By Dr. Shihan Mary Bolz
Master of Science Oriental Medicine
Doctor of Acupuncture & Oriental Medicine
Master Martial Arts Instructor
The incidence of allergic asthma and of eczema, which is associated with it, has steadily increased in industrialized countries in the recent past decades and both morbidity and mortality are increasing. In the USA, an estimated 20 million people (of which 5 million are children) suffer from asthma. In spite of new drugs, severe asthma is still the most common chronic debilitating disease in childhood and its mortality rate has not declined.
Long-term use of some anti-asthma drugs, i.e. bronchodilators, may have increased the mortality rate, which has increased by 45% in the last 10 years in the USA. In the UK, deaths from asthma in the 1960s surged after pressurized aerosols for asthma became available over the counter. As the sales went up, so did the deaths. In New Zealand, asthma deaths increased four-fold in the 1980s over five years. This was also attributed to the introduction of ß2 agonists. In the USA also, mortality from asthma has increased constantly from 1979. In the USA, asthma prevalence (the percentage of people who have ever been diagnosed with asthma and still have asthma) increased from 7.3% in 2001 to 8.4% in 2010. In 2010, 1.8 million people visited an ER for asthma-related care and 439,000 people were hospitalized because of asthma.
Symptoms and signs evolve from three basic characteristics that underlie the disease: 1) airway obstruction 2) airway hyper-responsiveness airway inflammation
Pathology is characterized by partial and temporary obstruction of airflow in the airways. Bronchial narrowing in asthma can be caused by three main factors: mucus in the bronchi, swelling of the internal layers, bronchial narrowing which interferes with ventilation and raises the resistance to airflow in the bronchi. This is more marked on exhalation and it causes air to be trapped in the lungs. The narrowed bronchi can no longer be effectively cleared of mucus by allergic asthma, the bronchospasm is caused by an allergic reaction due to immune hypersensitivity. This is also called anaphylactic or Type-I reaction. The narrowing of the airways is more often due to the other two factors.
Only IgE(reaginic) antibodies produce Type-I reactions. As these antibodies adhere strongly to tissues (and particularly to mast cells in the tissues), they are often called tissue-sensitizing antibodies.
What are some of the causes of this increase in modern societies? We know that almost all of our diseases and imbalances are caused by our diet and lifestyle and by the environment having been violated with human interference (e.g. human-made chemicals and human-caused chemical imbalances in the environment). Rarely is the cause entirely exogenous in reality, because if our immune system, our bodies, are in balance with nature, we remain in a state of homeostasis which we call good health. Some direct and specific causes are as follows:
Chemicals in food and in the air are likely a major culprit.
Look at the following chart or some common additives in boxed food.
￼ In patients with allergic asthma, inhalation challenge with an antigen produces an immediate broncho-constriction, reaching a maximum in 20 minutes. This early asthmatic response is almost identical in time course to the wheal reaction seen in the skin in cases of skin allergies, such as eczema, which often accompanies allergic asthma.
This shows that the primary etiological factor of allergic asthma is indeed the allergic reaction rather than the inflammation process following the allergic reaction. However, the main thrust of the therapeutic conventional medical intervention is based on the use of anti-inflammatory drugs (corticosteroid, such as Prednisone). While these class of drugs can relieve the symptoms and seemingly allow relief of symptoms, these are not really addressing the problem. The inflammatory process is not the cause, it is the result of the reaction. Therefore, the corticosteroid use of drugs such as Prednisone should be questioned as to the efficacy and one should think about the great side effects of these drugs. Some Chinese medicine doctors and medical thinkers place the stress on bronchoconstriction as opposed to inflammation as the main cause of asthma. Chemical mediators of inflammatory response are present in the normal lung and do not cause broncho-constriction: this seems to prove that inflammation is not the primary cause of asthma, while allergy is.
According to Dr. Giovanni Machiocca, (doctor of Chinese Medicine), asthmatics do not have a plateau to bronchoconstriction following histamine challenge. The lack of plateau with resulting unrestricted bronchoconstriction cannot be explained by excessive smooth muscle excitation by neural or humoral mediators. Dr. Machiocca states that Macklem1 thinks that airway smooth muscle hypertrophy is the main culprit in producing unlimited bronchoconstriction. As a result, Macklem expresses his doubts about steroid therapy as this has no effect on airway smooth muscles.
Many different allergens are implicated but the main ones are: house dust mite, fungal spores, feathers, animal dander and cats’ saliva.
