Sunday March 2, 2014
Primatene Mist CFC Inhaler was an over-the-counter (OTC) inhaler used for the treatment of immediate asthma symptoms, but was removed from the market in late 2011 because the harmful effects of its propellant on the environment. Since that time, the only available OTC asthma medications were Primatene in tablet form and Asthmanefrin in nebulized solution form. All prescription asthma inhalers were required to switch to a different propellant, called hydrofluoroalkane (HFA), which doesn't have harmful effects on the environment.
Primatene Mist HFA OTC was recently submitted for FDA approval, but subcommittees on OTC Products and Allergy/Pulmonary Drugs rejected this proposal. The reasons cited for the rejection included the lack of a dose counter, frequent clogging of the inhaler, and the fact that inhaled epinephrine is not routinely recommended for the treatment of acute asthma symptoms.
While physician groups are happy with the FDA's decision to reject the approval of Primatene Mist, this decision may make it harder for people with asthma to obtain OTC medications for the treatment of their symptoms. This may lead to more visits to urgent care centers and emergency rooms, as well as hospitalizations for asthma. On the other hand, given the better availability of healthcare as a result of Obamacare, asthmatics should be able to see a healthcare provider for the purpose of asthma treatment, which for most asthmatics includes the use of an asthma controller therapy -- none of which are currently available OTC without a prescription.
Tuesday February 25, 2014
Urticaria, the medical term for hives, is caused by the release of histamine into the skin by allergic cells such as mast cells. Chronic urticaria is often due to unknown causes or due to autoimmune disease. While antihistamines are the mainstay of treatment for chronic urticaria, many people find that there symptoms are not controlled with routine dosages of antihistamines. Xolair, an injectable medication for the treatment of asthma, targets IgE before it has the chance to bind to mast cells and cause the release of histamine into the skin. Xolair has been shown to reduce, and in some cases eliminate, symptoms in people with chronic hives. It will be interesting to see if Xolair is eventually approved for the treatment of chronic hives.
Wednesday February 19, 2014
There are a number of different kinds of unusual allergies, and I've highlighted quite a few in the past (allergic to money, exercise, sex, cold, work, etc). A particularly rare allergy is aquagenic urticaria, which is defined as an allergic reaction after direct skin exposure to water. Aquagenic urticaria is very rare, with only a few dozen reports over the past 50 years. Affected people will experience hives within a few minutes of exposure to water on the skin, regardless of the water temperature. Why this occurs isn't known, although some researchers think that water allows for a certain protein in the skin to be dissolved in the water, and that dissolved protein is then able to reach deeper layers in the skin where an allergic reaction will occur. The diagnosis of aqaugenic urticaria involves simply the placement of a drop of room temperature water onto the skin and observing for the formation of a hive within a few minutes. Treatment is similar to that of other forms of hives -- oral antihistamines may reduce or eliminate hives from forming with water formation. Other treatments have included smearing the skin with petroleum jelly prior to water exposure, which can prevent the allergic reaction as well.
A story of a woman in the United Kingdom with aquagenic urticaria who can't leave her home during a rainstorm raises questions: Why would she live in such a rainy place? Has she tried antihistamines to prevent the reaction? Why not move to drought-stricken California? Despite the article suggesting that people with aquagenic urticaria see a dermatologist, in my opinion allergists are far better equipped to treat this condition.
Tuesday February 18, 2014
The question of acupuncture helping allergies has been posed for years, and in the past the results were questionable. Acupuncture seems to help symptoms of allergies, but when compared to sham acupuncture (needles at sites without any meaning or significance), results were disappointing. Placebo effect is very strong, and therefore acupuncture treatment cannot be compared to no treatment -- rather acupuncture needs to be compared to sham acupuncture (placebo). A recent study compared the effects of acupuncture, sham acupuncture and no treatment in people with seasonal allergies. After a course of 12 acupuncture treatments over the course of 8 weeks, people receiving acupuncture treatments had less allergy symptoms compared to people receiving sham acupuncture or no acupuncture treatment. Unfortunately, the benefits didn't last beyond 8 weeks after the acupuncture treatment was stopped.
Therefore, there may be some limited, short-term benefit from acupuncture for the treatment of allergic rhinitis symptoms, but this benefit is short lived. It is not clear if continued acupuncture treatments would lead to ongoing benefit, and what the optimal course of treatment is for people with allergic rhinitis who choose acupuncture as a treatment for their symptoms.