Allergra is not metabolized by the liver whereas claritin, clarinex, and zyrtec are.
Our livers are already under pressure by having CF, and with all the meds we take, it's nice to give the liver a break.
Because allergra is not heptatically metabolized, I have known some top allergists to rx 180 mg 2-3 times a day if need (this is NOT referring to Allegra-D, which contains pseudo ephedrine..... I'm referring to the plain Allegra 180mg). You can NOT do this with zyrtec or claritin.
Showing posts with label Allergies. Show all posts
Showing posts with label Allergies. Show all posts
Tuesday, September 2, 2008
Thursday, August 7, 2008
Anti-histamines even when you don't have allergies
February 20, 2007
White Blood Cells In Lung Produce Histamine Seen In Allergies
In a surprise finding, scientists have discovered that histamine, the inflammatory compound released during allergic reactions that causes runny nose, watery eyes, and wheezing, can be produced in large amounts in the lung by neutrophils, the white blood cells that are the major component of pus.
Pus, a fluid found in infected tissue, is produced as a result of inflammation.
The study in mice is the first to show that lung neutrophils can produce histamine in significant quantities, according to principal investigator George Caughey, MD, chief of pulmonary/critical care medicine at the San Francisco VA Medical Center.
"Previously it was thought that the primary sources of lung histamine, in health as well as disease, was mast cells, which are classically associated with allergy," notes Caughey, who is also a professor of medicine at the University of California, San Francisco.
Caughey says the result could mean that histamine acts as a link between airway infections and asthma and bronchitis, which are associated with allergy. "In both, we observe inflammation - swelling, blood vessel leak, and muscle contraction that narrows the airway."
The study appears in the January 2007 issue of the Journal of Experimental Medicine.
Caughey was investigating the well-known fact that upper respiratory infections often trigger acute asthma attacks. "We hypothesized that an infection in the airway would release histamine from mast cells, and that would be one of the reasons," he explains.
To test the hypothesis, Caughey and his team exposed two different populations of mice to mycoplasma, a common respiratory infection in rodents and humans. One population had a genetic abnormality that causes a total lack of mast cells; the other population was made up of normal, wild-type mice. Both populations of infected mice developed pneumonia.
"We thought the mice without mast cells would do better than the wild-type mice, because the infection wouldn't be provoking mast cells to release histamine," recalls Caughey. "In fact, they did much worse. Even though there were no mast cells, histamine levels rose up to 50 times normal."
The reason was straightforward, Caughey says. Neutrophil numbers increased in response to infection, and neutrophils in turn produced histamine. "It's a direct effect of the mycoplasma bacteria on neutrophils. They induce neutrophils to produce the enzyme that produces histamine."
Individual neutrophils produce much less histamine than individual mast cells, says Caughey, but "because pus contains millions if not billions of neutrophils, the overall amount they make is very considerable."
The neutrophil-histamine effect was similar in the wild-type mice, reports Caughey: "Histamine levels from neutrophils blew right past the histamine levels contributed by mast cells."
The wild-type mice suffered less severe infections overall because "as a number of recent studies, including ours, have shown, mast cells actually play a role in protecting against bacteria," Caughey explains. "For example, a mouse without mast cells with the equivalent of a ruptured appendix will die of the resulting infection, while a mouse with mast cells can survive."
When the infected mice without mast cells were given antihistamines, the level of histamine, and therefore the severity of the pneumonia, dropped in proportion to the amount of antihistamine given.
"This is a study in mice, so we cannot freely extrapolate the results to human beings," cautions Caughey. "Nonetheless, antihistamines may deserve more of a look as therapeutic options in lung and airway infection."
He says the study also has implications for other types of airway infection "in which there are a lot of white blood cells -cystic fibrosis, for example, which can be associated with asthma-like airway contraction."
The next steps for Caughey and his research team are to investigate "how general this result might be. Does only one type of bacteria cause the effect, or do others, also? Is it limited to rodents, or does it carry forward to humans? And if it does, is the amount of histamine produced by neutrophils enough to make a clinical difference?"
###
Co-authors of the study were Xiang Xu, MD, PhD, Dongji Zhang, MD, PhD, Hong Zhang, PhD, Paul J. Wolters, MD, Nigel P. Killeen, PhD, Brandon M. Sullivan, Richard M. Locksley, MD, and Clifford A. Lowell, MD, PhD, of UCSF.
The study was supported by funds from the National Institutes of Health, the Diamond Family Foundation, and an Elizabeth Nash memorial fellowship from Cystic Fibrosis Research, Inc. A part of the NIH funds was administered by the Northern California Institute for Research and Education.
