Acupuncture treatment of urticaria

Thiamine (vitamin B1) as an insect repellent: a scoping review

While the desire for systemic repellents is high, ineffective repellents put one at risk of insect-vectored pathogens. Vitamin B1, or thiamine, has been touted as a systemic insect repellent since 1943, and denounced as an ineffective placebo for just as long. This paper presents a scoping review of 104 relevant case reports, research studies, and review articles to trace the evolution of this idea and identify an evidence-based, scientific consensus. Reports of thiamine's systemic repellency are primarily anecdotal and based on uncontrolled trials and/or used bite symptoms as a proxy for reduced biting. Controlled experiments on insect landing and feeding found no evidence of repellency. Of the 49 relevant review papers, 16 insect bite prevention guidelines, and 4 government documents, none after the 1990s claimed thiamine is a repellent. The findings of this review are that thiamine cannot repel arthropods in any dosage or route of administration. Due to limited available evidence, the possibility that thiamine reduces the subjective symptoms of insect bites cannot currently be ruled out. Unfortunately, many medical professionals and travelers today still believe thiamine may be effective despite the evidence stating otherwise. Continued promotion of debunked repellents on the commercial market poses a serious risk in countries with the endemic, mosquito-vectored disease.

Acupuncture and Cutaneous Medicine: Is It Effective?

Background: In China, acupuncture has been used as a form of medical therapy for more than 2500 years. It is a part of traditional medical practice and is used to treat the entire spectrum of human and veterinary disease. Although dermatologic disease has received much less attention in worldwide acupuncture research than pain and musculoskeletal conditions, there is a growing body of evidence suggesting acupuncture's usefulness in this area. Objective: The aim of this article was to review the evidence in the literature regarding the usefulness of acupuncture in managing dermatologic illness. Results: Trials and case reports of patients using acupuncture have been published in the areas of atopic dermatitis and urticaria, herpes zoster, psoriasis, acne, melasma, and hyperhidrosis, as well as in promoting wound healing. Itch modulation by acupuncture has been the focus of recent research as itch is a predominant symptom in allergic skin diseases and leads to serious impairment of quality of life. Conclusions: Although more research is needed, acupuncture's use in cutaneous medicine is promising in the area of itch modulation, in treating atopic dermatitis and herpes zoster pain, and in promoting wound healing.

Design of a stimulation protocol to predict temperature distribution in subcutaneous tissue using the finite element model

Moxibustion is a traditional Oriental medicine therapy that treats the symptoms of a disease with thermal stimulation. However, it is difficult to control the strength of the thermal or chemical stimulus generated by the various types and amounts of moxa and to prevent energy loss through the skin. To overcome these problems, we previously developed a method to efficiently provide RF thermal stimulation to subcutaneous tissue. In this paper, we propose a finite element model (FEM) to predict temperature distributions in subcutaneous tissue after radio-frequency thermal stimulation. To evaluate the performance of the developed FEM, temperature distributions were obtained from the FEM, and in vivo experiments were conducted using the RF stimulation system at subcutaneous tissue depths of 5 and 10 mm in the femoral region of a rabbit model. High correlation coefficients between simulated and actual temperature distributions-0.98 at 5 mm and 0.99 at 10 mm-were obtained, despite some slight errors in the temperature distribution at each depth. These results demonstrate that the FEM described here can be used to determine thermal stimulation profiles produced by RF stimulation of subcutaneous tissue.

The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: A Systematic Review

Background. Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English. Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria. Methods. A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement. Results. We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11-1.70; P = 0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41-2.22; P < 0.01). There were no severe adverse events related to acupuncture. Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited. Conclusions. Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. This trial is registered with PROSPERO CRD42015015702.

Acupuncture for patients with chronic urticaria: a systematic review protocol

INTRODUCTION

This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria.

METHODS AND ANALYSIS

We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data.

DISSEMINATION AND ETHICS

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42015015702.

A unique electrical thermal stimulation system comparable to moxibustion of subcutaneous tissue

Moxibustion strengthens immunity and it is an effective treatment modality, but, depending on the material quantity, shape, and composition, the thermal strength and intensity can be difficult to control, which may cause pain or epidermal burns. To overcome these limitations, a heat stimulating system which is able to control the thermal intensity was developed. The temperature distributions on epidermis, at 5 mm and 10 mm of depth, in rabbit femoral tissue were compared between moxibustion and the electric thermal stimulation system. The stimulation system consists of a high radio frequency dielectric heating equipment (2 MHz frequency, maximum power 200 W), isolation probe, isolation plate, negative pressure generator, and a temperature assessment system. The temperature was modulated by controlling the stimulation pulse duty ratio, repetition number, and output. There were 95% and 91% temperature distribution correlations between moxibustion and the thermal stimulus at 5 mm and 10 mm of depth in tissue, respectively. Moreover, the epidermal temperature in thermal stimulation was lower than that in moxibustion. These results showed that heat loss by the electric thermal stimulation system is less than that by the traditional moxibustion method. Furthermore, the proposed electric thermal stimulation did not cause adverse effects, such as suppuration or blisters, and also provided subcutaneous stimulation comparable to moxibustion.

