Periactin (antihistamine)

Periactin (antihistamine)

Users Face Risks: With "Classical Antihistamines"

Headline #3 may seem less tragic than the others, unless the worker is you -- and an antihistamine caused the job loss.
In fact, experimental studies and actual accidents cast the harsh light of reality on all three scenarios. The U.S. Air Force, for example, ordered pilots not to use antihistamines after a jet crashed into the aircraft carrier Nimitz several years ago. Officials blamed the fatal crash on the pilot's use of a sedating, nonprescription antihistamine.

Similar, if less deadly performance failures may threaten many of the 30 million Americans who take antihistamines each year for allergies or other problems. Some nighttime cold remedies and other medications, what is more, contain antihistamines, to induce sleep. Problems arise when the sedative effect unexpectedly lingers on the next day. Researchers suspect, too, that antihistamines used for nighttime sedation affect dreaming and reduce alertness, says pediatric allergy researcher Richard Evans, III, M.D., of Northwestern University, in Chicago.

Tests to document this lingering sedation are difficult -- and costly -- to do. So many physicians try to prescribe sedatives with the least carry-over effect in the morning, Dr. Evans says.

For overnight control of allergies and other problems that require an antihistamine, physicians increasingly are turning to non-sedating products, adds internist Richard Summers, M.D., of Johns Hopkins University, in Baltimore.
Various antihistamines caused drowsiness and other unwanted side effects in from 14 to 50% of patients, until non-sedating alternatives became available in the last decade, the literature shows. Now, antihistamines are split into "non-sedating" and "classical" categories. Terfenadine (Seldane(R)) and astemizole (Hismanal(R)) thus far are the only two nonsedating antihistamines available clinically in the U.S.; several others are under study. Terfenadine, which became available in 1985, already ranks as the nation's top-selling antihistamine -- and is the 9th most-commonly-prescribed drug.

The potential market for antihistamines is huge. It includes 40 million people with upper respiratory allergies; many of the 10 million with asthma; and some of the 25 million with itchy skin disorders such as hives (urticaria) and eczema.
A seminar that Drs. Evans and Summers gave for their medical colleagues yielded these additional observations about drugs and impaired performance:

- Among the millions who take antihistamines, some seem satisfied with classical products because they think these drugs do not affect them badly. However, studies show that a person who is taking an antihistamine is a poor judge of his or her own sedation level. In one such study, drivers taking classical antihistamines felt alert and competent -- until they began knocking down the pylons on the obstacle course on which they were driving.

- Some people believe a decongestant will fend off an antihistamine's unwanted side effects, because some decongestants' side effects include stimulation of the cardiovascular system. But this assumption does not prove to be consistently true, even if the decongestant does lessen drowsiness., The problem is that sedation is not physiologically the same as drowsiness -- and a drug that will counter one may not do so with the other.

- Well-known -- but often ignored -- warnings have been promulgated about operating machinery while drinking, or taking classical antihistamines, or consuming other potentially-sedating drugs. But what about the medication hazards one faces while seated at a desk?

- Some drugs diminish the ability to learn. Classical antihistamines have been shown to slow down mental reaction time. (See Table). They can prove especially tricky in this regard because they may do more than increase drowsiness. In children, they may cause an unexpected surge in hyperactivity and inattentiveness. (Hyperactivity also may be triggered by some popular decongestants.)

- A drug's wide availability is no guarantee of its safety. Some non-prescription cough medicines, for example, cause sedation because of their high alcohol content) 2.5% - 40%). On-the-road driving tests in the Netherlands identified nine major categories of drugs that affect performance. They include some antihistamines, pain relievers, mood-altering medications, blood pressure drugs and, paradoxically, stimulants.

Not all drugs in these categories affect performance, however. So it is important for consumers to read labels carefully, and question their doctors and pharmacists about a product's safety.

Mothers Who Smoke Can Aggravate Children's Asthma

The hazards of smoking appear to spread more widely with each study that pediatrician Andrew Murray, M.B.B.Ch., performs. His latest investigation shows that asthma is worse in asthmatic children whose mothers smoke, compared to asthmatics whose mothers don't smoke, the University of British Columbia, in Vancouver, researcher reports.
He analyzed some 250 children, ages 7-17, aud found that their asthma symptoms were 47% more severe if the mother smoked. Tests confirmed his clinical findings:

Smokers' children had lung function (FEV1) readings of 76%, on average, compared to 87% For non-smokers' children.
Dr. Murray's recommendation is that mothers of asthmatics shouldn't smoke around their children.

