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22


The allergist's dilemma

Chapter by: Ehrlich, Paul
in: Treating Eczema With Traditional Chinese Medicine by
[S.l.] : World Scientific Publishing Co. Pte. Ltd., 2022
pp. 13-14
ISBN: 9789811245923
CID: 5348832

Improvement of skin lesions in corticosteroid withdrawal-associated severe eczema by multicomponent traditional Chinese medicine therapy [Letter]

Uzun, Serife; Wang, Zixi; McKnight, Tory A; Ehrlich, Paul; Thanik, Erin; Nowak-Wegrzyn, Anna; Yang, Nan; Li, Xiu-Min
RATIONALE/BACKGROUND:We recently showed that multicomponent traditional Chinese medicine (TCM) therapy had steroid-sparing effects in moderate-to-severe eczema. We sought to evaluate TCM effects in severe eczema in a 7-year-old male with refractory disease and corticosteroid withdrawal syndrome. METHODS:Prior to referral, the patient had been treated since infancy with increasingly intensive standard of care, including high-dose topical and systemic corticosteroid and antibiotic therapy and was unable to tolerate further steroid treatment. The patient was administered a combination of oral and topical TCM for 17 months following discontinuation of his steroid regimen. His overall medical condition was assessed by SCORAD criteria and laboratory evaluations of serum IgE, absolute eosinophil count, and liver and kidney function tests. RESULTS:The patient showed rapid improvement of clinical measures of disease after starting TCM therapy, with marked improvement of sleep quality within the first week, complete resolution of itching, oozing, and erythema at 2 weeks, and a 79% and 99% decrease in his SCORAD values after one month and 3-6 months of TCM, respectively. Serum total IgE decreased by 75% (from 19,000 to 4630 (kIU/L), and absolute eosinophil counts decreased by 60% (from 1000 to 427 cells/μL) after 12 months of treatment. The patient did not require oral or topical steroids during the 17-month trial of TCM. TCM was tapered without complications. His dermatologic manifestations continued to be well-controlled 3 months after discontinuation. CONCLUSION/CONCLUSIONS:This case study suggests TCM should be further evaluated in controlled clinical studies of patients with severe, refractory eczema and steroid withdrawal syndrome.
PMCID:8268267
PMID: 34243796
ISSN: 1710-1484
CID: 4965742

Effect of Traditional Chinese Medicine (TCM) in moderate-to-severe eczema in clinic and animal model: beyond corticosteroids [Meeting Abstract]

Srivastava, K; Yang, N; Uzun, S; Thanik, E; Ehrlich, P; Chung, D; Yuan, Q; Nowak-Wegrzyn, A; Li, X -M
Rationale: Eczema is a chronic inflammatory skin disorder. We sought to evaluate efficacy and safety of TCM in humans and animal model of eczema.
Method(s): We retrospectively analyzed data of 28 patients with moderate-to-severe eczema who received TCM for at least 3 months in three cohorts based on eczema phenotype/endotype. Cohort #1 (n=10), ages 6 to 48 months, used topical steroids for at least 3 months prior to TCM with inadequate response. Cohort #2 (n=8), ages 2-40 years, had worsening eczema associated with sudden topical steroid withdrawal (TSW, n=8) at least 3 months prior to TCM. Cohort #3 had a very high total IgE (>5,000 kIU/L, n=10), ages 1-13 years. The TCM regimen included external herbal bath, cream, and oral tea. We also tested the TCM effects in a mouse model of eczema treated daily for 9 days.
Result(s): Following TCM treatment, cohort #1 showed reduced SCORAD and steroid use as early as one month (p<0.001) and close to zero by 6 months. Cohort #2 showed improved SCORAD (73.6%, p<0.001), and markedly decreased sleep disturbance (80%, p<0.001) as early as one month. Cohort #3 had markedly reduced total IgE from median 12,328 to 3,994 kIU/L after 6-24 months. TCM significantly reduced elevated blood eosinophils (p<0.05). No liver or kidney function abnormality was observed. Animal model of eczema showed distinctly reduced SCORAD, scratching scores, and skin eosinophil counts. TCM tea also showed dose dependent reduction of IgE, TNF-alpha and exotoxin production in vitro.
Conclusion(s): TCM is efficacious and safe in children and adults with steroid dependent-eczema.
Copyright
EMBASE:2004874796
ISSN: 1097-6825
CID: 4315102

Successful prevention of extremely frequent and severe food anaphylaxis in three children by combined traditional Chinese medicine therapy

