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RHINITIS MEDICAMENTOSAThis term defines nasal symptoms (rhinitis) caused by a medication you are taking (medicamentosa) to help some other medical problem (like high blood pressure). The most common symptom of rhinitis medicamentosa is nasal congestion, but runny nose, burning, bleeding, and a sensation of dryness in the nose may occur. There are two general types of rhinitis medicamentosa:
• Local Rhinitis Medicamentosa -”The Nose Drop Nose” – is caused by medications you are placing in your nose. Some examples include OTC nasal decongestant drops, sinus sprays, and cocaine. OTC nose drops or sprays used to unstop a congested nose are good news/bad news drugs. The good news is that they do unstop noses. The bad news is that if you use them for too long (more than about 5 to 7 days), they tend to “rebound.” This means that after opening the nose for a short time, they cause the lining of the nose to swell, thus stopping the nose up once again. Then, you use the spray to reopen your nose and it opens for a short time, but the swelling closes it again. At this point you are hooked on nose sprays or drops. All available OTC nasal decongestant sprays and drops will cause this rebound effect, so use them sparingly. It is likely that you are becoming hooked on nasal sprays if you cannot stop them after 5 to 7 days or find that your nasal congestion is worsening in spite of their use. If this happens, call your doctor. He or she can recommend medications which will stop this rebound effect.
• Systemic Rhinitis Medicamentosa – “The Iatrogenic Nose” – is caused by medications you are taking by mouth for other illnesses. Some examples include Accutane for acne and some blood pressure medications. The term iatrogenic refers to an unfavorable response to treatment caused by the treatment itself. The term systemic refers to the entire person, in contrast to a single part of a person, such as the nose. Systemic medications exert their effect throughout the body and have the potential of affecting any organ. Topical medications work only where they are placed (nose sprays work only in the nose). The term the iatrogenic nose refers to nasal symptoms that are caused by medications taken for medical conditions other than nasal problems.Systemic rhinitis medicamentosa results from a medication you are taking for some other problem. Like local rhinitis medicamentosa, its most common symptom is nasal congestion. The most common types of medications causing this are those for high blood pressure, such as those containing hydralazine, guanethidine, methyldopa, prazosin, and reserpine. These medications dilate blood vessels in the body, including the nose, and this causes nasal congestion. Other medications taken systemically can cause nasal symptoms. *30/322/5*

Some synthetic chemicals are excreted from our bodies unchanged – in urine, for example, or on our breath when we exhale. Some, such as DDT, are stored unchanged in the body’s fatty tissues. But the vast majority are acted on by enzymes, which change them chemically in biotransformation reactions. Ultimately, these reactions lead to the detoxification of the chemical.

In recent years, minor enzyme deficiencies have been found in some people, which do not normally make them ill unless they take a particular medicinal drug. Studies of such drugs in food-intolerant patients have shown that a large proportion of them suffer from these minor enzyme deficiencies. In one study, some of the patients also had chemical sensitivities, and when the results for these patients alone were considered, 90 per cent were found to be deficient in a particular enzyme system. Such a high percentage is unusual in medical research, and suggests strongly that there is a link between chemical sensitivity and enzyme deficiency. This result was for just one set of enzymes – and hundreds are involved in detoxification. Due to lack of resources, no further studies of this sort have been carried out as yet.

In another study certain artificial food colourings have been found to inhibit crucial detoxification enzymes. It is possible that enzyme inhibition by these artificial colours contributes to the problem in people whose enzymes are partially defective. This could account for the frequency with which food colourings have been identified as the source of adverse reactions.

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Asthmatics tend to breathe with the muscles of the shoulders and chest but not with the diaphragm, the muscle of the abdomen. This fills and empties only the top part of the lungs – it’s a type of breathing that’s shallow, inefficient and unhealthy. Deep, complete breathing is just the opposite. By learning to fill the lungs completely and to exhale fully with each breath, asthmatics can ward off wheezing, chest tightness and shortness of breath.

Deep-breathing exercises followed for five minutes every day can reduce the need for bronchodilators and other drugs. They can be practiced lying down, sitting or standing.

1. Think of the chest and abdomen as a container for air. As you (or your child) breathe in through the nose, slowly fill the bottom of the container first and keep filling until the stomach feels puffed up like an inflated balloon. To be sure you’re breathing correctly, place your hand on the area just above the belly button. Feel your middle rise and fall as you breathe.

