Jul
3
Leukotriene Modifier Montelukast (Singulair)
We used to think Singulair was a very cool drug. It is an oral prescription medicine that blocks the effects of those inflammatory chemicals called leukotrienes. So, it only made sense to us that a drug like Singulair would relieve symptoms. This medication is widely prescribed to ease the breathing problems associated with asthma.
Research suggests, however, that Singulair is only modestly effective for alleviating itching, sneezing, congestion, and runny nose. It is roughly comparable to antihistamines such as loratadine (Claritin). One study reported that Singu-
***** Corticosteroid Nasal Sprays
Most allergy experts believe that these steroid sprays are the most effective treatments available and should be the first-line therapy. They are not likely to cause drowsiness or sedation and should be safe for people who must drive or operate machinery.
Side effects: Nasal irritation, stinging, burning, and bleeding. Other adverse reactions may include sore throat (and, rarely, yeast infections), headache, nausea, and cough. Rare adverse reactions may include perforation of the septum, nasal ulcers, reduced growth. rate in children, glaucoma, cataracts, and asthma symptoms.
Downside: These drugs are pricey and may alter the senses of taste and smell.
Cost: Approximately $85 to $95 for brand•name nasal sprays. Generic flunisolide is $35 to $40 per bottle.
lair, which costs more than $3 per pill, was no more effective than the oral decongestant pseudoephedrine (Sudafed) for relieving typical allergy symptoms. 56 Generic pseudoephedrine is far less expensive than Singulair. It is harder to purchase these days because pharmacists can only dispense it from behind the counter. You don’t need a prescription, but you will have to sign for it. Too many people used pseudoephedrine to make the illegal drug methamphetamine, so states and the federal government cracked down on easy access.
The research demonstrating that pseudoephedrine is quite effective in relieving allergy symptoms has forced us to reevaluate this old and inexpensive vasoconstrictor. It works by shrinking blood vessels in the nose. Perhaps that’s why so many drug companies now add this OTC ingredient to their antihistamines. Whenever you see a D appended to the name of an allergy medicine, you can pretty much assume that there is a decongestant on board, and frequently it is pseudoephedrine. It is found in Allegra-D, Claritin-D, Clarinex-D, Zyrtec-D, and other similar formulations.
O.I would like to point out a side effect of allergy medications that contain pseudoephedrine for nasal decongestion. Taking Claritin-D left me completely unable to fall asleep. I was literally up all night with a racing heartbeat.
I have had insomnia problems before, so I did not immediately associate this with the medication and continued to take it for 5 days. I was so sleep deprived that I couldn’t work.
I finally read the warning about nervousness, dizziness, or sleeplessness. I called my doctor, who said I should switch to Claritin (non-D). On this drug I sleep like a baby.
I found that some OTC allergy medicines I had taken for years also contain pseudoephedrine. I suspect this contributed to my earlier insomnia problems.
I urge anyone with insomnia to check all medications for pseudoephedrine. It does not affect everyone, but some of us just can’t handle even a small amount.
A. Millions of people struggle with insomnia and many don’t realize that the medicines they take may be contributing to their problem.
Decongestants aren’t the only culprits. Antihistamines, antidepressants, asthma medicines, blood pressure pills, and pain relievers are some of the drugs that can cause insomnia.
As popular as pseudoephedrine may be, there are some side effects to be alert for. Many people complain of insomnia, anxiety, agitation, headache, nausea, dizziness, and tremor. The most serious adverse reactions are elevated blood pressure and irregular heart rhythms. Men with prostate enlargement must avoid this decongestant because it can make urination much more difficult.
