other leafy vegetables contain abundant amounts of these important nutrients. (Marz, 321, 1997.)
Increase consumption of EPA and linolenic acid sources such as flax oil, canola oil, walnuts, cold water fish, herring, sardines, and salmon. EPA selectively inhibits lipoxygenase by binding onto the enzyme and forming the 5 series of leukotrienes which have little broncho-constricting properties. (Marz, 321, 1997.)
Onions and grape skins contain quercetin which has the effect of stabilizing mast cells, inhibiting lipoxygenase, and increasing cAMP levels. (Marz, 321, 1997.)
• Avoid excessive calcium sources and bananas as these potentiate phospholipase. (Marz, 321, 1997.)
Vegan diet: No meat, fish, eggs, dairy products, coffee, ordinary tea, chocolate, sugar, salt, tap water, apples, citrus, soybeans and peas. Grains and potatoes either very restricted or eliminated. (Lindahl J. Asthma 1985;22:45-55.)
• Moderately low fat
• Low sugar
• High complex carbohydrates
• Protein 12-15% diet, decreasing foods high in arachidonic acid (red meats and dairy products)
• Vegan cleansing diet or alkaline juice fasts (3-7 days), followed by a vegetarian diet with emphasis on alkaline-forming foods
• Elimination/rotation diet, rotation diet, rotation diet expanded

therapeutic foods:
• Foods that tonify the Lung, tonify Lung Yin, pungent foods
• Garlic, onions, leeks, turnips, grapes, pineapple, green leafy vegetables, apricots, apricot kernels, almonds, walnuts, carrots, pumpkin, sunflower seeds, figs, daikon, lychee, tangerines, loquats, honey, molasses, mustard greens, sesame seeds (Ni, 106.)
• Collards, cauliflower, garlic, onions, turnips, endive, apricots, cherries, elderberries, green vegetables, raw nuts and seeds, sprouted seeds and grains (Jensen, 61.)
Increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil
Fruit rich in Vitamin C: Italian researchers report that children who consume vitamin C-rich fruit are less likely to experience wheezing. In the study, youngsters who ate kiwi or citrus fruits 5 to 7 times a week were about 30% less likely than other children who ate fruit less than once a week to suffer from wheezing, chronic coughing or nighttime coughing,
(Forastiere F, et al. Thorax. 2000 Apr;55(4):283-288.)
• Foods rich in Manganese, Calcium, Iron, Silicon (Jensen, 61.)
• Foods high in flavonoids and carotenoids: dark green leafy vegetables, deep yellow and orange vegetables

fresh juices:
• celery and papaya (Jensen, 50.)
• celery, endive, and carrot (Jensen, 50.)
• spinach and carrot (Walker, 123.)
• lemon juice in water (Shefi)
• lime, horseradish, and garlic
• carrot (Walker, 123.)

specific remedies:
• for shortness of breath: l lb. salmon, 2 oz. garlic, 1/4 oz. fresh ginger, salt and tamari. Place seasonings over salmon and steam. Divide and eat, three times daily. (Butt, Bloomfield, 124.)
• steam 120 g dried lychee and eat once daily (Lu, 82.)
• eat mango fruit and the skin, three times daily. (Yin-fang, Cheng-jun, 35.)
• take 120 g of dried lychee, discard skin and stones, steam in a covered pot then mash and serve (Yin-fang, Cheng-jun, 57.)
• for asthma of elderly, cough with thick phlegm: take 2 dried persimmons and 30 g candied honey. Add water, steam in a covered pot, mash and eat twice daily (Yin-fang, Cheng-jun, 63.)
• take a fresh lemon and add 1-2 tbsp. sugar. Steam in water until soft, mash and serve, including the skin, twice daily (Yin-fang, Cheng-jun, 64.)
• take 3 fresh peaches, peel and simmer with 30 g sugar in a covered pot. Discard the stones and eat once daily. (Yin-fang, Cheng-jun, 69.)
• take 30 g of walnut kernels, 15 g sugar and 6 g turnip seed. Steam for 30 minutes and serve twice daily (Yin-fang, Cheng-jun, 106.)
• take 60 g of walnut kernels and 3 g red ginseng. Cover with water and simmer into a soup. Serve twice daily for 3 days (Yin-fang, Cheng-jun, 106.)
• take 60 g of fresh chestnuts and 4 pieces Chinese date plus a small amount lean pork. Add water and simmer until cooked, eat once daily. (Yin-fang, Cheng-jun, 108.)
• take 10-15 g loquat fruit stones and crush them. Add 3 g fresh ginger, cover with water and simmer 1 hour. Serve twice daily (Yin-fang, Cheng-jun, 48.)
• for cough with thick phlegm: take 2 dried persimmons and 30 g candied honey. Add water, steam in a covered pot, mash and eat twice daily (Yin-fang, Cheng-jun, 63.)
• take a fresh lemon or orange, slice and add 15 g sugar. Steam in water until soft, mash and serve, including the skin, twice daily (Yin-fang, Cheng-jun, 64, 84.)
• take 50 g of shelled peanuts, add water and boil, then mash. Drink the broth and eat the peanuts twice daily (Yin-fang, Cheng-jun, 97.)

