Allergic to Dogs and Allergies in Dogs Resource

Risks of Using Natural Decongestants

The series Natural Decongestants and Allergies now turns its attention to the issue of risks associated with using natural decongestants.

Background Information

The section on Understanding Natural Treatment provides a useful backdrop to the following article by setting out the general principles and issues surrounding natural treatments. In particular,  as was pointed out in Risks of Using Complementary and Alternative Medicine (CAM), despite what many people think, the term ‘natural’ does not automatically convey that a given ingredient, medicine or treatment is safe to use, nor that it has proven efficacy.

To illustrate this point, mushrooms are natural but many are deadly poisonous. For example, Death Cap (Amanita phalloides) has a similar appearance to the safe and edible straw mushroom (Volvariella volvacea) and is responsible for numerous poisonings and deaths each year, such as occurred in the California mushroom soup incident 2012. Therefore, anyone interested in natural treatments must always apply due diligence and take time to understand the nature of the ingredients used and any possible issues surrounding them.

Specific Examples: Ephedra and Bitter Orange

Even though human beings have probably used natural ingredients medicinally in one form or another for as long as the species has existed, and despite millennia of anecdotal evidence in support of there usage, certain natural ingredients have, when subjected to scientific assessment, been associated with possible serious health conditions.

An example of this is the use of ephedra (See also: Traditional Chinese Medicine Decongestants) and synephrine, both of which were/are (depending one’s locale) used in certain natural decongestants and diet pills.

Risks of Using Natural Decongestants


The plant Ephedra sinica (Syn. Ephedra sinensis), commonly referred to as ephedra, and other species of the genus Ephedra are a natural source of the compounds ephedrine and pseudoephedrine. Though ephedra has been used in traditional Chinese medicine for thousands of years, sale of dietary supplements that contain it have been banned in many countries in recent years e.g. in 2004 in US. This is due to a number of reports, such as Bent et al. 2003, that have raised questions concerning possible serious side effects (heart attacks, strokes, seizures and even death) associated with using it.

Unfortunately, there is considerable confusion concerning whether it is legal to use ephedra products in some countries and even within certain states/regions in a given country. For example, the original 2004 US ban has been challenged legally on various occasions; it was overturned in Utah 2005, reinstated 2006, overturned again 2009 etc. However, the National Institutes of Health NCCAM (National Center for Complementary and Alternative Medicine) states that the 2004 US ban applies to dietary supplements containing ephedra and does not extend to:

  • Conventional foods (this includes traditional Chinese herbal remedies and herbal teas), or
  • Regulated drugs containing synthesized ephedrine to treat allergic reactions, asthma and bronchitis.

Bitter Orange

A common replacement for ephedra called bitter orange, derived from the plant Citrus aurantium, has also raised health concerns. Reports have linked the compound synephrine contained in bitter orange, to an increased risk of glaucoma, high blood pressure, abnormal heart rhythms, heart attacks, strokes and even death, especially when used in combination with stimulants such as caffeine e.g. Thomas et al. 2009.

Bitter orange is known by a variety of names such as Aurantii Fructus, Chisil, Bitter Orange Flower, Citrus amara, Fructus aurantii, Green Orange, Octopamin, Sour Orange or Zhi Qiao.

Interestingly, Stohs et al.2011 review concerning the safety of bitter orange and synephrine concluded, “based on current knowledge, the use of bitter orange extract and p-synephrine appears to be exceedingly safe with no serious adverse effects being directly attributable to these ingredients.

General Concerns

Examples like ephedra and bitter orange reinforce the need to always apply due diligence when using natural ingredients – even with those that have been used for countless generations and that appear relatively innocuous.

The various articles in the section Natural Decongestants and Allergies raised a number of related risk factors and general health concerns. Please refer to the relevant article for clarification but in summary, we discovered that:

Natural Nasal Decongestants

  • Blowing one’s nose incorrectly can increase the risk of intranasal pressure, secondary infections and earache.
  • The practice undertaken by some parents that involves sucking mucus from the nose of their child should be avoided.

Natural Posture, Pressure and Movement Decongestants

  • Although success can be obtained through self-treatment (the article outlined relevant yoga, accupressure, massage and movement exercises), it remains best practice to seek the advice of a qualified practitioner within each field of study.

Natural Moisture and Water Decongestants

  • The use of natural nasal sprays, drops and irrigation is generally considered safe but poor practice e.g. inappropriate hygiene standards and overuse of the techniques, can result in creating more problems than are solved.
  • Using steam, though traditional and often effective, is not recommended for children due to the risk of burns.
  • Vaporizers, humidifiers and dehumidifiers can all play a useful role in treating congestion but users should follow manufacturers recommendations, especially with regards to keeping the equipment clean.

Natural Decongestants and Heat

  • This summary guide provides links to related articles concerning how heat can be associated with tackling congestion. Risk issues are discussed within the relevant articles.

Natural Decongestant Salves

  • Common sense needs to be applied when adding a salve to boiling water to produce aromatic vapors, or when applying a salve to sensitive areas e.g. below the nostrils.
  • Remember that an individual may be irritated by, or even allergic to, a specific ingredient present in a salve. In particular, essential oils are concentrated and must be diluted before applying to the skin. They must never be consumed due to possible toxicity and can prove fatal if taken via the oral route.

Natural Decongestant Balm

  • There is considerable confusion over the term balm and in general, when most people refer to a balm in the context of decongestion, they are in fact referring to a salve.
  • The popular product Tiger Balm comes in various forms and sensitivity to the ingredients is possible. Due to containing high concentrations of a number of essential oils, the product should be tested on a small area of skin initially, it should never be ingested or used internally, unless specified by the manufacture do not apply to the face and never on the genitalia/anus, avoid contact with clothing, hands should be washed thoroughly after use to minimize cross contamination, and it is not suitable for children.

Natural Decongestant Foods and Drinks

  • There is always the possibility of sensitivity or an allergic reaction to a particular ingredient. Some people are particularly sensitive to foods containing irritants e.g. chilli peppers contain capsaicin.
  • Common sense should be applied regarding the use of boiling water when making a brew/tea infusion or when adding it to various concoctions and inhaling the aromatic vapors.
  • Avoiding foods and drinks that aggravate congestion can be highly beneficial for sufferers.

Natural Decongestants and Hydration

  • Remaining properly hydrated helps counteract congestion. Organizations differ concerning recommendations for daily fluid intake; figures cited typically range anywhere from 1.2 litres (40.58 US oz) to as high as 3 litres (101.44 US oz).
  • In order to help minimize the risk of dehydration, one can consume various fluids. Water, tea, coffee and milk are commonly recommended as good fluid sources, however the quality of the water is important; both tap and bottled water may contain chemical and microbial contamination even in developed countries. When prepared freshly, fruit juices and smoothies (without added sugar) can add variation but fizzy drinks, squashes and sports drinks are not recommended. Remember, moderation is key to a healthy diet e.g. excessive consumption of fruit juices can cause problems associated with ulcers and tooth cavities.

Traditional Chinese Medicine Decongestants

  • The well known traditional Chinese decongestant medicine ephedra, as discussed previously, has been linked with serious health concerns when used as a dietary supplement. However, the 2004 US ban does not apply to traditional Chinese herbal remedies and teas.
  • Pinellia must be prepared properly and due to containing ephedrine alkaloids, it comes under the same 2004 US ban as noted above for ephedra.
  • Siberian cocklebur must be prepared properly and when consume orally it should be labelled as ‘Stir-baked’ and not pounded or ground into powder.
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