What Should Health Care Professionals Do
Health care professionals should consider the risks and benefits of montelukast when deciding to prescribe or continue patients on the medicine. Counsel all patients receiving montelukast about mental health side effects, and advise them to stop the medicine and contact a health care professional immediately if they develop any symptoms included but not limited to those listed in the table above. Be aware that some patients have reported neuropsychiatric events after discontinuation of montelukast.
Only prescribe montelukast for allergic rhinitis in patients who have an inadequate response or intolerance to alternative therapies.
Natural And Alternative Treatments
If youre experiencing contact dermatitis but dont want to use prescription or OTC medications, there are some alternative treatments that may be effective. These include:
- Coconut oil, which has been shown to limit the growth of harmful skin bacteria, also has strong moisturizing properties when applied topically. Use cautiously though, as there have been cases of allergic reactions caused by coconut
- Vitamin E applied topically, which can provide relief from both itching and inflammation.
- Honey, applied topically, has antibacterial and antiseptic properties.
You should stop any alternative treatment immediately if you have a negative reaction.
Will I Have Allergic Asthma For My Entire Life
There isnt a cure for allergic asthma. However, you can control your symptoms and take care to control your environment avoiding an asthma attack. Your allergic asthma can be worse at certain times during the year. Talk to your healthcare provider about ways to manage your symptoms and the best medications to control your asthma. Allergic asthma is very common and you can live a normal life with this condition.
A note from Cleveland Clinic
Allergic asthma is a very common condition that many people experience throughout their lives. Though there isnt a cure for this type of asthma, it can be controlled. You can control you condition by learning about your triggers and taking steps to avoid a reaction. Talk to your healthcare provider about ways to manage your environment and avoid asthma attacks.
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What To Expect From Allergy Shots For Asthma
Before you get allergy shots for asthma, your doctor will want to do allergy testing. This is a way of finding out which allergens affect you. It will probably involve skin testing, in which a small amount of the allergen is scraped onto or injected under your skin. Allergy shots aren’t available for every kind of allergy.
Allergy shots for asthma include shots for:
Once you and your doctor have discovered which allergens affect you, the next step is to get the shots. The frequency of the injections varies, but you might get them once or twice a week for the first three to six months — or until you reach the maximum dose. After that, you might only need maintenance injections every two to four weeks. This might continue for three to five years. Although some people feel asthma symptom relief from their allergy injections quickly, it may take up to a year for others. In some people, allergy shots have no effect.
Additional Information For Patients And Parents/caregivers
- FDA is requiring a Boxed Warning stating that serious mental health side effects that may include suicidal thoughts or actions have been reported in patients taking the asthma and allergy medicine montelukast .
- Most reported cases occurred during montelukast treatment, but some occurred after stopping the medicine. In many cases, symptoms resolved after stopping montelukast however, in some cases symptoms continued after stopping.
- Serious mental health side effects have occurred in patients with and without a history of mental illness.
- Talk with your health care professional about the benefits and risks of montelukast, as many other safe and effective allergy medicines are widely available, including over-the-counter ones, without a prescription. These include antihistamines such as loratadine , fexofenadine , cetirizine , levocetirizine , and diphenhydramine , as well as steroid nasal sprays such as fluticasone , triamcinolone , and budesonide . Alternatively, allergen immunotherapy, also known as allergy shots, has been shown to decrease symptoms of allergic rhinitis. A pharmacist or other health care professional can help you decide which might be best.
- Stop taking montelukast and notify a health care professional right away if you or your child experience behavior or mood-related changes while taking the medicine. These may include:
- agitation, including aggressive behavior or hostility
- attention problems
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Products Contraindicated With Asthma
Asthma was once a labeled contraindication for allnonprescription products containing first-generation antihistamines. Therationale behind this labeled contraindication was discussed by an OTCreview panel appointed to examine antihistamines in its original 1976report: The Panel is aware that a controversy exists concerning the useof antihistamines in patients with bronchial asthma where a dryingaction is undesirable. Many physicians consider this effect to bedisadvantageous in patients with bronchial asthma and some maintain thatthe antihistaminic drugs are contraindicated in patients with thisdisease.2 Products carried this label for years. In 1985,the FDA published a tentative final monograph for antihistamines,agreeing with the need for this label.3
In 1992, however, the FDA published its final rule on labeling for nonprescription first-generation antihistamines.4In this document, the agency described the conclusions of a 1990meeting of the FDAs Pulmonary-Allergy Drugs Advisory Committee.Participants believed that first-generation antihistamines did not havesufficient anticholinergic effects to be problematic for those withasthma, removing the term asthma from the warnings. Second-generationantihistamines have never beenrequired to carry an asthma warning.