Individuals with allergic asthma have levels of IgE immunoglobulins up to six times higher than those found in patients suffering from non-atopic asthma. Atopic individuals have a hereditary predisposition to anaphylactic (orType-I) reactions. One of the main allergens is pollen. Once the mast cells have been primed by exposure to these allergens and high levels of IgE immunoglobulins adhere to them, they also become hypersensitive to other non-specific allergens such as: smoke, tobacco smoke, petrol fumes, dust, atmospheric pollutants and perfumes.
Occasionally, an allergic reaction in the bronchi can be elicited by ingested allergens from food which reach the bronchi via the bloodstream: shellfish, fish, eggs, milk, yeast and wheat. Viruses may also act as allergens and that is why an attack of allergic asthma in a child may be triggered by a viral infection, the most common ones being the respiratory syncytial virus (RSV) and influenza virus.
The “hygiene hypothesis,” i.e. increased incidence of atopy is due to lack of infections in childhood (itself partly due to immunizations). At birth, infants destined to become allergic have impaired production of interferon γ by their circulating T lymphocytes. Exposure to bacteria in early life increases production of interferon γ. This concept has given rise to the hygiene hypothesis in which changes to infant diets, early use of antibiotics and reduced exposure to bacterial substances predispose to the persistence of Th2 responses in childhood. In short, the children are not exposed to enough common and normal germs in every day life.
This is confirmed by a study conducted on children attending anthroposophic schools, where children are not vaccinated, use of antibiotics is minimized and fermented products with lactobacilli are consumed. Prevalence of atopy was lower in children from anthroposophic families than in children from other families. A study conducted in Guinea-Bissau, found that exposure to measles infection protected against the development of atopy in African children. The study also found that those who had been breastfed for more than one year were less likely to have a positive skin test to house dust mite. The clean living conditions of Western societies, by reducing the incidence of infection, may up the balance toward the TH2 phenotype and predispose people to asthma.
Another study concluded that: 1) Exposure to at least one course of antibiotics in the first year of life appears to be a risk factor for the development of childhood asthma. 2) This study also forms the hypothesis that growing up in a more hygienic environment with less microbial exposure may increase atopic immune responses and thus the development of asthma.
Dairy foods, which certainly are a possible etiological factor in asthma, are not mentioned in the etiology of Xiao-Chuan (ashma-type diseases) in Chinese medical texts simply because they are not eaten in China traditionally. Dairy has not been a food eaten traditionally in Japan nor any other Asian country. Before WW II, Japan did not use dairy products. It was after the United States destroyed them and they were lacking food, that the U.S. then sent powdered milk over there as well as other American foods because the war damage destroyed food crops, farmers, and jobs. Intolerance to milk is an important etiological factor in allergic asthma as well as sour, greasy or cold foods.
Phlegm is not the main pathogenic factor in allergic asthma, whereas it can be, in chronic asthma.The wheezing and breathlessness are due to narrowing of the airways from bronchospasm following an allergic reaction. The narrowed bronchi cannot be properly cleared of mucus by coughing.Seen from this point of view,phlegm is therefore the result rather than the cause of the wheezing. Other doctors also understood as early as 1868 that wheezing and breathlessness in asthma were due to bronchospasm rather than obstruction from phlegm and that this was the result rather than the cause of asthma. There is also a difference between the type of mucus in chronic bronchitis and in asthma.
According to Traditional Chinese Medicine theory, the immune hyper-reactivity which is at the basis of allergic asthma is due to a deficiency of both lungs and kidneys. Physiology confirms this as all cells involved in the immune response are derived from a common stem cell in the marrow (which is a product of the Kidney-Jing). The kidney’s Wei-Qi system is also involved (something similar, but not the same, as the immune system).
There are a few modern Chinese doctors who place emphasis on tonifying the kidneys in asthma. For example, Dr. Zhang Jing Lei believes that in order to treat the inflammation process, the atopy and the bronchoconstriction, it is necessary to nourish Kidney-Yin. Dr. Shen Zi Yin thinks that tonifying the Kidneys is necessary not only from the perspective of Chinese medicine but also from that of Western medicine. He says that using herbs with a sweet and sour taste stabilizes the cell membranes and therefore has a stabilizing effect on the mast cells in the bronchi. Dr. Shen also says that tonifying the Kidneys (and especially Kidney-Yang) in asthma has the effect of regulating immunity by regulating the T cells and reducing the levels of IgE.
