Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis – a patient- and examiner-blinded, randomized, placebo-controlled, crossover trial

Authors

  • F. Pfab,

    Corresponding author
    1. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
    2. Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
    3. Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
    • Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
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  • M.-T. Kirchner,

    1. Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
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  • J. Huss-Marp,

    1. Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
    2. Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
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  • T. Schuster,

    1. Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
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  • P. C. Schalock,

    1. Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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  • J. Fuqin,

    1. Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
    2. Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
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  • G. I. Athanasiadis,

    1. Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
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  • H. Behrendt,

    1. Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
    2. Christine-Kühne Center of Allergy Research and Education (CK-CARE), Munich, Germany
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  • J. Ring,

    1. Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
    2. Christine-Kühne Center of Allergy Research and Education (CK-CARE), Munich, Germany
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  • U. Darsow,

    1. Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
    2. Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
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  • V. Napadow

    1. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
    2. Department of Radiology, Logan College of Chiropractic, Chesterfield, MO, USA
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  • Edited by: Werner Aberer

Correspondence

Florian Pfab, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Harvard Medical School CNY 149-2301, 13th St. Charlestown, Boston, MA 02129, USA.

Tel.: +1-617-838-6644

Fax: +1-617-726-7422

E-mail: pfab@nmr.mgh.harvard.edu

Abstract

Background

Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been shown to exhibit a significant effect on experimental itch in AD. Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner-blinded, randomized, placebo-controlled, crossover trial.

Methods

Allergen-induced itch was evaluated in 20 patients with AD after several interventions in separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture (VAp and VAa), cetirizine (10 mg, VC), corresponding placebo interventions (preventive, PAp, and abortive, PAa, placebo acupuncture; placebo cetirizine pill, PC) and a no-intervention control (NI). Itch was induced on the forearm and temperature modulated over 20 min, using our validated model. Outcome parameters included itch intensity, wheal and flare size and the D2 attention test.

Results

Mean itch intensity (SE: 0.31 each) was significantly lower following VAa (31.9) compared with all other groups (PAa: 36.5; VC: 36.8; VAp: 37.6; PC: 39.8; PAp: 39.9; NI: 45.7; P < 0.05). There was no significant difference between VAp and VC (P > 0.1), although both therapies were significantly superior to their respective placebo interventions (P < 0.05). Flare size following VAp was significantly smaller (P = 0.034) than that following PAp. D2 attention test score was significantly lower following VC compared with all other groups (P < 0.001).

Conclusions

Both VA and cetirizine significantly reduced type I hypersensitivity itch in patients with AD, compared with both placebo and NI. Timing of acupuncture application was important, as VAa had the most significant effect on itch, potentially because of counter-irritation and/or distraction. Itch reduction following cetirizine coincided with reduced attention.

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