Adamis Pharmaceuticals has developed a prefilled epinephrine syringe as a cost-effective alternative to the automatic injectors. Currently, the only two available injections for epinephrine to treat severe allergic reactions are Epipen and Auvi=Q. Both work automatically to insert the needle and then deliver the medicine. However, both are expensive and cost constraints have led to some adults and children going without the protection.
The new prefilled syringe requires the patient or a caregiver to remove the needle shield, insert the needle into a muscle, then push the syringe to deliver the medicine and finally to remove the needle.
When studies were conducted on volunteers with no medical background 99% were able to successfully administer the medicine. This new tool called “Symjepi” has been FDA approved and provides a cost saving alternative to the auto-injectors.
Lumify is a new OTC eyedrop that helps “get the red out”. It is a selective alpha-adrenergic agonist that is available by prescription in higher concentrations. But the OTC form works well and unlike some other OTC eye drops, it does not cause rebound redness when you stop using it.
A pet surrogate is available for children/adults with pet allergy. Cats and dogs that look real and move in response to being held or petted are available at JoyForAll.com companion pets.
Previous issues of this newsletter have contained articles about the importance of the gut microbiome and human health in general and more specifically in good immune function. In this regard the use (and overuse) of antibiotics has come under intense scrutiny. This includes therapeutic antibiotics and those used in our food production. The premise here is that the antibiotics kill off some of our healthy microbiome and can lead to an overgrowth of “undesirables”.
A recent article published in “Nature” details research on the impact of non-antibiotic medications on the healthy microbiome. The investigators screened over 1,000 different medicines and found that 24% of them alter the healthy microbiome. The drugs that seemed to be the worst were antipsychotics and other psychoactive drugs, proton pump inhibitors, anti-cancer drugs and hormones.
What is a bit unsettling, is that this same research group has found preliminary evidence that an altered microbiome can promote some psychiatric and neurological diseases. So, the concern is that maybe the treatment that is supposed to help the condition might also contribute to it.
The researchers say more studies are needed to clarify these issues.
The answer is no, yes, or maybe so. I’m not trying to be obtuse, but the answer is different for different people.
Let’s start with the dry eye syndrome. It is very common and affects millions of Americans. Also, it can vary in severity from a mild nuisance to a vision altering severe condition. The common denominator for all people with dry eye syndrome, is compromised ocular lubrication. But, the condition has many causes which can overlap and interact.
Our tears are made by two different tear glands: the lacrimal glands which make the salt water component and the meibomian glands which make the oil component. Dry eye syndrome can be due to inadequate oil production. This imbalance can actually be worsened when the lacrimal glands over-produce the salt water which ends up diluting the oil further. And paradoxically someone with dry eyes might be “tearful”.
Dry eye syndrome can also be due to inadequate lacrimal output. The most common cause for this is certain rheumatologic syndromes especially Sjogren’s Syndrome. But lacrimal deficiency can also occur due to aging, contact lenses, and the drying effect of certain medications such as antihistamines.
Allergic individuals may not have ocular allergy until they develop dry eye syndrome, which leads to a paucity of tears and therefore impedes the natural removal process of allergens from the eye. Then if they take antihistamines to help their allergies they can worsen the drying of the eyes. Other medicines that can contribute to dry eyes include: diuretics, beta – blockers, some antidepressants, birth control pills and some herbal supplements, especially echinacea.
Finally, people who have a reduced blink rate (most commonly seen in Parkinson’s disease) don’t renew the protective tear film on the eyes and experience dry eye issues.
The immune system was once considered an independent, self-regulated system. But research over the past ten years has found that like most of the rest of the human body, it too is under the control of our nervous system.
Some of the early research in this regard was designed to understand why we seem more prone to get sick if we are under stress or depressed. As it turns out the brain does have significant control over certain aspects of the immune system. The brain uses the autonomic (also called automatic) nervous system to exert this influence. One of the main autonomic nerves is the vagus. Japanese scientists at Osaka University have discovered that using mild electrostimulation of the vagus nerve reduces immune mediated inflammation. Preliminary studies in rheumatoid arthritis and Crohn’s disease have shown improvement in both diseases with this therapy. Studies are also underway to determine benefit in reducing the inflammation that causes asthma.
One reason this research is so exciting is that unlike most anti-inflammatory drugs in current use, electrostimulation does not cause immune suppression and therefore avoids the increased risk of infection due to drug therapy.
The FDA has recently approved Aimovig (Erenumab) a once-a-month injection to prevent migraines. Aimovig is a monoclonal antibody that targets the calcitonin gene-related peptide receptor (CGRP). CGRP is a neurotransmitter that dilates blood vessels and stimulates pain. It was discovered that levels of CGRP go way up in people experiencing migraines. By blocking the receptor for CGRP the Aimovig is able to prevent headaches.
Since Aimovig is a preventative agent, it is currently only recommended for patients with frequent severe migraines or with chronic migraines. The cost of each injection is $600.00.
A recent study in Europe was done on people with mild-persistent asthma. The study compared daily use of a combination inhaler with long lasting bronchodilator and steroid versus just using the inhaler when the asthma started to flare up. The rate of severe exacerbation of the asthma requiring either an ER visit or treatment with oral steroids was the same in both groups.
Auvi–Q, a form of adrenaline auto injector has recently come out with a lower dose injector for emergency treatment of anaphylaxis in children weighing less than 33 pounds. It contains .1 mg of epinephrine and has a shorter needle (to avoid hitting the bone when injected). Previous to this the only other available doses were .15 mg for people 30 to 60 pounds and .30 mg for people over 60 pounds.
Dear Dr. K: I recently heard that the “black-box” warnings on LABAs (long-lasting bronchodilators) has been removed. Is that true, and are LABAs safe?
These are two great questions. The answer to both is “yes”. It’s best, however, that we explain a few things. The two most common of these bronchodilators are Formoterol and Salmeterol. They are basically long-acting forms of Albuterol. When they first became available about 20 years ago they could be used as a single agent to treat asthma. It soon became apparent this was not a good idea in moderate-to-severe asthmatics because they don’t treat the underlying inflammation that causes the asthma in the first place.
Until this was understood there were some asthmatics who were hospitalized or even died because of severe exacerbation of their asthma. This led the FDA to do two things: No. 1. To require the black-box labeling, and No. 2. To issue specific guidelines never to use LABAs by themselves, but only in combination with an inhaled steroid.
Once these guidelines were instituted, a number of academic studies have shown that these medications not only help control moderate and severe asthma, but also reduce hospitalizations and mortality.
It is for this reason that the FDA decided to do what is rarely done, and that is to remove the black-box warning. Their rationale for doing so is to eliminate patients’ fear of taking a medicine that could truly help (and not harm) them.