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Traditional Chinese Medicine and Allergy

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by Dr. Xiu-Min Li

Dr. Xiu-Min Li

Allergic diseases are a significant health problem in “Westernized” countries. They represent a tremendous burden on quality of life for both patients and their families, and health care expenditures for the society as a whole. Food allergy in particular has no definitive treatment. The rise of allergic disease is prominently attributed to the “hygiene hypothesis” which contends that modern hygiene and other byproducts of modern behavior have deprived our immune systems of their natural enemies—mostly parasites–and our immune mechanisms have turned on normally harmless proteins in food, pollen, and so forth, instead. The accustomed medical approach is to control the response through medication and curtailing exposure. Certainly these are valid and important. But in the long run, my colleagues and I believe that the answer to this “Western” problem may be found in the “East.” That is the point of our “integrative” approach.

To be sure, allergic diseases are not only found in modern societies. They have been observed in some form throughout recorded history, including China, where I come from. And that is why I am working to bring what Chinese doctors have learned over the centuries into American medical practice. By combining these components of Traditional Chinese Medicine (TCM) into what we call integrative medicine, we hope to take advantage of the fact that the most powerful medical tool we have is the body itself. TCM is a unique system of theory, diagnosis and treatments including herbal medicines, acupuncture, mind-body therapy and dietary therapy. These are part of mainstream medicine not only in China and other Asian countries such as Korea and Japan, and are beginning to play a role in health care in the US and Europe.

At the Mount Sinai School of Medicine, we have taken a classical herbal formula called Wu-Mei-Wan that has been used in TCM for treating parasite infection and symptoms of food allergy-like conditions, and turned it into an herbal formula named food allergy herbal formula-2 (FAHF-2). We have shown that FAHF-2 can prevent and reverse established peanut allergy in animal-model peanut anaphylaxis, and that the effect is long lasting. There is nothing mysterious about this work, which is often the case with other so-called alternative treatments; our work is conducted according to NIH protocols and has been published in premier peer-reviewed journals. We measure and control and analyze, like any other Western researchers; everything must be repeatable. These data suggest that FAHF-2, and perhaps other Chinese herbal medicines may have a potential for treating food allergy. FAHF-2 is the first botanical drug that has entered clinical trials as an FDA Investigational New Drug (IND). Our phase I studies showed that FAHF-2 is safe and well tolerated. Phase II studies are in preparation at two centers–Mount Sinai, and Arkansas Children’s Hospital Research Institute in Little Rock.

We also developed anti-asthma herbal medicine international (ASHMI), which was shown in preclinical study to affect asthma mechanisms including inhibition of airway hyper-reactivity, inflammation and mucus hyperplasia, and overactive T-cell activity that can result in an allergic response. ASHMI is also effective in aged mice with asthma. Most exciting is that in addition to being safe and effective, ASHMI remained effective long after therapy. Unlike steroids, ASHMI does not induce overall suppression of immune system or adrenal function. This benefit is more than anything representative of the goal I mentioned earlier—to use the body’s own capabilities to fight disease. (I might add that this approach also has implications for the treatment of cancer and autoimmune diseases.)

Our studies provide scientific evidence supporting the use of TCM as a potential treatment for allergy and asthma. The goal of our clinical study is to develop botanical drugs that doctors can prescribe to complement or replace other therapies.

Food allergic children also suffer from other allergic conditions such as eczema, and environmental allergies. Families and physicians are interested in alternative approaches for these multiple allergic conditions. In addition to our research, and because acupuncture and herbal medicines are lawfully used by licensed practitioners in the US, we initiated an off-site TCM clinical program to help children with stubborn eczema associated with food allergies. The clinical outcomes have been well received. Given the growing interest in alternative and complementary medicine (CAM) therapies, and to make the clinical program accessible to more children, Mount Sinai Medical Center has established a new TCM clinical program named “Center for Integrative Medicine for Allergy and Immunology”. This center is supported by Winston-Wolkoff Children’s Holistic Medicine for Allergy Foundation and FARE.

