Few victims, but plenty of chances to ingest

Heads up. This article is truly only intended for a very, very select group of individuals with severe food allergy. It addresses a very special situation when foods are found as an excipient (non-active ingredient) in a medication.

Excipients are added in manufacturing to protect, support or enhance stability or bioavailabilty of an active ingredient.

The amount of food found as an excipient is truly miniscule, and therefore, 99.99-plus percent of people actually allergic to that given food would not – repeat NOT – be affected by the tiny amount found in the medicine.

Some medicines that contain trace amounts of egg include: Interferon, some probiotics, vaccines against flu, measles-mumps-rubella (MMR), rabies and yellow fever; Propofol, Ibuprofen, some multi-vitamins, Rosiglitazone and diphenhydramine.

Tiny amounts of fish protamine are found in NHP insulin.

Gelatin is found in many capsules and tablets, and in some suppositories and nicotine chewing gum. Vaccines for flu, Japanese encephalitis, MMR, rabies, tick-borne encephalitis, typhoid, varicella, yellow fever and zoster also contain it.

Milk has four allergy-causing proteins: Casamino acids are found in vaccines (DTaP, meningococcal pneumococcal, Td). Casein is found in Cefditoren, Miconazole, some probiotics and vaccines (TDaP, typhoid). Lactalbumin is found in the oral polio vaccine. And lactose is found in many tablets, capsules and granules. It is also in some asthma inhalers: Foradil, Advair, Flovent, Ventolin, Pulmicort, Spiriva, Symbicort and Asmanex.

Peanut oil is found in dimercaprol injection, progesterone capsules and valproric acid capsules.

Pine nut resin is found in fluoride tooth varnish.

New Intranasal Therapies

New nasal spray help on the way. Three new nasal therapies for allergic rhinitis appear to bring “new help to the table.”

The first two are propellant-delivered intranasal steroids: QNASL, which delivers beclomethasone; and Zetona, which delivers ciclesonide. The same two medicines have been available in aqueous solution sprays.

The welcome difference is the improved delivery mechanism. Many people find the aqueous forms problematic because they drip down the throat, or they don’t seem to have enough oomph to get up in- to the congested areas. The new propellant devices use a chloroflurocarbon (CFC)-free puff that doesn’t drip and is mighty enough to get past the congestion (and doesn’t damage the ozone layer).

Additionally, a “first” among nasal sprays is now available – a combination spray. Dymista provides a topical steroid (Fluticasone) with a typical antihistamine (Azelastine). There seems to be a symbiotic benefit in combining the two classes of medicine into a single spray, especially in individuals who get an inadequate response to single-entity therapy. For now, the combo comes in an aqueous spray format.

Moms-to-be can help head off specific food allergies

Exciting results are out from an eight-year study by the Harvard Medical School that questioned the outcomes of allergy in children if their mothers either avoided completely – or purposefully consumed – peanut, milk and wheat during pregnancy.

These three foods were chosen because they account for a large proportion of food allergies found in young children, and cause or contribute to asthma, eczema and allergic rhinitis. The study included 1,277 mother/child pairs.

The results were quite dramatic:

  • Ingestion of peanut, especially during the first trimester, reduced the chance of peanut allergy by 47 percent!
  • Daily milk intake during pregnancy, again especially in the first trimester, markedly reduced the risk for asthma and allergic rhinitis.
  • Daily wheat intake, in both the first and second trimesters, significantly reduced the chance for the child developing eczema.

So, moms-to-be can relax a little. Based on their results, these Harvard researchers concluded that ingestion as indicated above of peanut, milk and wheat during pregnancy has a marked ability to reduce childhood allergies.

Dear Doc: Weather, temperature on allergy list?


Dear Doc: I came to see you for a severe spring tree pollen allergy. Those symptoms are much better with my allergy shots; however, I seem to be bothered a lot by physical stimuli such as weather fronts and temperature changes. Is this also allergy?

The unequivocal answer to your question is yes – and no.

Let’s start with what is well-known about allergy. We know it is an immune response to exposure to a protein molecule, such as oak pollen, which causes your spring symptoms. The presence of oak pollen leads to release of allergic molecules such as histamines that mediate typical allergic symptoms.

Of course, there is no foreign protein involved with physical stimuli, but rather a change in barometric pressure, temperature or humidity. Effects of these stimuli actually are neuronal-based symptoms of allergy. Believe it or not, the nerves of our nervous system can cause or contribute to myriad symptoms, including: red/itchy eyes, sneezing, nasal congestion, runny nose, cough, wheeze, airway mucus, GI symptoms and itchy, red, swollen skin.

The process involved: These chemical mediators, such as histamine, also stimulate the sensory nerves. These nerves carry a signal to the brain causing outgoing responses that trigger the sinus congestion and extra-nasal mucus that you experience from the weather change.

Non-allergic individuals can experience modest neuronal responses to physical stimuli, but allergic individuals are much more severely buffeted by a given stimulus. Reason: the sensory nerve input “up-regulates” the central nervous system’s outgoing response, making it much stronger than it otherwise should be.