`Non-Dairy' Labels Sometimes Can Be Dangerously Wrong

Unexpectedly, people with milk allergies may be waylaid by occult milk in "non-dairy" frozen desserts and in processed meats.

Milk may be present, unintentionally, in a frozen dessert because a dairy produced the food without scouring traces of milk out of the equipment. Bologna, hot dogs and even canned tuna fish may contain hydrolyzed sodium caseinate, a milk product which often is used as a flavoring -- but may not be specifically listed in the ingredients, says James Gem, M.D., an immunologist at Johns Hopkins medical school, in Baltimore. The desserts he tested contained half a teaspoon or less of milk per serving. The offending meat products contained as little as 0.3 milliliter of milk per portion.
Occult milk probably is uncommon: In an informal several months' search among their patients, Dr. Gern and his Johns Hopkins colleagues found only five cases in which hidden milk had triggered an allergic reaction. But, he worries, other milk-allergic people may have given up non-dairy desserts and meats unnecessarily, after suffering allergic reactions to products in which milk was the actual but unknown culprit.

His advice to patients: Stay loyal to products you have eaten successfully in the past. Also, keep reading food labels thoroughly to spot milk and related products such as casein and whey.

Avoiding milk in processed meats, meanwhile, will become easier after August 28: The U.S. Department of Agriculture will begin enforcing regulations that require meat and poultry products to list ingredients more thoroughly. Labels will identify milk-derived ingredients such as sodium caseinate more specifically than the current term, "natural flavorings," Dr. Gern says.

"Hydrolyzed protein" is another designation that presently may indicate the presence of sodium caseinate, adds Hopkins allergy researcher Jan Bernhisel-Broadbent, M.D.

The "non-dairy" desserts may pose a trickier problem: Manufacturers have not responded to Dr. Gern's inquiries about how milk got into their "non-dairy" products. But he assumes the milk was included accidentally, possibly when machinery was not thoroughly cleaned.

Asthmatic Attacks Linked to Allergens

Men and women admitted to Wilmington, Delaware emergency rooms for the treatment of acute asthmatic attacks were given allergy tests by researchers. They found that a third of these patients had high levels of immunoglobulin E (IgE) antibodies against one or more common allergens: dust mites, cat, cockroaches, grass, ragweed pollen.

As reported by Lawrence Gelber, M.D., of the University of Virginia, the investigators then visited the patients' homes to collect kitchen, living room and bedroom dust and dander. In a third of the homes they found high levels of residues from dust mites, cat, or cockroaches.

"The results show," the researchers report, "that one third of patients with acute asthma (14/44) were both highly `allergic' to and exposed at home to high levels of at least one of the three dominant indoor allergens."

Gamma Globulin Injections Relieve Severe Dermatitis

Doctors in Los Angeles report a successful experimental treatment in a desperately ill two-year-old boy. The child was suffering from severe atopic dermatitis.

He has a very high level of serum immunoglobulin E (IgE), and had failed to respond to topical steroids, antihistamines or dietary regimens that excluded wheat, soybeans and other food items to which he was allergic. In great discomfort, the child -- understandably -- was quite irritable.

The doctors initiated treatment with weekly doses of intravenous immunoglobulin. Within six weeks he was much improved.

The doctors report that the youngster's IgE level "dropped" significantly, "corresponding with a dramatic improvement in his dermatitis." His mood, too, was significantly improved.

According to Brian Greenburg, M.D., of the UCLA Medical Center, this leads the physicians to suggest that intravenous immuno-globulin injections may be appropriate for other patients with severe atopic dermatitis who are not helped by conventional treatment.

Control of High Blood Pressure

High blood pressure has long been recognized as one of the most important and controllable factors in reducing the risk of cardiovascular disease. Better detection and control of high blood pressure has contributed to the marked reduction in the death rate for stroke and heart disease that has occurred over the last 15 years. Since 1972, the death rate for stroke has declined by more than 50 percent and the death rate for coronary heart disease has declined by more than 40 percent.

About 30 percent of the adult population has high blood pressure. People with high blood pressure have three to four times the risk of developing coronary heart disease and as much as seven times the risk of stroke as do those with normal blood pressures.

Early efforts to address this important risk factor emphasized screening, detection, awareness of one's condition, and pharmacologic intervention (i.e., medication). As a result of these efforts, the number of individuals with high blood pressure who were unaware of their condition declined from approximately 50 percent (using 160/95 as the measure) in the early 1970's to about 25 percent in the second half of the decade. However, during that same time period only 34 percent of hypertensives were adequately controlled. High blood pressure screening and detection efforts now emphasize following up on referrals for evaluation and treatment, ongoing supervsion and blood pressure monitoring, and the use of reminder and client tracking systems. These activities can help to ensure that people with high blood pressure seek treatment and then continue to keep medical appointments and stay in treatment.

