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• W2051275892 abstract "To the Editor:The sensation of itch is the most common symptom and cause of suffering in many dermatologic and some allergic conditions.1Behrendt H. Krämer U. Schäfer T. Kasche A. Eberlein-König B. Darsow U. et al.Allergotoxicology—a research concept to study the role of environmental pollutants in allergy.ACI International. 2001; 13: 122-128Google Scholar, 2Sicherer S.H. Leung D.Y. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects.J Allergy Clin Immunol. 2005; 116: 153-163Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar In its subjective characteristics, it has some psychophysiologic similarity to pain, but recent neurophysiologic research has confirmed the distinctiveness of itch and pain pathways.3Yosipovitch G. Greaves M.W. Schmelz M. Itch.Lancet. 2003; 361: 690-694Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar Clinically, itch can be classified by distinguishing on the basis of the peripheral and central origins: pruritoceptive, neuropathic, neurogenic, and psychogenic itch. Pruritoceptive itch plays the greatest role in skin diseases and can be triggered by various itch mediators; it can be elicited experimentally most effectively through a histamine prick test.4Darsow U. Ring J. Scharein E. Bromm B. Correlations between histamine-induced wheal, flare and itch.Arch Dermatol Res. 1996; 288: 436-441Crossref PubMed Scopus (59) Google Scholar Acupuncture was shown to have antipruritic effects in early studies with healthy volunteers in the 1980s.5Belgrade M.J. Lawrence M.S. Lichter E.A. Effect of acupuncture on experimentally induced itch.Acta Derm Venereol. 1984; 64: 129-133PubMed Google Scholar, 6Lundeberg T. Bondesson L. Thomas M. Effect of acupuncture on experimentally induced itch.Br J Dermatol. 1987; 117: 771-777Crossref PubMed Scopus (64) Google Scholar It is unknown, however, whether acupuncture has a preventive effect on itch. Therefore this study aimed to evaluate a possible preventive effect of acupuncture on skin prick test histamine-induced itch and flare and wheal formation in 10 healthy volunteers.The study design was a blinded, randomized, prospective, 3-arm crossover trial. The acupuncturist and the observer were different individuals. All volunteers provided informed consent, had no acupuncture knowledge, and did not use medication with the potential to influence histamine reactions and normal itch or flare/wheal response to intraepidermal histamine injection.After a 15-minute resting period, the volunteers were randomized into one of 3 groups: “verum-point” acupuncture (A1), “placebo-point” acupuncture (A2) or no acupuncture (NA).7Birch S. Clinical research on acupuncture. Part 2. Controlled clinical trials, an overview of their methods.J Altern Complement Med. 2004; 10: 481-498Crossref PubMed Scopus (56) Google Scholar After acupuncture procedures (lasting 15 minutes) or after a corresponding resting period, an evaluated 1% histamine dihydrochloride stimulus was applied on the dorsum of the forearm of the subject's dominant hand. The technique was performed by the same investigator using conventional blood lancets for skin prick testing as in routine allergy diagnosis. Itch intensity was rated on a computerized visual analog scale (VAS) at 20-second intervals over a period of 10 minutes. At one third of the scale, the intervention point scratch threshold was installed; above this threshold, each individual strongly felt the desire to scratch, which was not permitted.Itch parameters were quantitatively expressed in percentages of the VAS at 30 different time points. The area under the curve was calculated as VAS (in percentages) multiplied by time (in seconds). After 10 minutes, wheal-and-flare reactions were measured at the stimulus site as averages of 4 perpendicular diameters, and the Eppendorf Itch Questionnaire (EIQ),8Darsow U. Scharein E. Simon D. Walter G. Bromm B. Ring J. New aspects of itch pathophysiology: component analysis of atopic itch using the “Eppendorf Itch Questionnaire.”.Int Arch Allergy Immunol. 