This program will provide an additional health care option for children with multiple allergic conditions. This program will also provide allergists and pediatricians and dermatologists within or outside the Mt. Sinai with a reliable resource of CAM therapy. The combined effort will enhance the patient compliance and clinical outcomes.

Furthermore, we recently organized the first East-West Scientific Conference on Allergy and Traditional Medicine (EWAT) in China. This landmark conference—the first ever to focus on integrative medicine and allergy gathered some of the world leaders in allergy and traditional medicine research to share the most up-to date and comprehensive views on allergic diseases and traditional medicine as well as other new interventions for allergy. It not only provided an opportunity for experts to share knowledge of conventional allergy treatments, but also resulted in new insight into the growing use of traditional medicine and resulted in new collaborative research programs into traditional medicine as a potential solution to the allergy epidemic. Using this conference as a starting point, we continue to build up national and international collaborations to accelerate efforts to develop safe, effective natural products and novel therapies.

Dr. Xiu Min Li is Professor of Pediatrics in the Division of Pediatric Allergy and Immunology at Mount Sinai Hospital in New York. She has published her research in Journal of Allergy and Clinical Immunology and other top journals. She did her medical training at Stanford and Johns Hopkins, as well as Henen Medical University in China.

Light at the End of the Peanut Allergy Tunnel, 20% of the Time

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By Dr. Paul Ehrlich
As someone who trained in pediatrics before I did my allergy fellowship, I take a long view of the process of growing up. I often tell people that as they approach puberty, children change in more ways than just the obvious ones.

Jared is a ten year old who came in today having had a long history of a peanut allergy. While at sleep-away camp, he inadvertently ate some peanut butter without a problem. Back at home his mom brought him in for testing, and it was negative. You would have thought he won the lottery. He leaped into the air shouting, “I love the smell of peanut butter.” (Smells like victory to me.)

He will try some at home. I really hope he is one of the 20% of children with peanut allergy who lose their sensitivity. (Kids outgrow other food allergies more frequently.) This raises a question: what does Mom do about the teen years? After years of hyper-vigilance, some mothers do have trouble adjusting. For more on this subject, see chapter 14 Asthma Allergies Children: a parent’s guide “Mom and the Rest of the Family.”

Physicians Mailbag

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Q: If a patient in the operating room, intubated, is on or has been given steroids, is it safe to give a drug that the patient is allergic to? What should be done to make it safer?
— Dr. M, surgeon

Dear Dr. M
One first has to establish whether it is antibiotic “x” and none other will do. If that is the case, then the choice is to desensitize the patient giving increasing dosage while monitoring for side effects until the maximum dose is reached. From that point on the recommended therapeutic dosage can be given.

However, if the patient is in the hospital, intubated and pretreated with steroids and an antihistamine (with epinephrine and other meds at the ready) one can be much more aggressive. But be prepared for anaphylaxis and know how to handle it.

Alternatively, if another unrelated antibiotic will do the job, go that route.