How does a deficiency of the Kidney’s Wei-Qi system arise? It may derive from: a) hereditary constitutional weakness; b) problems to the mother during pregnancy such as a shock, smoking, drinking alcohol, or using medications and drugs; c) problems at childbirth such as fetal distress, induction of labor and premature cutting of the umbilical cord; d) immunizations.
Some drugs may also been have shown to predispose infants to atopic disease. For example, beta-adrenergic receptor-blocking drugs taken for toxicosis of pregnancy, had elevated IgE levels in the cord blood and children developed clinical allergy during the first four years of life significantly more often than the children of placebo-treated control mothers.
The period of time during the actual birth has a bearing on the development of the Lung and Kidney’s Wei-Qi systems. Studies have shown that stress during the neonatal period may increase the risk of development of allergy later in life. In particular, premature severing of the umbilical cord may interrupt the vital flow of hormones and immune cells from the placenta to the offspring and the excretion of waste products from the baby to the placenta. IgG immunoglobulins which prevent IgE-mediated allergic reactions, are the only immunoglobulins that are transported across the placenta to reach the fetal circulation. Therefore, premature severance of the umbilical cord may lead to a deficiency of IgG immunoglobulins in the baby and therefore a predisposition to IgE-mediated allergic reactions later in life. Levels of IgE antibodies are already higher at birth in infants who later develop atopic disease. As IgEantibodies do not cross the placental barrier they must be of fetal origin. Elevated levels suggest a spontaneous antibody formation which is not suppressed by IgG immunoglobulins.
Umbilical cord blood is rich in stem cells found in bone marrow and has been used instead of bone marrow transplant. Placenta and umbilical cord has been used for the treatment of asthma in children in Chinese medicine. The very last development of lungs and kidneys takes place in the birth canal and in babies delivered by Caesarian section there is a higher incidence of allergic asthma.
Immunizations may sometimes trigger off atopic asthma and/or eczema in susceptible individuals. Animal studies have shown that pertussis bacteria induce IgE antibody formation, therefore pertussis immunization may induce excessive levels of IgE antibodies: more so if given during the pollen season. Some have suggested that the increasing incidence of asthma may be due to vaccinations, primarily to whole cell pertussis vaccine. Some have hypothesized that vaccines might change the balance of immunity towards allergic responses either directly (that is, caused by the immune responses to the vaccine) or indirectly (by altering the balance of immune responses to infections in infancy). Also, just by preventing infections in childhood, vaccinations may cause an imbalance in immune responses later in life. Studies have shown that atopic dermatitis was significantly lower in the babies of mothers avoiding dairy and other of the previously mentioned foods during the first six months of breastfeeding. Other studies have also shown that the incidence of asthma in children under 6 is higher in children who were introduced to milk other than breast milk before 4 months of age.
There are certain herbs in Traditional Chinese Medicine (TCM) that are used to help relieve the symptoms and there are certain herbs used to help cure asthma. All Chinese medicinals use formulas, not single herbs, as one single herb or folk-medicine type use of herbs, does not work. Many centuries have been put into the science and art of Chinese herbal pharmacology and it cannot just be guessed or bought over-the-counter to effect a real cure nor truly address the symptoms. Practitioners of TCM spend years of study and practice which give them the tools to diagnose and treat both allergic and chronic asthma successfully.
Interestingly, some of the herbs which Traditional Chinese medicine uses for treatment have been shown by modern research to reduce levels of IgE immunoglobulins which are responsible for the antigen-antibody reaction which triggers off an asthma attack. Acupuncture has been shown to provide immediate relief in helping to relax the bronchial spasms and provide more open airways. To cure the problem, consistent, ongoing acupuncture treatments must be done for a period of weeks or months. In some cases, acupuncture more controls the problem than cures it, depending on how difficult the case is.
TCM (Traditional Chinese Medicine) has reliable and flexible tools which can treat and often, not always, cure allergic asthma as well as chronic asthma. An additional benefit of using this type of medicine is that there are no long-term side effects or dangers of causing other diseases as in the use of allopathic pharmaceuticals. That, of itself, would help you breath easy!
1Macklem P T The Importance of Excessive Broncho-constriction in Asthma in Giornale Italianodi Allergologiae Immunologia Clinica, Vol. 2, No. 5, October 1992, p. 276., Vol. 2, No. 5, October 1992, p. 276.