Aug
1
Cetirizine
August 1, 2009 | Leave a Comment
Generic Name
Cetirizine (seh-TERE-ih-zene)
Brand Name Zyrtec
The information in this profile also applies to the following drugs:
Generic Ingredient: Azelastine
Generic Ingredient: Fexofenadine 91 Allegra
Generic Ingredient: Levocetirizine 91 Xyzal
Type of Drug Antihistamine.
Prescribed For
Azelastine: runny nose, sneezing, nasal itching, and post-nasal drip. Cetirizine: stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal and year-round allergy, and for other symptoms of allergy such as rash, itching, and hives; also prescribed for chronic itching and for asthma. Fexofenadine: sneezing, stuffy and runny nose; scratchy throat and mouth; and itchy, watery, and red eyes caused by seasonal allergies. Levocetirizine: stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal and year-round allergy, and for other symptoms of allergy such as rash, itching, and hives; also prescribed for chronic itching.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from the cell at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes. Cetirizine causes less sedation than older antihistamines and appears to be just as effective. Levocetirizine is the active portion of the cetirizine molecule and is as effective as cetirizine with a similar side effect profile.
Cautions and Warnings
Do not take cetirizine if you are allergic or sensitive to any of its ingredients.
People with kidney disease should receive reduced dosages of cetirizine and levocetirizine. Do not take these drugs if kidney disease is severe. Children with kidney disease should not receive levocetirizine.
Possible Side Effects
✓ Common: headache, drowsiness, fatigue, dry mouth, bitter taste in the mouth, dizziness, runny nose, and sore throat.
✓ Less common: nosebleeds, stuffy nose, sneezing, cough, nausea, upset stomach, changes in bowel habits, nervousness, and fever (children).
♦ Rare: fainting and weight gain. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Cimetidine may increase the level of azelastine in the blood.
• Cetirizine is less likely than other antihistamines to interact with drugs.
• Ritonavir increases the amount of levocetirizine and slows its breakdown in the body. This may result in increased levocetirizine side effects.
Food Interactions
• Ceterizine and levocetirizine may be taken without regard to food or meals.
Usual Dose
Azelastine Nasal Spray
Adult and Child (age 12 and over): 1-2 sprays in each nostril twice a day.
Child (age 5-11): 1 spray in each nostril twice a day.
Cetirizine
Adult and Child (age 6 and over): 5-10 mg once a day depending on symptoms. Reduce dosage in people with kidney disease. Child (age 1-5): 2.5-5 mg a day.
Child (age 6 months-1 year): 2.5 mg a day.
Fexofenadine
Adult (age 12 and over): 60 mg twice a day or 180 mg once a day. People with kidney disease should take 60 mg a day.
Child (age 6-11): 30 mg twice a day.
Levocetirizine
Adult and Child (age 12 and over): 5 mg every evening.
Child (age 6-11): 2.5 mg (1h tablet) every evening. Dosage for children should not exceed 2.5 mg a day. Child (under age 6): not recommended.
Overdosage
Drug overdose is likely to cause severe side effects. Overdose victims should be Oven ipecac syrup—available at any pharmacy—to make them vomit and be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Use extra caution while doing anything that requires concentration, such as driving a car or operating hazardous machinery.
Report sore throat, unusual bleeding, bruising, tiredness, weakness, or any other unusual side effect to your doctor. Do not combine these drugs with alcohol or other nervous system depressants. Do not put azelastine nasal solution into your eyes.
If you forget to take a dose of cetirizine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Oral antihistamines are generally considered safe for use during pregnancy. But do not take any antihistamine without your doctor’s knowledge if you are or might become pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of antihistamine pass into breast milk. Nursing mothers who must take cetirizine should use infant formula.
Seniors: Antihistamines are more likely to cause dizziness, sleepiness, and confusion in seniors. Dosage reduction may be recommended depending on kidney function.
