It's been one year since NEA, in collaboration with four peer patient advocacy organizations, hosted the landmark patient-focused drug development (PFDD) meeting dedicated to eczema.
Published On: Aug 22, 2017
Last Updated On: Aug 22, 2017
Xiu-Min Li, M.D., is Professor of Pediatrics in the Division of Pediatric Allergy and Immunology at the Icahn School of Medicine at Mount Sinai in New York.
Dr. Li focuses her research on food allergy and allergic asthma. Her clinical research has included clinical trials in both asthma and allergic diseases, including atopic dermatitis. In addition, Dr. Li is exploring Chinese herbal therapy for the treatment of eczema.
Dr. Li sat down with Henry Ehrlich, author of Food Allergies: Traditional Chinese Medicine, Western Science, and the Search for a Cure, and answered questions about traditional Chinese medicine in relationship to eczema.
A: Traditional Chinese medicine (TCM) has a long history of use in China, Korea, Japan, and other countries, where it is part of mainstream medicine and covered by insurance. As my friend and colleague Dr. Scott Sicherer says, what we call “traditional Chinese medicine” in the United States is just medicine in these countries, although all these countries also practice in the Western tradition.
TCM practice does not focus only on the disease or individual organs. Rather, it addresses establishing and maintaining the balance of yin-yang (two opposite-but-complementary forces), the homeostasis of organ systems in the body, and interactions with the environment. The treatment promotes self-healing.
Treatment may be similar if patients have similar symptoms, but usually it is customized for each patient. For example, a “classic” Chinese herbal formulation is a mixture of many herbs, but it can be modified for individual patients depending on the initial combination of symptoms and progress over time. I use these methods in my practice because they work. In my research I try to see why they work and how they can be improved.
A: First of all, it’s important to keep in mind that atopic dermatitis (AD) is, as the name implies, an atopic—allergic—disease. Readers are certainly aware of this because they use antihistamines [ed. note: antihistamines are used to help people with AD sleep, rather than to relieve itch] and topical steroids, both of which are generally staples of the medicine cabinet for allergic diseases.
AD is usually the first step in the allergic march that is often followed by a succession of environmental allergies, asthma, and food allergies. However, antihistamines and steroids do not get to the heart of the matter, which is that allergic diseases result when there is an imbalance between the parts of the immune system.
With TCM, we try to modulate these imbalances using a combination of lotions, creams, baths, teas, pills, and sometimes acupuncture and acupressure, which calm the immune system so that it eventually becomes less reactive.
Because the skin often has open sores and damaged tissue, we also use traditional herbal treatments for burns.
It is fundamental to TCM that we treat the whole body. Organ systems are not independent of one another. This has been borne out by the recent research on how eczematous skin may be an induction point for allergens like peanuts and may sensitize infants who have never eaten these allergens.
Treating the whole body is not easy or quick. That said, the skin frequently does improve much more rapidly than other allergic diseases that are being treated.
A: The research, per se, is part of the big picture work we are doing on food allergies and asthma, which also play a big role in AD, as with other allergies. The same “bad guys” such as allergen-specific IgE and elevated levels of IL-4 and IL-13 that are associated with allergic reactions are associated with AD. IL-5 helps attract eosinophils, a potent defense against intestinal parasites, which congregate wherever there is persistent inflammation, including the skin. We are lowering those. Likewise, they help elevate production of IgG4 blocking antibodies and interferon gamma, which are associated with protection from allergies.
This research allows us to understand the mechanisms by which all the medicines work, and discover ways to make them more effective.
A: We have had a great deal of success with patients whose AD was so bad that it represented a considerable threat to their quality of life and morale, both children and adults. When I began my clinical practice more than a decade ago, I started with eczema. Doctors sent patients to me after they felt they had done all they could do for them.
A: Patients should know that it is not, so far, reimbursable by insurance. The medicines are approved as supplements, not FDA pharmaceuticals. They should also know that the drugs are manufactured by reputable Chinese hospital pharmacies and tested for purity and consistency by WHO/FDA-approved laboratories. They are NOT to be lumped in with the kind of brand-name supplements that have been getting attention in the press.
TCM is appropriate for patients who have really exhausted all conventional therapies. It is also appropriate for those whose eczema is co-morbid with severe food allergies and asthma. In time, however, as these herbal treatments come into wider use, we may be able to treat people before they resort to steroids. We have done very well with small children who already have bad eczema.
A: We are now putting together plans for the first step in our creation of a “practice network” to train other practitioners to use some of these methods without having to learn an entire new discipline. This will begin with AD. It is enabled by the fact that the medicines are available as supplements. A small number of allergists and maybe dermatologists will spend time with me for instruction. Over a period of time, my hope is that we can build this network so that many patients in many parts of the country will achieve relief and a restored quality of life.