ANTIHISTAMINES TO TREAT ALLERGIC NOSESThe word antihistamine is a combination of terms: anti, meaning against, and histamine, a naturally-occurring bodily chemical that regulates a variety of bodily activities and is a chemical mediator of both allergic and non-allergic forms of chronic rhinitis.Histamine is present in the mast cells of the lining of your nose. Not only does it participate in normal nasal function, during allergic reactions it is released in abundance into the surrounding tissue where it becomes the primary mediator of common nasal symptoms: runny nose, sneezing, itchy nose, postnasal drainage, and stuffy nose.Histamine exerts its effect on the tissues of the nose through special structures on those tissues called histamine receptors. If there is no receptor for histamine, it cannot act on your tissues. No action on tissues, no symptoms. This fact becomes important in discussing how certain drugs act to counter the effects of histamine.Humans have three different types of histamine receptors: HI, H2, and H3 receptors. These receptors are located on most tissues in our bodies. Different tissue effects are produced through histamine’s action on each of these receptors. It is through the HI receptors that histamine exerts its effect on our noses. The actions that result from histamine acting with H2 or H3 receptors are currently not believed to play an important role in causing nasal symptoms.
Nasal Symptoms Caused by Histamine Acting on Tissue H1 ReceptorsSymptom Histamine Action on HI ReceptorNasal congestion Dilation of blood vessels, leaking of plasma from blood vessels into surrounding tissueSneezing Reflex stimulationItching of nose Reflex stimulation
How Antihistamines WorkAntihistamines work against (anti = against) histamine by competing with it for H1 receptors. Antihistamines as a group are commonly called H1 antagonists, because they impede the Hl-receptor effects of histamine.H1 receptors can act with only one agent at a time; thus, when they are acting with antihistamines, they cannot act with histamine. If histamine can’t act with the H1 receptor, it can’t cause any changes in your nose. And, if there are no nasal changes, you suffer no symptoms.*38/322/5*
Archive for the ‘Allergies’ Category
A mother should not waste her time trying to fight off her child’s asthma attack. She should put him to sleep in a dust-free bedroom that contains no animals, feathers, or odors, and give him large quantities of fluids to drink, together with an antihistamine cough mixture that does not contain any codeine. If the attack is strong, she should give him an aminophylline preparation by mouth or rectally. If three hours pass and the attack does not subside, she should give the child an injection of adrenalin which can be repeated in three hours. Any asthma attack that lasts more than a couple of days needs an antibiotic.
While in the hospital, the asthma attack usually improves dramatically in twenty-four to forty-eight hours because a change in the physical environment takes place as well as an easing of tensions.
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If enzyme deficiencies are at the root of the problem in chemical-sensitive patients then one might expect them to show the same sort of reaction to small amounts of a chemical as normal people show to large amounts of that chemical. Occupational medicine – the study of how exposures in the workplace affect workers’ health – is the main source of information here. This branch of medicine studies the effects of brief high-dose exposures (as during an industrial accident) and long-term exposures at a lower level (but still much higher than most people would encounter). It is the latter which are relevant to the chemical-sensitive patient, and they do provide some interesting and revealing parallels.
In the case of organic solvents, for example, the prime symptoms seen in workers exposed to regular ‘low’ doses are mental ones. For example, toluene (found in paints and glues) produces fatigue and vague feelings of malaise, while styrene (used in the manufacture of polystyrene) produces fatigue, a sense of ill-health and irritability. Trichloroethylene (an industrial solvent that is a common contaminant of drinking water) may produce tiredness, dizziness, headache, irritability and digestive problems. White spirit, which is a mixture of solvents, produces fatigue and general feelings of ill-health. These are very much the sort of symptoms seen in many chemical-sensitive patients when they are exposed to organic solvents. (Common sources of solvents are shown in Table 3.) are involved in detoxifying both chemicals – the two then ‘compete’ for the same enzyme, which is only present in limited amounts. Even chemicals that are broken down by different enzymes may ‘compete’: some enzymes need substances known cofactors to help them do their work, so the two chemicals are ‘competing’ for cofactors, rather than for the enzymes themselves. Many organic solvents interact with each other in this way, and it may be the combination of chemicals surrounding them that causes illness in chemical-sensitive patients. Most of the vitamins are enzyme cofactors, and some doctors believe that a lack of vitamins can make people more sensitive to environmental chemicals.