Jul
3
Allergy: Butterbur (Petasites hybridus)
July 3, 2009 | Leave a Comment
Butterbur (Petasites hybridus)
Another interesting allergy treatment involves the herb butter-bur. This botanical medicine has been used to treat symptoms of migraine headaches, asthma, and allergy. It has anti-inflammatory activity and blocks the formation of compounds called leukotrienes (pronounced lew-co-TRY-eens). These rascals cause all sorts of mischief in the nose, including itching, sneezing, swelling, and congestion. In some respects, leukotrienes may be even more of a problem than histamine. Leukotrienes contribute to the inflammatory cascade that underlies both allergy and asthma. The prescription asthma and allergy drug Singulair (montelukast) also works by inhibiting leukotriene formation. Swiss researchers compared butterbur with the antihistamine cetirizine (Zyrtec) in a randomized, double-blind study. They found that both products were equally effective at controlling symptoms, but butterbur was significantly less sedating than Zyrtec.
Q. I have suffered from chronic sinusitis, which in turn led to bronchitis and frequently into pneumonia. My physician put me on Allegra and then switched me to Clarinex.
I continued to have sinusitis and pneumonia annually for 5 years, so my doctor sent me to an allergist. He diagnosed several allergies and added a prescription for Nasacort to the Clarinex.
Two years ago, having suffered through another bout of sinusitis and pneumonia, I saw an integrative alternative medicine physician. He took me off Clarinex and prescribed butterbur, stinging nettles, and quercitin instead. I’ve taken this combination for 2 years and it has reduced the frequency of the sinusitis.I read that I should take butterbur only 6 weeks a year. Now I am concerned about the danger of liver damage.
A. Pharmacologist David Kroll, PhD, offered this clarification on butterbur. “I wanted to follow up on a reader who wrote to your newspaper column regarding the potential liver toxicity of butterbur (Petasites hybridus), an herb that’s become popular due to positive efficacy trials in migraine prevention and allergic rhinitis. While the herb is potentially toxic to the liver, it shouldn’t be a problem with high-quality products like Petadolex. I do-fear that some less honorable companies may latch onto this herb and not take such care with the high-tech extraction process that is necessary to reduce the risk. That might lead to some major liver injury cases.”
There is one fly in the ointment, however. Concerns have been raised about potential liver toxicity associated with compounds in butterbur. If the herbal preparation is not manufactured under very stringent quality-control conditions, there could be problems. As a result, we suggest that people use butterbur only temporarily (say, for 6 weeks during hay fever season) and that they monitor their liver enzyme activity with medical supervision. One product that should be safe is Petadolex. The German manufacturer is Weber and Weber, and it is available in the United States.
Jul
3
Nondrug Allergies Treatment
July 3, 2009 | Leave a Comment
Nondrug Approaches for Allergies
Even if you created a perfect living environment by eliminating carpets and rugs, minimizing stuffed furniture, banning your pets to the outdoors, and filtering your air, you could never truly eliminate allergens from your personal space. And every time you go outside, you are vulnerable to whatever is in the air. So, what can you do to minimize your reaction to pollen and all the other nasties flowing through your nose every time you breathe? Americans have a hard time imagining that you can clean your internal environment. But the Ayurvedic tradition of India encourages nasal washing with what’s known as a neti pot. This porcelain container looks a little like Aladdin’s lamp. It allows saltwater to be poured into one nostril and exit out the other. This washing process is supposed to clear the nasal passages of dust, pollen, and other allergens.
You can find neti pots at some health-food stores or by calling the Himalayan Institute at 800-822-4547. Visit their Web site at www.netipot.org to get an idea of what we are talking about. A ceramic pot costs $18 to $20.
For years I was troubled with allergies. But I have discovered the following natural approach. I use a ned pot to wash my sinuses with salt water Sinus and ear infections are now a thing of the distant past. Many people are grossed out at even the suggestion of pouring something into their noses, but the sensation is really very pleasant if done properly (with lukewarm filtered water and mild saline solution).
I also vacuum my bedding daily to get rid of dust mites.
Vitamin C
We are the first to acknowledge that vitamin C studies are squishy. There just have not been large, well-conducted clinical trials to test the effectiveness of ascorbic acid (vitamin Q against allergic disorders. The allergists will rightfully say that without decent data they cannot recommend this vitamin.