Neuronal Activity Stimulated by Liquid Substrates Injection at Zusanli (ST36) Acupoint: The Possible Mechanism of Aquapuncture

Aquapuncture is a modified acupuncture technique and it is generally accepted that it has a greater therapeutic effect than acupuncture because of the combination of the acupoint stimulation and the pharmacological effect of the drugs. However, to date, the mechanisms underlying the effects of aquapuncture remain unclear. We hypothesized that both the change in the local spatial configuration and the substrate stimulation of aquapuncture would activate neuronal signaling. Thus, bee venom, normal saline, and vitamins B1 and B12 were injected into a Zusanli (ST36) acupoint as substrate of aquapuncture, whereas a dry needle was inserted into ST36 as a control. After aquapuncture, activated neurons expressing Fos protein were mainly observed in the dorsal horn of the spinal cord in lumbar segments L3–5, with the distribution nearly identical among all groups. However, the bee venom injection induced significantly more Fos-expressing neurons than the other substrates. Based on these data, we suggest that changes in the spatial configuration of the acupoint activate neuronal signaling and that bee venom may further strengthen this neuronal activity. In conclusion, the mechanisms for the effects of aquapuncture appear to be the spatial configuration changes occurring within the acupoint and the ability of injected substrates to stimulate neuronal activity.

Gene Expression Profile of the Hypothalamus in DNP-KLH Immunized Mice Following Electroacupuncture Stimulation

Clinical evidence indicates that electroacupuncture (EA) is effective for allergic disorder. Recent animal studies have shown that EA treatment reduces levels of IgE and Th2 cytokines in BALB/c mice immunized with 2,4-dinitrophenylated keyhole limpet protein (DNP-KLH). The hypothalamus, a brain center of the neural-immune system, is known to be activated by EA stimulation. This study was performed to identify and characterize the differentially expressed genes in the hypothalamus of DNP-KLH immunized mice that were stimulated with EA or only restrained. To this aim, we conducted a microarray analysis to evaluate the global gene expression profiles, using the hypothalamic RNA samples taken from three groups of mice: (i) normal control group (no treatments); (ii) IMH group (DNP-KLH immunization + restraint); and (iii) IMEA group (immunization + EA stimulation). The microarray analysis revealed that total 39 genes were altered in their expression levels by EA treatment. Ten genes, including T-cell receptor alpha variable region family 13 subfamily 1 (Tcra-V13.1), heat shock protein 1B (Hspa1b) and 2′–5′ oligoadenylate synthetase 1F (Oas1f), were up-regulated in the IMEA group when compared with the IMH group. In contrast, 29 genes, including decay accelerating factor 2 (Daf2), NAD(P)H dehydrogenase, quinone 1 (Nqo1) and programmed cell death 1 ligand 2 (Pdcd1lg2) were down-regulated in the IMEA group as compared with the IMH group. These results suggest that EA treatment can modulate immune response in DNP-KLH immunized mice by regulating expression levels of genes that are associated with innate immune, cellular defense and/or other kinds of immune system in the hypothalamus.

A Parametric Study on the Immunomodulatory Effects of Electroacupuncture in DNP-KLH Immunized Mice

This study was conducted to compare the effects of low frequency electroacupuncture (EA) and high frequency EA at acupoint ST36 on the production of IgE and Th1/Th2 cytokines in BALB/c mice that had been immunized with 2,4-dinitrophenylated keyhole limpet protein (DNP-KLH), as well as to investigate the difference in the immunomodulatory effects exerted by EA stimulations at acupoint ST36 and at a non-acupoint (tail). Female BALB/c mice were divided into seven groups: normal (no treatments), IM (immunization only), ST36-PA (IM + plain acupuncture at ST36), ST36-LEA (IM + low frequency (1 Hz) EA at ST36), ST36-HEA (IM + high frequency (120 Hz) EA at ST36), NA-LEA (IM + low frequency (1 Hz) EA at non-acupoint) and NA-HEA (IM + high frequency (120 Hz) EA at non-acupoint). EA stimulation was performed daily for two weeks, and total IgE, DNP-KLH specific IgE, IL-4 and IFN-γ levels were measured at the end of the experiment. The results of this study showed that the IgE and IL-4 levels were significantly suppressed in the ST36-LEA and ST36-HEA groups, but not in the NA-LEA and NA-HEA groups. However, there was little difference in the immunomodulatory effects observed in the ST36-LEA and ST36-HEA groups. Taken together, these results suggest that EA stimulation-induced immunomodulation is not frequency dependent, but that it is acupoint specific.

Acupuncture for symptom management in patients with hyper-IgE (Job's) syndrome

OBJECTIVES

The objective of this study was to investigate the effects of acupuncture treatment for symptom management in patients with hyper-immunoglobulin E (IgE) syndrome (HIES).

