Medications for the Treatment of Asthma - Are They Safe and Effective?

A number of products that block the histamine receptor (anti-histamines) have been developed to treat the allergies that trigger attacks in those suffering from atopic asthma attacks. These include hydroxyzine (Atarax, Vistaril) and its breakdown product cetirizine (Zyrtec). These medications cause sleepiness. Other side effects include dry mouth and urinary retention, and more rarely, confusion, nightmares, nervousness, and irritability. Chlorpheniramine (Chlor-trimeton), cyproheptadine (Periactin), and diphenhydramine (Benadryl) are other older antihistamines. They can be associated with anti-cholinergic side effects (dry mouth, confusion, urinary retention), in addition to the side effects of Atarax.

The so-called second-generation antihistamines supposedly cause less drowsiness than the older products, but this is more hype than hope. They claim to specifically block the H-1 antihistamine receptor, and include fexofenadine (Allegra), loratadine (Claratin), and azelastine (Astelin). Side effects are similar to the older antihistamines. Drowsiness with all of the antihistamines is dose dependent. It is best to start with a low dose and work up.

One of the best selling allergy medications on the market is desloratadine (Clarinex). Clarinex is a newer generation anti-histamine medication that is marketed as a magic bullet for allergies. However what most people don't know is that Clarinex is merely an old drug, loratadine (Claritin), marketed by the drug company as new and improved. However Clarinex doesn't add anything to Claritin (other than more money for the coffers of its manufacturer, since Clarinex is still on patent). Clarinex is merely a metabolite (breakdown product) of its precursor, Claritin. That means that 20 minutes after you take Claritin, you will be getting Clarinex, but you'll be paying much less for it than if you took Clarinex. Folks have been getting Clarinex for years, even though they didn't know it, every time they took Claritin. The company patented the metabolite of their original product, and then did a misleading study where they compared differing doses of the two medications, coming to the erroneous conclusion that Clarinex was less sedating than the old drug. This was misleading because if a drug causes sedation, then higher doses of the drug will cause more sedation, so if you are not comparing the same doses of the drug, you are not making a fair comparison. This allowed them to promote Clarinex, which costs much more than the old drug that went off patent, and which in 2004 was bringing in close to a billion dollars a year in sales. Claritin and Clarinex as far as you are concerned are the same drug; so take Claritin and save some money.

Over the counter (OTC) epinephrine inhalers such as Primatene Mist are commonly used for the treatment of mild asthma. Over 115 million Primatene Mist inhalers have been sold over the past 20 years. These inhalers, however, are not as benign as they appear. About 20% of patients using OTC inhalers have severe asthma that needs medical care. Unfortunately, many asthma patients delay professional medical treatment while they use their OTC inhalers, often due to a lack of health insurance, to the point where it may be too late. OTC inhalers can also increase heart rate, and should not be used in patients with heart or thyroid disease. Thirteen deaths, mostly cardiovascular, have been reported to be associated with the use of OTC inhalers over the last 20 years. If you have a history of chronic asthma or a history of hospitalization for asthma you should not use OTC inhalers. If asthma symptoms do not resolve in 20 minutes after using an OTC inhaler, you should seek emergency treatment. Delaying medical treatment when you are using OTC inhalers may contribute to the overall severity and chronic nature of the disease over the lifetime.

Prescription short acting bronchodilators (�-2 agonists) are inhaled and promote dilation of airways. The most commonly prescribed inhalers are albuterol (Proventil) and levalbuterol (Xopenex). Side effects include tremors, jitters, and nervousness. There are no known long-term side effects. These medications are designed for temporary relief. If you find yourself using them often or with increasing frequency that means your asthma is getting worse and you need further evaluation by a doctor.

Asthma patients can also be treated with steroids in pill form for a short period of time. Corticosteroids can inhibit growth in children and decrease bone mineral density, although growth inhibition is reversible. Steroids suppress the immune response, increasing risk of infection, and decrease bone mineral density. Other side effects of steroids include low blood sugar, changes in consciousness, nauseas, seizures, or in rare cases death. You can also develop symptoms like Cushing's Disease (an excess production of cortisol in the body). These include deposits of fat on the upper back and face, high blood pressure, diabetes, slow wound healing, osteoporosis, cataracts, acne, muscle weakness, ulcers, thinning of the skin, and mood changes. When patients are treated for a long period of time, deaths from adrenal insufficiency have occurred with transfer from oral to inhalation steroids, especially during stressors like surgery. You should not be on steroids for long periods of time.

Non-allergic asthma is a chronic problem, and needs to be treated somewhat differently than allergic asthma, which may come and go with avoidable triggers and seasonal changes. Chronic asthma sufferers are more at risk for fatalities if they are not treated.

Corticosteroids

Patients with chronic asthma should be treated with inhaled corticosteroids. These include fluticasone (Flonase, Flovent), beclomethasone (Qvar, Beconase, Vancenase), flunisolide (Aerobid), budesonide (Rhinocort, Pulmicort), and triamcinolone (Azmacort, Nasacort). Inhaled corticosteroids have the same side effects of systemic steroids, but to a much lesser degree. Corticosteroids can inhibit growth in children and decrease bone mineral density, although growth inhibition is reversible. Steroids suppress the immune response, increasing risk of infection, and decrease bone mineral density. Other side effects of steroids include low blood sugar, changes in consciousness, nauseas, seizures, or in rare cases death. You can also develop symptoms like Cushing's Disease (an excess production of cortisol in the body). These include deposits of fat on the upper back and face, high blood pressure, diabetes, slow wound healing, osteoporosis, cataracts, acne, muscle weakness, ulcers, thinning of the skin, and mood changes. Studies have shown that inhaled corticosteroids (budesonide) can be used intermittently; there is no advantage to regular use of these medications.

