Jul
3
Allergy: Your Home Environment
July 3, 2009 | Leave a Comment
Your Home Environment
People are now exposed to a chemical soup at home and in the workplace. Buildings are tightly sealed for energy efficiency and may trap chemical gases and dust from a variety of sources. Cleaning agents left on floors and other surfaces dry and can eventually circulate on dust particles throughout the house or workplace and be inhaled with each breath. Fire retardants and other chemicals used in fabrics and foams in furniture, mattresses, and electrical insulation can be irritating to the airway. Mold can flourish wherever there is humidity—in basements, crawl spaces, bathrooms, air conditioners, and automobile air ducts.
It is crazy to treat the symptoms of allergies if you don’t examine your environment and try to eliminate what’s causing the problem in the first place. If you lived in a house with faulty wiring that kept blowing fuses or tripping the circuit breakers every day, it would be foolish to ignore the underlying problem. Continually throwing the circuit breaker to the on position or replacing fuses might leave you vulnerable to a fire. In the old days, people sometimes stuck a penny in the fuse box to bypass the warning system completely. No doubt some homes burned down as a result.
We know of one family that moved into a charming old house. Within a few months, the dad starting sniffling and sneezing. Then he developed asthma for the first time in his life. Not long after, both children also became congested and had periodic bouts of asthma. They were all treated with various medications to relieve their symptoms. It wasn’t until they moved that their symptoms eventually went away and their need for allergy and asthma drugs disappeared.
No dermatologist in his right mind would keep prescribing prednisone to someone who showed up with a poison ivy outbreak every other week. At some point the dermatologist would tell this patient to stay away from poison ivy to avoid the itchy, red rash in the first place. We wish allergists and lung experts would do more than prescribe antihistamines, bronchodilators, and corticosteroids for their patients. If they actually visited their patients’ homes or workplaces they might discover the cause of the symptoms.
Of course, that is not going to happen. Instead, you will have to become your own Sherlock Holmes, sniffing out the culprits if you can. In some cases it might even be worthwhile to employ a certified environmental engineer to look for sources of allergens in a house or apartment. Watch out for charlatans, though. There are lots of quacks out there who would love nothing more than to sell you a pricey home inspection and cleanup. Make sure that whoever analyzes your living space isn’t selling a service or recommending an organization they have a financial relationship with.
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.
Jul
1
Drugs for Asthma Treatment
July 1, 2009 | Leave a Comment
Asthma
Bronchial asthma is a spasmodic obstructive disease of the airways, and symptoms may vary from wheeziness to severe bronchoconstriction that can be fatal. Attacks may be precipitated by exposure to allergens, which may vary from house dust to pollen, fungal spores and animal hair. In some susceptible patients certain drugs, including aspirin, may initiate a severe asthmatic attack. Treatment is basically with drugs that have a relatively selective bronchodilatory action, and, in the case of those drugs given by aerosol inhalation, patients must be given careful instruction in the optimum response is to be obtained. Ephedrine and use of the inhaler device if the optisoprenaline have been used in asthma, but have been virtually replaced by salbutamol and other more selective P,-adrenoceptor stimulants. Adrenaline also has a powerful bronchodilator action, but it may cause cardiac arrhythmias, and it is now used mainly in acute anaphylaxis.
Salbutamol, now widely used, may be given orally by aerosol inhalation, or, in acute conditions, by injection. Ipratropium and oxitropium are anticholinergic agents with a relatively selective bronchodilator action, and are of value in patients who cannot tolerate sympathomimetic agents of the salbutamol type.
Some long-acting may limit their use. ome xanthine products have a sustained action associated with reduced side-effects, but such products are not necessarily bioequivalent, and a change from one product to another should not be made without good cause. Corticosteroids are also of value in both the prophylaxis and treatment of asthma, and those given by inhalation are beclomethasone, budesonide and fluticasone. The recently introduced salmeterol is a derivative of salbutamol intended for use together with inhaled corticosteroid therapy in the prophylactic treatment of asthma. It has a slow initial action, but twice daily treatment is claimed to give relief over 24 hrs. Other drugs for the prophylaxis of asthma are sodium cromoglycate and nedocromil, given by oral inhalation of a dry powder. Ketotifen is an antihistamine with some of the properties of sodium cromoglycate.
Approved names Brand names
bambuterol Bambec
eformoterol Foradil
fenoterol Berotec
reproterol Bronchodil
salbutamol Salbulin, Ventolin, Volmax
terbutaline Bricanyl, Monovent
tulobuterol Respacal other stimulat
orciprenaline Alupent
oxitropium Oxivent
xanthines
aminophylline Pecram, Phyllocontin Continua
theophylline Choledyl, Lasma, Nuelin,
beclomethasone Becotide, Becodisks, Becloforte
budesonide Pulmicort
fluticasone Flixotide
sodium Intel cromoglycate
ketoprofen Zaditen
nedocromil Tilade anticholinergic agents
pratroplum Atrovent
oxitropium Oxivent