Nevertheless, some research suggests that this nutrient might help reduce allergy symptoms through a kind of antihistamine action.”,” There is also the possibility that vitamin C modulates immune-system reactivity and has anti-inflammatory effects.37 The benefits, if they exist, appear fairly short-lived. That’s why the general recommendation is to take 500 milligrams of ascorbic acid three or four times a day.
Stinging Nettle (Urtica dioica)
The very name of this herb is enough to scare many folks away. If you were to come into contact with stinging nettle, which grows widely throughout Europe and North America, you would have even more misgivings. Touching the tiny hairs on this plant can cause an impressive rash that can itch and sting for up to 12 hours. This herb is well known in Europe, where it is used primarily to relieve allergy symptoms and improve urinary flow in cases of benign prostate enlargement. The dose that has been used for treating nasal symptoms is 300 milligrams of freeze-dried Urtica dioica per day.
Side effects: This herb is usually well tolerated. Mild digestive upset has been reported, especially if it is taken on an empty stomach. Some people may experience an allergic. rash and should discontinue use immediately if this occurs. Downside: Large, well-controlled trials are lacking. Better research is needed before we can give this herb a ringing endorsement.
Cast: Approximately $5 to $10 for a month’s supply
In Europe, where Urtica dioica is quite popular, physicians have been prescribing it to treat allergies for a long time. One double-blind trial noted that 58 percent of the study participants had good relief of SyMptoMS.41 Almost half of the patients said that stinging nettle was just as effective, if not more so, than their standard allergy medicine. Why something that contains histamine might actually help to relieve allergic symptoms is somewhat mysterious. Investigators suspect that it may help to modulate the immune response.
Q. I feel like I am caught between a rock and a hard place. My allergies are awful, but most antihistamines and decongestants warn that they’re not to be used by men like me. I have an enlarged prostate, so Benadryl and Sudafed are off limits. Is there anything natural that would help my allergies and not aggravate my prostate problem?
A. Most over-the-counter (OTC) allergy medicines contain either an antihistamine or a decongestant that can make urination more difficult for a man with an enlarged prostate. An herbal remedy that might substitute is stinging nettle (Urtica dioica).
According to European research, extracts of this herb can do double duty to relieve allergy symptoms and help improve urine flow in men with benign prostate enlargement. Side effects are uncommon.
Now that the value of saw palmetto has been called into question for treating benign prostate enlargement (BPH) ‘42 some men may want to consider stinging nettle instead. Urtica dioica has been used to treat BPH in Europe for decades. There are good reasons why this herb might be effective. For one thing, stinging nettle root affects sex hormone–binding globulin and its ability to interact with hormones like testosterone. Another key player in prostate problems, epidermal growth factor, is inhibited by 53 percent by stinging nettle lectins. In addition, this herbal extract has anti-inflammatory activity that interferes with an enzyme (Na/K-ATPase) that is necessary for prostate cell growth.
Most important, human studies have shown that nettle root extract improves urine flow and decreases the amount of urine left in the bladder after voiding. Many men with an enlarged prostate report that the herb reduces the number of times they have to get up at night to go to the bathroom. I read a letter in your column about a man with allergies. Because of an enlarged prostate, he couldn’t take the usual over-the-counter antihistamines.
You suggested the herb “stinging nettle’ as a substitute that might relieve allergy symptoms and improve the flow of urine. My husband looked these stinging nettles up and began taking them. He has improved 100 percent in both his allergy condition and his prostate symptom of frequent urination. In addition, his PSA number has come down! The urologist said, “Yes, I’ve heard of it and it helps some but not others.” We are so glad you mentioned this herbal medicine, and we have shared the information with others.