Theophylline (theodur, slophyllin) and the related aminophylline drugs are xanthine derivatives related to caffeine that act to dilate the bronchi. Aminophylline can cause rash in some people. They can be given either orally or intravenously for asthma emergencies. Toxicity results in seizures, irregular heartbeats, and pounding heartbeat. It interacts with ciprofloxacine and the other fluoroquinolone antibiotics (i.e. those ending with -xacine) as well as caffeine. They are not used much any more due to safety concerns and side effects.

Long acting beta-2 agonists have been promoted as reducing the need for inhaled quick relief medication. Drugs on the market include salmeterol (Serevent) and formoterol (Foradil). Serevent, approved in 1994, dilates breathing passages by stimulating the beta-2 adrenergic receptor. At least 300,000 children take this drug.

Serevent was isolated as one of five dangerous drugs still on the market by Dr. David Graham of the FDA in testimony to congress in November of 2004. In that testimony he described Serevent users "dying while clutching their inhalers."

In 1996, based on reports of paradoxical bronchospasm (a contraction of the breathing airway or bronchus that impairs breathing and can be fatal) with Serevent, the manufacturer undertook a large multi site randomized placebo controlled trial, the Salmeterol Multi-center Asthma Research Trial (SMART). This was a 28-week safety study comparing salmeterol (Serevent) and placebo in the treatment of asthma.115 In addition to their usual asthma therapy, patients received either Serevent or a placebo. The study was stopped in 2002 by the study's Data Safety Monitoring Board because of an increase in asthma related deaths. Analysis of 26,355 patients showed statistically significantly higher rates of asthma related deaths (13 versus 3, relative risk greater than four fold) in patients on Serevent.

In African Americans, who made up 17% of the study population, the study showed a statistically significant greater number of respiratory related deaths and life threatening events. Many had to get intubated, or have a tube put down their throat to let them breath related to respiratory causes (20 versus 5 for placebo, a four fold increase). In addition, there was a more than four fold increase in asthma-related deaths and life threatening respiratory events in patients taking salmeterol compared to those taking placebo. Overall the risk of death from any cause or having a life-threatening event was doubled in African Americans, another finding that was statistically significant. The data suggested that the risks of Serevent were greater in African Americans than in whites. About half of the patients were also taking an inhaled corticosteroid. In those patients not taking an inhaled corticosteroid, there were significantly more asthma-related deaths in all patients taking salmeterol compared to those taking placebo.

The manufacturers of Serevent initially showed data to the FDA that included the results from the 28-week trial plus a 6 month follow up period. The results for this time period were better than the initial 28 weeks alone. However the initial study protocol was for a 28 week trial, and the FDA appropriately requested the 28 week outcomes, which they posted on their web site in 2005. However the potential risks of long-acting beta agonists have long been known.116 A long acting beta agonist drug marketed in New Zealand was associated with an increase in asthma related deaths and was pulled from the market there in 1976. A recent meta analysis (where data from all published studies were combined) looking at trials from the past 20 years involving a total of 33,826 asthma patients treated with long acting beta agonists showed that all drugs in this class are dangerous.116 Overall there was a statistically significant increase in a number of parameters, including an increase in asthma exacerbations requiring hospitalizations by 2.6 fold, increased life threatening exacerbations of asthma by 1.8, and increased risk of asthma related death by 3.5 fold.

Based on these findings, I do not recommend use of a long-acting beta-2-agonist.

Advair, which contains Serevent and a steroid, also carries the same black box warning about increased asthma related deaths. This hasn't stopped it from running up 2 billion dollars in sales per year. Based on the SMART study we cannot conclude that long acting beta agonists when administered with steroids are safe; in studies where 75% of patients were taking a steroid there was still a 2-fold increased risk of asthma related death.

Montelukast (Singulair) and zafirlukast (Accolate) are part of a new generation of asthma medications that are leukotriene antagonists. These medications work by inhibiting the cysteinyl leukotriene CysLT-1 receptor, which is involved in the inflammatory response. In rare cases they may be associated with Churg-Strauss syndrome, which involves inflammation of the blood vessels. Zileuton (Zyflo) can cause lupus and liver toxicity and requires blood to be checked every six months. They are expensive and have not been shown to be more effective than steroids and antihistamines.

Other new drugs are the mast cell stabilizers like nedocromil (Tilade) and omalizumab (Xolair). Xolair is given by injection every 2-4 weeks. These meds have only recently been approved by the FDA, and so we have to adopt a wait and see attitude.

Learn more about hidden risks of prescription medications in 'Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won't Find on the Label of Commonly Prescribed Drugs, Vitamins and Supplements', by researcher and physician J. Douglas Bremner, MD.

Sinusitis - How I Beat It- You Can Too

After two painful sinus operations, I was still coming down with infections. I had to find some real remedy to my sinusitis problem, as I was tired of taking antibiotics and especially tired of the dull, deep headaches every time I had an attack.

