Boswellia: A Systematic Review of the Adverse Events
-
Ali Tavakoli
,
Zahra Salehi
,
Ehsan Amiri-Ardekani
,
Maliheh Saeedfiroozabadi
,
Fatemeh Tavakoli
,
Reza Moshfeghinia
Abstract
Boswellia is one of the oldest alternative medicinal plants in the world. Boswellia is thought to have anti-inflammatory effects, antioxidant properties, and immunity stimulating. This herbal medicine relieves several diseases such as osteoarthritis, asthma, and inflammatory bowel diseases. Little is known about the adverse drug reactions of Boswellia; this systematic review attempted to identify the potential side effects of this supplement and its severity in different diseases. Relevant studies conducted up to May 2024 were identified from Scopus, Science Direct, Web of Science, PubMed, Cochrane Library, and Embase databases. Spontaneous reports about the side effects of Boswellia were gathered from three international spontaneous reporting schemes, as well. Age, sex, type of disease, dosage, and duration of the drug as well as self-reported side effects were considered. Subgroup analysis was performed to determine the prevalence of each adverse effect of Boswellia. The quality of the included trials was assessed using version 2 of the Cochrane risk-of-bias tool (RoB 2). Sixty-two clinical trials were included in this review. Twenty-five of them reported side effects. Twenty-seven studies reported that Boswellia had no adverse effects, and 10 articles had not mentioned the side effects. Low-to-high risk of bias was found in clinical trials. Ten case reports were included in this study, but no case series was included. Spontaneous reporting schemes included 26 reports. The most common adverse effects were gastrointestinal disorders and cutaneous allergic reactions. Although most detected adverse effects were mild to moderate, two patients developed hypersensitivity pneumonitis and bezoar formation, respectively. This systematic study reported that Boswellia, as an herbal medicine, is often considered safe to use; however, it is possible to experience severe side effects. We suggest that Boswellia should be administered only under the supervision of a specialist doctor in usual medical treatment.
Ernst E. Frankincense: systematic review. BMJ 2008;337.
Zwerger M,Ganzera M. Analysis of boswellic acids in dietary supplements containing Indian frankincense (Boswellia serrata) by Supercritical Fluid Chromatography. J Pharm Biomed Anal 2021;201:114106.
Patil JS, Marapur S, Kadam D, Kamalapur M. Pharmaceutical and medicinal applications of Olibanum gum and its constituents: A review. J Pharm Res 2010;3:587-589.
Hamidpour S, Hamidpour M, Shahlari M, Hamidpour R. Chemistry, pharmacology and medicinal property of frankincense (Boswellia species): from the selection of traditional applications to the novel phytotherapy for the prevention and treatment of serious diseases. Glob J Med Res 2015;15:1-9.
Al-Harrasi A, Ali L, Hussain J, Rehman NU, Ahmed M, et al. Analgesic effects of crude extracts and fractions of Omani frankincense obtained from traditional medicinal plant Boswellia sacra on animal models. Asian Pac J Trop Med 2014;7:S485-S490.
Akbar S. Handbook of 200 medicinal plants: a comprehensive review of their traditional medical uses and scientific justifications. 2020.
Tošić NG, Nikolić VD, Miljković VM, Nikolić LB. 'Boswellia serrata'resin isolates: Chemical composition and pharmacological activities. Adv Technol 2022;11:76-87.
Mishra S, Bishnoi R, Maurya R, Jain D. Boswellia Serrata ROXB.–a Bioactive Herb with Various Pharmacological Activities. Asian J Pharm Clin Res 2020;13:33-39.
Jalili C, Salahshoor MR, Moradi S, Pourmotabbed A, Motaghi M. The therapeutic effect of the aqueous extract of boswellia serrata on the learning deficit in kindled rats. Int J Prev Med 2014;5:563.
Tajadini H, Saifadini R, Choopani R, Mehrabani M, Kamalinejad M, et al. Herbal medicine Davaie Loban in mild to moderate Alzheimer’s disease: A 12-week randomized double-blind placebo-controlled clinical trial. Complement Ther Med 2015;23:767-772.
Al-Yasiry ARM, Kiczorowska B. Frankincense–therapeutic properties. Adv Hygiene Exp Med 2016;70:380-391.
Liu X, Hunter DJ, Eyles J, McLachlan AJ, Adiwidjaja J, et al. Pharmacokinetic assessment of constituents of Boswellia serrata, pine bark extracts, curcumin in combination including methylsulfonylmethane in healthy volunteers. J Pharm Pharmacol 2020;72:121-131.
