Posts Tagged ‘allergy’

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

The black doctor’s phone rings in the dispensary.  The doctor on the other end of the line is frustrated.  She wants to prescribe an antibiotic to a patient with a sinus infection.  When the doctor asked the patient if she had any allergies, the patient said she couldn’t remember which medication she was allergic to.  The patient told the doctor to phone the pharmacy to get a list.  When I look at the patient’s profile on the pharmacy computer, I see at least 7 different medications the patient claimed to be allergic to.  Now the doctor is even more frustrated.  The only medication the doctor thought would work for the patient’s sinus infection was on the allergy list.  The doctor has no other medications in her arsenal to help the patient.

We really do have people who come into the pharmacy claiming to be allergic to everything.  Now, it isn’t that I’m calling them liars.  I am sure they have had a bad reaction to the medications they tell me about.  However, part of my job is to try to determine which are true allergies, and which are just intolerances.

So what is the difference between a medication allergy and an intolerance and why should you care?  An intolerance is a bad reaction like having an upset stomach, vomiting, diarrhea or headache.  Not that these aren’t very unpleasant reactions, but they aren’t true allergies.  True allergies are reactions such as a measles-like rash or hives. The most serious type of allergic reaction is called anaphylaxis.  Symptoms that could be suggestive of anaphylaxis include facial or throat swelling, light headedness from low blood pressure, asthma or wheezing,  and shortness of breath.

When you tell me that you had a bad reaction to a medication, I am listening for words like “my throat closed”, “I had trouble breathing”, or “my face puffed up”.  These can mean that you had an anaphylactic reaction, and another dose of that medication could kill you.  So I will put a big warning on my computer not to give you that drug or similar drugs in the future.  I will caution you to get a Medic Alert bracelet to warn doctors and EMS personnel that you have a life-threatening drug allergy.  We may even talk about whether you should get a referral from your family doctor to an allergy specialist.  If, instead, you tell me that you had the worst stomach cramps of your life, as unpleasant as they were, stomach cramps are not life threatening.  I will put a note on your file and we will tell doctors not to give you that particular medication again, but you didn’t have a drug allergy. 

As a patient, you might feel equally bad whether your reaction to a medication was horrible stomach cramps or puffy face and trouble breathing, but to me the difference is very important.  If you had stomach cramps on the antibiotic amoxicillin, we will try to not give you amoxicillin again.  But, if the doctor determines amoxicillin is the best medication for you, we can still give it to you.  We can tell the doctor to give you a lower dose for a longer time, or we can tell you to take it with food or maybe even recommend a stomach medication to take with the antibiotic to make it less likely to bother you.  If you tell me that your face got puffy and you had trouble breathing on amoxicillin, things will be different.

We will suspect you had an anaphylactic allergic reaction to amoxicillin.  Anaphylactic allergic reactions can be life threatening.  If you get amoxicillin again, the second reaction may be worse than the original reaction.  So if a doctor prescribes amoxicillin again, I will tell the doctor there is no way you should get the amoxicillin.  In fact, I will tell the doctor not to give you penicillin, cloxacillin, ampicillin, or clavulin because they are all very close chemical cousins to amoxicillin and may also cause a life threatening reaction.

If the doctor says, “Okay, what about cephalexin?” things get a little more complicated.  Cephalexin is a more distant chemical cousin to amoxicillin.  In pharmacy school, I was taught the chance of cross-reactivity between amoxicillin and cephalexin was about 10%.  Apparently, now experts are saying it is really more like 1%.  So there is very little chance that someone with an amoxicillin allergy will also be allergic to cephalexin.  However, if you tell me that your throat closed on amoxicillin, the doctor and I would still be very nervous about giving you cephalexin and would probably avoid it.  If you said you had a rash on amoxicillin, and the doctor wanted to give you cephalexin, I would probably say to go ahead.  Eventhough a rash is usually a sign of a true allergy, the chance of cross reactivity between amoxicillin and cephalexin is very low and a rash is not life threatening.