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Within the field of clinical ecology, doctors have developed four more allergies testing techniques – all highly controversial, but showing some promise nonetheless.
Intradermal skin titration is much like traditional skin testing, but with a slight twist. Instead of using a standardized test dose, testing begins with a weak dose and measures the weal produced by each subsequent dose, until reactions reach a plateau and weals no longer grow progressively larger. Doctors who use this technique say that it not only determines the degree of sensitivity to the substance but also indicates how strong the treatment dose should be. (To eliminate the power of suggestion, patients aren’t always told what they’re being tested for.)
Intradermal provocation is a variation of intradermal titration. The idea is to produce not only a weal-and-flare but symptoms – which are then immediately neutralized with subsequent injections of the diluted solution. Patients may also be sent home with pre-measured doses of the allergen – either to neutralize unpleasant reactions or to prevent them.
Mainstream allergy doctors who’ve tried these alternative methods of skin testing claim they do not give consistent, accurate information – contrary to what the tests’ advocates claim. Doctors familiar with those same tests, however, say that other doctors get poor results because they don’t follow the procedures correctly.
Sublingual (under-the-tongue) provocation is used primarily to identify allergy to foods and sometimes allergy to inhalants. Extracts are mixed half-and-half with glycerin and squirted under the tongue. If nothing happens within ten minutes, the next food is tested. If symptoms develop, neutralization is attempted with dilutions of the same food extract.
Over a series of several visits, dozens of foods can thus be tested – up to thirty or forty is usually adequate. You might say that sublingual provocation is comparable with a deliberate challenge with the food itself. And it’s very controversial: the few doctors who use the sublingual method swear by it, saying it works very well and is just the ticket for fidgety children or people who hate needles. Traditional doctors who’ve tried sublingual testing say they can’t get accurate results.
The cytotoxic test (or leukocytotoxic test) is also used to detect food allergy. A sample of blood is drawn and cells are added to a mixture of sterile water, and then applied to microscopic slides smeared with food extracts in a base of petroleum jelly. The slides are examined several times – within ten minutes, after thirty or forty minutes, after one hour, after one and a half hours and after two hours. Certain changes in blood cells are interpreted as a sure sign of allergy to the food smeared on the slide.
The big plus of cytotoxic testing is that doctors claim they can diagnose allergy to many, many foods from one sample of blood. The problem, though, is that cytotoxic testing may not be as reliable or valid as its proponents crack it up to be.
‘It may be reliable in the sense that two different lab technicians doing the same test on the same individual may get roughly the same result,’ says Iris Bell, at San Francisco Veterans Hospital and the University of California at San Francisco. ‘But there’s not a lot of good evidence that it’s valid – that a positive test really means you can’t eat the food.’
‘In other words,’ continued Dr Bell, ‘if the cytotoxic test shows you are sensitive to fifty items – and some show that – the question is, Can you really not eat all those foods without getting symptoms?’ Conversely, the test may show no reaction to a food to which you are blatantly allergic. In other words, the cytotoxic test has the same potential (or possibly more) for false positive results as does the traditional skin test.
An additional drawback of the cytotoxic test is that it gives no indication of type of sensitivity, even when the test is accurate. ‘There’s no way to tell from looking at a slide if you’re going to get a life-threatening asthma attack or break out in one hive,’ says Dr Bell.
At present, the cytotoxic test is no better than skin tests in diagnosing allergy. In fact, in some ways cytotoxic tests are less, accurate than skin tests.
‘I see the cytotoxic test at the level it’s been developed right now as being able to offer a hint that something may be going on,’ Dr Bell says. ‘But I don’t think it can be used to tell you what you absolutely can and cannot eat.’
As this brief review clearly shows, allergy testing is not an exact science. Try as they might, doctors cannot always tell exactly what’s going on in an allergic body. One thing that all these tests have in common is that they must be correlated with a complete and thorough medical history if they are to be interpreted correctly. No matter how sophisticated the tests become, there’s no substitute for a doctor asking you for details about your diet and the environment in your home, school or workplace.