Sinus Operations- Try to Avoid

The operations were no fun. After the first one my nose was "packed". This means that in order to stop the bleeding, the ENT specialist/surgeon put a large amount of gauze in my nose, which means that one can only breathe through the mouth for the week or so of recovery time. In other words, swallowing and breathing cannot occur at the same time. This is a good way to lose weight, as one cannot eat much, but it is not a great way to live. At the end of this period, before pulling out the gauze, the doctor said "this will feel like I'm pulling your brains out through your nose". This was the most accurate statement he ever made to me.

Pulling what seemed like 6 feet of moist, sticky gauze out of my nose was an almost surrealistically painful sensation. But I thought, "if my deviated septum is now fixed, at least I can look forward to no sinus infections in the future, or at least a lot fewer of them. I was wrong again, as they started coming back after a few months. I changed ENT specialists since the first one put me through tons of pain for no gain. After a couple of years of treatment with this new doctor, I decided to take his advice and try another operation. Among other therapies, I had allergy shots during that time, even though I only tested positive for minor allergies to a couple of things.

My nose was not "packed" this time, but there was still plenty of pain. Again my hopes for an infection-free future were dashed when they started up again after a few months. So after two operations by two different ENT specialists, I said "enough is enough". For those considering sinus operations to fix things like a deviated septum, here's my considered advice: don't do it. At least try the nasal irrigation recommended by Dr. Murray Grossan which is explained below before you do. One hears about people who have had 5 or 6 sinus operations, and these either don't work, or if they do cause improvement, it doesn't last very long. Some people have told me that a sinus operation "fixed" their problems, but I am skeptical.

Tried Various Approaches for Years

Throughout my years with significant sinus problems, I had read a number of books and tried different products and approaches. One author I read early-on was not very encouraging. He said that certain things aggravated sinus problems, and one should simply stop eating chocolate, cheese and other dairy products. Also, he said that in order to be cured there could simply be no drinking of alcoholic beverages either. Sorry, he said, but that's the way it has to be. For a person who lived in France and who has come to enjoy the excellent wine and numerous cheese varieties, this was awful.

What kind of a life would I have without drinking wine and eating cheese? At that point I did have to stop drinking, as even one glass of wine could be enough to trigger an infection almost every time. After six months of this I got sick of drinking soda and non-alcoholic beer, which tastes pretty bad. In fact I was ridiculed in a restaurant in France when I ordered a Buckler's , which is Heineken's nonalcoholic beer. The French owner asked my why I would order such a ridiculous beverage with his excellent meal, and I explained I had sinus problems. He replied that he bad sinus problems too, and he got headaches every day, but nothing would stop him from drinking red wine! I actually admired his attitude, but the headaches were too painful, and I felt like I was on the search for "Lorenzo's oil", like the father in the movie of the same title that needed a certain rare oil to cure his son.

It was also through this author, an ENT specialist, that I first heard about nasal irrigation, but the system suggested did not work well. He sold a saline solution, but it was too strong and caused a burning sensation in my nose. He suggested a sort of long-nosed pot called a Neti pot to use to pour the solution into each nostril. This approach did not work nearly as well as the system suggested by Dr. Grossan (see below), and I was wrongly convinced that nasal irrigation was not effective. It makes a big difference how the irrigation is done and with what kind of equipment and saline solution.

Dr. Murray Grossan to the Rescue

I thus started doing more research on other books and approaches, and in the course of this I came across a book by Dr. Murray Grossan called "The Sinus Cure- 7 Simple Steps". In a nutshell, Dr. Grossan's system worked. His book contains many technical explanations about sinusitis and how to deal with it. He clearly explains the reasons for the problem and suggests numerous remedies including diet considerations, home environmental improvements like duct cleaning and humidity control, and the most important aspect of the program: pulsating nasal irrigation with a saline solution.

Use a WaterPik and Adaptor

When I first started following Dr. Grossan's advice he suggested using a WaterPik machine, and these have been sold for years as devices to improve gum and dental health. Dr. Grossan simply sold an adaptor and a saline solution, although one can use table salt. Although much more expensive than salt, I find that this saline solution is convenient, works well, and has no preservatives. I usually purchase a dozen containers at a time, and these will last up to a year with one application per day. One simply puts a spoonful of saline solution into the WaterPik tank and then about 16 oz. of warm water to dissolve the powder. Then the nasal adaptor is put into one nostril and the machine will gently propel half the liquid through one's nasal canal, and it will drain out the other side.

One then puts the adaptor in the other nostril and repeats the procedure on that side. This procedure is done while leaning over a sink. I then normally put more water into the tank and use the WaterPik on my teeth as it was originally intended, and I've helped my gum and dental health as well. My dental hygienist has made several comments about how much better my gums and teeth are when I go in for cleanings. The whole effort only takes about 5 minutes or so, including wiping everything dry. I normally do the irrigation once a day about an hour before bed, but if I happen to wake up with more than the usual congestion in the morning, I'll do it then as well.

The Easiest Way to Start

In the past couple of years Dr. Grossan has come up with his own machine for nasal irrigation. It is called the Hydro Pulse(R) Nasal Irrigation System. For about $89 plus shipping one receives the Hydro Pulse Nasal/Sinus Irrigator(R), 2 Original Sinus Irrigator Tips (R), 2 Original Throat Irrigator Tips(R), Breathe-ease(R) XL Nasal Moisturizer (this is the saline solution), and excerpts from,"The Sinus Cure" by Dr. Grossan.