avoid:
Eliminate food allergies:
- Immediate sensitivity reactions are usually caused by (in decreasing order), eggs, fish, shellfish, nuts, and peanuts.
- Delayed sensitivity reactions are caused by (in decreasing order) milk, chocolate, wheat, citrus, and food colorings (tartrazine), but really any and all foods can cause or add to the allergic burden.
(Rowe AH, Young EJ. JAMA 1959;169:1158.)
Cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, catarrh-forming foods: oranges, tofu, tomatoes, meat, ice cream, shellfish, watermelon, salty foods, cold foods, bananas, mung beans
• Aspirin, non-steroidal anti-inflammatories
Avoid tryptophan which is converted to serotonin, a bronchoconstrictor (Marz, 321, 1997.)

also:
Eliminate environmental allergies: Eliminate rugs, wall hangings, cats, feather pillows and clean air filters for heating and cooling systems. Use environmentally sound cleaning solutions. Wet mop walls, floors, ceilings and use special high quality vacuum. Consider using an ionizer and/or ozone generator. Consider a formaldehyde bomb or shots.
(Marz, 1997; Spurlock B, Daily T. N Engl J Med, Dec 27 1990;323(26): 1845-1846.)

supplements

• Beta carotene 100,000 IU per day.
Vitamin B12 (Hydroxycobalamin) IM injections 1000 mcg (1 cc) per day for thirty days, then three times weekly for two weeks, two times weekly for two weeks, then once weekly; this protocol can be modified based on response. IM, especially asthma of 7 days duration. Considered highly reliable by many practitioners in the treatment of young children. Oral B12, 1 mg per day, can be helpful in some individuals. A deficiency of B12 can be linked to hypochlorhydria in some individuals and hence to increased reactivity to sulfites. (Simon J Allergy 2:183-5,1951; Simon. Res Instit of Scripps Clinic Scientific Report 39:57-58,1982-1983; Marz, 321, 1997.)
Vitamin B6 50-100 mg twice daily; 10 mg if on theophylline to counter side-effects - see below. Pyridoxal-5-phosphate (P5P), the activated ofrm of B6, may be more effective with many individuals. Supplementation with B6 can be especially helpful in children whose asthma is related to defects in tryptophan metabolism. Extended suppplementation with B6, particularly at levels above 400 mg per day for adults, could potentially cause neuropathies and should be supervised.
(Collip, et al. Ann Allergy 1975;35:93-97; Reynolds, Anatta. Am J Clin Nutr. 1985;41:684-688.)
Vitamin C 1-2 g, one to three times per day, inhibits histamine release, lowers blood histamine levels and promotes vasodilation by increasing prostacyclin production. Consuming Vitamin Can hour before exposure to stressors, such environmental allergens or exercise, can reduce the severity and duration of a reaction. Avoiding forms of Vitamin C made from potential allergens, such as corn or citrus, is important.
(Clemetson. J Nutr. 1980;110(4):662-668; Zuskin E, et al. Lung 1976;154:17-24; Bucca C, et al. Ann Allerg 1990;65:311-314; Ruskin SL. Am J Dig Dis 1947;14:302-306; Anderson R, et al. S Afr Med J. 1980 Dec 13;58(24):974-977.)
• Vitamin E 800 IU per day.
• Pantothenic acid 500 mg morning or afternoon
Magnesium 200 mg two to threee times per day, associated with improved pulmonary function of asthmatic patients, helpful in relieving tendency to spasm, particularly effective in relaxing bronchioles. Can use IV magnesium in acute asthmatic conditions and works very well. (Brunner, et al. J Asthma 1985;22:3-11.)