Dr. Ehrlich

The Allergist’s Calendar

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By Dr. Paul Ehrlich
Any parent–or doctor for that matter—who is mystified by sudden exacerbation of a child’s allergies should take a look at the calendar. It’s not just a matter of when the ragweed is flowering. Different parts of the country have different seasons and different native vegetation. But human behavior also operates according to the calendar. A pediatric allergist can plot his work year according to the school calendar. Right after school begins, when kindergartners and first graders pull out their mats and rugs at quiet time, we see dust-induced asthma and rhinitis. Guinea pigs and white mice are a soothing and educational addition to elementary classrooms, but they are also full of allergens.
The start of heating season is always busy in our offices. This is when custodians fire up the furnaces and all that dust and mouse droppings are swept from the heating ducts into the classroom. If your child has allergies that commence at certain times of the year, by all means think about the weather and the change of the seasons, but also consider these behavior-related environmental changes.
The study of allergy and the behavior that influences it encompasses much more than just what’s in the air. Certain foods may only be part of your diet at particular times of the year. I was reminded of this recently when I saw a young patient from an Ashkenazic Jewish family in the month before Passover. I suspected that one of his allergies was to legumes, but in wishing him and his mother a good holiday, I said they probably wouldn’t need me for a few weeks. Why? Because Ashkenazis exclude legumes from their diets along with other grains for Passover, and while legumes themselves are not chametz—that is they will not rise like flour upon exposure to water—it is not unheard of in the long history of the Jewish people for legumes to be inadvertently stored with other problematic grains, so to be safe, Rabbis have adopted strict rules.
Are there non-Jewish versions of this phenomenon? Undoubtedly. If your child is allergic to pumpkin or chestnuts, you have to be careful on Thanksgiving and Christmas, and the rest of the year you can probably rest easy. Pay attention to the environment, natural and man made. Allergies are often seasonal, but seasons are not just about the weather.

Pollen–a reader responds

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This reply was written in response to a recent Weekly Tip item:

Thanks for citing my father-in-law Roger Wodehouse’ 1935 work Pollen Grains (Asthma Allergies Children, page 219). “There is another important point to make about pollen: the nectar producing flowers that are pretty or fragrant attract insects, bats, or birds to inadvertently convey their sticky pollen to other flowers while feeding on their nectar. The inconspicuous flowers of grasses, trees, and ragweed rely on the wind or gravity to move their pollen to female flowers. They produce large quantities of pollen grains of small size, carried by the air to other plants and your nose. It is not the showy yellow goldenrod you can see but rather the unattractive green ragweed you overlook that is making you miserable. That is not to say that if you plunge your face into a peony you won’t sneeze, but you can learn to admire pretty flowers from a distance and not condemn them as allergens.”
–AW

The Basics of Managing Your Family’s Health Care

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Dr. Davis Liu
As a practicing primary care doctor, I’ve noticed over the years how individuals are increasingly uneasy about the medical care they receive. It’s no longer about the doctor-patient relationship, but more about customers wanting a service. Patients want to get better and don’t want to spend more than they have to. They are inundated with advertisements about prescription medications and encouraged to ask their doctor for them. Doctor television shows highlight the multiple hi-tech machines at our fingertips like MRIs and CT scanners, which can seemingly get to the truth about a person’s ailments. As a consequence, they begin to believe the increasing perception that the more medications, tests, and imaging the better.

If it were only that simple! Prescription medications are not to be used like the consumer goods toothpaste or sodas. They are meant for only those who truly need them. Pictures and images from CT and MRI scanners only tell part of the story, not the whole story. Our hi-tech devices are not any better or any worse at getting to the truth than you can get to at gazing at the Mona Lisa painting and trying to determine the reason for her smile. Would nausea that would explain that enigmatic expression? What did she have for lunch? Did she like Leonardo, or didn’t she? Like a painting, a picture from an MRI only tells part of the story.

The real secrets to saving money and staying healthy for you and your children are to:

* Educate yourself to do the boring preventive things like exercise, quit smoking, maintain a healthy weight, eat a balanced diet, get screened for cancer, heart disease, diabetes, and high blood pressure.
* Learn when you must seek medical care and when you can safely skip.
* Find a doctor who listens and thinks critically about your symptoms and problems and who thoughtfully determines when medications, tests, and referrals are necessary and when they are not needed. (Allergists are specialists at listening and taking histories, among other things.)

There is a reason Benjamin Franklin’s phrase “an ounce of prevention is worth a pound of cure” still holds true today. It is because it still works.

Maintain a healthy weight, exercise, and control blood pressure and cholesterol (if necessary with medication) to decrease your risk of a heart attack. (You’ll avoid the radiation from a CT heart scanner or open-heart surgery and the subsequent recovery).

Make your home and work environment allergen free so that your children’s allergies and asthma don’t flare-up. Get vaccinated. (You’ll avoid doctor visits, emergency room visits, and time off work all of which cost time, yours, as well as money.)