What Form Does This Medication Come In
CapletsEach pink, film-coated caplet imprinted âBenadrylâ on both sides contains 25 mg of diphenhydramine. Nonmedicinal ingredients: celluloses, dicalcium phosphate, D& C Red No. 27, PEG, polysorbate, starch, stearic acid, titanium dioxide, wax, and zinc stearate.
LiquigelsThis medication is available as a 25 mg capsule.
Childrenâs Chewable TabletsThis medication is available as a 12.5 mg chewable tablet.
Extra Strength capletThis medication is available as a 50 mg caplet.
Extra Strength CapsuleThis medication is available as a 50 mg capsule.
Childrenâs liquid Each 5 mL of colourless, bubble gum-flavoured liquid contains 6.25 mg of diphenhydramine. Nonmedicinal ingredients: artificial bubble gum flavour, carboxymethylcellulose, citric acid, glycerin, saccharin, sodium benzoate, sodium citrate, sorbitol, vanilla flavour, and water.
Topical cream Each gram of white-emulsion for topical use contains diphenhydramine 2% w/w. Nonmedicinal ingredients: cetyl alcohol, paraben, PEG, propylene glycol, and water.
ElixirEach 5 mL of red elixir contains 12.5 mg of diphenhydramine. Nonmedicinal ingredients: alcohol, FD& C Red No. 2, flavouring agents, sugar, and water.
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What Are Cetirizine And Loratadine
Cetirizine is a non-sedating . It is similar to other second-generation antihistamines including loratadine , and . Histamine is a chemical responsible for many of the signs and symptoms of allergic reactions such as swelling of the lining of the nose, sneezing, and eyes. Certirizine blocks one type of receptor for histamine and prevents activation of H1 receptor-containing cells by histamine. Unlike first generation antihistamines, cetirizine and other second-generation antihistamines do not readily enter the brain from the blood so they cause less drowsiness though cetirizine may cause more drowsiness than other second-generation antihistamines.
Loratadine is a long-acting, non-sedating antihistamine used to treat . Loratadine blocks one type of histamine receptor and thus prevents activation of cells with H1 receptors by histamine. Unlike some antihistamines, loratadine does not enter the brain from the blood and does not cause drowsiness when taken at recommended doses.
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What Are The Symptoms Of Allergic Rhinitis
Most people with allergic rhinitis have a blocked or runny nose. Some also have sneezing and itching in the nose and back of throat. Allergic rhinitis can also make the eyes itchy, red and teary. Not everyone with allergic rhinitis has all these symptoms.
People with asthma may not recognise that they also have allergic rhinitis, because the symptoms can be mistaken for asthma. For this reason, Australian and international guidelines for doctors recommend that people with asthma should be checked for allergic rhinitis.
Allergic rhinitis can occur all year round, or just at certain times of year.
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Respiratory Problems And Nonprescription Products
W. Steven Pray, PhD, DPhBernhardt Professor, Nonprescription Products and DevicesCollege of Pharmacy
Gabriel E. Pray, PharmD CandidateCollege of PharmacyWeatherford, Oklahoma
Pharmacists render dozens of judgments each week incommunity pharmacies when patients request assistance with treatment ofminor health problems with nonprescription products. Virtually allnonprescription products have contraindications, and a variety of theserefer to patients with respiratory problems such as asthma, wheezing,emphysema, or chronic bronchitis.1 When the pharmacist isaware that a particular patient has been diagnosed with a respiratoryproblem, it can be vital to advise against use of contraindicatedproducts, unless a physician has suggested that the patient use them.