NCIRE is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.
Contact: Steve Tokar
University of California - San Francisco
http://allergy-articles.blogspot.com/2007/02/white-blood-cells-in-lung-produce.html
White Blood Cells In Lung Produce Histamine Seen In Allergies
In a surprise finding, scientists have discovered that histamine, the inflammatory compound released during allergic reactions that causes runny nose, watery eyes, and wheezing, can be produced in large amounts in the lung by neutrophils, the white blood cells that are the major component of pus.
Pus, a fluid found in infected tissue, is produced as a result of inflammation.
The study in mice is the first to show that lung neutrophils can produce histamine in significant quantities, according to principal investigator George Caughey, MD, chief of pulmonary/critical care medicine at the San Francisco VA Medical Center.
"Previously it was thought that the primary sources of lung histamine, in health as well as disease, was mast cells, which are classically associated with allergy," notes Caughey, who is also a professor of medicine at the University of California, San Francisco.
Caughey says the result could mean that histamine acts as a link between airway infections and asthma and bronchitis, which are associated with allergy. "In both, we observe inflammation - swelling, blood vessel leak, and muscle contraction that narrows the airway."
The study appears in the January 2007 issue of the Journal of Experimental Medicine.
Caughey was investigating the well-known fact that upper respiratory infections often trigger acute asthma attacks. "We hypothesized that an infection in the airway would release histamine from mast cells, and that would be one of the reasons," he explains.
To test the hypothesis, Caughey and his team exposed two different populations of mice to mycoplasma, a common respiratory infection in rodents and humans. One population had a genetic abnormality that causes a total lack of mast cells; the other population was made up of normal, wild-type mice. Both populations of infected mice developed pneumonia.
"We thought the mice without mast cells would do better than the wild-type mice, because the infection wouldn't be provoking mast cells to release histamine," recalls Caughey. "In fact, they did much worse. Even though there were no mast cells, histamine levels rose up to 50 times normal."
The reason was straightforward, Caughey says. Neutrophil numbers increased in response to infection, and neutrophils in turn produced histamine. "It's a direct effect of the mycoplasma bacteria on neutrophils. They induce neutrophils to produce the enzyme that produces histamine."
Individual neutrophils produce much less histamine than individual mast cells, says Caughey, but "because pus contains millions if not billions of neutrophils, the overall amount they make is very considerable."
The neutrophil-histamine effect was similar in the wild-type mice, reports Caughey: "Histamine levels from neutrophils blew right past the histamine levels contributed by mast cells."
The wild-type mice suffered less severe infections overall because "as a number of recent studies, including ours, have shown, mast cells actually play a role in protecting against bacteria," Caughey explains. "For example, a mouse without mast cells with the equivalent of a ruptured appendix will die of the resulting infection, while a mouse with mast cells can survive."
When the infected mice without mast cells were given antihistamines, the level of histamine, and therefore the severity of the pneumonia, dropped in proportion to the amount of antihistamine given.
"This is a study in mice, so we cannot freely extrapolate the results to human beings," cautions Caughey. "Nonetheless, antihistamines may deserve more of a look as therapeutic options in lung and airway infection."
He says the study also has implications for other types of airway infection "in which there are a lot of white blood cells -cystic fibrosis, for example, which can be associated with asthma-like airway contraction."
The next steps for Caughey and his research team are to investigate "how general this result might be. Does only one type of bacteria cause the effect, or do others, also? Is it limited to rodents, or does it carry forward to humans? And if it does, is the amount of histamine produced by neutrophils enough to make a clinical difference?"
###
Co-authors of the study were Xiang Xu, MD, PhD, Dongji Zhang, MD, PhD, Hong Zhang, PhD, Paul J. Wolters, MD, Nigel P. Killeen, PhD, Brandon M. Sullivan, Richard M. Locksley, MD, and Clifford A. Lowell, MD, PhD, of UCSF.
The study was supported by funds from the National Institutes of Health, the Diamond Family Foundation, and an Elizabeth Nash memorial fellowship from Cystic Fibrosis Research, Inc. A part of the NIH funds was administered by the Northern California Institute for Research and Education.
NCIRE is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.
Contact: Steve Tokar
University of California - San Francisco
http://allergy-articles.blogspot.com/2007/02/white-blood-cells-in-lung-produce.html
Anti-histamines explained
So here's the low down with anti-histamines per my research. Keep in mind there are two items you must keep in mind in terms of drugs: efficacy & side effects. I'll examine both.
There are two generations: 1st and 2nd.
