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Charlie Chaplin, Atopic Dermatitis and Other Allergies

Jacob Schor ND FABNO

September 26, 2009

 

I was watching a Charlie Chaplin movie the other morning when the alarm clock went off.  Actually I was dreaming a Charlie Chaplin movie when the radio turned on and the classical music became the movie’s sound track.  I woke slowly and recalled the dream clearly for most of the day.

The day after waking from this dream, National Public Radio played a story about Ashok Aswani, a doctor in India who hands out DVDs of Charlie Chaplin movies to his patients as medicine. 

http://www.npr.org/templates/story/story.php?storyId=113029425&ft=1&f=1004

Studies have been appearing regularly in the peer reviewed medical literature that have used Charlie Chaplin movies as a standardized experience of humor. Most often they use Modern Times, a movie I still vividly recall first seeing 50 years ago.

Almost all of these studies are the work of Dr. Hajime Kimata, an allergist at Unitika Central Hospital in Uji-City, Japan.  Chaplin’s Modern Times seems to be his drug of choice in most of these studies though of late he has also been using Mr. Bean.

The first mention Kimata made of this humorous approach to treating allergic reactions was in a letter to JAMA in 2001.  He credits Norman with giving him the idea for this research.

In this first trial, 26 patients with atopic dermatitis who were all allergic to dust mites and most of whom were also allergic to cedar pollen and cat dander were studied. After going 72 hours with no medication, they underwent skin prick tests before and after viewing Modern Times. The size of the resulting wheal was measured. A similar procedure was repeated before and after an 87-minute video featuring weather information. The wheal responses to dust mites, cedar pollen and cat dander were significantly reduced after watching Chaplin and the effect lasted for hours. Watching the weather had no effect on the wheal size.

Kimata reported on a similar study in 2003.  These patients were allergic to latex rather than dust mites.  Instead of humorous movies he had them listen to classical music. A positive response was seen in patients who listened to Mozart music, but interestingly, no response was seen in patients who listened to Beethoven.

A 2004 paper in Human Behavior brought cell phones into the equation.  This study compared the effect on specific blood parameters in people with atopic dermatitis of watching Mr. Bean, weather information or writing text messages on a cell phone.  Rowan Atkinson's The Best Bits of Mr. Bean reduced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal size while weather information did not. Text messaging on a mobile phone enhanced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses. “However, previewing the comic video counteracted mobile phone-mediated enhancement of plasma neurotrophins or allergic skin wheal responses, whereas previewing the weather information failed to do so.”

The thought that we need Mr. Bean to antidote the stress of living with a cell phone is, in itself, humorous.

In a 2004 paper, Kimata compared watching a humorous film or non-humorous movie on patients with bronchial asthma and their reaction to known triggers.  As you can guess by now, watching the funny movie reduced the asthmatic reactions while the non-funny movie had no effect.   Laughter decreases production of IgE specific to allergens.

[We should note that Kimata’s work on asthma appears to contradict an earlier 2003 Australian study that indicated that mirth or laughter was a common trigger for asthma attacks in children. Perhaps watching movies does not provoke as intense a bout of laughter compared to laughing together with other kids. ]

It is not all fund and games; crying is also useful in treating skin conditions.  Rather than Chaplin, in a 2006 paper, Kimata tells us he had patients with latex allergies watch Kramer vs. Kramer.  Those patients who were moved to tears had a reduced allergic response.

A 2007 paper, Kimata reports that watching humorous films is useful in treating night time waking in children with atopic dermatitis.  Patients with atopic dermatitis often suffer from night-time waking. Ghrelin effect is one possible explanation for this. Salivary ghrelin levels during the night were measured in 40 healthy children and 40 patients with atopic dermatitis with night-time waking. Salivary ghrelin levels at 2:00 AM were markedly elevated in patients with atopic dermatitis compared to those in healthy children. In contrast, viewing humorous films improved night-time waking and lowered salivary ghrelin levels in the kids with atopic dermatitis.