2001; 124: 326-331Crossref PubMed Scopus (113) Google Scholar a validated instrument for qualitative and quantitative registration of pruritus, was presented to the volunteers. It contains 80 items, including questions concerning painful sensations. Each item was rated from 0 (not applicable) to 4 (very applicable).Verum-point acupuncture was performed on the arm of the subject's dominant hand at the point Quchi (Fig 1), which is, according to a Chinese standard acupuncture textbook, most important for treating cutaneous pruritus.9Zhang E. Chinese acupuncture and moxibustion. Publishing house of Shanghai College of Traditional Chinese Medicine, Shanghai1990Google Scholar A stainless-steel needle (0.25 × 40 mm) was inserted 2 to 3 cm and manipulated for a 15-second period. After 15 minutes, the needle was taken out without manipulation. Placebo acupuncture was performed on the dominant arm at a point in the same dermatome (C6) as Quchi but not belonging to the classic meridian system and thus far not acknowledged as an acupuncture point (Fig 1). Needling procedures were carried out equally in both acupuncture groups.All subjects reported itch without pain 40 seconds after histamine application (Fig 2). Maximum itch intensity and corresponding time were 46.7% at 4 minutes (NA group), 38.4% at 2.3 minutes (A1 group), and 41.2% at 4.3 minutes (A2 group). The mean VAS ratings for the entire 10-minute measurement period were significantly lower in the A1 group (31% ± 13%) compared with those in the A2 group (37% ± 17%, P < .001) and the NA group (39% ± 19%, P < .001). The area under the curve for itch intensity was significantly lower in the A1 group (18,600%s ± 6900%s) compared with that in the NA group (23,500%s ± 9500%s, P = .02) and the A2 group (22,100%s ± 9400%s, P = .05). At 15 of 30 time points, mean VAS ratings were significantly lower in the A1 group compared with that in the NA group; at 7 of 30 time points, mean VAS ratings were significantly lower in the A1 group compared with those in the A2 group. Measurements above the scratch threshold were significantly lower in the A1 group (9/30) compared with those in the A2 group (27/30, P < .0001) and the NA group (23/30, P = .001). The area above the scratch threshold was significantly (P = .05) lower in the A1 group (2600%s ± 2500%s) compared with that in the NA group (6500%s ± 6900%s). Corresponding mean flare/wheal sizes were 36.7/5.8 mm (NA group), 33.9/4.7 mm (A1 group), and 37.2/5.2 mm (A2 group), with a significant difference in mean wheal size between the A1 and NA groups (P = .03, see Table E1 in the Online Repository in the online version of this article at www.jacionline.org). In the EIQ (n = 9) descriptive ratings showed no significant difference between groups. The frequency of high emotional EIQ item ratings was significantly less in the A1 group compared with that in the NA group (P = .001) and the A2 group (P = .018). On a single-item level, the item “bothering” was rated significantly higher in the NA group compared with in the A1 group (P = .045).Fig 2Mean itch intensity in verum-point acupuncture reaches a lower score and decreases faster below scratch level (represented by the turquoise line at 33% itch intensity) than in control groups. Asterisks indicate time points of significant differences between Quchi acupuncture and control, and crosses indicate time points of significant difference between Quchi acupuncture and placebo-point acupuncture. ∗/+P < .05, ∗∗/++P < .01.View Large Image Figure ViewerDownload (PPT)The study showed a significant reduction of experimentally induced itch and wheal formation after acupuncture point pretreatment compared with placebo-point pretreatment and no pretreatment.Thus far, no controlled study has investigated the preventive effect of acupuncture on histamine-induced itch. We observed an influence of verum-point acupuncture on emotional EIQ ratings without changes in descriptive ratings. A similar effect has been noted in patients with chronic pain, in whom acupuncture influences affective rather than sensory experience. It is as yet difficult to explain the pathophysiology of the observed effects because acupuncture studies in this field are still rare. Some data indicate that acupuncture might influence itch-associated mediator effects10Zijlstra F.J. van den Berg-de Lange I. Huygen F.J. Klein J. Anti-inflammatory actions of acupuncture.Mediators Inflamm. 2003; 12: 59-69Crossref PubMed Scopus (222) Google Scholar: in the central nervous system opioids and serotonin, on the spinal level prostaglandin E2, and in the periphery substance P, calcitonin gene–related peptide, vasoactive intestinal peptide, neuropeptide Y, TNF-α, IgE, IL-1, IL-6, IL-8, and IL-10.Further studies are needed to specifically evaluate a possible role of these mediators in acupuncture prophylaxis or treatment of itch and to evaluate the clinical effect in histamine-mediated diseases. We conclude that prophylactic acupuncture at point Quchi can significantly reduce histamine-induced itch and wheal formation compared with placebo-point acupuncture and no intervention, showing the relevance of point specificity for both procedure and underlying condition. To the Editor: The sensation of itch is the most common symptom and cause of suffering in many dermatologic and some allergic conditions.1Behrendt H. Krämer U. Schäfer T. Kasche A. Eberlein-König B. Darsow U. et al.Allergotoxicology—a research concept to study the role of environmental pollutants in allergy.ACI International. 