DESIGN

This was a retrospective case series.

SETTING/LOCATION

The study was conducted at the The Clinical Research Center of the National Institutes of Health.

SUBJECTS

There were 8 adult patients with HIES ages 23-56 with varying symptoms in the study.

INTERVENTION

Acupuncture treatments were given from May 29, 2001 to February 17, 2009.

OUTCOME MEASURES

Acupuncture treatment efficacy was measured and evaluated using a 0-10 assessment instrument pre- and post-treatment.

RESULTS

The 8 patients with HIES suffered from a wide variety of symptoms related to the disease. Acupuncture treatments uniformly decreased the self-reported severity of symptoms.

CONCLUSIONS

This case series demonstrates that acupuncture is a clinically useful and safe therapy for symptom management in patients with HIES.

A design of RF stimulator which is similar to temperature distribution by moxibustion (preliminary study)

We developed a novel radio-frequency (RF) stimulator to mimic heat effects similar to the temperature distributions created by moxibustion in porcine tissue. Moxibustion is a traditional Oriental medicine technique using moxa, which is utilized not only to cure disease, but also to increase immunity. However, it may lead to undesired effects including severe pains, blisters, and burns because of the difficulty of controlling heat intensity during the process. To overcome these problems, a novel RF stimulator that can conduct thermal energy to the deep tissue of the body and also easily control the power of heat stimulation was proposed. RF stimulating protocols were designed to mimic the temperature profiles of two types of moxibustion. In our results, the temperature distributions created by the proposed protocols were similar to those attained by moxibustion. It was also shown that the proposed protocols were more effective than moxibustion for transferring heat effects into deep tissues.

The alpha-adrenoceptor mediation of the immunomodulatory effects of electroacupuncture in DNP-KLH immunized mice

Our previous study demonstrated that successive electroacupuncture (EA) at ST36 acupoint reduces IgE production in BALB/c mice immunized with 2,4-dinitrophenylated keyhole limpet protein (DNP-KLH) by suppression of the Th2 cell lineage development. Here, we report that pretreatment of phentolamine (alpha-adrenoceptor antagonist, 10mg/kg, i.p.) completely blocks the EA-induced suppression of antigen-specific and total IgE levels in serum and IL-4 production in anti-CD3 mAb-activated splenocytes in DNP-KLH immunized mice. The results suggest that alpha-adrenoceptor play an important role in mediating the suppressive effects of EA on IgE production and Th2 cell response in DNP-KLH immunized mice.

Dermatologic Manifestations of Complementary Therapy

The dermatologic manifestations of complementary therapy include reactions to herbs used orally and topically for treating skin disease, cutaneous reactions to drugs used orally and topically for treating other diseases, and reactions to alternative interventions. The safety of alternative medicine is in question. Unlike approved drugs, the quality, efficacy, and safety of herbal medicines is not regulated. Herbal medicines may be misidentified and contaminated with a variety of substances. The following review identifies and categorizes therapies according to their common uses with their adverse reactions.

Urticaria and angioedema: an overview

Persistent or frequent episodes of urticaria are difficult to evaluate and treat. The best test to identify most patients with a specific underlying cause (eg, physical trigger, allergen, systemic disease) likely is the taking of a careful and detailed history and performance of a physical examination by a specialist who is knowledgeable in urticarial disease. Further study of the pathogenesis and treatment of urticaria is crucial. Given the limited efficacy of presently approved antihistamine treatments and the significant side effects of steroids and cyclosporine, there is a pressing need to evaluate other anecdotally supported urticaria treatments in randomized, controlled trials.

Alternative therapy in pruritus

Because of its multitude of origins, the symptom complex of pruritus has a plethora of purported remedies and few therapeutic indications. Very few topical and systemic FDA approved medications have the indication of pruritus. Specific therapy still awaits a better definition of the exact physiologic events in chronic pruritus. Hence most medications actually focus on the central nervous system--the peripheral receptors--and the lack of specific physiologic targets has inhibited pharmacologic development. The resulting gap has opened the door to a variety of alternative therapies.

Acupuncture, electrostimulation, and reflex therapy in dermatology

Acupuncture is an old therapeutic method that includes both needle and nonneedle acupuncture. Nonneedle acupuncture includes moxibustion, cupping, and acupressure. In the field of dermatology, acupuncture has been reported to be beneficial for the treatment of acne, postherpetic neuralgia, psoriasis, atopic dermatitis, and urticaria. In acupuncture treatment of dermal diseases, both the filiform needle and the cutaneous needle are powerful tools. In the treatment of refractory dermal diseases, cutaneous needle acupuncture is usually followed by cupping to intensify the therapeutic effect. In cases where needle acupuncture is not possible, acupuncture-like transcutaneous electrical nerve stimulation (TENS) is a good alternative. In addition, reflex therapy based on foot reflex areas may also be an alternative. A lack of controlled studies is the main drawback for the methods mentioned above. However, the experiences from experts in this field may offer us new ideas to resolve refractory disorders in dermatology.