Hajimonfarednejad M, Ostovar M, Raee MJ, Hashempur MH, Mayer JG, et al. Cinnamon: A systematic review of adverse events. Clin Nutr 2019;38:594-602.
Hailu AD, Mohammed SA. Adverse drug reaction reporting in Ethiopia: systematic review. Biomed Res Int 2020;2020:8569314.
Jia L-Y, Feng J-X, Li J-L, Liu F-Y, Xie L-z, et al. The complementary and alternative medicine for polycystic ovary syndrome: A review of clinical application and mechanism. J Evid Based Complement Alternat Med 2021;2021:5555315.
Obakiro SB, Kiprop A, Kigondu E, K’Owino I, Odero MP, et al. Traditional medicinal uses, phytoconstituents, bioactivities, and toxicities of erythrina abyssinica lam. ex dc.(fabaceae): a systematic review. J Evid Based Complement Alternat Med 2021;2021:5513484.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1-9.
Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366.
Phillips MR, Kaiser P, Thabane L, Bhandari M, Chaudhary V, et al. Risk of bias: why measure it, and how? Eye 2022;36:346-348.
Badr P, Afsharypuor S, Tohidinik HR, Mohammadi AA, Daneshamouz S. Burn wound healing effect of a sterilized traditional formulation of boswellia carteri vs. silver sulfadiazine cream 1% in patients presenting second-degree burn wounds: a randomized, double-blind clinical trial. Iran J Med Sci 2023;48:137‐145.
Belcaro G, Gizzi G, Pellegrini L, Corsi M, Dugall M, et al. Supplementation with a lecithin-based delivery form of Boswellia serrata extract (Casperome®) controls symptoms of mild irritable bowel syndrome. Eur Rev Med Pharmacol Sci 2017;21:2249-2254.
Ferrara T, De Vincentiis G, Di Pierro F. Functional study on Boswellia phytosome as complementary intervention in asthmatic patients. Eur Rev Med Pharmacol Sci 2015;19:3757-3762.
Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges R. Therapy of active Crohn's disease with Boswellia serrata extract H 15. Z Phytother 2001;22:69‐75.
Gupta I, Parihar A, Malhotra P, Gupta S, Lüdtke R, et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med 2001;67:391‐395.
Holtmeier W, Zeuzem S, Preiss J, Kruis W, Böhm S, et al. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn's disease: good safety profile but lack of efficacy. Inflamm Bowel Dis 2011;17:573-582.
Karima S, Aghamollaii V, Mahmoodi Baram S, Balenci L, Lanctôt KL, et al. Boswellic acids improve clinical cognitive scores and reduce systemic inflammation in patients with mild to moderate alzheimer's disease. J Alzheimers Dis 2023;94:359-370.
Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee – A randomized double blind placebo controlled trial. Phytomedicine 2003;10:3-7.
Kirste S, Treier M, Wehrle SJ, Becker G, Abdel-Tawab M, et al. Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors: a prospective, randomized, placebo-controlled, double-blind pilot trial. Cancer 2011;117:3788‐3795.
Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int J Colorectal Dis 2007;22:1445‐1451.
Meshkat S, Mahmoodi Baram S, Rajaei S, Mohammadian F, Kouhestani E, et al. Boswellia serrata extract shows cognitive benefits in a double-blind, randomized, placebo-controlled pilot clinical trial in individuals who suffered traumatic brain injury. Brain Inj 2022;36:553-559.
Moein P, Abbasi Fard S, Asnaashari A, Baratian H, Barekatain M, et al. The effect of Boswellia Serrata on neurorecovery following diffuse axonal injury. Brain Inj 2013; 27:1454‐1460.
Pasta V, Dinicola S, Giuliani A, Harrath AH, Alwasel SH, et al. A randomized pilot study of inositol in association with betaine and boswellia in the management of mastalgia and benign breast lump in premenopausal women. Breast Cancer 2016;10:37‐43.
Pasta V, Gullo G, Giuliani A, Harrath A, Alwasel S, et al. An association of boswellia, betaine and myo-inositol (Eumastós) in the treatment of mammographic breast density. A randomized, double-blind study. Eur Rev Med Pharmacol Sci 2015;19:4419-4426.