Another theory to explain this nighttime waking has to do with melatonin.  Kimata published a study about nursing mothers in 2007.   This paper also focused on why kids with atopic exczema don’t sleep well, but this time they monitored melatonin levels.  Watching Charlie Chaplin increased production of melatonin in women, whether they had atopic dermatitis or not, and also increased melatonin in their breast milk.  The interesting thing is that, “..feeding infants with increased levels of melatonin-containing milk reduced allergic responses in infants.”  

Think how often you’ve seen cases like this; a distraught mother brings in an infant with horrifying eczema, the kid can’t sleep, the mother is exhausted at wits end, and nothing seems to help.  How much effort would it take for the mom to watch a Mr. Bean video each time she nurses?

One can even measure a change in eczema related chemicals in the sweat of people who’ve watched Modern Times. Dermcidin (DCD)-derived peptide is an antimicrobial protein produced by the sweat glands. There are lower levels of DCD-derived peptide in sweat with atopic eczema.  The levels of this DCD protein were measured in the sweat of twenty people before and after watching Modern Times. Watching the movie increased the levels of this specific protein and may be part of the reason it helped their skin.

Kimata has used other humorous films besides Charlie Chaplin.  In a study of older men, watching Mr Bean.  Kimata measured salivary testosterone levels and transepidermal water loss (TEWL) values on the back of the neck in 36 elderly healthy people and 36 elderly patients with atopic dermatitis (AD).  This TEWL measurement of water loss is basically a measurement of how easily the skin dries out. Salivary testosterone levels were decreased while TEWL values were increased in elderly patients with atopic dermatitis compared to those in elderly healthy people. Viewing The Best Bits of Mr. Bean, slightly elevated salivary testosterone levels and reduced TEWL values in elderly healthy people. But in the elderly dermatitis patients, viewing  the Bean film markedly elevated salivary testosterone levels and reduced TEWL. Viewing a control non-humorous film failed to change values in either the healthy or dermatitis groups. Not only is watching funny movies useful for atopic dermatitis but it may be useful simply for treating dry skin in elderly people.  

In an early 2009 paper, Kimata is back to Modern Times, demonstrating the benefit of his therapy in treating gynecological allergic reactions.  Post Chaplin, patients had a significant decrease in IgE production by seminal B cells as an allergic response to sperm cells.

It is worth thinking about the controls in these studies.  Most of them use a weather information station as the non-humorous control.  This raises the question in my mind about what effect the growth in popularity of the Weather Channel has had.  Have SitComs given way to weather?  Could the lack of humorous programming be increasing skin problems in TV viewers?  If the Weather Channel is neutral, having no significant effect, what about the category of TV programming, my daughter refers to as, “Dead Body Shows?”  One can guess what watching a few episodes of CSI might do to skin reactivity.

Incidence of atopic dermatitis has increased in recent years, at least in children.  Comparing the number of pediatric office consults during 2001 to 2004 against the number 1997 to 2000, there has been a significant increase in cases of atopic dermatitis.

The story on National Public Radio was light hearted almost making fun of Dr. Aswani who seemed almost obsessed with Chaplin, even dressing up as Chaplin in the office as he hands out copies of Modern Times for his patients to view.  Consider that steroids are the standard treatment for most of the conditions that Chaplin seems to be efficacious in treating, this treatment sounds far from silly.  Rather it is good evidence-based medicine, shown in double blind, placebo controlled, cross over trials to work.  The concept is anything but funny when you consider the harm caused by steroid prescriptions.

Extrapolating from this information can bring us to some interesting suggestions for patients.  For the nursing mom whose baby has atopic dermatitis, we could certainly suggest watching Mr. Chaplin or Mr. Bean.  We now have a reason to tell people, especially kids, that text messaging is bad, a fact we instinctually recognize but had no evidence to prove.  We also have a therapeutic rationale for interrupting our patient visits to tell a joke or two.