So talk to your doctor and pharmacist about your bad reactions to medications.  Tell them exactly what kind a reaction you had, how long after the starting the medication it happened and how long ago it happened.  If you tell your doctor you are allergic to four or five medications that really just gave you stomach cramps, that may make it very difficult for your doctor to give you medications that might really help you.  On the other hand, if you forget to tell your pharmacist that a certain medication made your throat close, we can’t stop you from getting a medication that could threaten your life.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

“Na Na-Na Na Na. Thunder.  Na Na-Na Na Na. Thunder.”  The opening bars of AC/DC’s Thunder Struck played over the speakers as the Parkland Source for Sports Thunder whizzed around the Ste Rose arena warming up.  Okay whizzed around might be a little strong.  Rode their sticks like ponies, ambled aimlessly, and made the occasional snow angel on the ice is more accurate, but the Source For Sports Thunder Novice team eventually got started on their warm up drills.  The seven and eight year old mostly boys and a couple of girls like my daughter on the Thunder were psyching up to play the mighty McCreary Mustangs.  I was lost in thought about how cool it would have been if my seven year old friends and I had a theme song playing over the speakers when we played hockey way back when.  Anthony Wiens was remarking how cold it was in the Ste. Rose rink eventhough it was up to -3 C outside.  Then he noted that not all music was created equal.  He said it was funny how the older rock songs just seemed to suit hockey games better than newer music.  And as I listened to the songs during the breaks in play, I began to think he was right.  Different pop music has different uses.

If you get an allergic reaction, one of the types of medication we reach for are antihistamines.  Not all medications that block histamine are created equal either.  Histamine blockers that block the H2 histamine receptor don’t even treat allergies.  They have names like ranitidine and actually are used to reduce stomach acid and treat heart burn and ulcers.  For our purposes, H2 blockers are like classical music, interesting but irrelevant for a discussion of pop music.  For allergies, we want H1 receptor blockers which are usually just called antihistamines.

Allergic reactions start more or less the same way.  When your body comes in contact with what you are allergic to (the allergen), certain cells in your immune system release a chemical messenger called histamine.  The histamine connects with the H1 histamine receptor and tells your body to start the allergy symptoms, like the runny nose, or the itchy rash.  So the easiest and best way to avoid an allergic reaction is to identify and avoid the allergen.  If you are allergic to the cat at your mother-in-law’s house, avoid your mother-in-law.  If that horrible cologne your wife bought gives you an itchy rash, don’t use it.  Simple, right?  Well, even if we can identify the allergen, sometimes they are hard to avoid.  If you are allergic to pollens that are common in Manitoba, you will probably get a stuffy nose in the fall no matter what you do.  So if we can’t identify and avoid the allergen, we may need to block the H1 histamine receptor with a medication.

There are two basic types of antihistamines.  The first generation antihistamines are have names like chlortripolon (chlorpheniramine), and benadryl (diphenhydramine).  They are inexpensive, work quite well, but they also often cause drowsiness, and some other side effects like urinary retention, and worsening glaucoma.  They work fast, which is great if you have an itchy rash, but they don’t last that long and you may have to take several pills a day.  So they are cheap and fast, but have no staying power and might bore you to sleep.  So, let’s call first generation antihistamines dance music.

Second generation antihistamines cause much less sedation, have far fewer side effects, but they are more expensive.  These are agents like reactine (cetirizine), and claritin (loratadine).  A nice benefit is one pill often lasts all day.  Reactine is good for both runny noses and itchy rashes, but I have seen it make some people sleepy.  Claritin only works well on runny noses, but it is much less likely to make someone sleepy.  So they are more expensive, but have fewer side effects and more staying power.  So, let’s call second generation antihistamines classic rock.

So, different antihistamines have different uses.  Classic rock is what should be played during breaks at hockey games.  Any beware the Source For Sports Thunder.  Or you’ll be Thunder Struck!

As always if you have any questions or concerns about these or other products, ask your pharmacist.

