Antihistamines

Antihistamines

Between 15% and 25% of the population around the world suffers from periodic allergic rhinitis. It can be occasionally annoying or severe enough to affect the quality of life. Antihistamines are the primary medication used to treat this and other forms of allergy.1

The older types of these medications, the first-generation antihistamines, are sedating. For that reason, they tend to be used more often as sleeping pills. Indeed, some 12% of those over age 65 take such medications for insomnia. This is concerning since over-the-counter sleep medications with the antihistamines diphenhydramine (Benadryl) and doxylamine (Unisom) are on the Beers List – medications to be avoided in those over age 65 because they can cause difficulty with thinking, problems with coordination, can worsen kidney or liver insufficiency, and lead to dizziness and falls. They are a common source of drug interactions including with some antidepressants and cardiac medications.2

Antihistamines are one of the most commonly prescribed drugs for children. Per a Cochrane Review (medical studies that are well-known for their scientific analysis and for thoroughness), the effectiveness of antihistamines for treating nonspecific cough in children is not certain. Also, children are more susceptible to antihistamine adverse effects, including sedation as well as paradoxical agitation and excitability.3   Topical antihistamines should be avoided in children

Some people also take antihistamines for their cold symptoms. While the older, first generation antihistamines may dry secretions, they can thicken the mucus excessively so that it is harder to cough them up.3

     Antihistamines are effective in the treatment of allergic rhinitis and chronic urticaria. For chronic allergy symptoms, regular use of an antihistamine is probably more effective than taking them only as needed. Allergic conjunctivitis is probably better treated with antihistamine eye medications. Antihistamine effects vary from person to person so if one type doesn’t help, another may. 4, 5

First generation antihistamines are not recommended because they can cause sedation as well as difficulty thinking. These medications should be avoided not only in those over 65 years of age, but also those with glaucoma, constipation, dementia, or benign prostate enlargement. Second generation antihistamines are much less likely to cause sleepiness but it can have this effect in some, especially in higher doses.5

Because many types of antihistamines are sold without a prescription, it is essential to discuss any use of them with your pharmacist so that they can determine if there are any interactions with your prescriptions. And remember, it is far superior to try to determine what is causing an allergic reaction and make every effort to eliminate exposure to such.

This article is not intended to replace your health care provider. The intent is to make important information about medications available.

References

1D. Passali, et al, “The International Study of the Allergic Rhinitis Survey:  outcomes from 4 geographic regions,” Asia Pacific Allergy, January, 2018; 8 (1): e7.

2O. Abraham, et al, “Over-the-Counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep.” International Journal of Clinical Pharmacy 297; 39(4) 808-817.

3J. Van Schoor, Antihistamines:  A brief review, Professional Nursing Today, 2012: 16(5).

4Dr. Koop’s Self-Care Advisor. Time Life Medical Books, 1996.

5The Merck Manual, 19th edition. Whitehouse, New Jersey:  Merck, Sharp and Dohme, 2011.

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Who’s watching out for you and your loved ones?

It seems that with all the regulation of medications and oversight of food production, everything available would be safe. We all know that isn’t true. On my blog, I hope to explore some of the negative and positive things that can be consumed. As a nurse practitioner and professor, I strive to pass on accurate information, and if information is of questionable value, I’ll include that as well. My blog is not intended to replace your health care provider. The intent is to help educate consumers to help them make wise decisions.

Dry Eye and Computer Vision Syndrome   

Dry Eye and Computer Vision Syndrome

Dry eye is a common problem that often worsens with aging. Symptoms include eye itchiness, burning, a scratchy feeling, blurred vision, and/or watery eyes. This can be a temporary problem caused by air conditioning, wind, smoke, dry heat, a dry or dusty environment, prolonged screen time, or even eating spicy foods.

     Chronic dry eye is usually caused by a problem producing meibum, the oil that is a necessary part of tears and keeps the front of the eye lubricated. The oil is made in tiny glands on the edge of each eyelid. When those glands become clogged or inflamed, they can’t release this oil. The abnormally tears lack sufficient oil and are watery, and they can’t protect the eye or nourish it adequately. Severe chronic dry eye can result in an infection or even a loss of vision.

Some medications can also cause or contribute to drying out of the surface of the eye:

Oral contraceptive (birth control pills)

Antihistamines, especially the older ones like diphenhyrdramine (Benadryl, etc.)