Jul
3
Allergy: Air Filters and Dehumidification
July 3, 2009 | Leave a Comment
Air Filters and Dehumidification
It is impossible to eliminate all the airborne allergens that trigger symptoms, but you can reduce the amount of dust floating around your rooms. Forget the old-fashioned fiberglass filters that only capture large particles. That is like trying to catch mosquitoes with a fishnet. We are not big fans of ozone-type air “purifiers” either. The fine folks at Consumer Reports warn that many small room-size ionizing air cleaners (or “electrostatic precipitators”) can generate ozone. As far as we’re concerned, ozone is the last thing someone with allergies or asthma needs, since it can be irritating and decrease lung function. Our first choice in air-cleaning technology is the HEPA (high-efficiency particulate air) filter. These devices are made of densely packed fibers that look like thick paper. The filters are pleated or folded and look like a mini-accordion. That way they maximize the air’s contact with the filter. Industrial-strength HEPA filters are used in computer clean rooms, pharmaceutical manufacturing plants, and hospitals, where it is essential to trap very small dust particles.
To install a whole-house HEPA filter you will need professional help. Ask a heating and air-conditioning (HVAC) expert whether they can retrofit such a system for your home. We think the Aprilaire Media Air Cleaner (formerly Space-Gard) is the place to start. This HEPA-type filter achieves 99 percent efficiency for particles bigger than five microns and 95 percent efficiency for the smallest one-micron-sized particles. (Pollen and mold spores usually range from 10 to 100 microns.) The longer you use the filter, the more efficient it becomes, at least to a point. It should be changed every one to two years.
If you cannot afford either a HEPA filter or an electronic air cleaner, consider the less efficient, do-it-yourself 4-inch American Air Filter for around $40 or the 1-inch 3M Filtrete for about $25. These should fit into your existing air return system in place of the old-fashioned filter you may be using.
We find it astonishing that there hasn’t been more clinical research on home air filtration. Pharmaceutical companies have spent hundreds of millions, if not billions, of dollars testing drugs to relieve symptoms. Only a pittance has been devoted to air quality in the home and its relationship to symptom relief.
One review of the available research concluded that “Among patients with allergies and asthma, use of air filters is associated with fewer symptoms. A small study showed that a HEPA air cleaner could reduce the amount of cat allergen levels in the house, but it did not demonstrate improvement in nasal symptom scores. Another tiny study showed that a HEPA filter could reduce dog allergens in the air.
A pilot study in two daycare centers demonstrated that when a HEPA filter was combined with a dehumidification system, airborne fungal spores were substantially diminished . Most people do not realize how serious dampness and humidity are for the home environment. Wherever there is moisture, mold has a marvelous opportunity to multiply. Mold spores can be highly allergenic.
The solution is to get rid of the source of the moisture and keep dampness under control by dehumidifying. The drier your home castle, the less likely it is that there will be mold, mildew, and dust mites. These latter nasty little critters live in mattresses, bedding, carpets, and furniture. Mite poop is also highly allergenic and is responsible for many people’s discomfort. Dry air makes it harder for mites to flourish.
By the way, we used to encourage folks with allergies or asthma to encase their mattresses and pillows with allergen-impermeable bed covers. The goal was to separate the allergy sufferer from the mite poop. Sadly, well-conducted clinical trials have established conclusively that this effort is ineffective.
Aprilaire Whole-House Air Cleaner
This high-efficiency particulate air (HEPA)-type filter is highly efficient, uses no electricity, lasts 1 to 2 years, and captures most pollen, mold spores, and large dust particles. The box that holds the filter needs to be installed next to your furnace by a heating, ventilating, and air-conditioning (HVAC) professional.
An alternative to the HEPA-type air filter is the Aprilaire Model 5000 Electronic Air Cleaner. Consumer Reports consistently gives this system its highest score.26
Downside: The Aprilaire HEPA-type filter needs to be changed every year or two. Initial installation requires a professional. The electronic alternative is pricey.
Cost: Initial installation of the HEPA filter box is done by your HVAC expert. Should cost less than $200. A packet of two filters is $50 to $60. The Aprilaire Model 5000 Electronic Air Cleaner is roughly $600. Installation can run an additional $200.
