Food allergy (FA) has increased over several decades affecting approximately 10% of both American children and adults. FA is an immune-mediated, potentially life-threatening adverse reaction comprising immunoglobulin (Ig) E–mediated immediate hypersensitivity reactions, delayed non–IgE-mediated reactions, and disorders combining both IgE-mediated and non–IgE-mediated immune pathways.
In 2016, the American Academy of Allergy, Asthma, and Immunology reported that FA has been one of the most common indications for CAM use (53.6%). Traditional Chinese medicine (TCM) is a major CAM modality in the United States. Asian countries have used it for thousands of years for various health conditions including gastrointestinal and skin systems(1).
Atopic eczema (AE) is a common allergic inflammatory skin disorder characterized by itchy, scaly, erythematous, and oozing skin, affecting up to 20% of children and 1% to 3% of adults in most countries. Currently, treatments for AE include emollients and topical corticosteroids, which have generally been well-tolerated. However, long-term use of topical corticosteroids may lead to resistance, dependence, and a variety of other side effects, such as skin atrophy, atrophic striae, and rosacea-like eruptions (2). Eczema pathogenesis is associated with multiple genetic and environmental factors. Immune cells such as eosinophils, mast cells, and cytokines. Topical corticosteroids (steroids) are the first-line treatment. Sudden steroid withdrawal results in sleep disturbance, extreme itching, painful skin, and stress, which are mediated by complex inflammatory cell and cytokine networks and altered skin integrity (1).
Food Allergy Herbal Formula 2 developed from TCM
Food Allergy Herbal Formula 2 (FAHF-2) is the first US FDA botanical investigational new drug for FA. It was developed from a classic 10-herb formula, Wu Mei Wan, used to treat intestinal parasite infections and gastrointestinal disorders with symptoms similar to FA and gastroenteritis. Some studies reveal the benefits of Wu Mei Wan with or without modification on diseases including rash, gastroenteritis, and asthma(1).
Efficacy analysis for clinical study of TCM in treating eczema
It is believed that eczema treatment can be enhanced with a multifaceted approach. Shi Zhe Tea is modified from traditional Xiao-Feng-San, in which schizonepeta stem, burdock fruit, atractylodes rhizome, and shrubby sophora root are reserved as main herbs against inflammation and microorganism, whereas cicada molting and silkworm can be used to relieve itching. For eczema itching, skin lesion, and sleep disturbance in patients who are topical steroid dependent or have steroid withdrawal, the triple herbal therapy may improve the symptoms, quality of life, and immune responses(1).
The TCM formulations and active compounds including derivatives from FAHF-2 may provide novel approaches that alter the process of FA by suppressing B-cell IgE production and mast cell histamine release and TNF-α and IL-8 production. For eczema, TCM can be used as monotherapy for infants and young children, the most vulnerable group, and may be able to spare them topical steroid treatment. Moreover, for patients who are steroid dependent and have withdrawal, TCM not only helps reduce infection and inflammation but can also help the skin to regain sustainable integrity(1).
The effectiveness and safety of acupuncture for atopic eczema
Acupuncture has been widely applied for the treatment of many chronic diseases, especially dermatological conditions.The core acupoint association networks were acupoints LI11, SP10, ST36, SP6, and LI4. Some clinical trials have demonstrated that acupuncture can significantly reduce itch intensity and allergen-induced basophil activation in patients with AE. Several systemic reviews also concluded that Acupuncture might be effective at reducing itch intensity and may be more effective than conventional medicine at reducing EASI and improving the global symptoms of AE(2,3,6).
A randomized, sham-controlled preliminary trial with thirty six participants conducted a 4-week acupuncture period (twice weekly) and a 4-week follow-up and then determined the visual analogue scale (VAS) for itching and insomnia, SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Patient Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI) scores over the course of the study. They found that the SCORAD, VAS (Pruritus), VAS (Insomnia), POEM, DLQI, and EASI were significantly improved in the verum acupuncture (VA )groups (4).
A unicenter, single-blinded (observer), prospective, randomized clinical pilot trial was designed and conducted with an additional experimental part in vitro basophil CD63 expression upon allergen stimulation (house dust mite and timothy grass pollen). The results from the study showed a reduction of itch intensity and of in vitro allergen-induced basophil activation in patients with atopic eczema after acupuncture treatment(5).
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References:
1.Wang, Z., Wang, Z. Z., Geliebter, J., Tiwari, R., & Li, X. M. (2021). Traditional Chinese medicine for food allergy and eczema. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 126(6), 639–654. https://doi.org/10.1016/j.anai.2020.12.002
- Jiao, R., Yang, Z., Wang, Y., Zhou, J., Zeng, Y., & Liu, Z. (2020). The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 38(1), 3–14. https://doi.org/10.1177/0964528419871058
- Zeng, Z., Li, M., Zeng, Y., Zhang, J., Zhao, Y., Lin, Y., Qiu, R., Zhang, D. S., & Shang, H. C. (2021). Potential Acupoint Prescriptions and Outcome Reporting for Acupuncture in Atopic Eczema: A Scoping Review. Evidence-based complementary and alternative medicine : eCAM, 2021, 9994824. https://doi.org/10.1155/2021/9994824
- Kang, S., Kim, Y. K., Yeom, M., Lee, H., Jang, H., Park, H. J., & Kim, K. (2018). Acupuncture improves symptoms in patients with mild-to-moderate atopic dermatitis: A randomized, sham-controlled preliminary trial. Complementary therapies in medicine, 41, 90–98. https://doi.org/10.1016/j.ctim.2018.08.013
- Pfab, F., Athanasiadis, G. I., Huss-Marp, J., Fuqin, J., Heuser, B., Cifuentes, L., Brockow, K., Schober, W., Konstantinow, A., Irnich, D., Behrendt, H., Ring, J., & Ollert, M. (2011). Effect of acupuncture on allergen-induced basophil activation in patients with atopic eczema:a pilot trial. Journal of alternative and complementary medicine (New York, N.Y.), 17(4), 309–314. https://doi.org/10.1089/acm.2009.0684
- Liu, Y., Cui, H., Du, R., Zhang, L., Yuan, H., Zhang, X., & Zheng, S. (2019). Acupuncture for patients with atopic dermatitis: A systematic review protocol. Medicine, 98(52), e18559. https://doi.org/10.1097/MD.0000000000018559
