Can I take antihistamines everyday? More than the recommended dose? What if I’m pregnant? Here’s what the research says
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Allergies happen when your immune system overreacts to a normally harmless substance like dust or pollen. Hay fever, hives and anaphylaxis are all types of allergic reactions.
Many of those affected reach quickly for antihistamines to treat mild to moderate allergies (though adrenaline, not antihistamines, should always be used to treat anaphylaxis).
If you’re using oral antihistamines very often, you might have wondered if it’s OK to keep relying on antihistamines to control symptoms of allergies. The good news is there’s no research evidence to suggest regular, long-term use of modern antihistamines is a problem.
But while they’re good at targeting the early symptoms of a mild to moderate allergic reaction (sneezing, for example), oral antihistamines aren’t as effective as steroid nose sprays for managing hay fever. This is because nasal steroid sprays target the underlying inflammation of hay fever, not just the symptoms.
Here are the top six antihistamines myths – busted.
Myth 1. Oral antihistamines are the best way to control hay fever symptoms
Wrong. In fact, the recommended first line medical treatment for most patients with moderate to severe hay fever is intranasal steroids. This might include steroid nose sprays (ask your doctor or pharmacist if you’d like to know more).
Studies have shown intranasal steroids relieve hay fever symptoms better than antihistamine tablets or syrups.
To be effective, nasal steroids need to be used regularly, and importantly, with the correct technique.
In Australia, you can buy intranasal steroids without a doctor’s script at your pharmacy. They work well to relieve a blocked nose and itchy, watery eyes, as well as improve chronic nasal blockage (however, antihistamine tablets or syrups do not improve chronic nasal blockage).
Some newer nose sprays contain both steroids and antihistamines. These can provide more rapid and comprehensive relief from hay fever symptoms than just oral antihistamines or intranasal steroids alone. But patients need to keep using them regularly for between two and four weeks to yield the maximum effect.
For people with seasonal allergic rhinitis (hayfever), it may be best to start using intranasal steroids a few weeks before the pollen season in your regions hits. Taking an antihistamine tablet as well can help.
Antihistamine eye drops work better than oral antihistamines to relieve acutely itchy eyes (allergic conjunctivitis).
Myth 2. My body will ‘get used to’ antihistamines
Some believe this myth so strongly they may switch antihistamines. But there’s no scientific reason to swap antihistamines if the one you’re using is working for you. Studies show antihistamines continue to work even after six months of sustained use.
Myth 3. Long-term antihistamine use is dangerous
There are two main types of antihistamines – first-generation and second-generation.
First-generation antihistamines, such as chlorphenamine or promethazine, are short-acting. Side effects include drowsiness, dry mouth and blurred vision. You shouldn’t drive or operate machinery if you are taking them, or mix them with alcohol or other medications.
Most doctors no longer recommend first-generation antihistamines. The risks outweigh the benefits.
The newer second-generation antihistamines, such as cetirizine, fexofenadine, or loratadine, have been extensively studied in clinical trials. They are generally non-sedating and have very few side effects. Interactions with other medications appear to be uncommon and they don’t interact badly with alcohol. They are longer acting, so can be taken once a day.
Although rare, some side effects (such as photosensitivity or stomach upset) can happen. At higher doses, cetirizine can make some people feel drowsy. However, research conducted over a period of six months showed taking second-generation antihistamines is safe and effective. Talk to your doctor or pharmacist if you’re concerned.
Myth 4. Antihistamines aren’t safe for children or pregnant people
As long as it’s the second-generation antihistamine, it’s fine. You can buy child versions of second-generation antihistamines as syrups for kids under 12.
Though still used, some studies have shown certain first-generation antihistamines can impair childrens’ ability to learn and retain information.
Studies on second-generation antihistamines for children have found them to be safer and better than the first-generation drugs. They may even improve academic performance (perhaps by allowing kids who would otherwise be distracted by their allergy symptoms to focus). There’s no good evidence they stop working in children, even after long-term use.
For all these reasons, doctors say it’s better for children to use second-generation than first-generation antihistimines.