Jul
3
Allergy: Diagnosis and FAQs
July 3, 2009 | Leave a Comment
ALLERGIES
• Install an Aprilaire HEPA-type air filter
• Use a high-quality vacuum cleaner (Miele)
• Rinse your nasal passages with saltwater
• Try vitamin C
• Experiment with the herbs stinging nettle and butterbur
• Try Nasal Crom (cromolyn) spray to prevent allergy symptoms
• Look for loratadine, an over-the-counter antihistamine
• Ask your doctor about a steroid nasal spray
• Consider pseudoephedrine for symptomatic relief
Breathing is basic. Most of the time we take it for granted. But if your nose is congested and your sinuses are stopped up, you are miserable. For one thing, your head feels as if it’s full of cotton. Studies have found that people suffering from allergies frequently experience sleep difficulties, fatigue, poor concentration, drowsiness, irritability, delayed reaction times, memory problems, and cognitive impairment. When you are in the middle of an allergy attack it is hard to drive safely even if you are not sneezing. Making decisions or operating other kinds of machinery can also be problematic.
Paradoxically, although antihistamines are the mainstay of allergy treatment, they can also cause drowsiness, delayed reaction times, sedation, and cognitive impairment. Even the so-called second-generation nonsedating antihistamines that are so heavily advertised to consumers may not be as benign as drug companies would have you believe. When given in doses that are adequate to relieve symptoms, some of these nonsedating antihistamines may also make people drowsy and impair performance.
Research has shown that driving skills are affected with both the older and the newer antihistamines. A massive study conducted for the National Highway Traffic Safety Administration discovered that driving while drowsy—no matter what the cause—increased the risk of a crash or near crash by four to six times.
Physicians often think of allergies as more of a nuisance than a life-threatening condition. But we now realize that impairment poses huge risks if people are driving. And allergy symptoms don’t just occur in the spring and fall, when pollen is in the air. Nowadays many folks are congested all year long. At last count, 50 million people are sensitive to things like dust mites, cat dander, cockroaches, mold spores, and pollens from oak, elm, and maple trees as well as ragweed and rye, blue,and Bermuda grasses.24 Symptoms include nasal stuffiness, runny nose, itching, sneezing, and coughing. Chronic sinusitis, which may develop as a consequence of allergies, affects more than 30 million people. And asthma, which can be life threatening, often has an allergic and inflammatory component.
What is so scary about these statistics is that they keep going up. No one knows why, but it appears that more people are suffering than ever before.
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Conclusions
Allergies don’t get the respect they deserve. When you complain about your congestion, most friends and family members will barely sympathize. But allergies can slow you down and make you dangerous behind the wheel. Finding the right treatment to ease your symptoms without causing worse problems is a challenge. Combining several options, including environmental control, may be the most effective solution for solving this common problem.
• Use a HEPA-type air filter and a dehumidifier to remove allergens from the air you breathe and make the environment inhospitable for the three Ms of allergy—mold, mildew, and mites.
• Get a high-quality vacuum cleaner that won’t spew dust and dirt back into the air. Miele models rank high on our list.
• Wash your nasal passages with saline. A neti pot will help.
• Consider an herbal approach such as stinging nettle (Urtica dioica) or butterbur (Petasites hybridus). Men with prostate enlargement may find nettles especially helpful since some OTC allergy medicines may make this condition worse.
• The natural products quercetin and bromelain may help stabilize mast cells and prevent histamine release.
• Cromolyn (NasalCrom) is an OTC remedy that also stabilizes mast cells. It should be used preventively before exposure to allergens occurs. Cromolyn does not cause drowsiness.
• Oral antihistamines can control symptoms, but they may also make you dangerous on the highways. Even nonsedating products may interfere with driving ability. Generic loratadine (Claritin) is now available without a prescription.
• Among prescription allergy medicines, steroid nasal sprays offer the most effective symptom relief with a minimum of side effects. The cost is significant, since they are available only by prescription. One generic variety (flunisolide) is less expensive than brand-name products like Flonase and Rhinocort AQ.
• Pseudoephedrine can be surprisingly effective at controlling allergy symptoms. Beware of side effects such as insomnia, nervousness, high blood pressure, and irregular heart rhythms.