Pérez-Piñero S, Muñoz-Carrillo JC, Victoria-Montesinos D, García-Muñoz AM, Andreu-Caravaca L, et al. Efficacy of Boswellia serrata extract and/or an omega-3-based product for improving pain and function in people older than 40 years with persistent knee pain: a randomized double-blind controlled clinical trial. Nutrients 2023;15.
Razavi SZE, Karimi M, Kamalinejad M. The efficacy of topical oliban oil (Boswellia Carterii B.) in relieving the symptoms of knee osteoarthritis. JPMRE 2019;1:7-13.
Reis D, Throne T, Keller J, Koffel C, Chen T, et al. Cancer-related fatigue: a pilot study evaluating the effect of frankincense essential oil in patients with cancer receiving chemotherapy. Cancer Nurs 2023;46:207-216.
Rezakhani S, Sedighi B, Pardakhty A, Shafiee K. Effects of boswellia serrata on improvement of memory impairment in patients with mild cognitive impairment: a double-blind, randomized, placebo-controlled study. J Kerman Uni Med Sci 2020;27:348‐355.
Sander O, Herborn G, Rau R. Is H15 (resin extract of Boswellia serrata, "incense") a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study. Z Rheumatol 1998;57:11‐16.
Sengupta K, Alluri KV, Satish AR, Mishra S, Golakoti T, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin® for treatment of osteoarthritis of the knee. Arthritis Res Ther 2008;10:R85.
Sengupta K, Krishnaraju AV, Vishal AA, Mishra A, Trimurtulu G, et al. Comparative efficacy and tolerability of 5-Loxin and AflapinAgainst osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study. Int J Med Sci 20107:366‐377.
Sontakke S, Thawani V, Pimpalkhute S, Kabra P, Babhulkar S, et al. Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian J Pharmacol 2007;39:27‐29.
Togni S, Maramaldi G, Bonetta A, Giacomelli L, Di Pierro F. Clinical evaluation of safety and efficacy of Boswellia-based cream for prevention of adjuvant radiotherapy skin damage in mammary carcinoma: a randomized placebo controlled trial. Eur Rev Med Pharmacol Sci 2015;19:1338-1344.
Vishal AA, Mishra A, Raychaudhuri SP. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of aflapin in subjects with osteoarthritis of knee. Int J Med Sci 2011;8:615‐622.
Gupta I, Gupta V, Parihar A, Gupta S, Lüdtke R, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res 1998;3:511-514.
Ahangarpour A, Heidari H, Fatemeh RAA, Pakmehr M, Shahbazian H, et al. Effect of Boswellia serrata supplementation on blood lipid, hepatic enzymes and fructosamine levels in type2 diabetic patients. J Diabetes Metab Disord 2014;13:1-5.
Azadmehr A, Ziaee A, Ghanei L, Huseini HF, Hajiaghaee R, et al. A randomized clinical trial study: anti-oxidant, anti-hyperglycemic and anti-hyperlipidemic effects of olibanum gum in type 2 diabetic patients. Iran J Pharm Res 2014;13:1003‐1010.
Baram SM, Karima S, Shateri S, Tafakhori A, Fotouhi A, et al. Functional improvement and immune-inflammatory cytokines profile of ischaemic stroke patients after treatment with boswellic acids: a randomized, double-blind, placebo-controlled, pilot trial. Inflammopharmacology 2019;27:1101‐1112.
Esmaelzadeh-Saeieh S, Rahimzadeh M, Khosravi-Dehaghi N, Torkashvand S. The effects of inhalation aromatherapy with Boswellia carterii essential oil on the intensity of labor pain among nulliparous women. Nurs Midwifery Stud 2018;7:45-49.
Faraji A, Aghdaki M, Hessami K, Hosseinkhani A, Roozmeh S, et al. Episiotomy wound healing by Commiphora myrrha (Nees) Engl. and Boswellia carteri Birdw. in primiparous women: a randomized controlled trial. J Ethnopharmacol 2021;264:113396.
Feragalli B, Ippolito E, Dugall M, Cacchio M, Belcaro G, et al. Effectiveness of a novel boswellic acids delivery form (Casperome®) in the management of grade II ankle sprains due to sport trauma-a registry study. Eur Rev Med Pharmacol Sci 2017;21:4726-4732..
Franceschi F, Togni S, Belcaro G, Dugall M, Luzzi R, et al. A novel lecithin based delivery form of Boswellic acids (Casperome®) for the management of osteo-muscular pain: a registry study in young rugby players. Eur Rev Med Pharmacol Sci 2016;20:4156-4161.