This is the easiest way to start, as you have everything needed. If the system works well and you want to continue to do nasal irrigation on a daily basis, I would suggest purchase of a pack of one dozen saline solution boxes, as the price is lower per box and there is only one shipping charge to pay. Of course one could still purchase a WaterPik at a retail store and buy the Dr. Grossan's adaptor and saline solution to work with it. For information about how to purchase these items, and also how to download a free ebook written by Dr. Grossan, follow the links at the end of this article..

Other Medications

For many people the nasal irrigation system will be enough to control your sinus problems. Those of us with particularly significant sinusitis may need to supplement this with medications, and I use Flonase before going to bed each night as well. If I feel like I'm on the verge of a sinus infection I might take some Zyrtec (an antihistimine) or if an infection seems imminent, I have my silver bullet, which is Prednisone. I don't use much of the latter, however, as there can be side affects with this steroid. My doctor usually prescribes 10 pills of 20 mg each, and these last for about a year. I never take a whole pill and usually take 5 mg or 10 mg maximum at a time for a day or two.

I'm told this is a reasonable amount and nothing to worry about. Speaking of bad side effects, prior to discovering Dr. Grossan's system, sometimes desperate for relief, I used an over-the-counter spray called afrin. The warnings on the label say to use this product for only 4 days or less. This medication can damage the cilia in one's sinuses and cause permanent damage if used too much. As frequent users know, there is also an effect called rebound congestion, so after using it you might end up just as congested as when you started. Thus, people are tempted to continue using it, and it is said to become addictive. Dr. Grossan simply recommends that you throw your afrin into the garbage and stay away from it. I have not used it for years now and am glad to be rid of it.

I haven't eliminated sinus infections entirely, and I might come down with perhaps one per year. I'm more susceptible when very tired, or after long flights, as we often go back and forth to Europe for our tour business. When flying anywhere I make sure to take some kind of decongestant, normally the Flonase. I can enjoy wine, cheese, chocolate, and I really don't need to avoid any particular foods. Dr. Grossan's system has worked for me, and I certainly don't miss the deep, painful sinus infection headaches that used to be all too familiar. Dr. Grossan has lots of other advice in his book as well, and I definitely recommend that anyone with sinusitis read it.

Best of luck to all sinusitis sufferers. I hope this information will help improve your lives as much as it has helped me. Please don't hesitate to forward this article to friends and family who suffer from sinusitis.

Walt Ballenberger is the founder of Beaux Voyages, which offers tours in France.For information about treatments for sinusitis and post nasal drip, visit Post Nasal Drip

The Misery of Pfizer Could Be The Joy Of Texas - Generic Drugs Are On The Rise

Pfizer can't be happy. Its patent on the best-selling drug in the world, Lipitor, expires in 2011, which doesn't give the pharmaceutical giant much time to figure out how to compensate for the billions of dollars in sales that will be lost when it happens, courtesy of generic companies reproducing the medicine's active ingredients. The United States alone buys $5 billion worth of the brand-name drug every year.

It's hard to believe that the world's greatest selling pharmaceutical medicine is a treatment for cholesterol, rather than for some horrible, chronic illness. . .well, that is until one considers it purely from a business perspective. Heart disease is still the number one killer of Americans, and one-third of all deaths in this country in 2004 were attributed to it. That means big bucks for companies that can market a treatment for this exploding, life-threatening problem.

Consumers can save up to fifty percent on prescription drugs, according to the Food and Drug Administration, if they just buy generic. Generic drug companies, health insurance providers, and patients alike are practically salivating in anticipation; Lipitor's expiring patent means that not only can other pharmaceutical companies reproduce the coveted, and much guarded, active ingredients, but also that dramatic price slashes will happen for consumers. Texas, with the majority of its population now obese -- a risk factor for heart disease -- and twenty-five percent of its population going without any health insurance, particularly stands to benefit from more cost-effective medication.

But Pfizer shouldn't feel so bad; Lipitor is not the only one. In fact, experts are predicting a golden era for generic drugs as patents on several high-dollar medications come due over the next few years -- $60 billion a year worth -- including Ambien, Norvasc, Zyrtec and Fosamax. Johnson & Johnson announced last week that it will eliminate close to 5,000 jobs in preparation for the generic reproductions of Risperdal, a drug for schizophrenia, Topamax, a seizure medication, and other medicines used for migraines. In 2009, Prevacid's formula, as well, relinquishes its secrets, a heartburn and ulcer drug producing $3.5 billion in annual sales.

While advances in treatments for cancer and other potentially fatal illnesses seem promising, few new medications with mass-market appeal are waiting to replace the old. While this is bad news, indeed, for pharmaceutical giants, it seems to be great news for the rest of the population.

Such patents expiring, without comparable replacements waiting, means the drug price inflation rate will remain under ten percent, despite the aging population's ever-increasing need for medication. This figure has almost always been in the double digits in recent years, according to Steven B. Miller, chief medical officer for ExpressScripts, which manages drug benefit plans. In 2002, in fact, it was eighteen and a half percent. "(The inflation rate) is much better than it was in the '90s, before these drugs starting going generic," said Miller.