Lifestyle behaviors and behavioral strategies also are increasingly important considerations in successful blood pressure management. Nonpharmacologic therapies can be effective in controlling high blood pressure and are being used with greater frequency, alone and in conjunction with medication. These approaches include weight reduction, reduction of alcohol intake, sodium restriction, physical activity, biofeedback, and relaxation techniques. In addition, whether pharmacologic or nonpharmacologic approaches are used, behavioral techniques can improve adherence to treatment and help to improve blood pressure control. Behavioral techniques include tailoring treatment as much as possible to the individual's lifestyle; patient contracting with an appropriate health professional (doctor, nurse, dietitian, health educator, etc.) to achieve a set goal (e.g., weight reduction, lower blood pressure); self-monitoring of blood pressure and/or medication-taking with recordkeeping and regular reporting; patient tracking to help maintain contact and alert the primary care provider when compliance breaks down; eliciting family or social support (especially for older adults and those living alone); and providing education that explains and reinforces why continued treatment is so important.

The efforts of the National High Blood Pressure Education Program (NHBPEP), which was established by the National Heart, Lung, and Blood Institute (NHLBI) in 1972, have contributed significantly to the improvements in blood pressure awareness and control in this country. The emphasis of the program has been on early detection and lifelong control of blood pressure through effective therapy. Since 1948, the American Heart Association (AHA) has also been a national leader in the effort to reduce premature death and disability from cardiovascular disease and stroke. This goal is approached through cardiovascular research, community programs that include public awareness of early detection and treatment, consumer publications, and support for professional education. (For additional information, see Resource List.)

One of the major challenges to achieving higher levels of blood pressure control as a Nation will be to improve the detection and management of high blood pressure among minorities and men. In this country, blacks have the highest rates of high blood pressure, related to an increased prevalence of overweight, and a possible genetic predisposition to salt sensitivity. In addition, men seem to have more difficulty than women in complying with prescribed treatment regimens to achieve blood pressure control. Men are also less likely to be seen by health professionals on a routine basis.

A pronounced geographical pattern has emerged in age-adjusted stroke mortality. The southeast portion of the country has come to be known as the "stroke belt" because of its higher incidence of stroke deaths. NHLBI, in cooperation with State health departments, has developed an education and treatment campaign called "Strike Out Stroke" to address these findings. (See Spotlight, p. 6.) Although definitive research results are not yet available, population-based studies suggest that the very same lifestyle practices that can help to successfully control high blood pressure may also prevent high blood pressure from ever developing. Maintaining a healthy weight, limiting alcohol consumption, engaging in regular physical activity, limiting sodium intake, and practicing effective stress management throughout life may be the keys to primary prevention of high blood pressure, especially for those at high risk.

National Heart, Lung, and Blood Institute Information Center. 4733 Bethesda Ave., Suite 530, Bethesda, MD 20814, (301)951-3260. Provides a large selection of publications related to high blood pressure control, including: Churches as an Avenue for High Blood Pressure Control, Compendium of Minority High Blood Pressure Programs, The Physician's Guide: Hove to Help Your Hypertensive Patients Stop Smoking, Community Guide to High Blood Pressure Control, and The Physician's Guide: Improving Adherence Among Hypertensive Patients.

American Heart Association. 7320 Greenville Avenue, Dallas, TX 75231-4599, (214) 706-1220.

Distributes educational material on all aspects of cardiovascular disease for both health professionals and the public, including some Spanish language pamphlets. A catalogue of publications is available through local affiliates listed in the telephone book.

Centers for Disease Control, Public Inquiries. 1600 Clifton Road NE., Atlanta, GA 30333, (404)639-3286; (404)639-3534 (publications); (404)639-3075 (Behavioral Risk Factor Surveys). Administers Prevention Block Grant funds to States for detection and treatment of hypertension as well as other efforts to combat chronic diseases and offer health education and preventive services. Also developed the Behavioral Risk Factor Surveys (BRFS) to permit States to collect consistent information on behaviors related to the ten leading causes of death that can be used for comparison among regions. Public Health Foundation. 1220 L Street NW., Suite 350, Washington, DC, (202)898-5600.

Collects and disseminates data including information on the number of persons screened for hypertension, referred for treatment, started on treatment, and complying with treatment. State health departments can use the information to support risk reduction and disease prevention activities.
Article copyright PNG Publications.

Share this with your friends