2. Exhale calmly through the mouth, as slowly as possible. The ‘container’ must be completely empty and the stomach flat before you slowly inhale once again.

3. Repeat. Inhale and exhale twelve times.

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Sinus trouble is one of the most common complaints treated by allergists. The basic problem is swollen, inflamed mucous membranes in the sinuses – eight hollow cavities behind your nose, cheeks and forehead. The swelling blocks the sinus openings that lead to the nose. Trapped mucus then presses against the sinus walls, so that your entire upper face and forehead feel painful and tender. And your nose is stopped up. But if you blow your nose too hard, the pressure forces mucus in the sinuses even harder against the sinus walls, inflaming the area all the more.

In allergic people, sinusitis usually affects those with chronic hay fever. It can also be caused by an infection like the type that accompanies a cold.

The first thing to do for allergic sinusitis is drain the sinuses. Applying a warm flannel to the face thins mucus and coaxes secretions out of sinus cavities. (Run the flannel under hot water to warm it, but be careful that the flannel doesn’t get too hot, or you’ll burn your face.) You can also breathe warm mist from a kettle of boiling water. (Don’t get too close to the steam or you’ll scald yourself.) Or you can drink a mug or two of steaming herb tea. Herbalists say that fenugreek is good for breaking up mucus.

Using nasal decongestant sprays or drops is not a good idea. They help reduce the swelling temporarily, but your sinuses will flare up worse than ever when you discontinue the drug. Oral decongestants aren’t ideal, either – they tend to make you jumpy and irritable. Instead of drugs, try vitamin Ñ. It acts as a natural antihistamine, shrinking swollen sinuses and reducing the hay fever reaction.

For complete relief of allergy-induced sinusitis, use the methods outlined in this book to avoid whatever triggers your hay fever. Doing that will prevent not only sinus pain but also permanent damage to sinuses – and uncontrolled sinusitis can lead to post-nasal drip, in which excess mucus from sinuses drips down your throat. If you don’t take good care of your sinuses now, they’ll bother you nonstop later on.

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Naturally, it would be helpful if a test existed to identify the foods at fault in hyperactivity. But as we mentioned in earlier chapters, skin tests rarely detect food allergy accurately, and blood tests are very expensive. For those reasons, many pediatricians feel that elimination diets are still the best method.

Dr Doris J. Rapp, author of Allergies and the Hyperactive Child, has done some of the most extensive work on diet and hyperactivity. To find out if hyperactivity in a child is related to food, Dr Rapp recommends that parents put their child on ‘a simple diet composed solely of fruit, vegetables and regular meats (no sausage, luncheon meats and the like) for one week, and then restore the questionable foods one each day during the second week (i.e., milk, wheat, eggs, sugar, dyes, corn and chocolate) and note the effect of each food.

Incidentally, salicylate-containing foods may cause problems in children allergic to aspirin, a salicylate compound. But Dr Feingold told us that he had reconsidered the role of salicylates and thought that they weren’t nearly as much of a problem as additives.

To help identify those children who are most likely to respond to a change of diet, Dr Rapp gives this thumbnail sketch of the child who most often experiences food-related hyperactivity: ‘If they have dark eye circles, bright red ears and a glassy look when the Jekyll and Hyde behavior develops, the answer may be a food.

‘These children often have associated classical hay fever or asthma symptoms, headaches, abdominal complaints, leg aches and [other] behavior problems.

The symptoms are often triggered by the very foods they crave (sugar, peanut butter, orange juice, apple juice) or foods they detest’.

The nicest thing about dietary control of hyperactivity, say doctors who use it, is that it’s totally safe.

‘In medical school we learn, or common sense tells us, that if a treatment will not harm and may help the patient, then it should be available to the patient and used,’ says Dr Richard G. Wanderman, of Memphis, Tennessee in a letter written to a medical newspaper and supporting dietary therapy of hyperactivity. ‘Is there anyone who will say that a good, nutritious diet without added chemicals, overly processed foods and poorly prepared foods will harm a patient?’ (Family Practice News.)

An added bonus is that even normal but active children behave better on a controlled diet. In a study of 300 elementary school children, researchers found that after two weeks on the Feingold diet, even non-hyperactive children were less easily distracted, could concentrate on work or play, and were less fidgety and demanding of attention (Journal of Learning Disabilities).