Giacosa A, Riva A, Petrangolini G, Allegrini P, Fazia T, et al. Positive effects of a Lecithin-based delivery form of boswellia serrata extract in acute diarrhea of adult subjects. Nutrients 2022;14:1858.
Kulkarni PD, Damle ND, Singh S, Yadav KS, Ghante MR, et al. Double-blind trial of solid lipid Boswellia serrata particles (SLBSP) vs. standardized Boswellia serrata gum extract (BSE) for osteoarthritis of knee. Drug Metab Pers Ther 2020;35.
Majdinasab N, Siahpush A, Mousavinejad SK, Malayeri A, Sajedi SA, et al. Effect of Boswellia serrata on cognitive impairment in multiple sclerosis patients. J Herb Med 2016;6:119-127.
Majeed M, Majeed S, Narayanan NK, Nagabhushanam K. A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytother Res 2019;33:1457‐1468.
Mehrzadi S, Tavakolifar B, Huseini HF, Mosavat SH, Heydari M. The Effects of Boswellia serrata Gum Resin on the Blood Glucose and Lipid Profile of Diabetic Patients: a double-blind randomized placebo-controlled clinical trial. J Evid Based Integr Med 2018;23:2515690X18772728.
Mohsenzadeh A, Karimifar M, Soltani R, Hajhashemi V. Evaluation of the effectiveness of topical oily solution containing frankincense extract in the treatment of knee osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. BMC Res Notes 2023;16:28.
Notarnicola A, Maccagnano G, Moretti L, Pesce V, Tafuri S, et al. Methylsulfonylmethane and boswellic acids versus glucosamine sulfate in the treatment of knee arthritis: Randomized trial. Int J Immunopathol Pharmacol 2016;29:140-146.
Pasta V, Dinicola S, Giuliani A, Harrath A, Alwasel S, et al. A randomized trial of Boswellia in association with betaine and myo-inositol in the management of breast fibroadenomas. Eur Rev Med Pharmacol Sci, 2016;20:1860-1865.
Pedretti A, Capezzera R, Zane C, Facchinetti E, Calzavara-Pinton P. Effects of topical boswellic acid on photo and age-damaged skin: clinical, biophysical, and echographic evaluations in a double-blind, randomized, split-face study. Planta Med 2010;76:555‐560.
Pellegrini L, Milano E, Franceschi F, Belcaro G, Gizzi G, et al. Managing ulcerative colitis in remission phase: usefulness of Casperome®, an innovative lecithin-based delivery system of Boswellia serrata extract. Eur Rev Med Pharmacol Sci 2016;20:2695-2700.
Prabhavathi K, Chandra US, Soanker R, Rani PU. A randomized, double blind, placebo controlled, cross over study to evaluate the analgesic activity of Boswellia serrata in healthy volunteers using mechanical pain model. Indian J Pharmacol 2014;46:475‐479.
Rad MZ, Taherian H. Effect of mouthwash with Boswellia extract on the prevention of dental plaque formation in patients under mechanical ventilation. Nurs Midwifery Stud 2020;9:77-82.
Ricci M, Micheloni G, Berti M, Perusi F, Sambugaro E, et al. Clinical comparison of oral administration and viscosupplementation of hyaluronic acid (HA) in early knee osteoarthritis. Musculoskelet Surg 2017;101:45-49.
Riva A, Giacomelli L, Totogni S, Franceschi F, Eggenhoffner R, et al. Oral administration of a lecithin-based delivery form of boswellic acids (Casperome®) for the prevention of symptoms of irritable bowel syndrome: A randomized clinical study. Minerva Gastroenterol Dietol 2019;65:30-35.
Samani MK, Mahmoodian H, Moghadamnia A, Mir APB, Chitsazan M. The effect of Frankincense in the treatment of moderate plaque-induced gingivitis: a double blinded randomized clinical trial. Daru 2011;19:288.
Sterk V, Büchele B, Simmet T. Effect of food intake on the bioavailability of boswellic acids from an herbal preparation in healthy volunteers. Planta Med 2004;70:1155-1160.
Togni S, Maramaldi G, Di Pierro F, Biondi M. A cosmeceutical formulation based on boswellic acids for the treatment of erythematous eczema and psoriasis. Clin Cosmet Investig Dermatol 2014;7:321‐327.
