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Laughter and Allergies: the Work of Hajime Kimata
Jacob Schor ND FABNO
Draft for NDNR
[final version published April, 2010]
In patients presenting with allergic symptoms, it is worth paying attention to their sense of humor and to make an assessment as whether they are ‘laughter deficient.’ Prescribing a routine of regular daily laughter may be helpful in treating their condition.
We’re all acquainted with the idea that, ‘laughter is the best medicine.’ Norman Cousins popularized the idea years ago in his book Anatomy of an Illness, which described his self-treatment of ankylosing spondylitis through watching Marx Brothers movies.
The first mention in the medical literature I recall of using laughter to treat allergies was a letter to JAMA in 2001 from Hajime Kimata, an allergist in Uji-City, Japan. He credited Cousins as his inspiration. Kimata described his first trial; he studied 26 patients with atopic dermatitis who were all allergic to dustmites and most of whom were also allergic to cedar pollen and cat dander. After going 72 hours with no medication, he put them through skin prick tests before and after viewing the Charlie Chaplin movie, Modern Times. The size of the resulting wheals were measured. A similar procedure was repeated before and after a video of the same length featuring weather information. The wheal responses to dustmite, cedar pollen and cat dander were significantly reduced after watching Chaplin and the effect lasted for hours. Watching the weather had no effect on wheal size.
Kimata has gone on over the last almost two decades conducting numerous related studies demonstrating the benefit laughter has on allergic response. Other researchers have modeled similar studies on Kimata’s work using Charlie Chaplin movies as a standardized experience of humor. This article will focus only on Kimata’s work as it deals primarily with moderating allergic response. As these movies are silent, they work well across cultures. Chaplin’s Modern Times seems to be his drug of choice, though of late Kimata has also used Mr. Bean. One can assume that similar results will be produced in people in outer countries that speak other languages. I vividly recall the first time I saw Modern Times, more than 50 years ago. Perhaps it may be my early memory that drew my attention to Kimata’s research.
Kimata reported the results of another wheal study in 2003. This time he chose patients allergic to latex rather than dustmites. 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.
In a 2004 paper in Human Behavior, Kimata brought cell phones into the equation. This study compared the effect on specific blood parameters in people with atrophic gastritis caused by 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 nothing. Text messaging made things worse; it 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….”
In a 2004 paper, Kimata compared watching a humorous film or a non-humorous movie on patients with bronchial asthma and their reaction to known triggers. Watching the funny movie reduced the asthmatic reactions while the non-funny movie had no effect. Laughter decreases production of IgE specific to allergens.
Moving a patient to tears might also be useful. Instead of watching Chaplin, in a 2006 paper, Kimata tells how he had patients with latex allergies watch Kramer vs. Kramer. Those patients who cried while watching had a reduced allergic response. My preference though is to try and make my patients laugh.
Two of Kimata’s studies that have a great deal of clinical implication in my mind are about night time waking in children with skin rashes. It is common for young patients with atopic dermatitis to suffer from night-time waking. Several theories have been proposed to explain this. One theory is that the hormone ghrelin is responsible. Kimata measured salivary ghrelin levels during the night in 40 healthy children and 40 patients with atopic dermatitis who suffered from night-time waking. Salivary ghrelin levels at 2:00 AM were markedly elevated in patients with atopic dermatitis compared to healthy children. Watching humorous films no only improved night-time waking but it also lowered salivary ghrelin levels in the kids with atopic dermatitis.
Telling parents to select videos that make their kids laugh rather than freezing them with fear seems a simple enough prescription to make and seems like common sense. Yet how often do doctors think to inquire about the video viewing habits of their young patients?
Kimata published another study looking at why allergic kids didn’t sleep well in 2007 but this time focused on the mothers of infants still nursing. Looking at nursing kids with atopic eczema who didn’t sleep well, Kimata monitored melatonin levels. Charlie Chaplin increased melatonin in the women, whether they had atopic dermatitis or not, and also increased melatonin in their breast milk. Kimata reports that, “...feeding infants with increased levels of melatonin-containing milk reduced allergic responses in infants.”
