AAAAI 2009: Chinese Herbal Preparations Show Efficacy Against Asthma, Atopy

Martha Kerr

March 17, 2009

March 17, 2009 (Washington, DC) — Chinese herbal preparations exert strong clinical and laboratory effects on asthma and atopy, with close to complete resolution of atopy symptoms and lower cytokine production in patients with asthma, according to findings from a number of studies presented here at the 2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting.

In 1 study, a team at Mount Sinai Medical Center, in New York City, led by Xiu-Min Li, MD, associate professor of Pediatric Allergy and Immunology, studied the effects of an anti-asthma herbal medicine intervention (ASHMI), a 3-herb formulation that has been shown in laboratory tests to improve symptoms of asthma.

ASHMI reduced total immunoglobulin (Ig)E levels in patients with allergic asthma, reported coinvestigator Laverne L. Brown, PhD, associate professor in the Department of Pharmaceutical Science at Mount Sinai Hospital.

"We set out to determine the mechanisms by which the individual herbs exert their effects," Dr. Brown told Medscape Allergy & Clinical Immunology. Her team evaluated IgE suppression by each of the herbs on human myeloma B cells.

The 3 components of ASHMI — GanCao, KuShen, and LingZhi — are most effective in a ratio of 3:9:20, she said.

The 3-herb combination lowered total IgE levels, from approximately 850 to 500 kU/L. When the compound was fractionated by polarity and acidity, KuShen suppressed IgE production by approximately 95% in one analysis.

"If we can find out what specific compounds in these herbs exert the greatest effect, we can isolate them and develop them for asthma. We wouldn't have to give the whole herb or other compounds that may not have the effect we want," Dr. Brown explained.

In another study under the direction of Dr. Li, Julie Wang, MD, from the Department of Allergy and Immunology and Pediatric Allergy and Immunology at Mount Sinai, presented results of a phase 1 safety study of Food Allergy Herbal Formula (FAHF)-2, which consists of 9 herbs.

Laboratory studies showed that FAHF-2 "completely protected a murine model against peanut-induced anaphylaxis for as long as 6 months," Dr. Wang told Medscape Allergy & Clinical Immunology.

The investigators studied the safety of FAHF-2 in 12 patients with a history of peanut, tree nut, fish, or shellfish allergy in a dose-escalation study. They were randomized to 2.2 g (4 tablets), 3.3 g (6 tablets), or 6.6 g (12 tablets) 3 times daily for 7 days. Subjects continued allergen avoidance for the duration of the study.

"All of the patients successfully completed treatment," Dr. Wang reported. "There were no significant differences in vital signs, laboratory data, electrocardiographic findings, or pulmonary-function tests before or after treatment.

"Only 2 patients reported mild gastrointestinal symptoms, 1 on FAHF-2 and 1 on placebo, which resolved without any need for treatment," she said.

"We don't know the clinical effect at this time. This was a safety study, and FAHF-2 is safe. . . . However, we saw a significant drop in cytokines, especially [interleukin]-5, with active treatment [P < .0008]," Dr. Wang said. "We are ready to continue to efficacy studies now."

Another study under the direction of Dr. Li involved 14 children (mean age, 5.4 years) with persistent atopic dermatitis. Children were treated with "traditional Chinese medicine . . . consisting of Erka Shizheng herbal tea, bath additives, creams, and acupuncture," John Wisniewski, MD, also from Mount Sinai Hospital, in New York City, reported.

Good improvement, with a reduction in Scoring Atopic Dermatitis scores, ranging from 60% to 90%, was seen in 13 of the 14 patients after 3.3 months. More than a 50% improvement in Dermatology Life-Quality Index scores were achieved in 13 of 14 patients in 2.4 months (range, 0.7 – 5.9 months).

Peripheral eosinophilia decreased from 1000±700 to 500±200 mc/L (P = .03) with no change in total blood counts. There were no liver- or kidney-function-test abnormalities.

Patients reported a reduction in use of steroids, antibiotics, and antihistamines within 3 months of traditional Chinese medicine treatment, Dr. Wisniewski told meeting attendees.

"While the results of Dr. Li's team are very strong and very promising, we have to be very careful here," Wesley Burks, MD, from the Department of Pediatrics and Allergy and Immunology at Duke University School of Medicine, in Durham, North Carolina, said in an interview with Medscape Allergy & Clinical Immunology. "Herbal preparations are not regulated. They can carry contaminants such as mold that can make the situation much worse.

"Dr. Li's team is using [mass spectroscopy] to control the ingredients and they are operating under [US Food and Drug Administration New Drug Application] regulations, so her results are especially interesting," Dr. Burks said.

"There is hope out there for asthma and atopic dermatitis, but these are still very investigational findings," Dr. Burks cautioned.

The investigators and Dr. Burks have disclosed no relevant financial relationships.

2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting: Abstracts 131, 673, 738. Presented March 16, 2009.


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