New antihistamine: less congestion, fewer side effects

Posted on October 15, 2013 by Stephen J. Klemawesch, MD
Researchers at Creighton University have developed a new antihistamine that blocks the H3 histamine receptor.  The new drug that blocks H3 is called by its research name – PF-03654746. It’s an exciting discovery because it appears to be the first antihistamine that reduces congestion.
Up until now the only way to reduce nasal congestion was to take an antihistamine/decongestant combination such as Allegra-D or Zyrtec-D. These drugs contain Sudafed, which works, but brings the potential issues of causing insomnia and raising blood pressure. Additionally, taken on a daily basis the body eventually becomes tolerant of its effects and the congestion comes back. Furthermore, because Sudafed can be used to make street drugs it has become closely controlled by the government.
This new antihistamine doesn’t raise blood pressure, cause insomnia or lead to tolerance. It seems to treat congestion by blocking the H3 receptors found in nerves in the nasal membranes.  Blocking the H3 on the nasal nerves keeps blood vessels from being engorged and leading to tumescence (i.e. nasal congestion).  Clinical trials done with the drug have shown it to be safe and effective. Hopefully, FDA approval will be forthcoming.
(There are currently four known histamine receptors in the human body numbered 1 through 4: H1 blockers are well known and include Benadryl, Allegra, Claritin, Zyrtec and others. H2 blockers are also known and numerous and include Zantac, Pepcid, Tagamet and Axid. H4 blockers are still an early research topic.)
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Internal medical devices: Reactions spotlight metal allergy

Posted on October 15, 2013 by Stephen J. Klemawesch, MD
Dear Dr. K: Do you have anything to share from your recent trip to the Southeastern Allergy meeting?
The meeting was excellent. The presentation I found most provocative was on allergy to medical devices. Unfortunately, this is becoming a more common source of allergic difficulty.  The spectrum of reactions has included allergy to joint replacements, fracture-stabilizing metals, spine-straightening rods, cardiac pacemakers, defibrillators and their wires, coronary and other arterial stents and dental products, including implants and orthodontic materials.
Although some reactions are to glues and adhesives, it seems that metal allergy is the primary cause for these reactions. The reaction to metals is found more commonly in people who already have known metal allergy, such as nickel allergy to earring materials. In fact, nickel allergy is the most common metal allergy, followed by chromium and cobalt allergies.
People who have multiple body piercing sites have a greater likelihood of developing metal allergy. The American Academy of Allergy recommends avoiding ear or other piercings until age 10 to lessen the chance for developing metal allergy.  It was once thought that titanium was allergenically inert but, unfortunately, allergic reactions are occurring to some titanium alloys.
The most common manifestation of the allergic reaction is a rash in the skin surrounding the implant site, or in the mucous membranes in the mouth in the case of dental allergy. In some patients there can also be sites of remote rash and other systemic symptoms, such as achiness and pain.
A special scenario can exist with arterial stent allergy. Sometimes the only manifestation is what is called rapid re-stenosis. That is, the artery that was reopened with the stent quickly closes again due to the allergic inflammation.
If someone has a known metal allergy and needs an implanted material, it is recommended that a patch test be done with the material prior to its being used.  Unfortunately, there are not yet any standardized test kits, so the approach is more seat-of-your- pants in nature. Usually a small piece of the to-be implanted metal can be obtained and a patch test carried out. In some very special cases, instead of a patch test, the test metal is actually surgically placed in a superficial pocket below the skin for several weeks to see if an allergy develops.  Obviously, this more invasive test is only undertaken in special high-risk cases.
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Congratulations to our very own world-class paddleboard team!

Posted on October 15, 2013 by Stephen J. Klemawesch, MD
Bucking waves, currents and winds made a really  tough  task  for  the athletes competing in  the 2013 World Paddleboard Championship in Hawaii even tougher. But our favorite relay team of Dr. Patrick and Dr. Steve Klemawesch beat the elements and finished the 32-mile, open-ocean stand-up paddleboard competition in July.
The crossing in open Pacific waters begins on Kaluakoi Beach on the north shore of Molokai and finishes in Maunalua Bay  on  the  south  shore  of Oahu. Competing as a  team  for  the  first  time,  the docs finished in –  try  to grasp how grueling – 6:48:57! Not exactly like doing laps at North Shore Pool! Tropical Storm Flossie threatened to sink the whole endeavor, but held off long enough to let the race follow its schedule.
Good for you, guys!
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Q – Tips: Elemental Silver

Posted on October 15, 2013 by Stephen J. Klemawesch, MD
• Elemental silver has been used for centuries for its antimicrobial properties. In the Middle Ages it was successfully used to treat syphilis, TB and other infections. It is still available today, but caution should be used because excessive doses of silver tonics available over the counter can be toxic to internal organs.
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Nice scents are great, unless they’re not tolerated

