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Drug: The Double Edged Knife (Part 24)
By: Mohamed H. Dahir. Chairman, Pharmaceutical Association of Somaliland
Email: mayakharaj@hotmail.com
Allergy (Continued)
People who are allergic to bees often receive insect desensitization shots in hope of preventing a fatal accident. This is properly a good precaution, but it does not involve some risk. There is always the possibility that a skin test or allergy shot itself could provoke anaphylactic shock.
Let’s recapitulate. Allergy is still very much a medical mystery. Even though there have been great advances in the recent years, there are still more questions than answers. Skin testing and desensitization injects are of questionable value. Antihistamines are a particularly useful therapeutic approach, but it is necessary to shop around until you find the particular product which is most effective and least bothersome for you. People who are taking antihistamines should never drive an automobile or operate machinery because motor coordination and judgement may be impaired. A cortisone-like nasal spray may provide relatively safe and long-lasting relief if at all other measures prove insufficient. Finally allergy shots may be tried when all else fail.
Allergy to certain drugs like penicillin or insect sting can result in a life-threatening condition called anaphylactic shock.
ASTHMA
Bronchial asthma is awful. Doctors treat it but rarely cure it. Sometimes it goes away all by it self, but more often it doesn’t. Sometimes Asthma kills.
Asthma is a problem with its roots stuck in the allergy quagmire. That is not to say that anyone with asthma is going to be allergic, but more often than not, somewhere in an asthmatic patient’s family there is a history of allergic problems. Its management should be directed to a competent allergist at least for evaluation, if not for treatment. With early detection and careful management, it is possible to reduce symptoms and maintain a patient in excellent condition.
Diagnosis of this disease is a relatively easy procedure. Tightness in the chest, accompanied by difficulty or distress when breathing, is often a tip-off that something is wrong. Wheezing is generally the clincher, though allergists can make sure by using fancy equipment to measure lung capacity. There are many things which can kick off an asthmatic attack, including smoke, chemical fumes, aerosol sprays, exhaustion, sudden temperature changes, allergens, and probably most important, emotional stress. Asthma may strike at any time, but it is interesting to note that it often hits when the patient is at rest or relaxed, well after exposure to an allergic agent or precipitating event. This can complicate the allergist’s job, since he must determine the specific allergens which sensitize his patient.
Asthma appears to result from the constriction of small circular muscles which surround and control the diameter of the air passages within the lungs. The partial closing off of these small baths or tunnels creates difficulty in breathing, and the characteristic wheeze becomes audible. Anyone who hasn’t experienced the scary feeling of not being able to breathe freely cannot appreciate the terrible anxiety which can build up in the asthmatic patient. It is a sensation not terribly different from that of slow suffocation.
The symptomatic treatment of asthma is geared to relaxing the spastic contractions of these muscles, promoting expectoration of the mucus which rapidly forms, and decreasing the accumulation of fluid in the lungs. Perhaps the most famous and widely used drug in the counterattack against asthma is Ephedrine. It has been used for at least five thousand years and dates back to ancient China. For people with mild to moderate problems, Ephedrine is quite effective in relieving asthmatic symptoms. It is somewhat less successful for patients who have a chronic daily problem because when it is used continuously (more than three a day, every day) its effectiveness is reduced considerably. Since Ephedrine is available generically, it is very inexpensive. Unfortunately, physicians seem to prefer to prescribe it in the more expensive brand name preparations where it is accompanied by other drugs.
While the safety of Ephedrine has long been established, a few precautions should be observed, people with high blood pressure or heart disease should not be reluctant to use this medication since its direct stimulant effect upon the heart and blood vessels could be dangerous. People with an overactive thyroid gland (hyperthyroidism) must also be cautious. On occasion Ephedrine may make urination difficult, so elderly men with tendency towards prostate trouble should stay away from it too.
To be continued next week.
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