Your Guide To Understanding Eczema
Eczema is a common itchy, inflamed skin condition that affects 11 percent of all children and 5 percent of adults in the U.S.
If you have eczema, its likely that someone else in your family does too. Its seen most often in people with allergic conditions. In fact, about 70 percent of people with ongoing eczema have a history of allergies such asthma, seasonal allergies or hay fever or other allergies. Eczema starts early in life 85 percent of people with eczema had it start before the age of 5 and 60 percent have it as infants before the age of one. While there is no cure for eczema, with proper skin care and topical ointments if needed, it can be managed well.
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How Do Doctors Determine If A Person Has Allergic Asthma
The most definitive sign of allergic asthma that can help a doctor diagnose the condition is if a person experiences asthmatic symptoms after exposure to an allergen.
If factors other than allergens, such as exercise or respiratory infections, trigger a persons symptoms, they may have a different type of asthma.
A person with allergic asthma should prioritize avoiding any known triggers to help control the condition. This may include:
- avoiding pets whose dander causes allergic reactions
- keeping dust to a minimum by regularly dusting their home with damp rags and washing clothes and other soft items regularly
- using allergen-proof bed coverings on mattresses and pillows to help keep dust mites off bedding
- vacuuming the home regularly to rid it of dust mites and cockroaches
- treating any sources of mold
- washing bedding regularly at a high water temperature to remove mites and other substances that may cause an allergic reaction
Asthma can be a long-term condition, although people may control and, in some cases, reverse asthma symptoms with treatment. In some people with long-term asthma, airways may narrow permanently and cause persistent problems breathing comfortably.
A person may need additional treatment for any conditions they have alongside allergic asthma, such as:
Wheezing Warnings On Nonprescription Products
Wheezing is defined as a high-pitched whistling sound thatis audible when the patient inhales and exhales, caused by air flowingthrough constricted airways.11 Wheezing is common withasthma, so much so that when the FDA requires labels to warn against usein asthma, the word wheezing must follow in parentheses.12
Despite the FDA requirement that asthma and wheezing beintertwined on some OTC product labels , wheezing is acomponent of many other medical problems. They include accidentalaspiration of a foreign object into the lungs, bronchiectasis,bronchiolitis, bronchitis, emphysema or chronic obstructive pulmonarydisease ,gastroesophageal reflux, heart failure/cardiac asthma, an allergicreaction to an insect sting, reactions to medications ,pneumonia, smoking, or a viral infection, especially when the patient isan infant younger than 2 years of age.11 Since the communitypharmacist is not trained to perform the examination required toestablish a diagnosis, patients with wheezing must be referred.
As mentioned above, salicylates and other nonprescriptionnonsteroidal anti-inflammatory drugs contain a warning againstuse with wheezing, in the context of the constellation of symptoms thatindicate an allergic reaction to the medications. Cromolyn also carries alabel warning against use in wheezing.5 Cromolyn would be ineffective treatment for any one of the multiple causes of wheezing as listed above.
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Other Things You Can Do
Saline rinses: Your doctor may recommend that you use a salt water solution daily to help clear your nose and soothe the lining of the nose. Syringes and rinse bottles are available from pharmacies.
Avoid smoke: People with allergic rhinitis should not smoke and should avoid other peoples cigarette smoke. Smoking makes asthma and rhinitis worse, and can prevent medicines from working properly. Bushfires and wood smoke may also worsen allergic rhinitis and asthma.
Avoid allergens: Your doctor can help you work out which allergens trigger your allergic rhinitis and asthma. Try to avoid your allergy triggers if you can. See Avoiding allergens for tips.
If medication does not clear a badly blocked nose, doctors may occasionally recommend a surgical operation called turbinate reduction. Surgery is not a cure for rhinitis, but may help with symptoms in severe cases.
Before taking any medication for allergic rhinitis, you should tell your doctor or pharmacist if:
- you have any other medical conditions or are pregnant
- you are taking any other medicines
- you have been experiencing nose bleeds.