Posted on October 15, 2013 by Stephen J. Klemawesch, MD
Reprinted and updated from Allergic Reaction, Vol. 1, No. 1, July, 1990
Dear Docs: Your staff asks patients and visitors not to wear perfume or other scented products
while visiting the office. Why is that? “The reason we ask people visiting our office not to wear them is because some of our patients are extremely sensitive to certain scents, including those in some perfumes and colognes, or to the petrochemical base used in these compounds to control their slow evaporation.
“We’re sure you’ll agree it just wouldn’t be considerate to wear a fragrance that might cause a severe reaction to someone else while you’re both here. Some people we’ve seen as patients can’t even go to church due to their sensitivity to perfume. “An allergist’s office is a sensitive environment, filled with sensitive people, and this is one of the things we can collectively work to control. That’s why we ask for the ‘sacrifice’ on your part – and it is appreciated!”
P.S. From that same 1990 issue: A Q(uick) Tip mentioning that magazines at that time had begun offering scent-free subscriptions. Readers could call to request a spot on the “allergy” list of subscribers. Now if we could just get newspaper insert advertisers to do the same . . . .
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Q – Tips: reactions

Posted on September 6, 2013 by Stephen J. Klemawesch, MD
• When trying to analyze what triggered an allergic reaction keep
in mind that many reactions are “biphasic.” That is, after exposure to an
airborne allergen or a food, many people have not only an immediate
reaction, but also a second, delayed reaction (delayed up to 8 to 12
hours) after a single exposure.
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Q – Tips: Ragweed

Posted on September 6, 2013 by Stephen J. Klemawesch, MD
• This is ragweed season. Keep in mind that rainfall releases more
ragweed pollen from the plants. Certain foods augment ragweed allergy,
especially melons and chamomile.
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Shitaki ‘shrooms tasty, but linked to streaky, itchy rash

Posted on September 6, 2013 by Stephen J. Klemawesch, MD
Now, say that fast three times with your mouth full of mushrooms.  Shitake toxicoderma is a very common dermatitis in Asia, especially, China, Japan and Korea.  However, it is being seen more commonly in the U.S. as the popularity of shitake mushrooms increases.  The rash is fairly unique, consisting of a long linear array of urticaria. The skin looks like it has been whipped with cat-o-nine tails having red raised streaks that are very pruritic. The itchy lines can last for several weeks, and typically occur within a day of eating raw or cooked shitake mushrooms.
The mechanism of rash is felt to be due to Lentinam a polysaccharide found in the mushrooms that has immune-modulating effects. In fact, Lentinan has been used for chemotherapy in the treatment of colon and gastric cancers, It seems that individuals who get the rash have a hyper-immune response. Sun exposure can act as an adjunctive factor. The rash can be treated with steroids, usually topically, but if the problem is severe, oral steroids are used.
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More reasons to protect with shingles vaccine: Vision-robbing after-effects, even blindness

Posted on September 6, 2013 by Stephen J. Klemawesch, MD
Since the article in the last issue of Allergic Reaction about Ramsay Hunt Syndrome from shingles, four patients from this office have commented on the much more common problem from shingles. That is eye involvement.  Four individuals either had the complication themselves or knew a relative or friend with the eye involvement. All four of them felt that since the eye issue is so severe, people should know about it so they can protect themselves with the vaccine.
So here are some facts:
The most common complication of shingles (herpes zoster) is post-herpetic neuralgia. This occurs in about 20 percent of people who have shingles and can be a life-long source of recurrent pain in the area where the shingles broke out.
The second most common complication of shingles is herpes zoster opthalmicus (eye involvement), which occurs in about 2.5 to 3 percent of cases of shingles. Types of eye problems include conjunctivitis, iritis, uveitis and keratitis. All of these conditions can lead to varying degrees of loss of vision – including blindness.  In some people the eye condition re-occurs repeatedly, even though the shingles don’t.
Once again, the best prevention for this complication is vaccination.  Of note, when the vaccine was first released, the recommended age was 60 and older.  Because the vaccine has proven to be so safe and so   effective in preventing shingles and its complications, the age recommendation has been shifted to 50 and older.
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Mosquito repellant works well, but…

Posted on September 6, 2013 by Stephen J. Klemawesch, MD
The frequent rains this summer have led to a bumper crop of hungry mosquitoes. Although many repellants are available, the most effective compound seems to be DEET. It works because its scent is extremely irritating to biting insects, such as mosquitoes and fleas.  Unfortunately, DEET is fairly allergenic with upwards of 30 percent of individuals developing a rash after repeated use. The types of rash seen are contact dermatitis (looks like poison ivy), eczema and urticaria (hives). The fact that DEET is a somewhat irritating chemical, and that it is repeatedly applied to the same skin areas, leads to the development of allergy.
Luckily, a new effective repellant has recently been developed – picordin. It, too, works because its scent dissuades biting insects; however, unlike DEET, it is not irritating or allergenic to the skin. Also, it is tolerated even in individuals already allergic to DEET.
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