What about using antihistimines while you’re pregnant? One meta analysis of combined study data including over 200,000 women found no increase in fetal abnormalities.
Many doctors recommend the second-generation antihistamines loratadine or cetirizine for pregnant people. They have not been associated with any adverse pregnancy outcomes. Both can be used during breastfeeding, too.
Myth 5. It is unsafe to use higher than the recommended dose of antihistamines
Higher than standard doses of antihistamines can be safely used over extended periods of time for adults, if required.
But speak to your doctor first. These higher doses are generally recommended for a skin condition called chronic urticaria (a kind of chronic hives).
Myth 6. You can use antihistamines instead of adrenaline for anaphylaxis
No. Adrenaline (delivered via an epipen, for example) is always the first choice. Antihistamines don’t work fast enough, nor address all the problems caused by anaphylaxis.
Antihistamines may be used later on to calm any hives and itching, once the very serious and acute phase of anaphylaxis has been resolved.
In general, oral antihistamines are not the best treatment to control hay fever – you’re better off with steroid nose sprays. That said, second-generation oral antihistamines can be used to treat mild to moderate allergy symptoms safely on a regular basis over the long term.
Janet Davies, Respiratory Allergy Stream Co-chair, National Allergy Centre of Excellence; Professor and Head, Allergy Research Group, Queensland University of Technology; Connie Katelaris, Professor of Immunology and Allergy, Western Sydney University, and Joy Lee, Respiratory Allergy Stream member, National Allergy Centre of Excellence; Associate Professor, School of Public Health and Preventive Medicine, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hearing voices is common and can be distressing. Virtual reality might help us meet and ‘treat’ them
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Have you ever heard something that others cannot – such as your name being called? Hearing voices or other noises that aren’t there is very common. About 10% of people report experiencing auditory hallucinations at some point in their life.
The experience of hearing voices can be very different from person to person, and can change over time. They might be the voice of someone familiar or unknown. There might be many voices, or just one or two. They can be loud or quiet like a whisper.
For some people these experiences are positive. They might represent a spiritual or supernatural experience they welcome or a comforting presence. But for others these experiences are distressing. Voices can be intrusive, negative, critical or threatening. Difficult voices can make a person feel worried, frightened, embarrassed or frustrated. They can also make it hard to concentrate, be around other people and get in the way of day-to-day activities.
Although not everyone who hears voices has a mental health problem, these experiences are much more common in people who do. They have been considered a hallmark symptom of schizophrenia, which affects about 24 million people worldwide.
However, such experiences are also common in other mental health problems, particularly in mood- and trauma-related disorders (such as bipolar disorder or depression and post-traumatic stress disorder) where as many as half of people may experience them.
Rawpixel/Shutterstock Why do people hear voices?
It is unclear exactly why people hear voices but exposure to prolonged stress, trauma or depression can increase the chances.
Some research suggests people who hear voices might have brains that are “wired” differently, particularly between the hearing and speaking parts of the brain. This may mean parts of our inner speech can be experienced as external voices. So, having the thought “you are useless” when something goes wrong might be experienced as an external person speaking the words.
Other research suggests it may relate to how our brains use past experiences as a template to make sense of and make predictions about the world. Sometimes those templates can be so strong they lead to errors in how we experience what is going on around us, including hearing things our brain is “expecting” rather than what is really happening.
What is clear is that when people tell us they are hearing voices, they really are! Their brain perceives voice experiences as if someone were talking in the room. We could think of this “mistake” as working a bit like being susceptible to common optical tricks or visual illusions.
There may be differences in the brains of people who hear voices. Triff/Shutterstock Coping with hearing voices
When hearing voices is getting in the way of life, treatment guidelines recommend the use of medications. But roughly a third of people will experience ongoing distress. As such, treatment guidelines also recommend the use of psychological therapies such as cognitive behavioural therapy.
The next generation of psychological therapies are beginning to use digital technologies and virtual reality offers a promising new medium.
Avatar therapy allows a person to create a virtual representation of the voice or voices, which looks and sounds like what they are experiencing. This can help people regain power in the “relationship” as they interact with the voice character, supported by a therapist.