Ronny Gal, analyst for Sanford C. Bernstein, which follows generic companies' activities, predicts a ten to thirteen percent growth in the generic drug industry by 2010. "(The change) is good for everybody but the branded pharmaceutical companies."

The high sticker price of many brand-name pharmaceutical drugs is, to a large extent, due to their research and development processes; industry leaders must invest billions of dollars and spend years of time to create a viable medication. They, then, make up for such significant initial costs by setting a high sale price, thereby ensuring billions in profits. Generic companies, on the other hand, do not invest such time and resources on development, which is one of the many reasons they can sell their versions anywhere from thirty to eighty percent cheaper, though they meet the same quality standards and contain the same active ingredients.

". . .(The lack of new drug formulas is) basically a failure of innovation," said Richard T. Evans, a consultant with Avos Life Sciences, a research and consulting firm for the drug industry.

Part of that industry, however, protests such claims. Caroline Loew, senior vice-president for scientific and regulatory affairs for the Pharmaceutical Research and Manufacturers of America, a trade group for brand-name companies, defends the ups and downs of the process. "I don't think we would support the contention there's a lull." Finding treatments for chronic and complicated diseases, like Alzhiemer's, Parkinson's, and cancer, takes more time and effort than for other conditions. The production of pharmaceutical drugs is "very much an emerging science," she said, and "the biological mechanisms are very poorly understood."

The high price of brand-name pharmaceutical medications and the exploding number of those going without health insurance have combined to create a growing demand for less expensive, imported drugs. Finding the cost of their medications too much to bear, many Americans are turning to Canada and Mexico to meet their pharmaceutical needs, despite warnings against possible safety issues. Though statistics on just how many are getting their medications from foreign sources are difficult to document, border states are especially susceptible to such temptations. A trip across international lines, after all, is under a day's drive away for most Texans.

The additional criticism that drugs cost thirty to fifty percent more in the U.S. than in Europe, due to the for-profit structure of the domestic pharmaceutical industry, only adds fuel to the fire on the debate over universal health care. With healthcare systems in cities like Dallas, Houston, and Austin nearly crushed by the flood of uninsured coming in from other parts of the state to receive care, it's easy to see where the argument for universal coverage may have some validity.

Research and proper investing seem the most viable solution to the current problem of high-cost prescription drugs in the U.S. Investing in a health insurance plan appropriate to one's needs and researching the availability of generic drugs can dramatically reduce one's healthcare costs. In fact, sixty percent of prescriptions written in this country are for generic medications, and that number is expected to rise. Patients also have the right to ask for a generic version, if available, to cut costs. As usual, much of a patient's outcome depends on his or her willingness to be assertive and research those issues dramatically affecting personal health. To keep its high profits going, Pfizer is just going to have to come up with some new innovation to amaze us, and to save us, from the overwhelming tide of disease.

Being aware of issues affecting the cost of healthcare is an important aspect of minding your health. How you take care of yourself will certainly affect you as you age, and eventually your wallet, as well. If you're a young individual who tries to keep informed and maintain a healthy condition and lifestyle, you should take a look at the revolutionary, comprehensive and highly-affordable individual health insurance solutions created by Precedent specifically for you. Visit our website, www.precedent.com, for more information. We offer a unique and innovative suite of individual health insurance solutions, including highly-competitive HSA-qualified plans, and an unparalleled "real time" application and acceptance experience.

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Persistence Will Get You The Medical Help You Need

If you know something is wrong with your body, here's how to face the medical community with all the ammunition you need to make them pay attention. Never give up!

You shouldn't wake up in the morning feeling like you've moved furniture all night. But that's how it is for me. Every joint is stiff and sore. I lay in the bed and stretch repeatedly to loosen up before I dare to try and walk. The path to the bathroom is lined with furniture and walls that I can use for stability and support.

I love petting my dog, but my arm gets tired after just a few minutes. It feels like there's lead in my muscles.

I'm so tired all the time. But lying down is the most frustrating thing I can do during the day, because my legs think it's the perfect time to run the track. They tighten and the only thing that relieves the tightening sensation is to move them.

I have two gorgeous grand-daughters that I want to play with, but I can't hold them anymore, I'm not strong enough. All the things I loved doing, dancing, crocheting, assisting the coach with my youngest daughter's softball team, everything is gone now. My family gets irritated with me because I can't do things with them like I once did.

After years of doctor's appointments and being told, "It's all in your head, probably stress related," I got angry. It's not 'all in my head' the pain is way too real. How could swollen joints be 'all in my head'?

My oldest daughter is a medic for the army, she knows me. I don't complain much, and she knows I wouldn't take this to her unless it's real. I emailed her in Afghanistan. I told her the doctor's think I'm crazy. She told me to list all the issues, whether I felt they were related or not, and send them back to her.

I began my list; tired, irritable, depressed, restless legs, can't sleep, muscle aches everywhere, joint pain and swelling, TMJ (jaw pain), headaches, changing from constipation to diarrhea at the drop of a hat, irritable bladder, and I feel like I could fall asleep at any given moment, if only my legs would just stop jumping. I'm so very tired all the time. And I'm not crazy!