Question: How Do I Choose An Over
Dr. James: For many years, people used diphenhydramine as an antihistamine for their allergies. But for many reasons, this medicine is not a good choice to take for allergy symptoms because of its short-term action to manage symptoms and several known negative side effects. The major side effects of diphenhydramine include drowsiness, sedation, and fatigue. It can also impair alertness, concentration, multitasking, and memory. In turn, this antihistamine can affect important functions, such as learning and test performance in children, as well as operation of machinery and cars in adults.
Diphenhydramine and related short-acting antihistamines should be avoided.
Fortunately, there are many newer over-the-counter antihistamines available that work much better, are longer acting, and are safer than diphenhydramine. These newer antihistamines are less likely to have major clinical side effects compared to older antihistamines like diphenhydramine. Also, these newer medicines do not carry the risk of toxicity and death that has been associated with older antihistamines. Finally, regarding the use of antihistamines in pregnancy, cetirizine and loratadine are the medicines of choice.
Important note: If you are experiencing symptoms of a severe allergic reaction known as anaphylaxis, the recommended treatment is epinephrine .
What Are My Treatment Options For Allergic Asthma
Allergic asthma is a long-term condition, but also involves episodes, or attacks, when youll need quick relief.
Your doctor may recommend both ongoing and short-term treatments to reduce symptoms. Theyll typically start by determining the severity of your symptoms before recommending specific treatments.
Oral Or Iv Corticosteroids
When inhaled agents are not sufficient for asthma control, a course of oral corticosteroids might be given short-term during asthma exacerbations or given intravenously during severe acute attacks.
Common side effects can include enhanced energy, difficulty sleeping, anxiety, increased appetite, altered blood sugar levels, and weight gain.
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Safe Dose Of Benadryl For Dogs
If you decide that Benadryl is the right option for your dog, it is essential to stick to the correct dosage. Giving your dog too much can result in an overdose.
The amount of Benadryl largely depends on your dogs weight. Generally, it is recommended to give your dog 2-4 mg of Childrens Liquid Benadryl for every kilogram of body weight. Thats approximately 1 mg per 1 pound of bodyweight.
You should always start with the lowest dose and work your way up as needed. Benadryl takes about 30 minutes to work.
It is always a good idea to work with your vet when administering a new medication to your dog. Your dogs current drugs, health conditions, and age can affect their Benadryl dosage.
Oral And Topical Antibiotics
In some cases, worsening atopic dermatitis can be a result of a skin infection or colonization with a common bacterium, Staphylococcus aureus, and a course of antibiotics against this type of bacteria is required. Itâs usually safe to continue the use of topical steroids even if the eczema is infected.
Topical antibiotics are typically enough for localized infections of eczema while oral antibiotics may be needed for infections involving larger areas of skin.
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Food Allergies And Eczema
Children with eczema are also more likely to have food allergies. They often make eczema symptoms worse for kids but not for adults. If you have eczema, eating â or just touching â certain foods can make your skin flare up. Food allergies linked to eczema may include:
- Cowâs milk and other dairy products
How can you tell which foods cause flare-ups? Sometimes, the best way is to look for skin symptoms after you eat that food. Your doctor can also give you a test called a food challenge. You eat the food that you think may cause the symptoms, and your doctor watches for a reaction.
What About Medicines For Blood Pressure
Beta-blockers, used to control blood pressure and heart disease, can make asthma worse. This group of drugs includes propranolol, atenolol, and metoprolol. If you have started taking a beta-blocker and your asthma gets worse, tell your doctor.
ACE inhibitors are another type of medicine given to treat blood pressure, heart disease and, sometimes, diabetes. Drugs such as captopril, enalapril, and lisinopril are included in this group. These medicines appear to be safe for people who have asthma. However, some people develop a cough when taking ACE inhibitors. If you start coughing while youre taking an ACE inhibitor, remember that the cough might not be caused by your asthma. If the cough is caused by the ACE inhibitor, it will usually go away a week or so after you stop taking the medicine. If you develop other problems that make your asthma worse, call your doctor to see if you should stop taking your ACE inhibitor.
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