Jason’s experience
Aged 53, Jason (not his real name) had struggled with persistent voices since his early 20s. Antipsychotic medication had helped him to some extent over the years, but he was still living with distressing voices. Jason tried out avatar therapy as part of a research trial.
He was initially unable to stand up to the voices, but he slowly gained confidence and tested out different ways of responding to the avatar and voices with his therapist’s support.
Jason became more able to set boundaries, such as not listening to them for periods throughout the day. He also felt more able to challenge what they said and make his own choices.
Over a couple of months, Jason started to experience some breaks from the voices each day and his relationship with them started to change. They were no longer like bullies, but more like critical friends pointing out things he could consider or be aware of.
A screenshot from HekaVR, the software used in the Australian AMETHYST trial. HekaVR, CC BY-ND Gaining recognition
Following promising results overseas and its recommendation by the United Kingdom’s National Institute for Health and Care Excellence, our team has begun adapting the therapy for an Australian context.
We are trialling delivering avatar therapy from our specialist voices clinic via telehealth. We are also testing whether avatar therapy is more effective than the current standard therapy for hearing voices, based on cognitive behavioural therapy.
As only a minority of people with psychosis receive specialist psychological therapy for hearing voices, we hope our trial will support scaling up these new treatments to be available more routinely across the country.
We would like to acknowledge the advice and input of Dr Nadine Keen (consultant clinical psychologist at South London and Maudsley NHS Foundation Trust, UK) on this article.
Leila Jameel, Trial Co-ordinator and Research Therapist, Swinburne University of Technology; Imogen Bell, Senior Research Fellow and Psychologist, The University of Melbourne; Neil Thomas, Professor of Clinical Psychology, Swinburne University of Technology, and Rachel Brand, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Shrimp vs Caviar – Which is Healthier?
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Our Verdict
When comparing shrimp to caviar, we picked the caviar.
Why?
Both of these seafoods share a common history (also shared with lobster, by the way) of “nutrient-dense peasant-food that got gentrified and now it’s more expensive despite being easier to source”. But, cost and social quirks aside, what are their strengths and weaknesses?
In terms of macros, both are high in protein, but caviar is much higher in fat. You may be wondering: are the fats healthy? And the answer is that it’s a fairly even mix between monounsaturated (healthy), polyunsaturated (healthy), and saturated (unhealthy). The fact that caviar is generally enjoyed in very small portions is its saving grace here, but quantity for quantity, shrimp is the natural winner on macros.
…unless we take into account the omega-3 and omega-6 balance, in which case, it’s worthy of note that caviar has more omega-3 (which most people could do with consuming more of) while shrimp has more omega-6 (which most people could do with consuming less of).
When it comes to vitamins, caviar has more of vitamins A, B1, B2, B5, B6, B9, B12, D, K, and choline; nor are the margins small in most cases, being multiples (or sometimes, tens of multiples) higher. Shrimp, meanwhile, boasts only more vitamin B3.
In the category of minerals, caviar leads with more calcium, iron, magnesium, manganese, phosphorus, potassium, and selenium, while shrimp has more copper and zinc.
All in all, while shrimp has its benefits for being lower in fat (and thus also, for those whom that may interest, lower in calories), caviar wins the day by virtue of its overwhelming nutritional density.
Want to learn more?
You might like to read:
What Omega-3 Fatty Acids Really Do For Us
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How To Lower Your Blood Pressure (Cardiologists Explain)
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Today we enjoy the benefit of input from Dr. Zalzal, Dr. Weeing, and Dr. Hefferman!
If the thought of being in an operating room with three cardiologists in scrubs doesn’t raise your blood pressure too much, the doctors in question have a lot to offer for bringing those numbers down and keeping them down! They recommend…
150 mins of Exercise
This isn’t exactly controversial, but: move your body!
See also: Exercise Less; Move More
Reduce salt
Most people eating the Standard American Diet (SAD) are getting far too much—mostly because it’s in so many processed foods already.
See also: How Too Much Salt May Lead To Organ Failure
Eating habits
There’s a lot more to eating healthily for the heart than just reducing salt, and over all, the Mediterranean diet comes out scoring highest:
- What Is The Mediterranean Diet Anyway? ← a primer for the uncertain
- Four Ways To Upgrade The Mediterranean ← includes a heart-specialized version!