‘My advice to young doctors is to listen to what the patient says,’ offered Dr Constantine J. Falliers, an allergist and asthma specialist in Denver, Colorado. ‘You can learn more from that than from doing the most expensive, fancy tests.’
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If you exceed the ‘ideal weight’ charts by ten or twenty pounds, you really have no cause for concern as far as health goes. In fact, some studies show that people who are under their ‘ideal weight’ by that amount are at a greater risk for disease than their portly friends. But if you’re more than twenty pounds overweight, you should probably trim down.
If you’re like most people, however, you’ve already tried to lose weight – more than once. And most likely, you regained anything you lost. You know full well that overeating produces extra pounds, but you haven’t been able to get perfect control over your food intake. Well, perhaps it’s time to look at overweight and eating habits in a new way.
Think about the foods you crave, the foods that seem to go straight from your plate to your hips: cakes, pies, ice cream, chips, soda, sweets, cream, cheese and the like. They all contain wheat, milk, eggs, corn (as corn syrup) or sugar – or some combination of those common food allergens.
‘These food cravings can be due to an allergy to these foods and, once the offending foods are avoided, the craving can diminish along with the weight,’ says Dr Doris J. Rapp, in her book, Allergies and Your Family. In other words, food allergies can explain the compulsive eating behavior that almost always leads to overweight.
There is definitely a link between allergies and obesity,’ says Thomas L. Stone, of Rolling Meadows, Illinois. ‘When you eat certain foods – especially wheat – you get ravenously hungry and try to eat everything.’
‘If you’re allergic to wheat, which is a common allergen in overweight people, and you’re accustomed to having the equivalent of two slices of bread and you cut down to half a slice a day, you’re not going to be satisfied,’ says Dr Theron Randolph, an allergist in Chicago, Illinois, ‘So you’ll eat more of something else to fill up.’
Another problem among people with allergies to foods is that they often experience dramatic ups and down in their weight because of water retention, and these fluctuations discourage their weight loss attempts.
‘If you eat a food to which you are allergic, you can retain up to 4 per cent of your body weight,’ says Dr. Stone. ‘That means that if you weigh 150 pounds, you can gain 6 pounds as water within 24 hours. Food-allergy-related weight gain produces certain puffiness.’
A Rotary Diet (in which foods are widely and carefully varied) can help people lose weight, even though the programme is not specifically designed as a weight loss diet. By breaking the cycle of eating allergenic foods every day, you will automatically eat less of those foods and reduce your allergy to them. It’s a step away from compulsive eating.
‘You can abolish food cravings by taking an organized approach,’ says Dr Randolph. ‘I don’t consider myself an “overweight expert”, but I’ve seen this work in many people, some of whom have lost phenomenal amounts of weight’
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Hives – those ugly red or pale bumps that seem to pop up out of nowhere – are truly the scourge of any self-respecting skin. Science has even given hives a creepy-sounding name: urticaria. Actually, it’s not the skin itself that’s reacting to allergens, but tiny blood vessels in the skin, which release histamine and other substances that cause the skin to swell, burn and itch.
One out of five people has hives at one time or another, and an episode can last six weeks. Some people even get hives again and again. To top it off, hives are one of the most unpredictable of allergic reactions: one young woman we know is so susceptible that she broke out in hives just being interviewed about her allergies.
That brings us to the psychological side of hives – which has been quite overrated. While you are more apt to break out when you’re worried or distraught, most people get hives in response to something they eat, breathe or touch.
Drugs such as penicillin and aspirin are the most common cause of allergic hives. In 5 to 10 per cent of all people with hives, diet aggravates or triggers the problem. The most common causes of food-induced hives are nuts, fish, eggs, seafood, strawberries, yeast, salicylates (aspirin-related compounds in certain foods), azo dyes (such as El02, or tartrazine) and benzoic acid or other benzoates (common preservatives in fruit products and fruit drinks).