My daughter took the emailed message to her doctor friends on the base. They discussed it and sent me back a link to a website. I immediately clicked the link and began reading. I'm sure that who ever wrote this knew me. The page described me in detail. The link was to the John's Hopkins Hospital, and the heading at the top of the page read; Fibromyalgia. I can't even explain how it felt to have confirmation that I wasn't nuts after all. I printed the page and took it to my family doctor.

He read through the symptoms and perused my giant chart. He confirmed it. Fibromyalgia. He wrote me a referral to a rheumatologist. I finally had a clue! I was as excited as a woman could be, having had no sleep in weeks.

The rheumatologist couldn't see me for six weeks. I took that time to relish the thought that I wasn't crazy after all, and to learn as much as I could about Fibromyalgia.

After weeks of great anticipation I finally got to see this new doctor. He had the personality of a rock, he didn't say much at all, and when he did it patronizing. He ran a ton of tests on my blood, confirmed the Fibromyalgia diagnosis, and wrote a bunch of prescriptions. "I'll see you in a month", he said as he walked out the door. I sat there a moment alone in a whirlwind of confusion, gathered up my prescriptions, and left.

I honestly felt that I knew more about my condition before I saw him then I did when I left.

Getting all those prescriptions filled put a huge dent in my financial status, but I began taking them all religiously. I wanted them to 'fix' the problem. I did sleep better for the first time in a very long time. Even that was short lived.

I answered most of my questions through library and internet research. I did some research on each of the nine different medications I was taking every day. Over the counter Aleve, Zoloft, Zyrtec (allergies), Carbidopa, and Lorezapam, to name a few. I was no more impressed with the medications than I was with the doctor.

I have had a name for my ailment for over a year now. And I have a new doctor. He is able to answer questions and discuss with me some of the things I've read about on the internet. He knows I'm not crazy. It has been a long and difficult path to the knowledge I have now. The symptoms haven't changed much, but it's certainly easier to deal with it since I have the support of a decent doctor. I will get through this.

If you know without a doubt that something is wrong, don't give up. Research your condition on one of the websites like the one at Johns Hopkins, or WebMD. They hold a wealth of information. Check out your suspicions and keep pushing. I know that Fibromyalgia dose not have a cure, but I also know that I'm not the only one that has it, and I know that there are people working diligently on a cure. Just don't give up.

My name is Linda Spradlin, I'm a mother of five and grandmother to three. I have spent many years in doctors offices trying to figure out what was wrong with me. Finally, I have a name for it. For more information, please contact me at gramalinda23@yahoo.com

Home Remedy for Hives

Hives also known as urticaria. Allergic reaction to a drug or food is a cause of hives. They range in size from a few millimeters to several inches in diameter. Hives can be round, or they can form rings or large patches. Hives can occur on any skin surface, but usually spare the palms and soles of the feet. Hives are classified as acute or chronic depending on the length of the episode. Hives are raised, often itchy, red welts on the surface of the skin. Hives may be associated with dramatic swelling reactions; swelling of the lips, eyes, and ears can suddenly and grotesquely alter the appearance of an allergy victim. Swelling of the lips and tongue may occur immediately after eating a food and may be life-threatening because of airway obstruction. Some patients get hives occasionally only when they ingest a specific food or food additives. Other get hives as a chronic problem which can go-on for years. Most studies of chronic hives suggest a low % of food allergy causes usually because diet revision attempts were inadequate to reveal the hidden food causes. Swelling from angioedema can also occur around your hands, feet, and throat.

Hives and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Hives and angioedema can happen at any age. Angioedema typically causes swelling of the lips, larynx (producing hoarseness or shortness of breath), or the lining of the stomach and intestines (causing abdominal pain). Symptoms include muscle soreness, shortness of breath, vomiting, and diarrhea. Urticarial disease is thought to be caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. Histamine causes fluid to leak from the local blood vessels leading to swelling in the skin. In rare cases urticaria and angioedema are accompanied by shock and difficulty breathing. This is called anaphylaxis. Ordinary hives may be widespread and disturbing to look at, but the vast majority of cases do not lead to life-threatening complications. Sometimes hives are caused by a physical stimulus like contact with heat, water, or pressure. Hives can also be caused by contact with substances that are irritating. Just about any substance has the potential to be irritating.

The treatment of hives depends on the severity of the symptoms. Psychological treatments such as stress management can sometimes lessen severity and occurrence. The most commonly used oral treatments are Non-sedating antihistamines, including Allegra, Claritin, Clarinex, and Zyrtec, are also used to treat hives, expecially hives that last longer than 6 weeks. Chronic hives may be treated with antihistamines or a combination of medications. When antihistamines don't provide relief, oral corticosteroids may be prescribed. Oral steroids (Prednisone, Medrol) can help severe cases of hives in the short-term, but their usefulness is limited by the fact that many cases of hives last too long for steroid use to be continued safely. Other treatments can sometimes include doxepin (Sinequan), an antidepressant that can work as a potent antihistamine, montelukast (Singulair), and medications such as ranitidine (Zantac) or cimetidine (Tagamet), which are more commonly used to treat reflux. To mangage hives and swelling avoid hot water (use luke warm), gentle or mild soap, apply a cool compress or wet cloths to the affected areas, enter a cool room, wear light weight clothes. Avoid irritating the area with tight-fitting clothing. Apply calamine lotion.

Home remedy for Hives Tips

1.Calamine lotion-applying this lotion it can grant you relief from the itchy feeling.