Reduce alcohol
According to the WHO, the only healthy amount of alcohol is zero. According to these cardiologists: at the very least cut down. However much or little you’re drinking right now, less is better.
See also: How To Reduce Or Quit Alcohol
Maintain healthy weight
While the doctors agree that BMI isn’t a great method of measuring metabolic health, it is clear that carrying excessive weight isn’t good for the heart.
See also: Lose Weight (Healthily!)
No smoking
This one’s pretty straight forward: just don’t.
See also: Addiction Myths That Are Hard To Quit
Reduce stress
Chronic stress has a big impact on chronic health in general and that includes its effect on blood pressure. So, improving one improves the other.
See also: Lower Your Cortisol! (Here’s Why & How)
Good sleep
Quality matters as much as quantity, and that goes for its effect on your blood pressure too, so take the time to invest in your good health!
See also: The 6 Dimensions Of Sleep (And Why They Matter)
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Hold Me Tight – by Dr. Sue Johnson
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A lot of relationship books are quite wishy-washy. This one isn’t.
This one is evidenced-based (and heavily referenced!), and yet at the same time as being deeply rooted in science, it doesn’t lose the human touch.
Dr. Johnson has spent her career as a clinical psychologist and researcher; she’s the primary developer of Emotionally Focused Therapy (EFT), which has demonstrated its effectiveness in over 35 years of peer-reviewed clinical research. In other words, it works.
EFT—and thus also this book—finds roots in Attachment Theory. As such, topics this book covers include:
- Recognizing and recovering from attachment injury
- How fights in a relationship come up, and how they can be avoided
- How lot of times relationships end, it’s not because of fights, but a loss of emotional connection
- Building a lifetime of love instead, falling in love again each day
This book lays the groundwork for ensuring a strong, secure, ongoing emotional bond, of the kind that makes/keeps a relationship joyful and fulfilling.
Dr. Johnson has been recognized in her field with a Lifetime Achievement Award, and the Order of Canada.
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Fitness Freedom for Seniors – by Jackie Jacobs
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Exercise books often assume that either we are training for the Olympics, and most likely also that we are 20 years old. This one doesn’t.
Instead, we see a well-researched, well-organized, clearly-illustrated fitness plan with age in mind. Author Jackie Jacobs offers tips and advice for all levels, and a progressive week-by-week plan of 15-minute sessions. This way, we’re neither overdoing it nor slacking off; it’s a perfect balance.
The exercises are aimed at “all areas”, that is to say, improving cardiovascular fitness, balance, flexibility, and strength. It also gives some supplementary advice with regard to diet and suchlike, but the workouts are the real meat of the book.
Bottom line: if you’d like a robust, science-based exercise regime that’s tailored to seniors, this is the book for you.
Click here to check out Fitness Freedom for Seniors, and get yours!
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Avocado, Coconut & Lime Crumble Pots
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This one’s a refreshing snack or dessert, whose ingredients come together to make a very good essential fatty acid supplement. Coconut is a good source of MCTs, avocados are rich in omega 3, 6, and 9, while chia seeds are a great ALA omega 3 food, topping up the healthy balance.
You will need
- flesh of 2 large ripe avocados
- grated zest and juice of 2 limes
- 3 tbsp coconut oil
- 1 tbsp chia seeds
- 2 tsp honey (omit if you prefer a less sweet dish)
- 1 tsp desiccated coconut
- 4 low-sugar oat biscuits
Method
(we suggest you read everything at least once before doing anything)
1) Blend the avocado, lime juice, coconut oil, honey, and half the desiccated coconut, in a food processor.
2) Scoop the mixture into 4 ramekins (or equivalent-sized glasses), making sure to leave a ½” gap at the top. Refrigerate for at least 2–4 hours (longer is fine if you’re not ready to serve yet).
3) Assemble, by crumbling the oat biscuits and sprinkling on top of each serving, along with the other half of the desiccated coconut, the lime zest, and the chia seeds.
4) Serve immediately:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
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