Valente IVB, Garcia D, Abbott A, Spruill L, Siegel J, et al. The anti-proliferative effects of a frankincense extract in a window of opportunity phase ia clinical trial for patients with breast cancer. Breast Cancer Res Treat 2024;204:521-530.
Fatima S, Ahmad T, Shahid M, Sofi G. Comparative study of kundur (Boswellia serrata) and tareeq (diaphoresis) in the management of samne mufrit (obesity): a randomised clinical trial. Int J Health Sci Res 2017;7:186-196.
Asadı E, Shahabı Kaseb MR, Zeıdabadı R, Hamedınıa MR. Effect of 4 weeks of frankincense consumption on explicit motor memory and serum BDNF in elderly men. Turk J Med Sci 2019;49:1033-1040.
Ghorat F, Sepidarkish M, Saadattalab F, Rezghi M, Shahrestani S, et al. The clinical efficacy of Olibanum gum chewing in patients with Mild-to-Moderate Alzheimer disease: A randomized Parallel-Design controlled trial. Neuropsychopharmacol Rep 2024;44:109-114.
Gupta PCHSSB. Clinical evaluation of Boswellia serrata (Shallaki) resin in the management of Sandhivata (osteoarthritis). AYU 2011;32:478‐482.
Inamdar NK, Roqaiya M, Husain N, Ahmed K, Baig S. The Efficacy of Kundur (Boswellia serrata Roxb. Ex Colebr.) in Vulvovaginal Candidiasis: a Randomized Control Trial. Altern Ther Health Med 2023;29:97‐103.
Mobaraki M, Golmakani N, Salari R, Mazloum SR, Mirteimouri M. Effect of boswellia and Lanolin Ointment on pain intensity of nipple in Lactating Women: a Randomized Clinical Trial. Iran J Obstet Gynecol Infertil 2019;22:58‐66.
Rigano L, Maramaldi G, Bonfigli A, Togni S, Meneghin M, et al. Skin-damage protective and recovery properties of an activated olibanum extract (from Boswellia serrata) on mechanical and physical skin damage: a single-blind evaluation on healthy volunteers. Esper Dermatol 2015;17:139-142.
Riva A, Morazzoni P, Artaria C, Allegrini P, Meins J, et al. A single-dose, randomized, cross-over, two-way, open-label study for comparing the absorption of boswellic acids and its lecithin formulation. Phytomedicine 2016;23:1375-1382.
Sedighi B, Kamali H, Pardakhti A, Shafiee K, Hasani BN, et al. Effect of boswellia papyrifera on cognitive impairment in multiple sclerosis.A double-blind, randomized, placebo controlled study. Mult Scler 2014;20:936.
Soltani R, Saberi Z, Ghanadian SM, Taheri A, Entezarhojjat A. The effectiveness of olibanum orally disintegrating tablet in the treatment of oral aphthous ulcers: a randomized, double-blind, placebo-controlled clinical trial. J Res Med Sci 2022;27:8.
Vaziri M, Hasanpour Dehkordi A, Salehi Tali S, Ebrahimi N. The effects of Boswellia (Frankincense) gel and hydrocolloid dressing on healing of second- and third-degree pressure ulcers among hospitalized patients. J Herb Med 2021;29:100461.
Karimi M, Rohani S, Akbari MG, Kargozar E, Zargaran A, et al. The efficacy of boswellia carterii oleogel in pain relief and functional improvement among patients with carpal tunnel syndrome: a triple-blind randomized, controlled trial. Shiraz E Med J 2021;22:e107952.
Acebo E, Ratón JA, Sautúa S, Eizaguirre X, Trébol I, et al. Allergic contact dermatitis from Boswellia serrata extract in a naturopathic cream. Contact Dermatitis 2004;51:91-92.
Buonomo M, Hylwa S. Allergic contact dermatitis from Boswellia carterii (frankincense) oil. Contact Dermatitis 2021;85:465-467.
El Fortia M, Badi H, Elalem K, Kadiki O,Topov Y. Olibanum bezoar: complication of a traditional popular medicine. East Mediterr Health J 2006;12:927-929.
Lukoševičiūtė-Zikė D, Misevičienė V, Zaveckienė J. Paediatric hypersensitivity pneumonitis pre-senting with tuberculosis-like symptoms. in Pediatric pulmonology. Supplement: 14th International Congress on Pediatric Pulmonology. Vol 50. Wiley-Liss. Krakow 2015.