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

I have something very important to tell you.  Come in really close.  Don’t tell ANYONE where you heard this.  Oprah might be wrong.  The reason I don’t want my name disclosed is I’m pretty sure the Queen of Day Time Talk could make me disappear if she wanted. 

Obviously I’m kidding (and a little scared) about Oprah.  But neti pots were my first introduction into Ms. Winfrey’s powers.  A few years ago, people started coming into the pharmacy demanding neti pots.  I had no idea what they were talking about.  I few days later I saw a re-run of Oprah on in the evening and low and behold one of her guests, I think it was Dr. Oz, was demonstrating neti pots.

A neti pot looks like a little tea pot.  The user fills the pot with a salt water solution.  Then they tip their head to the side over a sink.  They place the neti pot spout into their top nostril and pour gently.  The salt water runs into the top nostril, through the sinuses and out the bottom nostril into the sink.  The Oprah guest said the first time you try the neti pot, it will feel like you are drowning.  I have tried it, and yes, it does feel like you are drowning.

So after the Oprah Show, everyone wanted a neti pot.  The more medical term for what a neti pot does is called nasal irrigation.  It isn’t a new practice.  Some yoga practitioners have espoused the benefits of nasal irrigation for years.  I remember a medical resident talking about nasal irrigation.  A specialist that had taught during her training actually liked the idea of nasal irrigation.  However when the specialist recommended nasal irrigation to patients, the patients usually refused as it was too weird.  The resident thought it was funny now that Oprah recommended nasal irrigation, the masses were running to the pharmacy to pour salt water into their noses.

So what does nasal irrigation with a neti pot do?  Well, from personal experience, it definitely washes mucus and all the dust, dirt and other assorted gunk out of your nose and sinuses.  There are some more interesting claims I read as well.  One is the salt water (saline) reduces swelling in your nasal passages and sinuses because the fluid causing the swelling flows into the saline and is flushed out.   Another claim is that the saline rinse flushes histamine and leukotrienes out of the sinuses.  These chemical messengers that your body produces can cause inflammation and swelling.  A negative claim says that the saline rinse gets rid of good stuff like immune globulins from your nasal passages.  Immune globulins can help fight infection.

There are some small studies saying that nasal irrigation may be modestly effective in reducing sino-nasal symptoms.  The side effects of nasal irrigation are mild and infrequent.  They include nasal irritation, stinging or burning in a small number of patients.  Nasal irrigation is relatively inexpensive.  So it sounds like Oprah hit it out of the park when she sent everyone to the pharmacy looking for neti pots.  Well, there might be a fly in the ointment.

There is a small study showing some possible harm from nasal irrigation.  Now usually people would irrigate their sinuses for a few days to a couple of weeks because they were stuffed up.  This study followed 68 people.  These people got that drowning feeling once a day for a year.  Then half the people stopped pouring salt water into their sinuses while the other half kept pouring.  The non-irrigating group got fewer sinus infections. 

Why did the non-neti potters get fewer infections?  Is Oprah leading us down the garden path?  We don’t know.  It was a small study, so the results could be a fluke.  It could be the neti potters didn’t clean their apparatti properly and infected themselves.  It could be all that continuous saline washed out important stuff in the nasal passages that should be there to protect us from infections.

So was Oprah wrong?  Probably not.  If you want to try nasal irrigation, keep your neti pot clean, only use it once or twice a day to prevent dryness and don’t use it for more than a couple weeks in a row.  If you are also on a prescription nasal steroid, use the neti pot first then the steroid.

When I tried nasal irrigation, I used a product called HydraSense.  It is more expensive than a neti pot, but it is an all in one product.  You don’t need to mix the salt water or use the clumsy tea pot up the nose.  It comes pre-mixed in a pressurized nose spraying bottle.  Yes I got the water to go all the way from one nostril, through my sinuses and out the other nostril.  Yes my nose and sinuses felt clean.  Yes it felt like I was drowning.  No, I don’t think I’ll do it again.  And I’m really sorry I suggested Oprah might be wrong.

As always if you have any questions or concerns about these or other products, ask your pharmacist.