1st generation includes meds like diphenhydramine (Benadryl). This med, in terms of efficacy, is by far the best. Benadryl is an extremely powerful anti-histamine. Side effects, however, are just as strong. It has anti-cholinergic effects and can dry up sputum. Additionally, the med crosses the blood brain barrier and causes lots of drowsiness (a SUBJECTIVE measurement) and impairment (OBJECTIVE measurement). There is a difference between drowsiness and impairment.
2nd generation includes Claritin (loratadine), Clarinex (desloratadine), Zrtec (ceterizine) and Allegra (fexofenadine).
Claritin was 1st to market and was considered a miracle drug cuz it worked pretty well and didn't have those horrible side effects like drowsiness and impairment like Benadryl did. The makers dosed it at 1/2 the European dose, though, so that it wouldn't cause as much drowsiness. Many people don't feel the efficacy of Claritin unless they double the 10mg dose to 20mg. At 20mg, the Euro dose, it can cause drowsiness or impairment. But it does not have anti-cholinergic effects.
Claritin is metabolized by the liver into Clarinex (loradadine into desloradadine) so you can treat them as the same drug.
There are 2 head to head studies, 1 compariing Zyrtec to Claritin, 1 comparing Allegra to Claritin, showing that both Zyrtec and Allegra relieve allergy symptoms better than Claritin.
Zyrtec has more sedation & impairment side effects than Allegra & Claritin, as it readily crosses the blood brain barrier. It also has mild anti-cholinergic effects, but not as bad as Benadryl.
Allegra does not have anti-cholinergic affects nor does it cross the blood-brain barrier so sedation & impairment do not occure.
2 head to head studies, both studying patients with the most severe allergy symptoms, showed that Allegra & Zyrtec are equally as powerful.
So the winner in my mind, and what I take, is Allegra 180mg.
Hope this helps
Anti-histamines Benedryl (diphenhydramine), Claritin (loratadine), Clarinex (desloratadine), Allegra (fexofenadine), Zyrtec (ceterizine), Xyzal (levoceterizine)
There are two generations: 1st and 2nd.
1st generation includes meds like diphenhydramine (Benadryl). This med, in terms of efficacy, is by far the best. Benadryl is an extremely powerful anti-histamine. Side effects, however, are just as strong. It has anti-cholinergic effects and can dry up sputum. Additionally, the med crosses the blood brain barrier and causes lots of drowsiness (a SUBJECTIVE measurement) and impairment (OBJECTIVE measurement). There is a difference between drowsiness and impairment.
2nd generation includes Claritin (loratadine), Clarinex (desloratadine), Zrtec (ceterizine) and Allegra (fexofenadine).
Claritin was 1st to market and was considered a miracle drug cuz it worked pretty well and didn't have those horrible side effects like drowsiness and impairment like Benadryl did. The makers dosed it at 1/2 the European dose, though, so that it wouldn't cause as much drowsiness. Many people don't feel the efficacy of Claritin unless they double the 10mg dose to 20mg. At 20mg, the Euro dose, it can cause drowsiness or impairment. But it does not have anti-cholinergic effects.
Claritin is metabolized by the liver into Clarinex (loradadine into desloradadine) so you can treat them as the same drug.
There are 2 head to head studies, 1 compariing Zyrtec to Claritin, 1 comparing Allegra to Claritin, showing that both Zyrtec and Allegra relieve allergy symptoms better than Claritin.
Zyrtec has more sedation & impairment side effects than Allegra & Claritin, as it readily crosses the blood brain barrier. It also has mild anti-cholinergic effects, but not as bad as Benadryl.
Allegra does not have anti-cholinergic affects nor does it cross the blood-brain barrier so sedation & impairment do not occure.
2 head to head studies, both studying patients with the most severe allergy symptoms, showed that Allegra & Zyrtec are equally as powerful.
So the winner in my mind, and what I take, is Allegra 180mg.
Hope this helps
Anti-histamines Benedryl (diphenhydramine), Claritin (loratadine), Clarinex (desloratadine), Allegra (fexofenadine), Zyrtec (ceterizine), Xyzal (levoceterizine)
Differences Between Nose Sprays per my Research
Differences Between Nose Sprays per my Research
There are 4 Rx nose sprays on the market. Flonase, Nasacort AQ, Nasonex and Rhinocort Aqua.
Rhinocort Aqua is by far the weakest. Unlike the others on the market, you need to titrate up for maximum efficacy. This can mean 4 sprays per nostril per day - and a prescription that only lasts about 2 weeks. But RA does lack alcohol, which is a good thing.