Diuretics and certain other blood pressure medications

A medication for severe acne called isotretinoin

Some medications for gastrointestinal problems such as those for diarrhea

Some sedatives (tranquilizers) and antidepressants

 

Dry eyes are common with prolonged reading, watching television or looking at a computer screen because you blink less often and blinking helps release the oil needed for healthy tears. It is good to take a break from those activities every 10 minutes or so and fully closing your eyes, with upper and lower lids touching, for 2 seconds. Also, wear glasses or sunglasses when exposed to wind and use a humidifier to keep the air moist, and avoid smoke and fans. You can also hold a warm, clean washcloth to your eyes for 10 to 15 minutes a day. That will help unclog the oil glands. Artificial tears also can help prevent and treat chronic dry eye.

Computer vision syndrome can occur in those who spend two or more continuous hours a day focused on a computer screen or other similar screen. It is caused by sitting closer than 2 feet from a screen, requiring prolonged contraction of circular muscles needed to focus at a close proximity to the eyes. This prolonged straining can make it difficult for the muscles to relax, leading to blurred vision. It can also result in headaches, dry eyes, or decreased visual acuity.

These problems can be prevented by following the 20-20-20 rule (no pun intended but it may help preserve 20/20 vision). This rule is a good reminder to look away from screens every 20 minutes for 20 seconds and focus instead on something 20 feet away. Try to keep eyes level with the top of your computer monitor since your eyes focus optimally when you’re looking downward. Also, partially closed eyes have less surface area for tear evaporation, lessening eye dryness. Decreasing glare can be helpful too. It is important to keep any corrective lens prescription up-to-date.

Eye drops that reverse eye redness are actually harmful. They decrease blood flow through small blood vessels on the surface of the eye and if used repeatedly, can cause rebound redness, inflammation or even injury to the cornea.

Contacts should never be worn longer than prescribed. Good hand washing before putting them in is also critical. Some eye infections can be very difficult to treat and even lead to permanent eye damage.

Dark green, leafy vegetables, salmon, eggs, and ground flaxseed support healthy eyes. Some research also suggests that vitamin C, zinc, copper, vitamin E, and beta carotene may also benefit the eyes. Being able to see is miraculous. These few steps are pretty cheap insurance to keep the eyes working well.

Vitamin B12 deficiency – still a serious threat

Even if an individual eats a well-balanced diet, a vitamin B12 deficiency can occur and cause serious damage before a lack of this nutrient is even suspected. It’s estimated that some 6% of the population under age 60 has a lack of vitamin B12, and about 20% of people 60 and older. Of those 85 and older, 23% are deficient. Deficiency can impact everyone, from an embryo to the very old, in some of the following ways:

  • It can cause infertility, miscarriage, and premature birth
  • Like a folate deficiency, a lack of B12 can lead to spinal abnormalities
  • Babies lacking B12 may have problems with sucking and with swallowing
  • Adults with a B12 deficit may experience numbness and tingling of the hands and feet, weakness, fatigue, decreased appetite, constipation, and weight loss
  • A type of anemia called macrocytic anemia can develop but this doesn’t always occur
  • Neurological and psychological problems may be present even when the blood B12 level is normal or only slightly below normal.
  • Problems with memory and reasoning – because of this, it is often confused with dementia, especially in older individuals – a group at high risk of having a B12 deficiency
  • Difficulty walking and with balance or fine motor tasks like using silverware or scissors

Who is at risk for a B12 deficiency?

Anyone over age 50 is more prone to atrophic gastritis with a decrease in gastric acid and thus less able to release B12 from animal protein – a very common cause of deficiency

Strict vegetarians (vegans) – because the main source of B12 is meat, eggs, dairy products and other sources of animal protein

Those with celiac disease, Crohn’s disease, and those who had weight loss surgery

Individuals who are H. pylori positive (this is specialized testing usually done when someone develops an ulcer since the bacteria cause ulcers too) – the bacteria devour B12 in the gut

Some medications can interfere with B12 absorption – proton pump inhibitors, H-2 receptor blockers (both of these are used to prevent and treat ulcers and GERD), the type 2 diabetes drug metformin (Glucophage), some antibiotics and certain medication to prevent seizures

The best test for a vitamin B12 deficiency isn’t a B12 level. Either a total homocysteine or MMA level may be superior. These chemicals accumulate when there is insufficient B12, so elevated levels indicate a deficiency.

Crystalline vitamin B12 is a synthetic form of the vitamin. It is in the free form so it doesn’t require the usual high level of stomach acid for it to be made available for absorption. This makes it effective for prevention and treatment of a vitamin B12 deficiency.

