Written by a Medical Acupuncture for Veterinarians course graduate . Signed release obtained from client/author. 4368
Abstract: This case report pertains to a gelding who suffers from severe airborne allergies. While I am not certain if Zip’s allergies are improved by his acupuncture sessions, I believe that they have made his life more comfortable by alleviating muscle stress caused by chronic exuberant scratching.
History and Presentation: Zip is a 10-15 year old American Quarter Horse gelding who has suffered from worsening chronic atopy-induced pruritus for several years. His owner has tried a range of anti-histamines which seem to have minimal effect. Multiple times a year (more commonly in the spring and summer), he develops full body urticaria, for which he receives dexamethasone injections (typically a single injection). Zip is a pasture pet/occasional trail riding horse.
Physical Examination and Assessment: Total bilateral alopecia of the face (rostral to the orbits is completely bald) with hyperpigmentation of the skin in this location. The rest of his hair coat is shiny but thin. His owner applies a homemade mixture of coconut oil and peppermint to his face in the bald areas. Vitals and body condition are otherwise normal.
Myofascial Examination at first visit 7/17/17: Marked trigger points along right cervical spine (extending from poll to shoulder). Trigger points along left gluteals and hamstrings.
Myofascial Examination 7/20/17: Cervical trigger points have completely resolved. Lumbar spine trigger points (right > left) present. Trigger pints along left gluteals still present. Temporomandibular trigger points today.
Myofascial Examination 7/24/17: Cervical spine remains comfortable. Temporomandibular joint trigger points have resolved. Right lumbar and left gluteal trigger points persist.
Myofascial Examination 8/2/17: Similar to 7/24 examination. Hair is growing back (minimal) over bald face.
Medical Decision Making: The goal with acupuncture in this case was to see if we could improve his immune function (by tempering his allergic response) and to make him comfortable and resolve his trigger points, some of which may be related to his itching.
It is believed that some cases of chronic allergy are strongly linked to over active neuro-endocrine dysfunction, thus neuromodulation of the nervous system (and stress hormone pathways) may lead to decreases in chronic atopy. Interaction between the needles and skin/connective tissue/associated nerves and vascular structures may thus influence the immune system and may help to decrease overstimulation there. Additionally, the needles may influence local immune system components, like mast cells, potentially leading to decreased release of histamine, and decreased itchiness.
Unfortunately, two of the large “immune modulating” acupuncture points shown to have an effect in dogs and humans do not transpose well to horses – namely LI 4 and LU 6. However, ST 36 is easily accessible in horses, and is also known to be a prominent “immune modulating point.”
Differential Diagnoses: Atopy. History of chronic right stifle arthritis (which may have lead to the right lumbar sensitivity and left gluteal sensitivity from compensation).
Definitive Diagnosis: Atopy – diagnosed via seasonal history of clinical signs.
Acupuncture Treatments: Treatments were performed on 4 occasions.
7/17/17: LI 16, GB 21 and Bai Hui were chosen as initial points to introduce Zip to acupuncture and for relaxation/parasympathetic modulation. BL 10 was placed bilaterally, and un-named cervical spinal points were placed in a line extending from BL 10 to the shoulder in the locations of the trigger points aforementioned. ST 36 was placed bilaterally for immune neuromodulation (although he was resistant to placement on the right – possibly due to chronic stifle injury). BL 27-30, GB 29, GB 30, BL 54, BL 37, BL 38, and BL 40 were placed bilaterally in response to trigger points on the left and to balance him on the right. All needles used were tubed pink (0.23 mm x 30 mm) Serins, and the session lasted 20 minutes.
7/20/17: Same treatment as above, excluding the un-named cervical spine points, as these trigger points has resolved. TH 21 and ST 7 placed bilaterally for temporomandibular trigger points. Needle selection was the same.
7/24/17: Head/neck trigger points have all resolved. GB 21, LI 16, ST 36, and Bai Hui as above with pink Serins. BL 22-30 bilaterally and BL 31-34 bilaterally using pink Serins. GB 29, GB 30, BL 54, BL 37, BL 38 bilaterally using tubed purple (0.25 mm x 30 mm) Serins. Bladder points and GB points were chosen in response to trigger points. Larger needles were used in an effort to see if more of an effect could be elicited to diminish the hind end trigger points.
8/2/17: Same treatment as on 7/24/17
Outcome, Discussion, References: Zip’s musculoskeletal pain responded very well to acupuncture and he seems to enjoy his sessions. His owner relayed that within 6 hours of his first treatment, she let him out and he “trotted around the paddock with his head up and tail out like a show pony” which she stated that she hasn’t seen him do in years. While I don’t think that there has been any significant decrease in his pruritus attributable to the acupuncture at this time, I do believe that his chronic scratching led to musculoskeletal pain that has now been alleviated. I believe that the persistent hind-quarter trigger points are likely related to his chronic stifle arthritis and probably would benefit from maintenance acupuncture sessions. It is possible that with further sessions, we may see more change in his atopy.
Two scientific reports that speak to the link between the immune system and atopy are as follows:
- The neuroendocrine-immune connection regulates chronic inflammatory disease in allergy by Peters in Chemical Immunology and Allergy in 2012.
- Acupuncture modulates the neuro-endocrine-immune network by Ding al in Quarterly Journal of Medicine in 2013.