2001; 13: 122-128Google Scholar, 2Sicherer S.H. Leung D.Y. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects.J Allergy Clin Immunol. 2005; 116: 153-163Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar In its subjective characteristics, it has some psychophysiologic similarity to pain, but recent neurophysiologic research has confirmed the distinctiveness of itch and pain pathways.3Yosipovitch G. Greaves M.W. Schmelz M. Itch.Lancet. 2003; 361: 690-694Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar Clinically, itch can be classified by distinguishing on the basis of the peripheral and central origins: pruritoceptive, neuropathic, neurogenic, and psychogenic itch. Pruritoceptive itch plays the greatest role in skin diseases and can be triggered by various itch mediators; it can be elicited experimentally most effectively through a histamine prick test.4Darsow U. Ring J. Scharein E. Bromm B. Correlations between histamine-induced wheal, flare and itch.Arch Dermatol Res. 1996; 288: 436-441Crossref PubMed Scopus (59) Google Scholar Acupuncture was shown to have antipruritic effects in early studies with healthy volunteers in the 1980s.5Belgrade M.J. Lawrence M.S. Lichter E.A. Effect of acupuncture on experimentally induced itch.Acta Derm Venereol. 1984; 64: 129-133PubMed Google Scholar, 6Lundeberg T. Bondesson L. Thomas M. Effect of acupuncture on experimentally induced itch.Br J Dermatol. 1987; 117: 771-777Crossref PubMed Scopus (64) Google Scholar It is unknown, however, whether acupuncture has a preventive effect on itch. Therefore this study aimed to evaluate a possible preventive effect of acupuncture on skin prick test histamine-induced itch and flare and wheal formation in 10 healthy volunteers. The study design was a blinded, randomized, prospective, 3-arm crossover trial. The acupuncturist and the observer were different individuals. All volunteers provided informed consent, had no acupuncture knowledge, and did not use medication with the potential to influence histamine reactions and normal itch or flare/wheal response to intraepidermal histamine injection. After a 15-minute resting period, the volunteers were randomized into one of 3 groups: “verum-point” acupuncture (A1), “placebo-point” acupuncture (A2) or no acupuncture (NA).7Birch S. Clinical research on acupuncture. Part 2. Controlled clinical trials, an overview of their methods.J Altern Complement Med. 2004; 10: 481-498Crossref PubMed Scopus (56) Google Scholar After acupuncture procedures (lasting 15 minutes) or after a corresponding resting period, an evaluated 1% histamine dihydrochloride stimulus was applied on the dorsum of the forearm of the subject's dominant hand. The technique was performed by the same investigator using conventional blood lancets for skin prick testing as in routine allergy diagnosis. Itch intensity was rated on a computerized visual analog scale (VAS) at 20-second intervals over a period of 10 minutes. At one third of the scale, the intervention point scratch threshold was installed; above this threshold, each individual strongly felt the desire to scratch, which was not permitted. Itch parameters were quantitatively expressed in percentages of the VAS at 30 different time points. The area under the curve was calculated as VAS (in percentages) multiplied by time (in seconds). After 10 minutes, wheal-and-flare reactions were measured at the stimulus site as averages of 4 perpendicular diameters, and the Eppendorf Itch Questionnaire (EIQ),8Darsow U. Scharein E. Simon D. Walter G. Bromm B. Ring J. New aspects of itch pathophysiology: component analysis of atopic itch using the “Eppendorf Itch Questionnaire.”.Int Arch Allergy Immunol. 