Translate the patients in these studies to clinical cases; a distraught mother brings in an infant with horrifying eczema, the kid can’t sleep, the mother is exhausted at wits end, nothing seems to help. Think how easy it would be for her to watch Mr. Bean before and while she nurses.
It’s not just kids who benefit from laughter. One can measure a change in the eczema related chemicals in the sweat of older 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 in people with atopic eczema. The levels of this DCD protein was 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 eczema.
As mentioned, Kimata seems to prefer movies that don’t need translation and besides Chaplin has experimented with 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) before and after watching the Best of Mr. Bean. This TEWL measurement tells us how easily the skin dries out. Salivary testosterone levels were decreased while TEWL values were increased in elderly atopic dermatitis patients compared to those in healthy people the same age. While viewing Bean, slightly elevated salivary testosterone levels and reduced TEWL values in the healthy people, in the dermatitis group, viewing the film markedly elevated salivary testosterone levels and reduced TEWL. Viewing a control non-humorous film failed to change numbers 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 a 2009 paper Kimata came back to Modern Times and demonstrated the benefit of laughter in treating gynecological allergic reactions. After watching Chaplin, patients had a significant decrease in IgE production by seminal B cells in female patients who develop atopic eczema as an allergic response to sperm cells.
Incidence of atopic dermatitis cases, at least in children, has increased. Back in 1997 there were an estimated 620,000 pediatric visits for atopic dermatitis. Six years later, in 2003, the number had more than doubled to 1,700,000. This makes me wonder if there has, in recent years, been a shift in children’s television to less humorous content?
There is no standardized way to clinically assess a ‘laughter deficiency’ that I have come across in my reading. During office visits I track whether patients tell me jokes or use humorous analogies in describing their symptoms. I try various jokes on them to see how easily I can get them to laugh. What I prescribe for patients in order to treat this deficiency varies. I get them to talk about what they find funny. Not everyone is a fan of Chaplin or Mr. Bean. Some people actually liked the Home Alone movies. Whatever they admit makes them laugh becomes my drug to prescribe. Some people get sent to live comedy clubs, some are told to just to sit around with family and friends and trade jokes. But if there is a video that makes them laugh, that’s my preference.
As far as dose, or duration of exposure, having little more to go on, 87 minutes, the length of Modern Times, has become the suggested initial loading dose, followed by shorter daily exposures during the course of the week.
Kimata H. Effect of humor on allergen-induced wheal reactions. JAMA. 2001 Feb 14;285(6):738. Link to full text: http://jama.ama-assn.org/cgi/content/full/285/6/738
Kimata H. Listening to mozart reduces allergic skin wheal responses and in vitro allergen-specific IgE production in atopic dermatitis patients with latex allergy. Behav Med. 2003 Spring;29(1):15-9.
Kimata H. Laughter Counteracts Enhancement of Plasma Neurotrophin Levels and Allergic Skin Wheal Responses by Mobile Phone—Mediated Stress. Behav Med. 2004 Winter;29(4) 149-154
Kimata H. Effect of viewing a humorous vs. nonhumorous film on bronchial responsiveness in patients with bronchial asthma. Physiol Behav. 2004 Jun;81(4):681-4.
Kimata H. Reduction of allergen-specific IgE production by laughter.Eur J Clin Invest. 2004 Jan;34(1):76-7.
Kimata H. Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy. J Psychosom Res. 2006 Jul;61(1):67-9.
Kimata H. Viewing humorous film improves nighttime wakening in children with atopic dermatitis. Indian Pediatr. 2007 Apr;44(4):281-5.
Kimata H. Laughter elevates the levels of breast-milk melatonin. J Psychosom Res. 2007 Jun;62(6):699-702.
Kimata H. Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video. J Psychosom Res. 2007 Jan;62(1):57-9.
Kimata H. Elevation of testosterone and reduction of transepidermal water loss by viewing a humorous film in elderly patients with atopic dermatitis. Acta Medica (Hradec Kralove). 2007;50(2):135-7.
Kimata H. Viewing a humorous film decreases IgE production by seminal B cells from patients with atopic eczema. J Psychosom Res. 2009 Feb;66(2):173-5.
Horii KA, Simon SD, Liu DY, Sharma V. Atopic dermatitis in children in the United States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns. Pediatrics. 2007 Sep;120(3):e527-34.