Traditional Chinese medicine techniques improve symptoms in asthma, allergic conditions

Key takeaways:

• Acupuncture reduced serum specific IgE levels in allergic rhinitis patients.
• TCM triple therapy improved topical steroid withdrawal symptoms.
• TCM research is ongoing with the goal of FDA approval.

BOSTON — Acupuncture and other traditional Chinese medicine techniques may be helpful for allergic conditions, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“Traditional Chinese medicine [TCM] is a major component of complementary and alternative medicine,” Xiu-Min Li MD, MS, MPH, professor of pathology, microbiology and immunology at New York Medical College, said during the presentation.

“TCM is a medical system that uses a variety of physical and psychological approaches to treat and prevent health issues,” Li, who also teaches otolaryngology and dermatology at the college, said. “The modalities include acupuncture, acupressure, botanical medicines and so on.”

Acupuncture

Li explained that acupuncture has gained popularity since the 1970s, with the FDA now classifying an acupuncture needle as a therapeutic class 2 device. Some states even require special licensure to practice acupuncture.

There are evidence-based studies on acupuncture and allergic rhinitis, Li said. She cited a systematic review and meta-analysis that showed significant reduction in nasal symptom scores, medication scores and serum specific IgE levels in patients who underwent acupuncture treatments.

“Importantly, there were no serious reactions related to acupuncture treatment for asthma,” Li emphasized.

She cited another systematic review meta-analysis done in 2023 by Pang and colleagues, which included more than 600 subjects randomly assigned to either acupuncture treatment or “sham” placebo treatment. The analysis showed acupuncture was well-tolerated. It improved lung function and quality of life and reduced asthma symptom scores.

Li then explained the mechanism behind acupuncture.

“There are numerous attempts to find evidence for acupuncture stimulation-induced natural endorphins, opioids or other biomarkers to explain how acupuncture reduces pain and inflammation specific to allergy,” she said.

Studies show that the reduction of itch intensity was associated with the suppression of basophil activation, she explained. She also noted that certain acupuncture points — such as the LI11 large intestine acupuncture point found on the lateral side of the elbow and the SP10 acupuncture point found on the inner thigh — reduced IgE levels, mast cell activation and tyrosine kinase and spleen tyrosine kinase in mast cells in urticaria rat models.

TCM and eczema

“Eczema is a chronic inflammatory skin condition affecting up to 20% of children and as many as 10% of adults in the U.S. alone,” Li said. “Sleep disturbance, intense pruritus and skin lesions affect the quality of life in children.

“Severe asthma in young children is also associated with increased risk of growth delay, mental health disorders and allergies,” she continued. “It's not only a problem for their current quality life but also for their future health.”

She emphasized the importance of improving and preventing severe eczema and the role that TCM can play in doing that.

Li and her colleagues published a review article in 2020 titled “Traditional Chinese Medicine for Food Allergy and Eczema.” They presented key TCM regimens that could improve eczema and immunity that were not corticosteroids but still had a high safety profile.

TCM and eczema steroid withdrawal

“Topical steroid withdrawal (TSW) causes worse symptoms at all levels, particularly in the acute phase, and these symptoms are often persistent,” Li said. “However, awareness and acceptance of TSW remains controversial between patients, families, communities and health providers.”

She pointed out a study that said failure to acknowledge the patient’s concerns can weaken the patient-health care relationship and delay care.

“So, patients sometimes seek treatment that is not under supervision,” Li said. “Therefore, TSW is an important public health issue and needs to be addressed.”

To address how TCM can be involved in evidence-based treatment, Li presented findings from an ongoing study by her and her colleagues on how TCM was used to address and treat TWS.

The retrospective case-control study included 147 patients (107 with TSW and 40 controls without TSW; age range, 6-48 months). Patients had an eczema diagnosis and a family-reported TSW exacerbation or family-reported non-TSW eczema. Data collected included demographic information, skin intensity score, itching score, sleep disturbance score and immunological data.

“In the past, TSW studies report that many folks are adults because they have a long-term chronic use of steroids,” Li said. “But in recent years, TSW in children has been unmired.”

The TSW group had a higher sleep disturbance score compared with the non-TSW group, according to Li. The same result was seen in other symptoms such as itching and skin redness. The study also showed that eosinophil counts and total IgE levels were higher in the TSW group.

“TSW in children not only affects their skin, but also drastically disturbs their immunity,” Li noted.

The research group introduced a triple therapy TCM protocol to treat the patients for TSW. The protocol included external cream, baths and internal tea supplements. The treatment milestones included quality of life and skin improvement.

The treatment consisted of three phases. The first phase occurred when the patient had severe skin lesions, and the full triple therapy protocol was used. The second was used when the skin looked almost normal, and the full protocol was still used. The third was marked by the skin looking normal and stable with no flares. At this point, the full treatment protocol was reduced and stopped.

“The goal is to build off treatment and have long-term remission,” Li said.

After these treatments were concluded, Li and colleagues conducted a retrospective case series on severe TSW cases. The series showed that sleep disturbances, itching, skin redness and oozing/crust significantly improved post-treatment. Total eosinophil counts and IgE levels also saw a significant reduction.

With the retrospective results, Li and her team are now carrying out a 6-month prospective real-world study to determine the effect of the TCM protocol on severe eczema. They used the same cohort of patients aged 6 to 48 months with severe eczema due to TSW. There will be 20 patients in both the TWS and normal biomarker control groups.

So far, they recruited 18 patients but already have preliminary data. Patients in the TSW group had significantly reduced SCORAD index scores and transepidermal water loss (P < .001). After 3 months of treatment, the TSW group also saw a disappearance or reduction of Staphylococcus aureus colonization on their skin as well as a restoration of diversity in the skin microbiome.

In conclusion

“Acupuncture was effective for allergic rhinitis, asthma and eczema,” Li said. “I think this can be incorporated in our practice, particularly if the patient will not respond to conventional treatment very well.”

Li further emphasized that the TCM triple protocol was effective for skin conditions.

“TCM is a rich source for developing interventions for allergy and immunology,” she said. “We continue our study with the goal to generate strong clinical and scientific data to obtain the FDA’s approval of triple therapy and the botanical drug mechanism for treating and preventing severe eczema with long-term remission of treatment.”

References:

• Pang J, et al. Complement Ther Med. 2023;doi:10.1016/j.ctim.2023.102956.
• Wang Z, et al. Ann Allergy Asthma Immunol. 2021;doi:10.1016/j.anai.2020.12.002.