Mejía MG, Jimenez-Canizales CE,Trespalacios RF, Niebles O. Exogenous Cushing Syndrome Associated With Homeopathic Cream (Boswellia Serrata). J Endocr Soc 2021; 5:A131-A132.
O'Connor TM, Cusack R, Landers S, Bredin CP. Case Report: Holy Saturday asthma. BMJ Case Rep 2014;2014.
Reis D, Jones TT. Frankincense essential oil as a supportive therapy for cancer-related fatigue: A case study. Holist Nurs Pract 2018;32:140-142.
Tsimpidakis A, Rigopoulos D, Gregoriou S. Aromatherapy: Cure or curse? A case report of allergic contact dermatitis caused by essential oils. Contact Dermatitis 2020;83:141-143.
Wagner AC, Vogt T, Müller CSL. Sweet's syndrome with acral involvement triggered by boswellia: a case report. Aktuelle Derm 2019;45:604-607.
Badr P, Mohammadi AA, Daneshamouz S, Afsharypuor S, Ayaz M. Allergic contact dermatitis by boswellia carterii ointment in a deep 2nd degree burn wound: a case report. J Pharm Pharmacogn Res 2018;5:1‐3.
Kumar N, Ashaq M. Safety and toxicity of botanical medicines: a critical appraisal. Int J All Res Educ Sci Methods 2021;9:676-686.
Soni A, Bohra N. Boswellia serrata‑Propogation and uses—A Review. Int J Adv Res Biol Sci 2021;8:35-46.
Zare H, Amiri Ardekani E, Tavakoli A, Bradley R, Tavakoli F, et al. Reporting of adverse effects of pomegranate in clinical studies: a systematic review. J Complement Integr Med 2024;21:154-166.
Koonrungsesomboon N, Morakote N, Karbwang J. Ethical considerations and challenges in herbal drug trials with the focus on scientific validity and risk assessment. Phytother Res 2021;35:2396-2402.
Fung K, Suhail M, McClendon B, Woolley C, Young D, et al. Management of basal cell carcinoma of the skin using frankincense (Boswellia sacra) essential oil: a case report. Researchgate net 2013;1:1-5.
Xia D, Lou W, Fung KM, Wolley CL, Suhail MM, et al. Cancer chemopreventive effects of boswellia sacra gum resin hydrodistillates on invasive urothelial cell carcinoma: report of a case. Integr Cancer Ther 2017;16:605-611.
Kong Y, Zhang Q, Wei M. Can new diagnostic criteria of rheumatoid arthritis really do an early diagnosis?-a case report of early diagnosis and treatment of rheumatoid arthritis with traditional medicine. Chin J Integr Med 2016;22:237-240.
Mohammadi Kenari H, Kordafshari G, Moghimi M. Treatment of meniere’s disease with persian medicine: a case report. Arch Neurosci 2019;6:e82409.
Mahroozade S, Akhtari E, Mokaberinejad R. Successful pregnancy by improving sperm parameters based on iranian traditional medicine (persian medicine)–a case report. Asian J Tradit Complementary Altern Med 2019;2:16-22.
Morris BA. The importance of case reports. CMAJ: Can Med Assoc J, 1989;141:875-876.
Fletcher A. Spontaneous adverse drug reaction reporting vs event monitoring: a comparison. J R Soc Med 1991;84:341-344.
Christensen CM, Morris RS, Kapsandoy SC, Archer M, Kuang J, et al. Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study. BMC Complement Med Ther 2017;17:1-8.
Li H, Deng J, Deng L, Ren X, Xia J. Safety profile of traditional Chinese herbal injection: an analysis of a spontaneous reporting system in China. Pharmacoepidemiol Drug Saf 2019;28:1002-1013.
Hailu AD, Mohammed SA. Adverse drug reaction reporting in Ethiopia: systematic review. BioMed Res Int 2020;2020:8569314.
Fung FY, Linn YC. Developing traditional Chinese medicine in the era of evidence‐based medicine: current evidences and challenges. Evid Based Complement Alternat Med 2015;2015:425037.
Organization WH. WHO traditional medicine strategy: 2014-2023. 2013:World Health Organization.
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| Issue | Vol 10, No 3, 2025 | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/tim.v10i3.19766 | |
| Keywords | ||
| Adverse Effect Boswellia Clinical trial Frankincense Systematic review | ||
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