As a matter of fact, researchers have noted that nearly half of all people with chronic, hard-to-diagnose hives are allergic to aspirin and other salicylates, and, to a lesser degree, to tartrazine and benzoates. So if you’re bothered by hives, it may be worthwhile to eliminate those substances from your diet and see if the problem subsides. A researcher in the Netherlands did just that with forty-seven of his patients, and the results were terrific. Sixty-seven per cent of the people with chronic, unexplained hives had a prompt and permanent cure. Even more surprisingly, half the people with heat-induced hives – usually a thorny problem – were cured. Going off the diet and eating one of the offending substances invariably triggered a rapid and immediate outbreak of hives – confirming the diagnosis.
Two other common additives that are beginning to show up as causes of hives are BHA and BHT (butylated hydroxyanisole and butylated hydroxytoluene). In one instance, a thirty-two-year-old pediatrician suffered from hives for three years before allergy specialists finally isolated BHA and BHT as the cause (Annals of Allergy).
Potato chips, breakfast cereals, canned pudding, doughnuts and pork sausages are just a few of the foods likely to contain BHA and BHT. Reading labels helps to avoid those and other additives, as does cutting down on processed foods.
As bad as hives are, people with hives are luckier than people with other allergic reactions – hives have a tendency to disappear for good. People with food-induced hives are often able to return to their regular diet after as little as six months of dietary control.
Infants who develop hives when new or solid foods are first introduced may later tolerate those foods if they are withdrawn and reintroduced after the child is twelve months old. By that time, their intestinal enzymes will have matured enough to break down food molecules so that they are no longer allergenic, says Dr John R. T. Reeves, of the University of California, San Francisco, School of Medicine.
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People with coeliac disease react to gluten – a nutritious protein in wheat and other grains – as if it were poison. Gluten damages their intestines so badly that they cannot absorb food, vitamins or minerals. They suffer abdominal cramps, gas, diarrhoea, malnutrition and weight loss. The disease is so debilitating that children with it grow slowly – if at all.
Coeliac disease isn’t an allergy. But it’s related to allergy in that many cases are provoked early in infancy by an allergic reaction to cow’s milk. The damaged intestines then reject not only wheat and milk, but sometimes other foods as well. And coeliac disease is treated much like an allergy – by careful avoidance of gluten-containing grains.
The four offenders in coeliac disease are wheat, rye, barley and oats (although some coeliacs can eat oats safely). Their close botanical relative, rice, and distant cousins, corn and millet, have such low levels of gluten that most coeliacs can tolerate them, especially after several months of totally avoiding all sources of gluten.
But even when eating high-gluten grains, some coeliacs do not get as severely ill as others. A study in Britain tested the effects of barley, rye, rice and corn in a group of coeliacs. As expected, rice and corn did no harm. With barley and rye, the damage varied from one person to another, even though everyone ate the same amounts. Evidently, coeliacs vary in how much damage their intestines suffer when they eat gluten (Quarterly Journal of Medicine).
Standard treatment for coeliac disease begins with a high-protein, gluten-free diet of skimmed milk, egg whites, lean meat, fish, liver and protein-rich vegetables such as peas and beans. Starchier foods such as fruit, vegetables and low-gluten grains come later, after the digestive system has healed enough to be able to handle them.
But because gluten can show up where you least expect it, you need to stop and think before you put anything in your mouth. For example, a woman in Toronto was doing very poorly despite a strict gluten-free diet. Doctors finally discovered that the woman, a Catholic, was receiving daily Communion -and that the wafers were made of wheat flour. Within two days of taking Communion without wafers, she no longer had abdominal cramps, bloating or diarrhoea (Lancet).
‘It’s not unusual for a person to adhere strictly to the diet but to be unaware that the Communion wafer or stick of gum may be an unsuspected source of gluten,’ says Joyce Gryboski, a pediatrician at Yale University School of Medicine (American Journal of Diseases of Children).
Until you heal, you will probably need to take a B-complex vitamin and other nutritional supplements to replace nutrients lost either through poor absorption or from avoiding grain and other B-vitamin-rich foods.