Get screened for breast cancer and colon cancer when at the appropriate age, even if you feel well. When detected early, the problem can be addressed before it cuts your life short prematurely. (You’ll avoid having painful weeks, months, or years of very expensive chemotherapy and a quality of life that increasingly goes downhill).

Educate yourself. Ask questions. Find doctors who listen to you rather than automatically prescribe medications, tests, or x-rays every time you see them.

If that’s too much to do, then you can learn the same secrets another way.

Go to med school and get your own degree.

Davis Liu, M.D., is a practicing board-certified family physician with the Permanente Medical Group in Northern California since 2000. His comments have appeared in Fortune, Smart Money, Remedy, Real and Simple, and the NY Times. He has penned opinion pieces that have appeared in the San Francisco Chronicle and the Sacramento Bee.
His book Stay Healthy, Live Longer, Spend Wisely can be purchased here.

Skin in the Game: Unexpected Ingredients in Body Creams, Cosmetics, Skin Care Products, and Sunscreen

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Food labels aren’t the only ones you have to read. The outside of the body, your skin, can be just as sensitive to allergens as the inside. A surprising number of skin products contain highly allergenic ingredients: milk, egg, and soy are found in many shampoos; body scrubs may contain macadamia nut oil; almond oil and shea nut butter are common softening ingredients in lip balm; pistachio butter and pistachio seed oil are used in body butter and soap. Even Cetaphil, that staple of skincare for babies with eczema, now has several versions with almond oil. (Eczema in a baby is a sign of allergic potential; the last thing you want to do is slather their skin with almond oil twice a day for several months.) Men’s shaving products, too, can contain almond oil. My personal favorite find — sesame seed oil in lipstick.

Organic, all-natural products use even more peanut, tree nut, milk, egg, and soy-derived ingredients than regular ones. These “natural” ingredients may make for attractive marketing, but they can be trouble if you have allergies. It’s ironic that our population, more likely to seek out fragrance-free, simpler products, is often better off with artificial chemicals. Always check and double-check the ingredients.

How Much of a Risk?

Don’t panic. Most of these oils and butters are used in very small amounts, and unless your child is extraordinarily sensitive, holding hands with an adult who used a hand cream hours earlier shouldn’t cause any problems. According to the Food Allergy and Anaphylaxis Network, “There is no evidence that coconut oil and shea nut oil/butter are allergenic.” (My family avoids them anyway, just to be on the safe side.) Almond, macadamia, and other nut oils, however, should be carefully avoided by nut-allergic patients, as should peanut oil, if you’re allergic to peanut, and sesame oil, if you’re sesame allergic. Many online retailers list product ingredients; drugstore.com and its sister site, beauty.com, have an ingredients tab for most items. It’s very interesting reading.

How’s Your Latin?

Strict USA labeling laws, which require clear, understandable language for food ingredients, don’t necessarily apply to cosmetics and other skin products. Sweet almond oil is often listed by its Latin name, Prunus Amygdalus Dulcis oil. If you’re a gardener, you may recognize the name, but it’s pretty confusing for the rest of us! Shea nut can be disguised as shea oil, shea butter (the word nut is missing!) and, quite frequently, Butyrosperum Parkii. Huh? And you might not want to use mom’s shampoo on your toddler if it contains ovum, which is Latin for egg. So check all the ingredients before you use a skin product. Still confused? Do some research. Feel free to call the company and ask them to clarify. Most companies have consumer relations departments for exactly this purpose. For greater detail, a book worth looking at is A Consumer’s Dictionary of Cosmetic Ingredients by Ruth Winter, which is now in its 7th edition. I find her companion book on food additives to be extremely useful.

By the way, when you travel, those little complimentary toiletries are never labeled, so bring your own soap and shampoo from home—more about that in another column.

Home Air Filters–What Works Best?