2.Milk of magnesia on the lesions, provides some relief. As milk of magnesia is an alkaline solution it helps in removing the irritating itchy sensation

3.Stop the itching get 1/2 a tub filled with warm water, add 1/2 cup cornstarch and 1/2 cup baking soda. Soaking yourself at least once a day can make a lot of difference.

4.Applying aloe vera gel or vitamin E oil to the affected area at least twice a day can benefit you a lot.

5.Have nettle tea which is made by 2 tsp. powdered stinging nettles. You can add honey or lemon to add flavor your tea.

6.Consume cayenne pepper capsules to help the healing procedure. You can also have vitamin C, vitamin E or zinc for quick relief.

7.Herbal tea is very good for health. To soothe your nerves, go in for peppermint or passionflower tea. Other good options include chamomile, valerian and catnip

8.To relieve pain, apply cool compression on the affected area.

9.Make a paste with 2 cups of oatmeal and 3 tablespoons of cornstarch. Add a little water to make it into a paste. Apply to affected area for 15-30 minutes. It dries the hives up within a couple of hours.

10.Take cayenne pepper in capsule form to aid the healing process.

11.Take an Ice cold shower or bath and sit in front of a fan on high for about five minutes.

Juliet Cohen writes articles for health care clinic and home remedies. She also writes articles on beauty tips.

Allergy Skin Tests as a Method of Diagnosing Allergy in Children

Similarly like in the case of adults, skin tests can be performed in children of any age, but we know from experience that the skin of a child up to the 3rd year is very sensitive and reacts strongly to allergens, often in such a way that makes it difficult to make correct diagnosis.

One of the most common allergen upsetting small children and infants is the food (ingested allergene). It affects the child's skin more seriously than inhaled allergens. It may lead to an incorrect readings of tests performed in small children. The skin tests carried out on older children are much more reliable. A positive skin reaction occurs if a person is allergic to a particular allergen and if the mast cells of the skin contain the appropriate IgE antibody to this substance. During the skin tests, the mast cells of the skin undergo a process of degranulation in which histamine is released. It is the histamine which causes skin changes such as erythema or bumps. The mast cells of a child's skin contain smaller amount of antibodies and this may be the reason why we cannot observe a stronger reaction to the allergen.

Skin tests performed in an allergic child may turned out to be negative, when the child is administered antihistamines. Different medicines can also slightly influence the results of the tests. That is why it is necessary to know what medicines has been administered to the child by the child before scheduling the skin tests.

The following medicines should not be taken by the patient during the period preceding the skin tests:

* first-generation antihistamines (Clemastine, Fenergan, Diphergan, Hydroxyzinum) - for 3-4 days


* cetirizine (Zyrtec) - for 3-4 weeks


* loratadin (Claritine) - for 2-3 weeks


* astemizol (Hismanal) - for 4-6.weeks


* ketotifen (Zaditen, Pozitan) - for 2 weeks,

There are three main types of skin tests:

* puncture, scratch test ("prick test", percutaneous).


* intradermal test (intracutaneous),


* patch test (epicutaneous)

Patch tests are performed by a dermatologists if a contact allergy is suspected or other reactions typical to occupational allergy. The results can be obtained in 48 or 72 hours. Children are diagnosed using scratch tests. Such tests are considerably easy to perform and correlate well to the specific IgE antibodies in serum and to the appropriate inhaled provocative test under the influence of the same allergen. Skin reaction can be observed in 5-10 minutes after placing the allergen onto the surface of the skin.The test is carried out by placing a small amount of the suspected allergy-provoking substance on the skin. Next, the skin is gently scratched through a small drop of the allergen. The scratched place should not bleed. The results of the test can be collected in 15-20 minutes or even earlier if the blisters extend rapidly and form protrusions, which indicates an occurrence of pseudopodia.

The best place to perform a skin test is the inner part of the forearm or one's back. Children should be diagnosed by performing the tests on their forearm unless there are no visible skin changes. The skin tests can be considered to be done correctly if a positive control test (1 per cent solution of histamine) and a negative control test are carried out. The last one uses saline extra phenol added to the suspension of allergens as a preservative. If the results of the positive control are negative, the tests cannot be regarded reliable. In such a case, the reaction of the skin is inhibited by antihistamine medicines.

Such tests should be repeated after some time, having carefully examined the methods of the child's treatment within the last period of time. Sometimes, the reaction with the solution of sodium chloride can turn out to be positive. It may happen if the reagent has been contaminated or the child displays some symptoms of dermographism.

The extent of the reaction is determined by measuring the diameter of the blister using a special transparent scale. This is the most accurate testing method. A control histamine testing will produce a 5-7mm blister. In order to confirm a positive result of the test, the diameter of the allergene-provoked blister should not be smaller than 3mm. All tests carried out without positive and negative control testing are unreliable. Another method of determining the results of tests is marking the examined places with (+) or (-). If the diameter of the blister is at least 5mm, the histamine test result is marked with a triple pluses +++. In this method, which is not recommended, the smallest positive place is labelled with ++, which corresponds to a blister allergic reaction of 3mm. The blisters usually disappear after several minutes or after an hour. In some cases, after 4-6 hours, a delayed reaction may occur.

During intradermal tests, a small amount (0,05-0,1 ml) of a special allergen solution is injected into the skin. The readings should be made after 15-20 minutes. This test is more painful and it produces more false positive results.