Shorts from You-Tube:

Modern Times:

http://www.youtube.com/watch?v=8-UiCnxARJY

http://www.youtube.com/watch?v=WT57MGaR02I&feature=related

http://www.youtube.com/watch?v=Ln3XMwcULy0&feature=related

Mr. Bean:

Mr Bean goes to the swimming pool:

http://www.youtube.com/watch?v=a4cmrMJul1g&feature=fvw

Mr Bean goes to the Dentist:

http://www.youtube.com/watch?v=6mpDdSErO8c&feature=related

Mr Bean at the Barber:

http://www.youtube.com/watch?v=Ujo0ME_pOsM&feature=related

Mr. Bean learns Judo:

http://www.youtube.com/watch?v=Omhy1ZumsPQ&feature=related

Mr. Bean paints his apartment:

http://www.youtube.com/watch?v=3hNkUyQaXwE&feature=related

References:

JAMA. 2001 Feb 14;285(6):738.Click here to read Links

    Effect of humor on allergen-induced wheal reactions.

    Kimata H.

Link to full text: http://jama.ama-assn.org/cgi/content/full/285/6/738

Click here to readjavascript:PopUpMenu2_Set(Menu11176910);

Behav Med. 2003 Spring;29(1):15-9.Click here to read Links

Listening to mozart reduces allergic skin wheal responses and in vitro allergen-specific IgE production in atopic dermatitis patients with latex allergy.

Kimata H.

Department of Allergy at Ujitakeda Hospital, Kyoto, Japan.

In atopic dermatitis patients with latex allergy, listening to Mozart reduced skin wheal responses induced by latex, but not by histamine, whereas listening to Beethoven failed to produce similar results. Listening to Mozart also decreased in vitro total IgE and latex-specific IgE production with concomitant skewing of the cytokine pattern toward the Th1 type, that is, an increase in Th1 cytokine production and decrease in Th2 cytokine production by peripheral blood mononuclear cells, whereas listening to Beethoven failed to do so. These results suggest that therapy using specific types of music may be an effective treatment of allergic diseases.

Behavioral Medicine

              Issue:     Volume 29, Number 4 / Winter 2004

              Pages:                149 - 154

              URL:     Linking Options

              DOI:      10.3200/BMED.29.4.149-154

Laughter Counteracts Enhancement of Plasma Neurotrophin Levels and Allergic Skin Wheal Responses by Mobile Phone—Mediated Stress

Hajime Kimata A1

A1 Ujitakeda Hospital Department of Allergy

Abstract:

Laughter caused by viewing a comic video (Rowan Atkinson's The Best Bits of Mr. Bean) reduced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses in patients with atopic dermatitis, whereas viewing a nonhumorous video (weather information) failed to do so. In contrast, stress induced by writing mail on a mobile phone enhanced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses. However, previewing the comic video counteracted mobile phone-mediated enhancement of plasma neurotrophins or allergic skin wheal responses, whereas previewing the weather information failed to do so. Taken together, these results suggest that, in patients with atopic dermatitis, writing mail on a mobile phone causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter. These results may be useful in the study of pathophysiology and treatment of atopic dermatitis.

 

Physiol Behav. 2004 Jun;81(4):681-4.Click here to read Links

Effect of viewing a humorous vs. nonhumorous film on bronchial responsiveness in patients with bronchial asthma.

Kimata H.

Department of Allergy, Ujitakeda Hospital, 24-1, Umonji, Uji, Uji-City, Kyoto 611-0021, Japan. h-kimata@takedahp.or.jp

The effect of viewing a humorous film on bronchial responsiveness to methacholine [methacholine study: 20 healthy participants and 20 patients with house dust mite (HDM)-allergic bronchial asthma (BA)] or to epigallocatechin gallate (EGCg; EGCg study: 15 normal participants and 15 EGCg-allergic BA patients) was studied. At baseline, bronchial challenge test to methacholine (20 normal participants and 20 HDM-allergic BA patients) or EGCg (15 normal participants and 15 EGCg-allergic BA patients) were performed. After 2 weeks, patients and healthy participants were randomly assigned to watch a humorous or a nonhumorous film. Two weeks later, the alternate film was watched. Immediately after viewing, bronchial challenge test to methacholine or ECGg to each study group were performed. Viewing a humorous film significantly reduced bronchial responsiveness to methacholine or EGCg, while viewing a nonhumorous film failed to do so in BA patients without affecting bronchial responsiveness to methacholine or EGCg in healthy participants. These findings indicate that viewing a humorous film may be useful in the treatment and study of BA.

