- A few ways to battle allergies
- A Natural Approach to Allergens
- Other Medicines – Interstitial Cystitis Association
- Alpha Blockers
- Histamine Blockers
- Leukotriene Inhibitors
- Urinary Antacids
- Antimuscarinics (“gotta go” medicines)
- Effects of thyroid hormone analogue and a leukotrienes pathway-blocker on renal ischemia/reperfusion injury in mice
A few ways to battle allergies
Q. I take Singulair for asthma and it seems to help, though what I notice the most is that my allergies have gotten dramatically better. Is it for both?
–N.S., Birmingham, Ala.
A. There is science behind the fact that drugs such as Singulair help allergies, but they are FDA-approved only for asthma and are often prescribed along with inhaled steroids.
Drugs Singulair, including Accolate and Zyflo, are all known as leukotriene inhibitors (pronounced luke-o-try-ene).
They are called this because they block the body from dumping leukotrienes, which create all those bad asthmatic symptoms such as swelling of tissues and tightening of muscles in the throat, which cause the throat to close during an asthma attack.
If you can keep the cells from dumping leukotrienes, then you can reduce the number of asthma attacks. However, these drugs don't stop an attack once it is happening.
Now, read carefully.
Most people realize that when we come into contact with something we're allergic to, our cells go nuts and start to dump all that histamine, which leads to the sneezing, runny nose, itching, watery eyes and so forth.
Hence, we take an antihistamine. But this is only half the story, and I shared this information with the public years ago. Histamine is partly responsible for allergies. Leukotrienes are also responsible.
You've probably put two and two together by now. A great regimen for someone who suffers with serious and unrelenting allergies might include a leukotriene inhibitor as well as an antihistamine. Of course, there are other wonderful choices as well, such as nasal sprays.
But even better would be to get to the heart of your allergies without drugs–simply because you can treat allergies all you want with drugs, but they won't go away until you figure out and eliminate what's triggering the event in the first place.
Most people don't even realize that there are histamine and leukotriene receptors in the gut, so allergies often start with food triggers even though allergic symptoms happen in the eyes, nose and throat. So if you can minimize sugar and meat and also eliminate wheat (gluten), dairy and fried foods, you will lighten the toxic burden in the body.
Other culprits include artificial sweeteners, red and blue dyes and peanuts. When you eliminate certain foods, your immune system will become more energized and allergies and asthmatic symptoms should ease.
So, yes, Singulair does work for both asthma and allergies, but it is not widely prescribed for both. The decision to use this medication in the treatment of allergies is strictly between you and your doctor. Drugs in this class have side effects such as headache, abdominal pain, nausea, diarrhea and liver problems.
Did you know?
The lung infection tuberculosis is spread by contact with someone who is infected; it can also be acquired by drinking unpasteurized animal milk.
This information is not intended to treat, cure or diagnose your condition. Suzy Cohen is a registered pharmacist. To contact her, visit www.dearpharmacist.com.
“,”author”:”Suzy Cohen, R.Ph., Tribune Media Services”,”date_published”:”2003-11-02T00:00:00.000Z”,”lead_image_url”:”https://www.trbimg.com/img-56f02a81/turbine/chi-default-open-graph-ct-logo/1200/1200×650″,”dek”:null,”next_page_url”:null,”url”:”https://www.chicagotribune.com/news/ct-xpm-2003-11-02-0311020489-story.html”,”domain”:”www.chicagotribune.com”,”excerpt”:”Q. I take Singulair for asthma and it seems to help, though what I notice the most is that my allergies have gotten dramatically better. Is it for both?”,”word_count”:488,”direction”:”ltr”,”total_pages”:1,”rendered_pages”:1}
A Natural Approach to Allergens
Allergies can be caused by so many things that we are in contact with every day, including food, the environment, pets, chemicals, lotions, potions, medications, and even natural substances.
You might find that you suddenly have allergies you never had before. I have had countless patients say to me, “Doc, my allergies seem to get worse every year, and they’re active longer.
Why is this?
Usually there’s a very simple explanation. I tell my patients how I think of it. Imagine a cup that is half full.