2001; 124: 326-331Crossref PubMed Scopus (113) Google Scholar a validated instrument for qualitative and quantitative registration of pruritus, was presented to the volunteers. It contains 80 items, including questions concerning painful sensations. Each item was rated from 0 (not applicable) to 4 (very applicable). Verum-point acupuncture was performed on the arm of the subject's dominant hand at the point Quchi (Fig 1), which is, according to a Chinese standard acupuncture textbook, most important for treating cutaneous pruritus.9Zhang E. Chinese acupuncture and moxibustion. Publishing house of Shanghai College of Traditional Chinese Medicine, Shanghai1990Google Scholar A stainless-steel needle (0.25 × 40 mm) was inserted 2 to 3 cm and manipulated for a 15-second period. After 15 minutes, the needle was taken out without manipulation. Placebo acupuncture was performed on the dominant arm at a point in the same dermatome (C6) as Quchi but not belonging to the classic meridian system and thus far not acknowledged as an acupuncture point (Fig 1). Needling procedures were carried out equally in both acupuncture groups. All subjects reported itch without pain 40 seconds after histamine application (Fig 2). Maximum itch intensity and corresponding time were 46.7% at 4 minutes (NA group), 38.4% at 2.3 minutes (A1 group), and 41.2% at 4.3 minutes (A2 group). The mean VAS ratings for the entire 10-minute measurement period were significantly lower in the A1 group (31% ± 13%) compared with those in the A2 group (37% ± 17%, P < .001) and the NA group (39% ± 19%, P < .001). The area under the curve for itch intensity was significantly lower in the A1 group (18,600%s ± 6900%s) compared with that in the NA group (23,500%s ± 9500%s, P = .02) and the A2 group (22,100%s ± 9400%s, P = .05). At 15 of 30 time points, mean VAS ratings were significantly lower in the A1 group compared with that in the NA group; at 7 of 30 time points, mean VAS ratings were significantly lower in the A1 group compared with those in the A2 group. Measurements above the scratch threshold were significantly lower in the A1 group (9/30) compared with those in the A2 group (27/30, P < .0001) and the NA group (23/30, P = .001). The area above the scratch threshold was significantly (P = .05) lower in the A1 group (2600%s ± 2500%s) compared with that in the NA group (6500%s ± 6900%s). Corresponding mean flare/wheal sizes were 36.7/5.8 mm (NA group), 33.9/4.7 mm (A1 group), and 37.2/5.2 mm (A2 group), with a significant difference in mean wheal size between the A1 and NA groups (P = .03, see Table E1 in the Online Repository in the online version of this article at www.jacionline.org). In the EIQ (n = 9) descriptive ratings showed no significant difference between groups. The frequency of high emotional EIQ item ratings was significantly less in the A1 group compared with that in the NA group (P = .001) and the A2 group (P = .018). On a single-item level, the item “bothering” was rated significantly higher in the NA group compared with in the A1 group (P = .045). The study showed a significant reduction of experimentally induced itch and wheal formation after acupuncture point pretreatment compared with placebo-point pretreatment and no pretreatment. Thus far, no controlled study has investigated the preventive effect of acupuncture on histamine-induced itch. We observed an influence of verum-point acupuncture on emotional EIQ ratings without changes in descriptive ratings. A similar effect has been noted in patients with chronic pain, in whom acupuncture influences affective rather than sensory experience. It is as yet difficult to explain the pathophysiology of the observed effects because acupuncture studies in this field are still rare. Some data indicate that acupuncture might influence itch-associated mediator effects10Zijlstra F.J. van den Berg-de Lange I. Huygen F.J. Klein J. Anti-inflammatory actions of acupuncture.Mediators Inflamm. 2003; 12: 59-69Crossref PubMed Scopus (222) Google Scholar: in the central nervous system opioids and serotonin, on the spinal level prostaglandin E2, and in the periphery substance P, calcitonin gene–related peptide, vasoactive intestinal peptide, neuropeptide Y, TNF-α, IgE, IL-1, IL-6, IL-8, and IL-10. Further studies are needed to specifically evaluate a possible role of these mediators in acupuncture prophylaxis or treatment of itch and to evaluate the clinical effect in histamine-mediated diseases. We conclude that prophylactic acupuncture at point Quchi can significantly reduce histamine-induced itch and wheal formation compared with placebo-point acupuncture and no intervention, showing the relevance of point specificity for both procedure and underlying condition. Appendix. Supplementary data Download .pdf (.02 MB) Help with pdf files Appendix Download .pdf (.02 MB) Help with pdf files Appendix" @default.
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• W2051275892 title "Preventive effect of acupuncture on histamine-induced itch: A blinded, randomized, placebo-controlled, crossover trial" @default.
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