The only real problem with a controlled diet is that some hyperactive children may begin to see themselves as sickly or somehow different from other children. Parents can minimize that problem by taking a positive attitude towards dietary changes and following these tips.

• Don’t give a hyperactive child the impression that you find preparing special dishes to be a burden or nuisance. Instead, make ‘safe’ foods that the whole family can enjoy.

• Include the child in meal planning so he or she feels that his or her personal preferences count. That way, the diet will seem more like a game than punishment or therapy.

• Keep the child off cola drinks, tea, chocolate and other caffeine-containing foods. The last thing an overactive child needs is more stimulation.

• Read labels like a hawk. Be sure to watch out for unsafe ingredients in products such as toothpaste and chewing gum -or anything that goes into your child’s mouth, for that matter.

• Routinely record your child’s behavior and diet, even if it is a simple matter of rating how good or bad the day’s behavior was on a scale of 1 to 10 (10 being excellent or uneventful, and 1 being the worst).

• In addition to eliminating the bad foods, increase the good. That will build up the child’s resistance to colds, sore throats and ear infections. Your child will be sick less often and have a better self-image.

• Don’t overreact to minor infractions. Kids can’t be expected to have any more willpower than adults when it comes to sticking to a diet 100 per cent. Accept the fact that, once in a while, Johnny or Susie will sneak a soda or whatever. To help minimize these opportunities, though, keep plenty of safe foods in the cupboard and refrigerator – with enough variety available so that your child has lots to choose from. And be sure to send your child off to school with a favorite ‘safe’ snack or two tucked in his or her lunch box.

• Be on the alert for all forms of sugar, including corn syrup, honey, brown sugar and molasses. Doctors say that sugar in any form seems to fuel hyperactivity, no matter what else the child is allergic to. A pediatrician in Denver told us that he recommends diluting fruit juices with 50 per cent water, to help reduce a child’s total sugar intake.

Set an example. Children are born mimics, and you’re going to have a hard time getting a youngster to avoid sugar and additives if you routinely swig soda and snack on junk food.

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Colitis – what a doctor would sedately call an ‘inflamed colon’ – is more like a fiery nightmare. Diarrhoea so constant the bathroom seems like a prison cell. Stools that are bloody and full of mucus. Abdominal cramps. Fever. Pale, sweaty skin. What’s worse, an attack can hit at any time, so that a colitis sufferer always has to have a bathroom nearby. Not exactly a fun way to plan your life.

The traditional view is that peace of mind will produce peace in the colon – stress and anxiety are considered major causes of an attack (some psychiatrists even claim they’re at the root of the problem). But trying to avoid stress is a never-ending and not always successful effort. There are temporary ceasefires, but the colon remains a battle zone.

Because the colon is the section of the intestine where food fibre absorbs water to create a stool, diet is another logical focus of treatment. The only problem is that nobody can agree which diet is right. ‘More fibre!’ cry some doctors. ‘Less fibre” recommend others. ‘A straight answer!’ pleads the colitis victim

Well, although fibre may not be the solution, it could be that the diet-therapy doctors are on the right track. As with many other gastrointestinal complaints, milk allergy is a common cause of colitis. Less frequently, colitis is caused by allergy to wheat corn, eggs, chocolate, meats or nuts. In a very few cases, water or antibiotic drugs are the cause.

‘As the first line of treatment [of colitis], all food or drug allergens are removed from the diet,’ says Dr James Ñ Breneman, chairman of the Food Allergy Committee of the American College of Allergists. Dr Breneman feels that allergy therapy should be given a fair chance in the treatment of colitis before drugs or surgery are used – as they often are. An allergy-free diet, in many cases, may be the only treatment necessary says Dr Breneman. In his words, ‘It’s better to remove the milk than to remove the colon.’

Sometimes colitis gets so bad that ulcers form in the intestine. Then, too, food allergy can be at fault.

‘I’ve found that in susceptible people allergic reaction to commonly eaten foods is the direct cause of ulcerative colitis ‘ says Barbara Solomon, a doctor in Baltimore, Maryland. Dr Solomon tests all her patients for food allergies. She finds that people with ulcerative colitis are always allergic to milk products and grains that contain gluten: wheat, oats, barley, rye and corn When her patients eliminate those foods (and sometimes other foods as well), the disease improves greatly. But not always.

‘Food allergy isn’t the only cause of ulcerative colitis,’ Dr Solomon told us. ‘Sometimes a patient doesn’t get well until I take him off tap water and have him drink only distilled water. Tap water is full of chemicals, and one of them could be causing the problem.’

