NEW GENERATION ANTIHISTAMINESThe term new “generation antihistamines” refers to the development of four new antihistamines that, in contrast to prior antihistamines, cause little or no drowsiness. The generic names for these new products are as follows:Astemizole CetirizineLoratadine TerfenadineThe new generation antihistamines do not cause drowsiness because they are made in such a way that they cannot accumulate in the brain. Thus, they can’t act on the histamine receptors in this area and can’t make you drowsy. In addition, these antihistamines have little if any effect on the gastrointestinal tract, so abdominal cramping, nausea, and reduced appetite are uncommon.
Characteristics of the New Generation AntihistaminesThese new generation antihistamines vary considerably in how long each takes to clear from the body. Here’s a closer look at each of these new antihistamines:
AstemizoleA member of the class V antihistamine group and metabolized by the liver, astemizole stands out as the member of the group that lasts the longest in the body: allergy skin tests can be inhibited as long as six weeks after stopping the medication. It should be stopped for four months before attempting to get pregnant. Astemizole’s rate of absorption is significantly slowed if it is taken with food. In fact, it should be taken at least 2 hours after a meal or at least 1 hour before the next meal for best results. Astemizole is available in the United States and Canada under the trade name of Hismanal. Warning: Astemizole (Hismanal) should not be taken with any erythromycin product, Biaxin (clarithromycin), Zithromax (azithromycin), TAO (troleandomycin), Nizoral (ketoconazole) or Sporanox (itraconazole). Because of the close similarity between antifungal medications, it should not be used with Diflucan (fluconazole), Flagyl (metronidazole), and intravenous Monistat (miconazole). It should not be taken in the presence of liver disease. The recommended dose of l0 mg daily must not be exceeded.
CetirizineA member of the class IV antihistamine group, cetirizine is unique among the new generation antihistamines in that it is not metabolized in the liver. In fact, it is eliminated slowly, and is unchanged in the urine. Because it is eliminated from the body through the kidney, in the presence of kidney disease (reduced kidney function), its dose should be reduced to prevent excessive accumulation in the body. Doctors usually prescribe it once daily. Unlike the other new generation antihistamines, Cetirizine can cause drowsiness. It is not available in the United States as of this writing, but it is being studied and may be available soon.
LoratadineA member of the class V antihistamine group and metabolized by the liver, loratadine too is eliminated relatively slowly from the body Doctors usually prescribe it once daily. Of the three available new generation antihistamines loratadine is not contraindicated in patients taking erythromycin products, ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), azithromycin (Zithromax), other antifungal agents, or in patients with liver disease. A study conducted in 12 healthy volunteers showed that when loratadine was taken with ketoconazole, that levels of loratadine increased. There were no significant differences in clinical adverse events between loratadine tablet groups with or without ketoconazole. However, Loratadine should be administered with caution in patients taking these medications or in the presence of liver disease. The most commonly reported side effects in clinical trials were: headache, occuring with 12% of people, drowsiness (8%), fatigue (4%), and dry mouth (3%); the same rates as in people taking placebo (sugar pill). Loratadine is available under the trade name Claritin.
TerfenadineA member of the class VII antihistamine group and metabolized by the liver, terfenadine is cleared rapidly enough from the body to require twice daily administration. Terfenadine is the most widely prescribed antihistamine worldwide and has been available in the United States for several years under the trade name of Seldane. Warning: Terfenadine (Seldane) should not be taken with any erythromycin product, Biaxin (clarithromycin) Zithromax (azithromycin), TAO (troleandomycin), Nizoral (ketoconazole) or Sporanox (itraconazole). Because of the close similarity between antifungal medications, it should not be used with Diflucan (fluconazole), Flagyl (metronidazole), and intravenous Monistat (miconazole). It should not be taken in the presence of liver disease. The recommended dose of 60 mg daily must not be exceeded.*45/322/5*

2. Allergy to a particular food item can be prevented. The following are some examples.

a.    Cow’s milk: A baby must be breast fed (and not fed a formula based on cow’s milk).

b.     Cereal grains: Cereals should be introduced into baby’s diet one at a time (and not in a mixed form) to see which ones the baby tolerates well.

ñ     Fresh juices (orange, etc.): These should be started at four months of age and one at a time.

d.     Egg: A tiny piece of hard-boiled yolk should be tried at the age of seven months, and, if this is tolerated well, it is to be followed by egg white.

e.     Shellfish, nuts, chocolate, and strawberries: These foods are not to be given to the allergic baby at all.

f.     Additives: Snacks in cellophane bags should not be used as part of a baby’s diet.

The food of an atopic baby who has diarrhea should be made very simple because sensitivity to food is more likely to develop if the bowels are inflamed.

Although a baby may outgrow his food allergies, it is not wise to wait for him to do so. Food allergy in a baby should be considered seriously and steps should be taken to avoid it. Otherwise, the allergy persists and opens the door to further food allergies in childhood.

3. At the age of three or four years, foods lose their importance as allergens, and inhalants (light substances which float in the air) become the chief cause of allergies. The following preventive measures against these have to be carried out in the bedroom of the allergic child:

a.     Filtering devices, air conditioners, and electronic precipitators have to be installed (for brand names see the Appendix).

b.     The bedding should be made of allergy-free material. The pillows should be made of sponge rubber and should not contain feathers.

    c.     The house must not have a damp or moldy basement.

d.     The temperature of the house and that of the bedroom should always be kept at about 70°F.

e.     Strong odors in general are to be avoided (in the whole house and especially in the bedroom). The odors of fresh paint, perfumes, scented flowers, mothballs, cleaning fluids, or cigarette smoke are especially dangerous.

f.     Pets should not be introduced into the bedroom and preferably the house (sensitivity to feathers and to animal hair is easily acquired).

4. Besides eliminating inhalants inside the bedroom, an allergic child should avoid them outdoors.

Although it would be impossible to entirely avoid outdoor allergens short of staying at home all the time, some suggestions help to considerably reduce the chances of exposure:

a.     Vacations should be planned around the child’s allergies, making sure not to leave certain allergens at home while running into others in the vacation area.

b.     While outdoors, the child should avoid bees and other stinging insects, grass being mowed (as this can churn up mold spores and grass pollen), ragweed shrubs (because pollen concentration rises sharply the nearer one gets to its source), the poison ivy plant, and outdoor pets (as these can be multiple allergy carriers).

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It has been suggested that diabetes might be due to food intolerance, but this seems very unlikely. It is possible, however, that immune reactions to food may aggravate any autoimmune disease – a disease in which the immune system attacks the body’s own cells. One such autoimmune disease is systemic lupus erythmatosus. Some patients with this disease fare much better if they are investigated with an elimination diet and treated for reactions to food and other environmental factors – which suggests that these sensitivities may make the underlying disease worse. In the same way, food sensitivity might make the autoimmune type of diabetes worse.

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