Then add dust mites, cat and dog dander, pollen, ragweed, mold, chemicals in our environment (which we’ll address in a moment), medications, poor food choices, etc. Soon the cup is overflowing.
Essentially, the immune system can no longer keep in check what it had kept in check for so long.
The Asthma and Allergy Foundation of America defines “allergy” as an overreaction of the immune system to substances that usually cause no reaction in most individuals. Essentially, what is normally a benign and inert substance, the body sees as a foreign invader. Through a complex series of chemical messages and reactions, matters get control.
For allergy sufferers these symptoms include sneezing, nasal stuffiness, itching or discharge; itching anywhere else; rashes or hives; burning/itchy, watery eyes; difficulty thinking and/or concentrating; fatigue; headaches (usually from the nasal congestion) and swelling; and the list can go on. These symptoms can be mild to extreme. Mild is more of a nuisance for most, while extreme can be life threatening (anaphylaxis).
Let’s address two of the main causes of allergies. First, food. Many people wonder about the difference between a food intolerance or sensitivity versus an allergy. WebMD puts it succinctly: “Food intolerance is a digestive system response rather than an immune system response.
It occurs when something in a food irritates a person’s digestive system or when a person is unable to properly digest, or break down, the food. Intolerance to lactose, which is found in milk and other dairy products, is the most common food intolerance.
” Essentially, food intolerance is a local gastrointestinal response, which is non-immune mediated and generally produces few systemic issues. Food allergies are immune-mediated, have many more systemic symptoms, and can even lead to anaphylaxis in some susceptible individuals.
Food intolerances are much more common than food allergies, which affect only about 5% of the population.
Second, a very contentious and contemporary allergy issue: the environment. There are more than 83,000 chemicals registered with the U.S. Environmental Protection Agency (EPA).
Most of these have not been thoroughly tested for their effects on human health (let alone our beloved animal friends).
The Centers for Disease Control’s (CDC) 2011 National Report on Human Exposure to Environmental Chemicals (NHANES), Fourth Report, presented data on 212 chemicals, including 75 measured for the first time in the U.S. population.
Key findings from the report include widespread exposure to some commonly used industrial chemicals, first available exposure data on mercury in the U.S. population, and first-time assessment of acrylamide exposure in the U.S. population, just to name a few.
The research literature clearly points to many of these chemicals acting as neuroendocrine disruptors that get stored in fat tissue, organs and the fatty sheaths surrounding nerves, wreaking havoc on many of our systems. Two of these systems are our immune and detoxification systems.
As the body is overburdened by attempting to rid itself of these chemicals, it can become “preoccupied” and over-reactive. What was normally an inert, benign substance (such as your beloved cat, for example) now causes symptoms.
In next month’s issue I will address the topic of environmental medicine and detoxification.
How are we to deal with this? Conventional medicine’s approach is usually to treat the symptoms and calm down the immune system with the use of anti-histamines (of which there are different kinds), leukotriene inhibitors (mostly used with asthma), mast cell stabilizers, anti-inflammatory medications, and/or steroids. Another method that many are familiar with is immunotherapy (desensitization) or allergy shots, where very small amounts, in gradually increasing doses, of the offending substance(s) are injected into the subcutaneous tissues. Sometimes this is done orally.
These medications are not without their side effects. The most common with anti-histamines (particularly first generation) are drowsiness, dry mouth, urine retention, difficulty concentrating, and blurred vision.
Leukotriene inhibitors’ common side effects include headache, earache, sore throat, respiratory infections, heartburn, fever, stuffy nose, cough, and rash. Mast cell stabilizers can cause throat irritation, coughing, or skin rashes.
Eye drops may cause burning, stinging, or blurred vision.
Allergy shots tend to be painful and can cause anaphylaxis. Although they can help a lot of people, evidence has shown them to be clinically efficacious only in asthma, allergic rhinitis, and insect venom.
Inhaled corticosteroids have side effects of nasal irritation, and sometimes there is nasal bleeding or perforation of the nasal septum.
Long-term use of oral/systemic corticosteroids can cause osteoporosis and a depressed immune system.
By definition, an allergen is an IgE-mediated and Th2-cell immune response. Physical disruption of tissue and various substances can trigger histamine release directly, independent of IgE. Mast cells are widely distributed but are most concentrated in skin, lungs, and GI mucosa; histamine facilitates inflammation and is the primary mediator of clinical hypersensitivity.