PMID: 15178163

Eur J Clin Invest. 2004 Jan;34(1):76-7.Click here to read Links

    Reduction of allergen-specific IgE production by laughter.

    Kimata H.

Pediatr Pulmonol. 2003 Aug;36(2):107-12.Click here to read Links

Mirth-triggered asthma: is laughter really the best medicine?

Liangas G, Morton JR, Henry RL.

School of Women's and Children's Health, University of New South Wales, New South Wales, Australia.

Mirthful emotions such as laughter and excitement are unrecognized but perhaps important triggers of asthma. Our study aimed to explore the prevalence, mechanisms, and associations of mirth-triggered asthma (MTA) in children. Our MTA prevalence questionnaire was given to 285 children who presented to the Emergency Department of Sydney Children's Hospital (SCH) with an acute episode of asthma. Our MTA profile questionnaire study was a cross-sectional study of 541 children with asthma. The parents completed a questionnaire regarding their child's asthma. In our laughter diary study, diary cards were given to the parents of 21 children with asthma. The diary required details regarding the mirthful stimulus, symptoms of asthma, and recording of peak expiratory flow (PEF) measurements. Of the selected cohort, 31.9% had mirth-triggered asthma. In the cross-sectional study, mirth-triggered asthma was more common: with increasing age (P = 0.02); in those who in the last 3 months had taken more doses of salbutamol (P = 0.005), and who had more wheeze, nocturnal symptoms, and early morning symptoms (P < 0.0005); and in those who reported exercise-induced asthma (P < 0.0005). Laughter was more commonly reported as a trigger than excitement; cough was the most prominent symptom; and symptoms mostly occurred within 2 min of the mirthful stimulus. In the laughter diary study, 59 of 130 recorded events described symptoms of asthma. Mirth while watching a film led to PEF of 73% of baseline, compared with 81% for mirth with exertional play, and 95% for mirth with nonexertional play (P = 0.01). Mirth-triggered asthma is common, and is an indicator of suboptimal asthma control. Copyright 2003 Wiley-Liss, Inc.

J Psychosom Res. 2006 Jul;61(1):67-9. Links

Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy.

Kimata H.

Department of Allergy, Satou Hospital, Hirakata, Osaka 573-1124, Japan. kimata@misugikai.jp

OBJECTIVE: Allergic responses are enhanced by stress, whereas they are reduced by laughter in atopic eczema patients. Emotion with tears decreases plasma IL-6 levels in patients with rheumatoid arthritis. Thus, the effect of emotion with tears on allergic responses in patients with atopic eczema was studied. METHODS: Sixty patients with atopic eczema having latex allergy viewed both the weather information video and the heart-warming movie, Kramer vs. Kramer. Just before and immediately after viewing each video, allergic responses to latex were measured. RESULTS: Viewing the weather information video did not cause emotion with tears in any patients, and it failed to modulate allergic responses. In contrast, viewing Kramer vs. Kramer caused emotion with tears in 44 of 60 patients, and it reduced allergic skin wheal responses to latex and latex-specific IgE production in them. CONCLUSION: Emotion with tears reduced allergic responses, and it may be useful in the treatment of allergic diseases.

Indian Pediatr. 2007 Apr;44(4):281-5.(pdf) Links

Viewing humorous film improves nighttime wakening in children with atopic dermatitis.

Kimata H.