After you’ve done well on the high-protein, low-gluten diet for six months, you can work towards a regular diet by adding one food at a time. It may take a year or two for the intestinal damage to heal completely. Some coeliacs can eventually eat wheat and other sources of gluten, especially if they begin with rice or corn. A few lucky ones – mostly children – are able to eat gluten indefinitely without symptoms. But the basic tendency for gluten intolerance will remain, so it’s best to eat only small amounts of gluten-containing foods occasionally rather than making them a major part of your daily diet.
Some people, however, may not improve until milk or egg has also been removed from the diet. One doctor noticed that out of 120 people with coeliac disease, ten did not improve on a gluten-free diet until milk protein was avoided. Two other coeliacs failed to get better until egg was avoided (Progress in Gastroenterology).
Other doctors report the case of a woman who was careful to follow a strict gluten-free diet, yet failed to improve. They noticed that her symptoms were the worst when she ate egg, chicken or tuna. But when those foods – along with gluten -were removed from her diet, she made a full recovery, say Drs Alfred L. Baker and Irwin H. Rosenberg, of Chicago, Illinois. The doctors emphasize that while coeliac disease due to foods other than gluten is unusual, it does occur {Annals of Internal Medicine).
Coeliac disease seems to be somewhat preventable. The first step is for women to breastfeed their babies, especially if coeliac disease or allergies run in their family – or if they’re Irish. (Irish people or their descendents are genetically more susceptible to the problem.) A study done a few years ago shows that coeliacs are more likely to have asthma, hay fever and eczema than non-coeliacs. While no one understands the full significance of the coeliac-allergy connection, it could indicate that since breastfeeding protects against allergies, it may guard against coeliac disease, too. Also, by delaying exposure to cow’s milk until the baby has developed the proper enzymes to handle it, breastfeeding also prevents the intestinal damage that sets the stage for coeliac disease.
And don’t be too hasty to add cereal and other solid foods to the baby’s diet. Wait until the infant is at least four to six months old, and then add each grain, one at a time, in small amounts. Begin with rice, millet and other low-gluten grains.
‘Delayed introduction of gluten to the diet in infancy may prevent. . . gluten intolerance and lead to a drop in the number of people who get coeliac disease,’ say doctors in Britain.
Other doctors report that as more mothers breastfeed – and breastfeed longer – the incidence of coeliac disease seems to be dropping. ‘We believe that the incidence of coeliac disease in childhood is falling and that this is directly related to changes in infant feeding practices occurring in the mid-1970s,’ they conclude {Lancet).
It’s nice to hear that even some of the most mysterious health problems are within our control – if we know what to do about them.
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The impact of stress on health is undeniable. Stress is not a disease, however, but a normal element in the weather of life. It’s like rain. With too little, life is barren. With too much, you get flooded.
For people with allergies, the stress clouds hang a bit thicker and lower than usual. Along with the usual stresses of everyday life – temperamental children, money worries, job hassles -people with allergies have additional concerns. Changing your habits or diet to side-step allergy triggers is fraught with stress. Plus there’s the strain sometimes created by trying to get other people to accommodate you.
The other people you live with may resent being asked to go outside to spray their hair, or having to remember not to polish their shoes around you,’ says Dr Bell.
All that stress may have a direct effect on the immune system, aggravating allergic reactions.
‘Any period of stress may weaken the immune system so that you react more easily to foods or chemicals,’ explained Dr Bell. ‘But if you have yourself in better control of stress, when something does happen — when you encounter an allergy trigger — your symptoms won’t get as bad.’ In other words, managing stress helps you weather allergic encounters.
Relaxation
‘An important approach I use to alleviate stress is some form of relaxation therapy,’ says Dr Bell. ‘There are a variety of approaches. One is imagery, in which I tell people to imagine themselves in a safe environment whenever they find themselves exposed to a threatening food or chemical. That takes advantage of what the mind can do for the body; a message is sent from the brain to the rest of the body, putting you in a stronger biological state.
‘The relaxation method you choose is not all that important, as long as it works for the individual,’ she adds. ‘All achieve the same basic goal – reducing stress.’ They do that, she explained, by putting your body in a state that is the exact opposite of how it operates when you feel tense and under stress.
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