Jul
3
Allergy Medications: Antihistamines
July 3, 2009 | Leave a Comment
Antihistamines
Antihistamines have been the mainstay of allergy treatment for decades. The so-called first-generation drugs like diphenhydramine (Benadryl), brompheniramine (Dimetane, Dimetapp), and chlorpheniramine (Chlor-Trimeton) are linked to drowsiness and cognitive impairment 47 Second-generation antihistamines such as cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), and loratadine (Claritin) have been promoted as nonsedating. Because they were supposed to be so much safer and better tolerated than the old-fashioned drugs, many came with a very steep price tag ($2 to $3 per pill). But there is growing concern that when given in doses that are adequate to relieve allergy symptoms, even these newer compounds may cause some sedation in some patients and produce mild impairment.48 Researchers now believe that “a clear and consistent distinction between sedating and nonsedating antihistamines does not exist.”‘
What this means is that the allergy victim is truly caught on the horns of a dilemma. Suffering with allergies makes you spacey, sleepy, and irritable and can impair your ability to function. Antihistamines can also cause sedation and impair performance. If such drugs only partially control symptoms (a fairly common situation), then you may end up with the worst
Claritin used to be the most widely prescribed antihistamine on the market. When it lost patent protection, the company took it OTC. Compared to many of the older nonprescription antihistamines, loratadine is probably less likely to cause drowsiness at recommended doses. We have seen no data to suggest that it is less effective than pricier prescription antihistamines.
Side effects: Headache, sleepiness, dry mouth, fatigue, jitteriness, and stomach upset. Liver problems may be a rare adverse reaction.
Downside: More expensive than old-fashioned antihistamines. Insurance companies may deny you affordable access to drugs like Allegra now that loratadine is available OTC. Loratadine may cause sedation and impair driving in susceptible people. Do not assume you are safe behind the wheel.
Cost: Approximately $5 to $10 for a month’s supply when purchased generically in bulk. The brand-name Claritin can cost two to four times that much.
situation of all—sedation from the medicine and from the allergic condition.”
In such a confusing situation, we would normally suggest that the allergy sufferer experiment with a variety of antihistamines to try and determine which one works best and is least troublesome in terms of side effects. The difficulty is that people are notoriously bad at assessing their level of impairment. There is a warning on the label of Benadryl and many other OTC allergy medicines reminding users that “marked drowsiness may occur” and urging them to “be careful when driving a motor vehicle or operating machinery.” Such cautions are as meaningless as telling a drunk to be careful behind the wheel. In fact, researchers have reported that diphenhydramine”had a greater impact on driving than alcohol did: ,51 These scientists discovered that “drowsiness ratings were not a good predictor of impairment, suggesting that drivers cannot use drowsiness to indicate when they should not drive.”
By the way, did you know that you could be arrested for driving while impaired after taking an OTC allergy pill? If your driving skills are not up to par, an officer can give you a ticket even though you have no alcohol in your system.
So, dear reader, we have no easy answers. We would like to say, if you have allergies, do not drive, especially if you are taking antihistamines. That would be the only prudent thing. We know that some people will disobey such a suggestion, however. Some experts believe that fexofenadine (Allegra) may be one of the least sedating and safer antihistamines to take if you must drive. 52,51 Others point out that even this non-sedating antihistamine may pose problems at higher doses. 54 If driving or operating machinery is essential or if you must make important decisions, we encourage you to look for other options besides oral antihistamines.
There is now a prescription antihistamine nasal spray called azelastine (Astelin). It is fairly fast acting but has the disadvantage of requiring twice-daily nasal spritzing. Some data suggest it may be as effective as oral antihistamines. Side effects may include a bitter taste in the mouth (20 percent of patients), headache, drowsiness (11 percent of patients), nasal burning or inflammation, sore throat, dry mouth, sneezing, fatigue, and dizziness. A 1 -ounce bottle can cost $75 to $85. Not exactly a perfect solution to the problem, eh?
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?
Nose Cleaning with Neti
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. 38
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.
It is ironic that these hairs contain a witches’ brew of ir-*** Stinging Nettle (Urtica dioica)
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
ritating chemicals, including histamine and formic acid (also found in ant stings), yet the herb may be helpful in controlling allergy symptoms. When the leaves and other parts of the aboveground plant are extracted and swallowed, they may offer some fascinating pharmacological benefitS.39′
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. 41
O. 1 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: 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
*Take quercetin and bromelain
•Try NasalCrom (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.19 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. 20 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. 23
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.
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.