 

References

  1. O’Leary, et al “Vitamin B12 status, dietary protein intake and proton pump inhibitors use in geriatric rehabilitation subjects.” Nutrition and Dietetics, 2011: 68, 109-114.

Mary Cadogan, “Functional Implications of Vitamin B12 Deficiency,” Journal of Gerontological Nursing, Vol. 36, no. 6, 2010.

Samantha Nash, “Vitamin B12 deficiency,” British Journal of Midwifery, Nov. 2016, Vol. 24, #11

Radon, is it really a serious threat to health?

Radon, is it really a serious threat to health?

Yes, radon is a serious health hazard. It is a radioactive substance that comes from uranium and thorium in the rocks and soil of the earth. It leaks from the ground and into the air at the soil-air junction such as in basements. Radon quickly breaks down and attaches to air and water particles, making it easy to inhale. These particles, radon progeny, stay in the lung, emitting radiation and causing damage that can lead to cancer (from “Radon Action Month:  Why Nurses Should care about Radon Exposure,” by P. Allen, et al, Tar Heel Nurse, Winter, 2015).

Because radon primarily gets into the body through inhalation, it isn’t surprising that lung cancer is the main disease it has been linked to and is the only one officially identified by the CDC (EPA, 2015). Because it is naturally occurring, odorless, and colorless, people rarely suspect its presence. An estimated 15% of lung cancer deaths are believed to be caused by it and it is the number one cause of lung cancer in non-smokers. It is the leading preventable cause of death and decreasing it in buildings could save more lives than efforts to eliminate home fires, fall prevention and drownings, not to take away from these important measures (from J. Worrell, et al, “Radon Exposure:  Using the Spectrum of Prevention Framework to Increase Health Care Provider Awareness,” in Clinical Journal of Oncology Nursing, Dec. 2016).

Kits to measure radon levels are available at home improvement stores but in some areas, kits are offered at reduced cost through the state’s radon detection program or health departments. The kits should be placed at the lowest level where people live. For a reading of 4.0 pCi/L or greater, a mitigation system can be installed to vent the radon to outdoor air, where it is quickly diluted and no threat. Radon should be measured every few years if the level is above two or if a mitigation system is installed (American Family Physician, Audio Digest for December, 2017).

Radon can be found all over the world. In the U.S., parts of the Midwest have high rates, as does Kentucky, and the northeast. Portions of the West near fault lines may have radon problems too. The only way to really know is to use a kit to measure it. There is great variability even from one house to the next due to difference in building materials, environment, etc. Also, the U.S. population is quite mobile so current exposure doesn’t indicate lifetime risk.

Smoking is still the number one risk for lung cancer in smokers and even thought radon is the main cause in non-smokers, it is important to understand that there is a ten to twenty-fold greater risk of lung cancer from radon for smokers compared to non-smokers (Worrell, et al, 2016). To put it another way, the EPA estimates that 86% of radon-induced lung cancer deaths are found among current and former smokers (from Editorial Letters in the American Journal of Public Health, Sept. 2013, Volume 103, #9.

Good Egg, Bad Egg

Good Egg, Bad Egg

Eggs are an amazing food, packed with many nutrients, usually inexpensive, and readily available. They are an exceptional source of several B vitamins, the micronutrients iron, iodine, and selenium, as well as potassium and phosphorus, and one of only several natural sources of vitamin D. Egg white (also called albumen) is the most excellent protein thus far identified. The choline in eggs is another strengths. This nutrient is important for nerve and artery health and is necessary for many metabolic processes. Developing fetuses in particular need it. Nine years ago, the Institute of Medicine added choline to their list of recommended nutrients.1 The American Medical Association recommended adding it to prenatal vitamins.2

Because eggs are nutrient-dense, those that are malnourished or at high risk of it stand to benefit the most from eggs. Some over age 65 are at high risk of sarcopenia, a decrease in muscle mass. This disorder increases the chances of a person falling and of developing osteoporosis, so increasing intake of protein, especially one that contains the easily digested protein such as that found in eggs, is a priority. Eggs are a good source of the vital amino acid leucine, adding to their value.3

In research done in Ecuador, babies ages six to nine months were fed one egg a day. This produced a drop in stunting by 47% and a 74% decrease in underweight. Older children that are malnourished can also benefit from eating eggs daily. But USDA data revealed that eggs made up only 1% of food expenses even though they are low cost. In the same survey, soft drinks comprised more than 9% of household food expenses. Access to fresh eggs and a lack of cooking facilities may contribute to that problem. 2