Lisann, Lauren; Song, Ying; Wang, Julie; Ehrlich, Paul; Maitland, Anne; Li, Xiu-Min
BACKGROUND: Despite strict avoidance, severely food-allergic children experience frequent and potentially severe food-induced anaphylaxis (FSFA). There are no accepted preventive interventions for FSFA. A Traditional Chinese Medicine (TCM) formula prevents anaphylaxis in murine food allergy models, and has immunomodulatory effects in humans. We analyzed the effects of TCM treatment on three pediatric patients with FSFA. CASE DESCRIPTION: Three FSFA patients (P) ages 9-16 years (P1 allergic to milk; P2 and P3 to tree nuts) qualified for case analysis. All experienced numerous reactions requiring administration of rescue medications and emergency room (ER) visits during the 2 years prior to starting TCM. P1 experienced approximately 100 reactions, 50 epinephrine administrations, 40 ER visits, and 3 admissions to intensive care units. P2 experienced 30 reactions, all requiring epinephrine administration, as well as 10 emergency hospitalizations. P3 experienced 400 reactions, five of which required epinephrine administration and ER visits. TCM treatment markedly reduced or eliminated reactions in all. P1 experienced no reactions after 2.5 years of TCM. P2 experienced no reactions after 1 year of TCM treatment, at which time she passed an oral almond food challenge. She continues to be reaction-free 6 months off TCM while consuming nuts. P3 has achieved a 94% reduction in reaction frequency following 7 months of TCM, has discontinued daily antihistamine use, and has required no epinephrine administrations or ER visits. CONCLUSIONS: Three children treated with TCM experienced dramatic reductions or elimination of FSFA. This regimen appears to present a potential option for FSFA, and warrants further investigation in controlled clinical studies.
PMCID:4322482
PMID: 25670938
ISSN: 1710-1484
CID: 1463392

Identifying children at very low risk of intra-abdominal injuries undergoing acute intervention [Meeting Abstract]

Holmes J.; Lillis K.; Monroe D.; Borgialli D.; Kerrey B.; Mahajan P.; Adelgais K.; Ellison A.; Yen K.; Atabaki S.; Menaker J.; Bonsu B.; Quayle K.; Garcia M.; Rogers A.; Blumberg S.; Lee L.; Tunik M.; Kooistra J.; Kwok M.; Cook L.; Dean M.; Sokolove P.; Wisner D.; Ehrlich P.; Cooper A.; Dayan P.; Wooton-Gorges S.; Kuppermann N.
Background: Use of abdominal computed tomography (CT) in children with blunt abdominal trauma is highly variable due to limited evidence available to clinicians. Objectives: To derive a clinical prediction rule to identify children with blunt abdominal trauma who are at very low risk for intra-abdominal injuries (IAIs) undergoing acute intervention. Methods: We prospectively enrolled children (< 18 years old) with blunt torso trauma in 20 emergency departments (EDs) and documented history and physical examination findings onto data forms prior to abdominal CT, if obtained. Patients discharged from the ED were contacted by telephone and hospitalized patients were followed for IAI outcomes. We used binary recursive partitioning to create a prediction rule to identify patients at very low risk for IAI undergoing an acute intervention (therapeutic laparot- omy, angiographic embolization, blood transfusion for abdominal hemorrhage, or IV fluid administration for > 2 days in those with pancreatic/duodenal injuries). We considered only historical and physical examination variables with acceptable inter-rater reliability for possible inclusion into the rule. Results: We enrolled 12,044 patients with a mean age of 9.8 +/- 5.4 years; 5,179 (43%) underwent abdominal CT in the ED. of the 761 patients with IAIs, 203 (27%; 95% CI 24, 30%) had IAI undergoing acute intervention. The derived clinical prediction rule for IAI undergoing acute intervention consisted of: complaints of abdominal pain, history of vomiting, evidence of abdominal wall trauma (including seat belt sign), Glasgow Coma Scale score < 14, abdominal tenderness, evidence of thoracic wall trauma, and decreased breath sounds. The rule identified 197/203 (97%; 95% CI 95, 99%) patients with IAI undergoing acute intervention and had a negative predictive value of 5,028/5,034 (99.9%; 95% CI 99.8, 100%). Conclusion: We derived a clinical prediction rule consisting of simple clinical variables, which identifies almost all children with IAI undergoing acute intervention. Patients lacking these variables are at very low risk of IAI requiring therapeutic intervention. CT scanning is typically not warranted for these patients
EMBASE:70473696
ISSN: 1069-6563
CID: 135604

Asthma allergies children : a parent's guide

Ehrlich, Paul; Chiaramonte, Lawrence T; Erhlich, Henry
Brooklyn NY : 3rd Ave. Books, 2010
Extent: xi, 297 p. ; 22cm
ISBN: 9780984383207
CID: 2188

AsthmaAllergiesChildren.com, 2010-

AsthmaAllergiesChildren.com : a parent's (web) guide

Ehrlich, Paul; Chiaramonte, Lawrence
(Website)
CID: 150919

Immunological aspects of allergy and anaphylaxis

Chapter by: Ehrlich, Paul M; Field, Jonathan D
in: Essential clinical immunology by Zabriskie, John B [Eds]
Cambridge UK : Cambridge University Press, 2009
pp. ?-?
ISBN: 0521516811
CID: 5430

Proof of electro-osmotic drug delivery : a prejudiced clinical trial, delivering from mouth to nose

Ehrlich, Paul; Sceusa, Nicholas
ORIGINAL:0006786
ISSN: 1071-7544
CID: 113737

Development of fibroblast cell lines from patients with venous ulcers for the nia aging cell repository [Meeting Abstract]

Tomic-Canic, M; Stojadinovic, O; Ehrlich, P; Diegleman, R; Golinko, M; Coppock, L; Brem, H
ISI:000244741900071
ISSN: 1067-1927
CID: 107020