Molybdenum IV stimulates sulfite metabolism. However, it is not very effective orally; try molybdenum picolinate 1 mg. (Marz, 322, 1997.)
Selenium 50-250 mcg per day, can go up to 400 mcg per day, increases glutathione peroxidase activity and protects lung tissue from oxidative damage; especially for environmental allergies (Marz, 322, 1997.)
EPA 3 g per day.
Flax oil 1-2 Tbsp. per day for anti-inflammatory action.
Hydrochloric Acid (Betaine HCl): start with vinegar and work up to 5 grains per dose, physicians trained in nutritional therapies have been known touse doses as high as 90 grains. Hypochlorhydria may increase the number and severity of dood sensitivities, increase reactivity to sulfites, and impair absorption of key micronutrients.
(Bray. Quart J Med. 1931;24:181-197.)
N-acetyl cysteine, 50-500 mg twice daily, increases glutathione peroxidase activity and protects lung tissue from oxidative damage
Quercetin 500 mg 1/2 hour before meals; stabilzes mast cells to reduce histamine release
• Staphage lysate start with 0.5 cc intradermally and work up to 2.5 cc intranasally
Note: Avoid tryptophan which is converted to serotonin, a bronchoconstrictor.

» drug interactions:
theophylline (Aminophylline): theophylline inhibits extracellular pyridoxal kinase, the subsequent shortage of PLP (pyridoxyl-5-phosphate) results in multiple decreased B6-dependent enzyme activity
(Ubbink, et al., 1990;120:1352-1359; Ubbink, et al., 1990;585:285-294.)
• prednisone/prednisolone: causes Sodium retention
• prednisone/prednisolone: causes reduced activation of Vitamin D; 1,25(OH)2D3 can be measured to determine if supplementation necessary, with low levels can use calcitriol
(Travato, 1991;44:1651-1658; Tuttle, 1982;126:1161-1162.)
• prednisone/prednisolone: causes increased urinary excretion of Zinc, Vitamin K and Vitamin C (Buist, 1984; 4 (3):114.)


footnotes

Anderson R, Hay I, van Wyk H, Oosthuizen R, Theron A. The effect of ascorbate on cellular humoral immunity in asthmatic children. S Afr Med J. 1980 Dec 13;58(24):974-977.

Anibarro B, et al. Asthma with sulfite intolerance in children: A blocking study with cyanocobalamin. J Allerg Clin Immunol 1992;90:103-109.

Arm JP, Horton CE, Eiser NM, et al. The effects of dietary supplementation with fish oil on asthmatic responses to antigen. Allerg Clin Immunol 1988;81:183. (Abstract)

Bray GW. The hypochlorhydria of asthma in childhood. Quart J Med 1931;24:181-197.
Abstract: 80% of 200 asthmatic children had sub-normal levels of gastric acidity.

Broughton KS, Johnson CS, Pace BK, et al. Reduced asthma symptoms with n-3 fatty acid ingestion are related to 5-series leukotriene production. Am J Clin Nutr 1997;65:1011-1017.

Brunner EH, Delabroise AM, Haddad ZH. Effect of parenteral magnesium on pulmonary function, plasma cAMP, and histamine in bronchial asthma. J Asthma. 1985;22(1):3-11.
Abstract: Parenterally administrated magnesium significantly improved pulmonary function of asthmatic patients. The degree of improvement was positively correlated with serum magnesium levels.

Bucca C, Rolla G, Oliva A, Farina J-C. Effect of vitamin C on histamine bronchial responsiveness of patients with allergic rhinitis. Ann Allerg 1990;65:311-314.