These neuronal-based issues are currently under intense scrutiny in an attempt to “down-regulate” the sensory feedback and, thereby, lessen symptoms.

Q – Tips: Biaxin interaction

  • A new drug interaction has been discovered between the antibiotic Biaxin and some calcium-channel blockers (verapamil, amlodipine and diltiazem). The antibiotic inhibits the metabolism of the calcium channel blocker, which in a small number of cases can lead to very high levels of the medication, with subsequent marked lowering in blood pressure. In these cases, hypotension or even kidney injury due to slow blood flow can result.

Q – Tips: Shellfish and iodine

  • Shellfish and radio contrast both contain iodine. However, allergies to shellfish are IgE- mediated with the allergic target being the shellfish protein, not iodine. Allergy to radio contrast is not IgE-mediated but rather, is due to the concentration of the contrast. Some hypersensitive individuals happen to be allergic to both, but one doesn’t lead to the other. 

Theophylline: Oldie-but-goodie still contributes to allergy arsenal

Theophylline has been used to treat asthma and COPD for more than 80 years. Because it has been around forever, it is sometimes regarded as outdated or “old-school.” And yet much current research indicates that it has a lot to add to the current popular therapies of inhaled steroids, and inhaled short-and long-acting bronchodilators.

Theophylline has been known to have three generalized mechanisms of action: bronchodilation, anti-inflammatory effect and improvement of diaphragm muscle strength.

Now a fourth mechanism is being researched at Lon- don’s National Heart and Lung Institute. Scientists there have found that the drug inhibits the cough reflex through a novel process. They used human and guinea pig research to demonstrate that theophylline decreases excitability of sensory nerves found in the lungs and bronchial tubes that lead to the cough reflex by opening calcium-activated potassium channels.

Almost everyone with asthma and COPD coughs. Coughing can be more troublesome than wheezing in these diseases, as it puts a strain on the body in many ways. Cough can affect urinary continence, lead to hernias and worsen acid reflux issues – which itself often worsens asthma and COPD.

The London scientists are using the theophylline research as a springboard to study new drugs that also may work on the sensory fibers that cause cough.

Asthma in seniors calls for adept diagnoses and care

A review of the diagnosis and treatment of asthma in older adults was just published in The American Journal of Medicine. Asthma in older adults can fall into two broad groups: those with long-standing disease, present since childhood; and those with late-onset asthma. The review was aimed at this latter group.

With late-onset asthma there is greater likelihood for confusing asthma with other conditions, especially COPD (chronic obstructive pulmonary disease) and congestive heart failure. In pulmonary testing, patients with both COPD and asthma will show obstruction of air flow, but this obstruction improves with inhalation of a bronchodilator in asthmatics, but not in COPD patients.

Another distinguishing fact in pulmonary testing is how the diffusion capacity of gas from lung to blood- stream is normal in asthma, but is decreased in COPD.

In comparing lifelong asthmatics with late-onset, the former more commonly have other allergic symptoms, such as hay fever or food allergy. The former respond very quickly to a bronchodilator, while the older asthmatic may need up to 30 minutes to feel the benefit of a bronchodilator.

Also, older asthmatics often will respond better to a combination bronchodilator with both albuterol and ipatropium, rather than albuterol alone. The inflammatory cells that cause airway inflammation are different. In young asthmatics it’s neutrophils. This fact alone, coupled with the burgeoning baby-boomer population has led to intense research to find anti-inflammatories that work better on neutrophil cells.

Older asthmatics seem more prone to respiratory infections which exacerbate the asthma. In part, this susceptibility is from aging of the immune system.

But another recently discovered cause is that older asthmatics tend to not keep their inhalers and spacers clean, allowing them to become colonized with disease-causing bacteria.

This dizziness can be relieved

Benign paroxysmal positional vertigo (BPPV) is by far the most common type of dizziness, affecting 3 -to-4 percent of the population at some point. Some people have a single, brief attack, whereas others can have repeated and sometimes prolonged episodes.

The condition is more common in people over 50, in women more than in men (3:1), in persons with osteopenia or osteoporosis and those low in vitamin D. Dizziness typically occurs while rolling over in bed, getting in or out or tilting the head back or for- ward. Many patients also have nausea.

BPPV is caused by little dislodged crystals getting into one of the ear’s three semi-circular canals that stimulate nerve endings, leading to a vertiginous nerve signal being sent to the brain. Therapy involves special head maneuvers to reposition the out- of-place crystals. An accurate diagnosis and instruction in proper therapeutic maneuvers are best done at a balance center.

New psoriasis treatment effective

Good news for the roughly 50 percent of psoriasis sufferers whose current treatment fails to control their chronic itching — a novel therapy has been re- ported by researchers at Temple University. Instead of indirectly combatting the itching through steroid creams that reduce skin inflammation, their drug goes right to the specific cause of the itch. The new cream, only called CT327, inhibits TrkA kinase, a compound responsible for pruritis (itching).

In the Temple research study there was a 60 per- cent reduction in itching. The therapy was safe with few side effects.

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