My treatment approach, as with most naturopathic physicians, is to first reduce the allergen burden as much as possible, and second, to change this Th2-dominant immune response to the less inflammatory Th1 response. This will help calm the over-reactive immune system and mitigate allergy symptoms. Third is to heal the gastrointestinal tract.
Fortunately, there are many natural substances that can change this Th2-dominant state. There are also natural anti-histamines, mast cell stabilizers, leukotriene inhibitors, and medicines that have corticosteroid- effects.
Examples of Th2 down regulators include zinc, astragalus membranaceus (also known as Huang qi), all medicinal and edible mushrooms (avoid the white button in stores and make sure the mushrooms are preferably organic), and fish oils. Natural anti-histamines and mast cell stabilizers are vitamin C and flavonoids, freeze-dried nettles (Urtica dioica), and n-acetyl-cysteine.
Examples of leukotriene inhibitors include Omega 3 essential fatty acids and Indian frankincense (Boswellia serrata). Examples of corticosteroid modulators include Ashwagandha (Withania somnifera), black currant (Ribes nigrum) and licorice (Glycyrrhiza glabra). The aforementioned treatments are quite safe and usually very well tolerated.
However, some of these herbs should not be used without the guidance of a well-trained physician. For example, licorice can cause edema (swelling) and high blood pressure. Too much zinc can chelate out copper, causing heart arrhythmias.
There is also a homeopathic desensitization approach to dealing with allergies. This is in the form of sublingual immunotherapy (SLIT), versus subcutaneous immunotherapy (SCIT), or allergy shots. Outside of the U.S., SLIT is the most common method of treating allergies.
Although they work via different physiological pathways in the body, the advantages of SLIT over SCIT are fewer visits to the physician, no shots, and a much larger safety profile.
One form of SLIT uses homeopathically diluted substances that an individual is allergic to and desensitizes that person to the offending substance over a relatively short time (similar to how SCIT works).
The clinical efficacy of SLIT is not statistically different from SCIT, and both treatments are clinically effective compared with placebo. I have used this treatment with countless patients and have seen them come off their allergy medications completely, with little to no side effects.
The above are just a few of the many natural treatments that naturopathic physicians and other integrative physicians employ to help allergy sufferers deal with their symptoms.
Again, my integrative medicine approach is not to use these medicines as Band-Aids, but rather to find all the triggers, remove them as much as possible, and allow the body’s own natural systems to come back into balance.
My goal is to eliminate the need for medications or to only use them as a last resort in the worst-case scenarios.
A great example of how naturopathic medicine can help severe allergy sufferers is a patient I saw during my residency. He was a 45-year-old South Korean man who stated he had been suffering from allergies all his life.
Since moving to Seattle, Washington and beginning medical school (yes, at the age of 45!), his eyes burned all the time; he had difficulty breathing; his wife said his sonorous snoring kept her up all night; he had difficulty concentrating and thinking; the anti-histamines were making him drowsy; and he was suffering from constant post-nasal drip, which caused a cough. He said he was embarrassed to say this, but his family also complained of extremely malodorous breath.
Upon physical exam, his frontal and maxillary sinuses were tender to palpation on both sides; his eyes were watery and red; he had a thick white coating on his tongue, white posterior streaking on the back of his throat (an indication of post-nasal drip), swollen tonsils and neck lymph nodes. There were also a few small pits in his tonsils (common in childhood that usually close up in adulthood). His ears had a small amount of fluid behind the tympanic membranes (ear drum), along with plenty of cerumen (ear wax). His lungs were clear through the stethoscope.
I gave him my “How to Allergy Proof Your Life” handout, which discusses all the basics of lowering your exposure to common allergens of pets, the house and self. I gave him high dose Omega 3 essential fatty acids and a combination product of flavonoids and vitamin C.
I told him besides the post-nasal drip, food was mostly ly getting stuck in those little pits (I have seen this many times), putrefying and causing the bad breath. I suggested he chew his food more thoroughly to create a smaller size and therefore decrease the lihood that it would get stuck in there.