Chiaramonte LT, Altman D. Food sensitivity in asthma: perception and reality. J Asthma 1991;28:5-9.

Clemetson CA. Histamine and ascorbic acid in human blood. J Nutr 1980 Apr;110(4):662-668
Abstract: When 11 normals with either low vitamin C levels or high blood histamine levels were given ascorbic acid 1gm for 3 days, blood histamine levels fell in all 11 subjects.

Collipp PJ, et al. Pyridoxine treatment of childhood bronchial asthma. Ann Allergy 1975;35:93-97.
Abstract: 76 asthmatic children who received B6 200mg daily demonstrated significant symptoms improvement and a reduction in dosage of bronchodilators and cortisone required to relieve symptoms.

Collipp PJ, et al. Tryptophan metabolism in bronchial asthma. Ann Allergy 1975;35:153-158.

Delport R, Ubbink JB, Vermaak WJ, Becker PJ. Theophylline increases pyridoxal kinase activity independently from vitamin B6 nutritional status. Res Commun Chem Pathol Pharmacol. 1993 Mar;79(3):325-333.

Delport R, Ubbink JB, Serfontein WJ, Becker PJ, Walters L. Vitamin B6 nutritional status in asthma: the effect of theophylline therapy on plasma pyridoxal-5'-phosphate and pyridoxal levels. Int J Vitam Nutr Res. 1988;58(1):67-72.

Drouet M, Sabbah A. [Asthma induced by food additives]. Presse Med. 1984 Nov 17;13(41):2518. [Article in French]

Dry J, Vincent D. Effect of a fish oil diet on asthma: results of a 1-year double-blind study. Int Arch Allerg Appl Immunol 1991;95:156-157.

Flatt A, Pearce N, Thomson CD, et al. Reduced selenium in asthmatic subjects in New Zealand. Thorax 1990;45:95-99.

Forastiere F, Pistelli R, Sestini P, Fortes C, Renzoni E, Rusconi F, Dell'Orco V, Ciccone G, Bisanti L. Consumption of fresh fruit rich in vitamin C and wheezing symptoms in children. Thorax. 2000 Apr;55(4):283-288.
Abstract: BACKGROUND: A beneficial effect of fresh fruit consumption on lung function has been observed in several studies. The epidemiological evidence of the effect on respiratory symptoms and asthma is limited. The consumption of fruit rich in vitamin C was examined in relation to wheezing and other respiratory symptoms in cross sectional and follow up studies of Italian children. METHODS: Standardised respiratory questionnaires were filled in by parents of 18 737 children aged 6-7 years living in eight areas of Northern and Central Italy. The winter intake of citrus fruit and kiwi fruit by the children was categorised as less than once per week, 1-2 per week, 3-4 per week, and 5-7 per week. A subset of 4104 children from two areas was reinvestigated after one year using a second parental questionnaire to record the occurrence of wheezing symptoms over the intervening period. RESULTS: In the cross sectional analysis, after controlling for several confounders (sex, study area, paternal education, household density, maternal smoking, paternal smoking, dampness or mould in the child's bedroom, parental asthma), intake of citrus fruit or kiwi fruit was a highly significant protective factor for wheeze in the last 12 months (odds ratio (OR) = 0.66, 95% confidence intervals (CI) 0.55 to 0.78, for those eating fruit 5-7 times per week compared with less than once per week), shortness of breath with wheeze (OR = 0.68, 95% CI 0.56 to 0.84), severe wheeze (OR = 0.59, 95% CI 0.40 to 0.85), nocturnal cough (OR = 0.73, 95% CI 0.65 to 0.83), chronic cough (OR = 0.75, 95% CI 0.65 to 0.88), and non-coryzal rhinitis (OR = 0.72, 95% CI 0.63 to 0.83). In the follow up study fruit intake recorded at baseline was a strong and independent predictor of all symptoms investigated except non-coryzal rhinitis. In most cases the protective effect was evident even among children whose intake of fruit was only 1-2 times per week and no clear dose-response relationship was found. The effect was stronger (although not significantly so (p = 0.13)) in subjects with a history of asthma; those eating fresh fruit at least once a week experienced a lower one year occurrence of wheeze (29. 3%) than those eating fruit less than once per week (47.1%) (OR = 0. 46, 95% CI 0.27 to 0.81). CONCLUSIONS: Although the effect of other dietary components cannot be excluded, it is concluded that the consumption of fruit rich in vitamin C, even at a low level of intake, may reduce wheezing symptoms in childhood, especially among already susceptible individuals.