Robert Rogers, a doctor in Melbourne, Florida, also treats ulcerative colitis as a food allergy. The first patient he cured of the disease was himself.

‘I developed ulcerative colitis early in my medical school career,’ he told us. ‘I had bleeding from the bowel, a lot of profuse diarrhoea and terrible cramps. It was very debilitating. I got books out and read about it and the professors told me about it.

‘But the only treatment was drugs. Drugs to slow down the feacal stream, drugs to take the cramps away, drugs to coat the bowel, drugs to tranquillize me. But while I was taking all these drugs, I was feeding the disease with the foods I was allergic to,’ says Dr Rogers. ‘Eventually I discovered on my own that all forms of dairy products and chocolate and caffeinated beverages were my enemy. If I don’t eat those foods, I don’t have ulcerative colitis.’

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Emergency kits of allergy drugs, sold through chemists, are prescribed to people who have at any time experienced life-threatening reactions or who have a history of very severe symptoms. If you fall into either of those categories, you should own an allergy kit or an automatic-injectable adrenalin kit. One kit should be carried in your handbag, briefcase or car, and another should be kept at home. If you begin to react and have any reason to feel you’re headed towards a severe, uncontrollable reaction, you should be prepared to take emergency action immediately.

Say you inadvertently eat nuts, to which you are extremely allergic, and you begin to feel very sick. The first order of business is to reverse all the alarming changes your body is going through. So every emergency kit contains a vial of adrenalin. That’s a synthetic form of epinephrine, the hormone that plays a key role in keeping all body systems running on an even keel. A single shot of adrenalin pushes blood pressure back to normal and reduces swelling (which keeps your airways open and helps you breathe). It’s the quickest and most effective way to neutralize a severe reaction. Adrenalin calls for medical directions; your doctor should teach you how to give yourself an injection and supervise a practice shot. The procedure is easy to learn, since adrenalin is simply injected into the fatty tissues under the skin, and not into a hard-to-pinpoint muscle, vein or artery.

The adrenalin in your emergency kit should be checked once a month to be sure the solution is not discolored or out-of-date, which would indicate a decrease in potency. The drug deteriorates in sunlight, so don’t store the kit on the dashboard of your car or in front of a window.

Adrenalin is also available in an aerosol form, which you can inhale to restore normal breathing. Although not a substitute for injected adrenalin, the aerosol may help to relieve laryngeal oedema or asthma more quickly. Test spray your aerosol adrenalin periodically to be sure that the valve opening is free of dust. If it’s clogged, clean it with soapy water.

Kits are also usually equipped with antihistamine tablets to further counteract the flood of antihistamine that is to blame for much of an allergic reaction. Find out exactly how much antihistamine you should take, to save valuable time in an emergency. If you’ve been prescribed asthma medication, be prepared to take that, too. As much as we advocate drug-free means for day-to-day control of allergies, you shouldn’t hesitate to use whatever first-aid measures are necessary in a life-threatening situation. The possible side effects of a single dose of these drugs are a minor concern compared with the certain consequences of not taking them.

Tourniquets are also included in many allergy first-aid kits. Applied near a sting, a tourniquet will slow the circulation and absorption of venom. The problem is that a tourniquet also stops the circulation of blood. While routine use of tourniquets is discouraged by most doctors, many allergists say that if a highly sensitive person is stung by an insect, a tourniquet is justified – if it’s applied immediately after the sting occurs and on an arm or a leg only. Even then, a tourniquet is merely a stopgap measure to block the spread of venom until a doctor can be reached.

If no tourniquet is available, you can make do with a strip of cloth, thick cord, belt, dog leash or other similar device. Tie the tourniquet two to four inches above the sting (towards the trunk of the body). Do not tie the tourniquet so tightly that circulation is cut off. You should be able to slip your fingers under the band. And be sure to loosen the tourniquet every five minutes.

If the sting was inflicted by an insect with a stinger, scrape the stinger out of the skin with your fingernail or a dull knife. Do not grasp or try to pull the stinger out – that would only squeeze more venom into the wound.

Place a cold pack or ice wrapped in cloth on the sting area to reduce total swelling.

After taking these first-aid steps, you should call an ambulance or have someone drive you to the nearest hospital casualty department. There you will be given further medication and oxygen, if necessary, to bring the reaction under complete control.

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