Head to head studies of Nasonex vs. Flonase demonstrate that Flonase has superior efficacy. But Nasonex does lack alcohol whereas Flonase contains alcohol (which causes nose bleeds and heads).
Head to head studies of Flonase vs. Nasacort AQ demonstrate equal efficacy (even in patients with severe symptoms). Nasacort AQ lacks alcohol as well.
Nasacort AQ is the winner.
There are 4 Rx nose sprays on the market. Flonase, Nasacort AQ, Nasonex and Rhinocort Aqua.
Rhinocort Aqua is by far the weakest. Unlike the others on the market, you need to titrate up for maximum efficacy. This can mean 4 sprays per nostril per day - and a prescription that only lasts about 2 weeks. But RA does lack alcohol, which is a good thing.
Head to head studies of Nasonex vs. Flonase demonstrate that Flonase has superior efficacy. But Nasonex does lack alcohol whereas Flonase contains alcohol (which causes nose bleeds and heads).
Head to head studies of Flonase vs. Nasacort AQ demonstrate equal efficacy (even in patients with severe symptoms). Nasacort AQ lacks alcohol as well.
Nasacort AQ is the winner.
Wednesday, August 6, 2008
How I treat Allergies
What I do to treat allergies
1. Allergy testing. Many people have house-hold allergies in addition to outdoor allergies. Controlling indoor allergies can greatly diminish symptoms of outdoor allergies. But first, you need to get skin tested (by an allergist, not a GP) - IgE blood levels are useless so don't go down that route.
2. Most of us have dust mite feces allergies. I have dust mite encasings on my pillows and mattress (purchased at www.allergyasthmatech.com)
3. I have no carpet in my place, but when I did in college I put dust mite powder on my carpet (simple to use - just put it on the carpet and then vacuum it up a few hours later. it lasts 6 months). Also can be found at www.allergyasthmatech.com
4. HEPA air purifier in the room that I do meds and my bedroom. Nothing else but HEPA will do. I bought mine at www.costco.com
5. I never open windows in my house. It's a pain, but it lets allergens in. Instead, I run my air conditioner
6. I take an anti-histamine. 70% of the allergic cascade is attributed to histamines. As Nicole said, check out my blog for an explanation of the differences between anti-histamines (school down to categories on the left, then click medications)
7. I take a leukotriene agonist. 30% of the allergic cascade is attributed to leukotrienes. Singulair is my med of choice there
8. I take an intranasal steroid. Flonase has alcohol in it (spraying alcohol up my nose hurts, burns, smells badly and causes nose bleeds). I use Nasacort AQ instead. It's just as powerful, but no alcohol.
9. Allergy shots.
10. One thing I forgot - getting rid of down comforters and pillows if you're allergic to down. What a difference that makes!
Treating allergies when you have CF can dramatically improve lung function. Allergies cause inflammation in the lungs - and as you know, as CFers, we already deal with so much inflammation to begin with. So heading allergies off at the pass is essential to good health.
1. Allergy testing. Many people have house-hold allergies in addition to outdoor allergies. Controlling indoor allergies can greatly diminish symptoms of outdoor allergies. But first, you need to get skin tested (by an allergist, not a GP) - IgE blood levels are useless so don't go down that route.
2. Most of us have dust mite feces allergies. I have dust mite encasings on my pillows and mattress (purchased at www.allergyasthmatech.com)
3. I have no carpet in my place, but when I did in college I put dust mite powder on my carpet (simple to use - just put it on the carpet and then vacuum it up a few hours later. it lasts 6 months). Also can be found at www.allergyasthmatech.com
4. HEPA air purifier in the room that I do meds and my bedroom. Nothing else but HEPA will do. I bought mine at www.costco.com
5. I never open windows in my house. It's a pain, but it lets allergens in. Instead, I run my air conditioner
6. I take an anti-histamine. 70% of the allergic cascade is attributed to histamines. As Nicole said, check out my blog for an explanation of the differences between anti-histamines (school down to categories on the left, then click medications)
7. I take a leukotriene agonist. 30% of the allergic cascade is attributed to leukotrienes. Singulair is my med of choice there
8. I take an intranasal steroid. Flonase has alcohol in it (spraying alcohol up my nose hurts, burns, smells badly and causes nose bleeds). I use Nasacort AQ instead. It's just as powerful, but no alcohol.
9. Allergy shots.
10. One thing I forgot - getting rid of down comforters and pillows if you're allergic to down. What a difference that makes!
Treating allergies when you have CF can dramatically improve lung function. Allergies cause inflammation in the lungs - and as you know, as CFers, we already deal with so much inflammation to begin with. So heading allergies off at the pass is essential to good health.
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