Genton C, Frie PC, Pecoud A. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. J Asthma 1985;76:40-45.

Guinot P, Brambilla Dunchier J, et al. Effect of BN 52063, a specific PAF-ascether antagonist, on bronchial provocation test to allergens in asthmatic patients - a preliminary study. Prostaglandins 1987;34(5):723-731.

Hasselmark L, Malmgren R, Zetterstrom O, Unge G. Selenium supplementation in intrinsic asthma. Allerg 1993;48:30-36.

Haury VG. Blood serum magnesium in bronchial asthma and its treatment by the administration of magnesium sulfate. J Lab Clin Med 1940;26:340-344.

Hodge L, Salome CM, Peat JK, et al. Consumption of oily fish and childhood asthma risk. Med J Austral 1996;164:137-140.

Johnson JL, et al. Molybdenum cofactor deficiency in a patient previously characterized as deficient in sulfite oxidase. Biochem Med Metabol Biol 1988;40:86-93.

Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Foods, Drugs, and Cosmetics, Second ed. New York: John Wiley and Sons, 1996, 227-229.

Lindahl O, Lindwall L, Spangberg A, et al. Vegan regimen with reduced medication in the treatment of bronchial asthma. J Asthma 1985;22:45-55.
Abstract: 25 patients were treated with a pure vegan diet which prohibited meat, fish, eggs, dairy products, coffee, ordinary tea, chocolate, sugar, salt, tap water, apples, citrus, soybeans and peas. Grains and potatoes were either very restricted or eliminated. 71% improved within 4 months and 92% improved by one year.

Malo JL, Cartier A, Pineau L, L'Archeveque J, Ghezzo H, Martin RR. Lack of acute effects of ascorbic acid on spirometry and airway responsiveness to histamine in subjects with asthma. J Allergy Clin Immunol. 1986 Dec;78(6):1153-1158.

Onorato J, Merland N, Terral C, Michel FB, Bousquet J. Placebo-controlled double-blind food challenge in asthma. J Allergy Clin Immunol. 1986 Dec;78(6):1139-46.
Abstract: To determine the prevalence of food allergy as a cause of exacerbation of asthma, we studied 300 consecutive patients with asthma (7 months to 80 years of age) who attended a respiratory clinic. Each patient was screened for possible food allergy by means of a questionnaire and by skin prick tests with the six food allergens most common in our area. Patients with either a suggestive history and/or a positive prick test and/or RAST underwent double-blind food challenge with lyophilized food in capsules or food mixed in a broth to disguise its taste. Pulmonary function tests and symptoms were followed for 8 hours after each challenge. Of the 300 patients screened, only 25 had either a history or skin prick tests or RAST responses suggestive of food allergy. Twenty patients had interpretable food challenges. In these 20 patients, food challenge caused asthma in six and caused other symptoms (atopic dermatitis and gastrointestinal symptoms) in five. On rechallenge after pretreatment with disodium cromoglycate (300 mg 30 minutes before the food challenge), the asthmatic response was blocked in four of five subjects. The patients with asthma with food allergy were generally young, had a current or past history of atopic dermatitis, and high total serum IgE levels. Our findings confirm that food allergy can elicit asthma, but its incidence is low, even in the population attending a specialty clinic. Food elimination diets should not be prescribed for all patients reporting an adverse reaction to foods or having a positive skin prick test and/or RAST with food allergens. In patients with asthma caused by food allergy, disodium cromoglycate may be used to complement elimination diets.