I also suggested swishing and gargling with water after meals.
the dream patient all physicians love, he did everything I told him and came back in two weeks and said he couldn’t believe he was 90% symptom free! He reported that his energy was back to normal and he felt great. His wife even stated his breath no longer smelled and he wasn’t snoring. A win-win for everybody!
Dr. Born is a licensed naturopathic physician in Avon, CT, and is an active member of the American Association of Naturopathic Physicians.
He practices at Whole Health Associates, LLC, which offers natural medicine care for the entire family, including naturopathic medicine, chiropractic care, acupuncture, and massage therapy.
For more information or to schedule an appointment, please visit www.wholehealthllc.com or call 860-674-0111. See ad on .
Other Medicines – Interstitial Cystitis Association
A list of other medicines that may be prescribed to relieve IC symptoms follows. Each of these classes of medicines comes with its own set of side effects and drug interactions. Remember to always make sure that you check with your doctor before trying any new medicine or therapy.
Certain alpha blockers are used to treat benign prostatic hyperplasia (prostate enlargement) in men in the United States. The drugs include:
- Doxazosin (Cardura)
- Terazosin (Hytrin)
- Tamsulosin (Flomax)
Two of these, Cardura and Hytrin, and another not on the US market, alfuzosin, have been studied in chronic prostatitis and have been found to help reduce overall symptoms or pain.
Researchers are discovering that many men with this condition have glomerulations or Hunner’s ulcers on the bladder walls, and some researchers think that IC and chronic prostatitis (at least for a subset of men with chronic prostatitis) may really be the same. This is why some doctors are also trying these alpha blocker medicines in women with IC.
Dextroamphetamine sulfate (Desedrine)is a stimulant that promotes wakefulness and reduces appetite. It is approved for use in attention deficit hyperactivity disorder (ADHD) and narcolepsy.
In 2005, case reports of two women with IC found dexamphetamine to be helpful in treating their symptoms.
The hypothesis is that dextroamphetamine may help certain people with IC who experience idiopathic edema, a type of swelling of bodily tissues due to excess fluid retention.
Originally developed as an anti-seizure medicine, gabapentin (neurontin) is also used to treat nerve-related pain. Some types of IC pain may to be generated by nerve endings and the central nervous system. A few small studies showed that gabapentin may improve symptoms in some IC patients.
Most antihistamines prescribed for allergy and IC are called “H1” blockers. When histamines bind to the histamine receptors on cells, that produces an allergic reaction. The H1 receptors aren’t the only ones that histamines go to, however. They can also bind to H2 receptors, and drugs that block these receptors can also be helpful in calming allergic reactions. H2 blockers include
- Cimetidine (Tagamet)
- Ranitidine (Zantac)
- Nizatidine (Axid)
- Famotidine (Pepcid)
By blocking these H2 receptors in the gut, these medicines reduce stomach acid secretions and, thus, stomach pain.
Studies with one of these H2 blockers, cimetidine, showed it reduced bladder pain as well, maybe because of the histamine-blocking action. But why it works in IC really isn’t so clear.
In two small studies (one with 9 and one with 14 patients), Tagamet reduced bladder pain for 40 to 60 percent of the IC patients.
In Japan, Suplatast tosilate, also known as IPD-1151T and available is indicated for IC, as well as asthma and allergies.
This medicine acts somewhat earlier in the allergic process than histamine or leukotriene blockers do by affecting IgE. Suplatast tosilate helps suppress the production of IgE.
It also helps to block production of cytokines and suppresses allergy-related eosinophils. This medicine remains under investigation in the US.
Tagamet, Zantac, Axid, and Pepcid are available over the counter.
Leukotrienes which are substances produced by some immune system cells and mast cells, promote inflammation. Drugs that block leukotrienes are fairly new and are being used in the treatment of asthma and allergy. They include the prescription medicines:
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
Some studies have implicated leukotrienes in inflammation of the bladder in IC. The receptors have been found in the bladder muscle in IC patients. A study of 10 IC patients in Denmark who took Singulair for three months showed significant reductions in frequency and pain.
Misoprostol (Cytotec) is an oral prostaglandin (a protective hormone- substance found throughout the body).