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I wanted your advice as I am looking into buying new air purifiers in connection with my son’s asthma/allergies. I have heard that I should NOT purchase one that works with ions (ionic technology). Am I wrong?
The ones I bought about four years ago are a bit noisy. So I am planning to purchase the latest
technology. Before I purchase them, I want to make sure that the ionic ones will not be a
problem. One other advantage is that I will not have to change any filters, which I have been doing every 2-3 months, but just clean the blades regularly; also, they are supposedly very quiet. Since I have a
small apartment, I cannot afford to have something bulky and big. Hence, am thinking of something sleek that does not necessary have to be placed in the middle of room (as per the current ones). Please advise.
–Ms. D

Sorry to disappoint you. All air purifiers must be HEPA (High Efficiency Particle Air filters). The ones about which wrote are sub-standard – easier to care for – but not good products. Call 1-800-ALLERGY. That is the simple fact.

–Dr. Ehrlich
{Note: For more on air filters click here}

Shellfish problems and iodinated contrast media (“x-ray dye”)

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(This was written in response to Dr. Ehrlich’s post, “The Relevant Allergist,” which mentioned the persistent myth that shellfish-allergic patients will react to the iodine in dye used during x-rays, by a board-certified radiologist who practices in upstate New York.)

Radiologists years ago considered a patient’s history of an allergic reaction to shellfish as a contraindication to giving contrast for an IVP (kidney study), angiogram, CT (a.k.a. cat scan), or other radiologic studies. I say “years ago” because I have been in practice for 30 years and it was dogma when I started.

Because lots of radiology is about science, later studies were done that showed no connection between a patient’s shrimp “allergy” and the incidence of contrast reactions. The American College of Radiology produces a 98-page contrast manual. Its latest iteration Version 6 was issued in 1998. If you search it for the word “shellfish” you find only one mention on page 13:

The predictive value of specific allergies, such as those to shellfish or dairy products, previously thought to be helpful, is now recognized to be unreliable.

We don’t really understand contrast allergies or if they are even allergies at all. My patients who have broken out in hives with an injection may have no hives the next time. There is no definite connection between the hives and the anaphylactic reactions. Generally patients with lots of allergies are more likely to have reactions to contrast. If the benefit of the injection is very great, I go ahead and inject those with a history of hives. If the patient says his tongue swelled up and he can’t remember what happened before he woke up in the ER, I don’t inject unless the patient has been pre-treated with whatever combination of steroids and antihistamines is in vogue. If the patient has had a really bad contrast reaction, any future study requiring an injection ought to be done not in an outpatient office but in a real hospital with an emergency room.

All this being said, I have seen only 4 serious contrast reactions in my 30 years. They all did well. One did indeed have a shellfish history. Her reaction was not to injected “dye” but to the mixture of water and 2 tablespoons of water soluble contrast given by mouth. Because of the shrimp history we had no intention of injecting her. It did not protect her from the profound diarrhea she experienced.

Dr. A

U.K. “Market Basket” of Goods

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By Dr. Paul Ehrlich
I noticed in our “News” page here at AsthmaAllergiesChildren (AAC for short) that the United Kingdom has included in its “market basket” ( a consumer cost-of-living measurement) a bottle of allergy medication. As a physician I spent some time in London in the 70’s, and over the years since I have followed changes in English medical practice, particularly regarding my own specialty. When a New York patient went to London to work for a bank, he informed me that English doctors have stopped immunotherapy (allergy injections) because some people were reacting to the shots in undesirable ways. I’m sure that the rates there were no higher than they are here, and that they were helping lots more people than they were hurting, but whoever decides these things on behalf of the National Health Services was convinced they weren’t worth it. I disagree.

Still, I am pleased to see that the 20% of the UK population who have allergic disorders are treating themselves to the extent that allergy medication would be included in the market basket. Allergies and asthma are becoming more pervasive, and maybe specialty treatment will make a comeback. By the way, garlic bread is also new to the list, while lipstick is gone.

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