Owen S, Pearson D, Suarez-Mendez V, et al. Evidence of free-radical activity in asthma. N Engl J Med 1991;325:586-587. (Letter)

Reynolds RD, Natta CL. Depressed plasma pyridoxal phosphate concentrations in adult asthmatics. Am J Clin Nutr 1985;41:684-688.
Abstract: 7 patients and 6 controls received 50mg 2x daily. Both plasma and red blood cell pyridoxal phosphate levels only increased significantly in the controls. All asthmatics reported a dramatic decrease in the frequency, duration, and severity of asthmatic attacks and wheezing ceased in about one week.

Rowe AH, Young EJ. Bronchial asthma due to food allergy alone in ninety-five patients. JAMA 1959;169:1158.
Abstract: 50 children and 45 adults were treated solely by eliminating allergenic foods from their diet. The typical patient had recurrent attacks every 2-6 weeks with total relief in the summer. Patients in this study often did not give a history suggestive of food allergy. Negative skin tests to foods were present in 48% of food sensitive patients. In this study, these patients all responded well within 1-4 weeks. Diagnosis depended on a trial diet which eliminated cereal grains, milk, egg, chocolate, fish, and other less commonly consumed foods. Recurrent head and bronchial colds particularly from autumn to late spring, were also relieved by food elimination. Of 173 patients over the age of 55, food allergy alone appeared to be the cause in 40%. Inhalants were about equally important in this age group.
Note: Generally, the younger an asthma patient, the more the allergen will be foods. The older a patient, the more the allergen will be related to inhalants

Ruskin SL. Sodium ascorbate in the treatment of allergic disturbances. The role of adrenal cortical hormone-sodium-vitamin C. Am J Dig Dis 1947;14:302-306.

Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992;327:380.

Schafer A, Adelman B. Plasma inhibition of platelet function and of arachidonic acid metabolism. J Clin Invest 1985;75:456-461.

Simon. Vitamin B12 therapy in allergy and chronic dermatosis. J Allergy 1951;2:183-185.
Abstract: 18/20 patients improved following IM injections of B12 1000mcg once weekly for 4 weeks.

Simon RA. Sulfite-sensitive asthma. Res Instit of Scripps Clinic Scientific Report 1982-1983;39:57-58.
Abstract: Vitamin B12 was more effective than pharmacologic agents in blocking asthmatic reactions and was effective over a longer period of time, when given prior to a sulfite challenge.

Skobeloff EM, et al. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA 1989;262:1210-1213.

Spurlock B, Daily T. Toothpaste-Induced bronchospasm N Engl J Med, Dec 27 1990;323(26): 1845-1846.
Abstract: A 21 yr old woman on theophylline, a beta antagonist, and an inhaled steroid product switched toothpastes and found dramatic relief of her symptoms. When rechallenged, her wheezing returned in 10 minutes. The only difference between the two toothpastes was that they had different artificial flavorings.

Stevenson DD, Simon RA. Sulfites and asthma. J Allergy Clin Immunol. 1984 Oct;74(4 Pt 1):469-472.

Stone J, Hinks LJ, Beasley R, et al. Reduced selenium status of patients with asthma. Clin Sci 1989;77:495-500.

Sur S, Camara M, Buchmeier A, et al. Double-blind trial of pyridoxine (vitamin B6) in the treatment of steroid-dependent asthma. Ann Allerg 1993;70:141-152.

Thien FCK, Woods RK, Waters EH. Oily fish and asthma - a fishy story? Med J Austral 1996;164:135-136. (Editorial)

Townes SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatr 1984;73:631-637.

Ubbink JB, Vermaak WJ, Delport R, Serfontein WJ, Bartel P. The relationship between vitamin B6 metabolism, asthma, and theophylline therapy. Ann N Y Acad Sci. 1990;585:285-294. (Review)

Weir MR, et al. Depression of vitamin B6 levels due to theophylline. Ann Allergy 1990;65:59-62.

Welton AF, Tobias LD, Fiedler-Nagy C, et al. Effect of flavonoids on arachidonic acid metabolism. Prog Clin Biol Res 1986;213:231-242.

Zuskin E, et al. Byssinosis and airway responses due to exposure to textile dust. Lung 1976;154:17-24.