But not all the egg news is good news. Eggs were attacked for their high cholesterol level for many years. The high cholesterol content of eggs has not been found to increase significantly the blood cholesterol level (saturated fat, however, does). Still, some studies found that those with type 2 diabetes, especially men, who ate at least one egg a day were more likely to develop heart disease. Since 10% of Americans have type 2 diabetes and 30% have pre-diabetes, this isn’t a miscellaneous detail. Eating five or more eggs a week may also increase the risk of developing type 2 diabetes. Higher egg consumption could also increase the risk for aggressive prostate cancer. The authors of this article recommend that the well-nourished limit their egg consumption to four per week.4

     Labels  on egg cartons can be misleading. Cage-free is good for the hens but not necessarily for humans eating their eggs. Stating eggs are “hormone free” is also meaningless since all eggs are hormone-free. But the “USDA Organic” label is important. It indicates that the hens are fed an organic, vegetarian diet that is without antibiotics or pesticides.4 Eating raw eggs offers no advantages but does pose risks.Try to buy eggs produced locally as time and travel can lead to a decrease in some nutrients. Eggs high in omega-3 fatty acids are also a very good thing.5

 

References:

Reinhard, Tonia. Super Foods the Healthiest Foods on the Planet. Buffalo, New York:  Firefly Books, Inc., 2014.

Rains, Tia, PhD. “Eggs for the Nutritionally Vulnerable,” in Nutrition Close-up, Summer, 2017.

Smith, A. and Gray, J. “Considering the benefits of egg consumption for older people at risk of Sarcopenia,” in British Journal of Community Nursing, June, 2016, vol. 21, #6.

Liebman, Bonnie, “Unscrambling Eggs Health food or bad yolk,” in Nutrition Action Healthletter, June, 2015.

Guarneri, Mimi, M.D. The Science of Natural Healing. Chantilly, VA:  The Teaching Company, 2012.

Diseases, Drugs and Vitamin D deficiency

Vitamin D Deficiency, diseases and drugs

Vitamin D is needed by almost every tissue in the body, so the harm from deficiency isn’t surprising. The majority of research on vitamin D deficiency and depression found a correlation between the two, but a few studies didn’t. In one such study, “Low vitamin D status is associated with more depressive symptoms in Dutch older adults,” (E.M. Brouwer-Brolsma, et al, in European Journal of Nutrition, 2016, 55:1525-1534) supplementing those with depression with vitamin D for two years didn’t lead to any improvement. Is there some other benefit from sun exposure apart from vitamin D synthesis that improves mood?

Vitamin D is needed to absorb calcium. It also helps regulate this mineral in the body. So, it isn’t surprising that vitamin D deficiency is associated with weak even deformed bones in children. A lack of this vitamin can also lead to seizures and heart failure. In adults, vitamin D deficiency can lead to hypertension, coronary artery disease, and heart failure. In one study of patients with heart failure, 87% were found to be significantly deficient in vitamin D. Muscle weakness is common with a shortfall of the vitamin, so it isn’t surprising that falls and fractures are more common in those with a lack of it.

It has long been known that vitamin D is needed by many of the immune system cells and those that are deficient in t have a much higher risk of developing autoimmune disorders such as type 1 (juvenile) diabetes as well as multiple sclerosis. A country in northern Europe started giving infants vitamin D every day for their first year and after twenty years of this practice, the rates of type 1 diabetes fell by over 80%! Resent research shows a link between a lack of vitamin D and type 2 (adult onset) diabetes. The immune system is more able to fight infections if the blood level of vitamin D are normal.

Vitamin D appears to boost the body’s cancer-fighting ability. Those with metastatic colon cancer may have a longer life expectancy if they maintain adequate levels of it. This isn’t surprising given the way it supports immune system functioning.

Some medications have been found to be linked to vitamin D deficiency. This information comes from “Vitamin D deficiency as adverse drug reaction? A cross sectional study in Dutch geriatric outpatients.” (A.C.B. van Orten-Luiten, et al, in European Journal of Clinical Pharmacology, 2016, 72:605-614). The following are those uncovered thus far:

  • metformin for type 2 diabetes
  • loop diuretics such as furosemide and potassium-sparing diuretics like spironolactone
  • digoxin used for heart failure and atrial fibrillation
  • warfarin, a medication that decreases blood clot formation
  • ACE inhibitors such as lisinopril and
  • SSRI antidepressants such as sertraline.

See your health care provider if you are taking one of these medications and ask if a vitamin D supplement may be recommended. Those needed to avoid sun exposure may want to ask about this as well.