Department of Allergy, Moriguchi Keijinkai Hospital, Osaka Prefecture, Japan. kimata-keijinkai@mkc.zaq.ne.jp

INTRODUCTION: Patients with atopic dermatitis suffered from night-time wakening, but the exact mechanism of it was not known. Ghrelin was involved in growth hormone secretion, regulation of appetite, anxiety, night-time wakening and stress. METHODS: Thus salivary ghreli levels during the night were measured in 40 healthy children or 40 patients with atopic dermatitis with night-time wakening. Salivary ghrelin levels at 02:00 h were markedly elevated in patients with atopic dermatitis compared to those in healthy children. RESULTS: Neither viewing control non-humorous film nor viewing humorous film had any effect on healthy children. In contrast, viewing humorous film improved night-time wakening and reduced elevation of salivary ghrelin levels in patients with atopic dermatitis, while viewing control film failed to do so. CONCLUSION: Viewing humorous film may be useful in the treatment of night-time wakening in patients with atopic dermatitis.

PMID: 17468523 [PubMed - indexed for MEDLINE]

J Psychosom Res. 2007 Jun;62(6):699-702. Links

Laughter elevates the levels of breast-milk melatonin.

Kimata H.

Department of Allergy, Moriguchi-Keijinkai Hospital, Moriguchi, Osaka, Japan. kimata-keijinkai@mkc.zaq.ne.jp

OBJECTIVE: Patients with atopic eczema (AE) often complain of sleep disturbance. Melatonin is involved in sleep, and the levels of blood melatonin in patients with AE are decreased in comparison to healthy subjects. However, the levels of breast-milk melatonin had only been reported in healthy subjects. Laughter increased natural killer cell activity in blood and free radical-scavenging capacity in saliva in healthy subjects. Thus, the effect of laughter on the levels of breast-milk melatonin was studied in mothers with AE. Moreover, the effect of feeding with breast milk after laughter on allergic responses in infants was studied. METHODS: Forty-eight infants aged 5-6 months were enrolled. All of the infants had AE and were allergic to latex and house dust mite (HDM). Half (n=24) of the mothers of these infants were patients with AE, while another 24 mothers were healthy subjects. The mothers viewed either an 87-min humorous DVD (Modern Times, featuring Charlie Chaplin) or an 87-min nonhumorous weather information DVD at 2000 h. After viewing, breast milk was collected sequentially from 2200, 2400, 0200, 0400 to 0600 h. The levels of breast-milk melatonin were measured. In addition, skin wheal responses to HDM and histamine were studied in infants. RESULTS: Laughter caused by viewing a humorous DVD increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers. In addition, allergic responses to latex and HDM of infants were reduced by feeding with breast milk after laughter of mothers with AE or of healthy mothers. CONCLUSION: Laughter increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers, and feeding infants with increased levels of melatonin-containing milk reduced allergic responses in infants. Thus, laughter of mothers may be helpful in the treatment of infants with AE.

J Psychosom Res. 2007 Jan;62(1):57-9. Links

Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video.

Kimata H.

Department of Allergy, Moriguchi Keijinkai Hospital, Moriguchi City, Osaka Prefecture, Japan. kimata-keijinkai@mkc.zaq.ne.jp

OBJECTIVE: Dermcidin (DCD)-derived peptide is an antimicrobial peptide produced by the sweat glands. However, the levels of DCD-derived peptide in sweat were decreased in patients with atopic eczema (AE). The effect of viewing a humorous video on the levels of DCD-derived peptide was studied. METHODS: Twenty patients with AE viewed an 87-min humorous video (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, sweat was collected, and the levels of DCD-derived peptide and total protein in sweat were measured. RESULTS: Viewing a humorous video increased the levels of DCD-derived peptide without affecting the levels of total protein in sweat. CONCLUSION: Viewing a humorous video increased DCD-derived peptide in sweat of patients with AE, and thus, it may be helpful in the treatment of skin infection of AE.

Acta Medica (Hradec Kralove). 2007;50(2):135-7.Links

Elevation of testosterone and reduction of transepidermal water loss by viewing a humorous film in elderly patients with atopic dermatitis.

Kimata H.