Skin tests, which are the basic methods of diagnosing allergies, cannot be carried out on patients suffering from severe allergic reactions (e.g. an allergic shock resulted from a contact with allergen mentioned in the case history). In such situations, a safe method of diagnosis consists in isolating characteristic IgE in the blood. In some very rare cases, during performing the skin tests an anaphylactic reaction to an allergen may occur. Although such reactions are usually harmless, it is necessary for an allergist to have an anti-shock medical kit at hand in order to help the patient if necessary.

Copyright (c) 2006 Radoslaw Pilarski

Radoslaw Pilarski is a PhD candidate working on anticancer properties of Uncaria tomentosa at PAS, Poland. mLingua Worldwide Translations, Ltd. provides professional language translations.

Managing Allergies During Pregnancy

Rhinitis during pregnancy can be due to allergic rhinitis, sinusitis, or non-allergic rhinitis. If the woman has had allergic rhinitis prior to pregnancy, this could worsen, stay the same, or even improve. This change in symptoms may be dependent upon many factors, including the presence of seasonal allergens and increase in pregnancy hormones.

Non-allergic rhinitis in pregnancy may also be due to an increase in pregnancy hormones, leading to nasal congestion, runny nose and post nasal drip. This is called "rhinitis of pregnancy". The symptoms may mimic allergies, but since they are non-allergic in nature, do not respond to anti-histamines.

The pregnant woman with rhinitis may be concerned about the safety of medications during pregnancy, and therefore avoid taking medications.

If avoidance of allergic triggers is not possible or successful, medications may be needed to control symptoms.

Diagnosis of Allergic Rhinitis During Pregnancy

Allergy testing includes skin testing or blood tests, called a RAST. In general, allergy skin testing is not done during pregnancy, given the small chance of anaphylaxis which may occur. Anaphylaxis during pregnancy, if severe, could result in a decrease in blood and oxygen to the uterus, possibly harming the fetus. Therefore, allergy testing is usually deferred during pregnancy, although a RAST would be a safe alternative if the results are needed during pregnancy.

Safety of Allergy Medications During Pregnancy

According to the Food and Drug Administration (FDA), no drugs are considered completely safe in pregnancy. This is because no pregnant woman would want to sign up for a medication safety study while she is pregnant. Therefore, the FDA has assigned risk categories to medications based on use in pregnancy.

Pregnancy category "A" medications are medications in which there are good studies in pregnant women showing the safety of the medication to the baby in the first trimester. There are very few medications in this category, and no asthma medications.

Category "B" medications show good safety studies in pregnant animals but there are no human studies available.

Pregnancy category "C" medications may result in adverse effects on the fetus when studied in pregnant animals, but the benefits of these drugs may out weight the potential risks in humans.

Category "D" medications show clear risk to the fetus, but there may be instances in which the benefits outweigh the risks in humans. And finally, category "X" medications show clear evidence of birth defects in animals and/or human studies and should not be used in pregnancy.

Before any medication is taken during pregnancy, the doctor and patient must have a risk/benefit discussion. This means that the benefits of the medication should be weighed against the risks - and the medication should only be taken if the benefits outweigh the risks.

Treatment of Rhinitis During Pregnancy

Nasal saline. Rhinitis of pregnancy tends not to respond to anti-histamines or nasal sprays. This condition seems to respond temporarily to nasal saline (salt water), which is safe to use during pregnancy (it is not actually a drug). Nasal saline is available over the counter, is inexpensive, and can be used as often as needed. Generally 3 to 6 sprays are placed in each nostril, leaving the saline in the nose for up to 30 seconds, and then blowing the nose.

Anti-histamines. Older anti-histamines, such as chlorpheniramine and tripelennamine, are the preferred agents to treat allergic rhinitis during pregnancy, and are both category B medications. Newer anti-histamines such as over-the-counter loratadine (Claritin(R)/Alavert(R) and generic forms) and prescription cetirizine (Zyrtec(R)) are also pregnancy category B medications.

Decongestants. Pseudoephedrine (Sudafed(R), many generic forms) is the preferred oral decongestant to treat allergic and non-allergic rhinitis during pregnancy, although should be avoided during the entire first trimester, as it has been associated with infant gastroschisis. This medication is pregnancy category C.

Medicated nasal sprays. Cromolyn nasal spray (NasalCrom(R), generics) is helpful in treating allergic rhinitis if it is used before exposure to an allergen and prior to the onset of symptoms. This medication is pregnancy category B and is available over the counter. If this medication is not helpful, one nasal steroid, budesonide (Rhinocort Aqua(R)), recently received a pregnancy category B rating (all others are category C), and therefore would be the nasal steroid of choice during pregnancy.

Immunotherapy. Allergy shots can be continued during pregnancy, but it is not recommended to start this treatment while pregnant. Typically the dose of the allergy shots is not increased, and many allergists will cut the dose of the allergy shot by 50 percent during pregnancy. Some allergists feel that allergy shots should be stopped during pregnancy, given the risk of anaphylaxis and possible danger to the fetus as a result. Other than anaphylaxis, there is no data showing that the allergy shots themselves are actually harmful to the fetus.

Cindy Heller is a professional writer. Visit allergy relief guide to learn more about dust mite allergy and allergy treatment.