It inhibits the secretion of stomach acid and is often given to counteract the side effects of certain pain relievers such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) naproxen sodium (Naprosyn) or ibuprofen (Motrin), which can cause gastrointestinal problems. One European study found that misoprostol may help to treat IC by reducing inflammation.
Citrates, which include potassium or sodium citrate, tricitrates, and citric acid, either alone or in combination (Bicitra, Citrolith, Oracit, Polycitra, Urocit-K), are usually used to prevent certain types of kidney stones. But because they make the urine less acidic, they may help relieve bladder pain. These are available by prescription.
Antimuscarinics (“gotta go” medicines)
Antimuscarinics are drugs that help relax muscles in the bladder and urinary tract and may help with urinary frequency and urgency. These medicines include:
- Detrol LA
- Ditropan XL
- Flavoxate (Urispas)
Revised Wednesday, March 25th, 2015
Effects of thyroid hormone analogue and a leukotrienes pathway-blocker on renal ischemia/reperfusion injury in mice
Hoste EA, Schurgers M: Epidemiology of acute kidney injury: how big is the problem?. Crit Care Med. 2008, 36: S146-S151. 10.1097/CCM.0b013e318168c590.
- Google Scholar
Milhoan KA, Lane TA, Bloor CM: Hypoxia induces endothelial cells to increase their adherence for neutrophils: role of PAF. Am J Physiol. 1992, 263: H956-H962.
Lucchesi BR: Role of neutrophils in ischemic heart disease: pathophysiologic role in myocardial ischemia and coronary artery reperfusion. Cardiovasc Clin. 1987, 18: 35-48.
Goldman G, Welbourn R, Klausner JM, Valeri CR, Shepro D, Hechtman HB: Thromboxane mediates diapedesis after ischemia by activation of neutrophil adhesion receptors interacting with basally expressed intercellular adhesion molecule-1. Circ Res. 1991, 68: 1013-1019.
- Google Scholar
Jerome SN, Dore M, Paulson JC, Smith CW, Korthuis RJ: P-selectin and ICAM-1-dependent adherence reactions: role in the genesis of postischemic no-reflow. Am J Physiol. 1994, 266: H1316-H1321.
Paterson IS, Klausner JM, Goldman G, Kobzik L, Welbourn R, Valeri CR, et al: Thromboxane mediates the ischemia -induced neutrophil oxidative burst. Surgery. 1989, 106: 224-229.
Lucchesi BR: Myocardial ischemia, reperfusion, and free radical injury. Am J Cardiol. 1990, 65: 141-231.
Bonventre JV, Zuk A: Ischemic acute renal failure: an inflammatory disease?. Kidney Int. 2004, 66: 480-485. 10.1111/j.1523-1755.2004.761_2.x.
- Google Scholar
Takada M, Nadeau KC, Shaw GD, Marquette KA, Tilney NL: The cytokine-adhesion molecule cascade in ischemia/reperfusion injury of the rat kidney. Inhibition by a soluble P-selectin ligand. J Clin Invest. 1997, 99: 2682-2690. 10.1172/JCI119457.
- PubMed Central
- Google Scholar
Donnahoo KK, Meng X, Ayala A, Cain MP, Harken AH, Meldrum DR: Early kidney TNF-alpha expression mediates neutrophil infiltration and injury after renal ischemia-reperfusion. Am J Physiol. 1999, 277: R922-R929.
Daemen MA, van't Veer C, Wolfs TG, Buurman WA: Ischemia/reperfusion-induced IFN-gamma up-regulation: Involvement of IL-12 and IL-18. J Immunol. 1999, 162: 5506-5510.
Kofler J, Yokota N, Weisfeldt M, Traystman RJ, Rabb H: Acute renal failure after whole body ischemia is characterized by inflammation and T cell mediated injury. Am J Physiol: Renal Physiol. 2003, 285: F87-F94.
Donnahoo KK, Meldrum DR, Shenkar R, Chung C, Abraham E, Harken AH: Early renal ischemia, with or without reperfusion, activates NFκB and increases TNF-α bioactivity in the kidney. J Urol. 2000, 163: 1328-1332. 10.1016/S0022-5347(05)67772-5.
- Google Scholar