Department of Allergy, Moriguchi-Keijinkai Hospital, Osaka Prefecture, Japan. kimata-keijinkai@mkc.zaq.ne.jp

The effect of viewing a humorous film on salivary testosterone levels and transepidermal water loss (TEWL) values on the back of the neck in 36 elderly healthy people (36 male, mean 70 years) and 36 elderly patients with atopic dermatitis (AD) (36 male, mean age 70 years) were studied. Salivary testosterone levels were decreased while TEWL values were increased in elderly patients with AD compared to those in elderly healthy people. Viewing a humorous film (The Best Bits of Mr. Bean, Universal studios, 1996) slightly, but significantly (P<0.05), elevated salivary testosterone levels and reduced TEWL values in elderly healthy people, while viewing a control non-humorous film (weather information) failed to do so. Similarly, but more pronouncedly, viewing a humorous film markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD, while viewing a control non-humorous film failed to do so. These finding indicate that viewing a humorous film may be useful in the study of testosterone and TEWL, and treatment for dry skin in elderly people with or without AD.

J Psychosom Res. 2009 Feb;66(2):173-5. Epub 2008 Nov 22. Links

Viewing a humorous film decreases IgE production by seminal B cells from patients with atopic eczema.

Kimata H.

Department of Allergy, Moriguchi-Keijinkai Hospital, Moriguchi, Osaka, Japan. kimata-keijinkai@mkc.zap.ne.jp

OBJECTIVE: Sperms induced IgE production by seminal B cells from patients with atopic eczema via interaction of B cells with galectin-3 on sperms. We studied the effect of viewing a humorous film on IgE production by seminal B cells cultured with sperms. METHODS: Twenty-four male patients with atopic eczema viewed a humorous film (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, semen was collected, and seminal B cells and sperms were purified. Seminal B cells were cultured with sperms and IgE production was measured, while expression of galectin-3 on sperms was assessed. RESULTS: After viewing the humorous film, IgE production by B cells cultured with sperms was significantly decreased. Moreover, expression of galectin-3 on sperms was reduced. CONCLUSION: Viewing a humorous film reduced galectin-3 expression on sperms, which in turn decreased IgE production by seminal B cells cultured with sperms. These results indicate that viewing a humorous film may be helpful for the study and treatment of local IgE production and allergy in the reproductive tract.

Pediatrics. 2007 Sep;120(3):e527-34. Links

Atopic dermatitis in children in the United States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns.

Horii KA, Simon SD, Liu DY, Sharma V.

Section of Dermatology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108, USA. kahorii@cmh.edu

OBJECTIVE: Atopic dermatitis is the most common chronic inflammatory skin disease of childhood and is increasing in prevalence throughout the world. Morbidity and resource use for atopic dermatitis are comparable to other chronic diseases. Topical corticosteroids are first-line therapeutic agents for atopic dermatitis; topical calcineurin inhibitors are considered second-line agents for patients who are older than 2 years. The aims of this study were to examine trends in visits for atopic dermatitis in children in the United States between 1997 and 2004, identify factors that were associated with a pediatric visit for atopic dermatitis, and assess changes in the treatment of atopic dermatitis over time. METHODS: Visits for atopic dermatitis by children (0-18 years) to office-based physicians and hospital outpatient departments using 1997-2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey databases were analyzed. Medication prescribing rates during 2 time periods (1997-2000 and 2001-2004) were also analyzed. RESULTS: There were an estimated 7.4 million visits for atopic dermatitis. Statistically significant differences in patients with atopic dermatitis included age 2 to 5 years, black race, Asian race, and specialist or hospital outpatient clinic evaluation. The increase in atopic dermatitis visits per year was statistically significant. No statistical differences in prescribing rates were identified between the 2 time periods. Between 1997 and 2000, topical corticosteroids were prescribed in 34% of visits, decreasing to 25% between 2001 and 2004. Between 2001 and 2004, topical calcineurin inhibitors were prescribed in 23% of visits. In the same period, topical corticosteroids were prescribed in 24% of visits by children who were younger than 2 years; topical calcineurin inhibitors were prescribed in 22% of visits. CONCLUSIONS: Visits for atopic dermatitis in children are increasing. A recommended first-line treatment was prescribed in a minority of the visits.