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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Why are my muscles sore after exercise? Hint: it’s nothing to do with lactic acid
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As many of us hit the gym or go for a run to recover from the silly season, you might notice a bit of extra muscle soreness.
This is especially true if it has been a while between workouts.
A common misunderstanding is that such soreness is due to lactic acid build-up in the muscles.
Research, however, shows lactic acid has nothing to do with it. The truth is far more interesting, but also a bit more complex.
It’s not lactic acid
We’ve known for decades that lactic acid has nothing to do with muscle soreness after exercise.
In fact, as one of us (Robert Andrew Robergs) has long argued, cells produce lactate, not lactic acid. This process actually opposes not causes the build-up of acid in the muscles and bloodstream.
Unfortunately, historical inertia means people still use the term “lactic acid” in relation to exercise.
Lactate doesn’t cause major problems for the muscles you use when you exercise. You’d probably be worse off without it due to other benefits to your working muscles.
Lactate isn’t the reason you’re sore a few days after upping your weights or exercising after a long break.
So, if it’s not lactic acid and it’s not lactate, what is causing all that muscle soreness?
Muscle pain during and after exercise
When you exercise, a lot of chemical reactions occur in your muscle cells. All these chemical reactions accumulate products and by-products which cause water to enter into the cells.
That causes the pressure inside and between muscle cells to increase.
This pressure, combined with the movement of molecules from the muscle cells can stimulate nerve endings and cause discomfort during exercise.
The pain and discomfort you sometimes feel hours to days after an unfamiliar type or amount of exercise has a different list of causes.
If you exercise beyond your usual level or routine, you can cause microscopic damage to your muscles and their connections to tendons.
Such damage causes the release of ions and other molecules from the muscles, causing localised swelling and stimulation of nerve endings.
This is sometimes known as “delayed onset muscle soreness” or DOMS.
While the damage occurs during the exercise, the resulting response to the injury builds over the next one to two days (longer if the damage is severe). This can sometimes cause pain and difficulty with normal movement.
The upshot
Research is clear; the discomfort from delayed onset muscle soreness has nothing to do with lactate or lactic acid.
The good news, though, is that your muscles adapt rapidly to the activity that would initially cause delayed onset muscle soreness.
So, assuming you don’t wait too long (more than roughly two weeks) before being active again, the next time you do the same activity there will be much less damage and discomfort.
If you have an exercise goal (such as doing a particular hike or completing a half-marathon), ensure it is realistic and that you can work up to it by training over several months.
Such training will gradually build the muscle adaptations necessary to prevent delayed onset muscle soreness. And being less wrecked by exercise makes it more enjoyable and more easy to stick to a routine or habit.
Finally, remove “lactic acid” from your exercise vocabulary. Its supposed role in muscle soreness is a myth that’s hung around far too long already.
Robert Andrew Robergs, Associate Professor – Exercise Physiology, Queensland University of Technology and Samuel L. Torrens, PhD Candidate, Queensland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Goji Berries: Which Benefits Do They Really Have?
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Are Goji Berries Really A Superfood?
Goji berries are popularly considered a superfood, and sold for everything from anti-aging effects, to exciting benefits* that would get this email directed to your spam folder if we described them.
*We searched so you don’t have to: there doesn’t seem to be much research to back [that claim that we can’t mention], but we did find one paper on its “invigorating” benefits for elderly male rats. We prefer to stick to human studies where we can!
So how does the science stack up for the more mainstream claims?
Antioxidant effects
First and most obvious for this fruit that’s full of helpful polysaccharides, carotenoids, phenolic acids, and flavonoids, yes, they really do have strong antioxidant properties:
Immune benefits
Things that are antioxidant are generally also anti-inflammatory, and often have knock-on benefits for the immune system. That appears to be the case here.
For example, in this small-but-statistically-significant study (n=60) in healthy adults (aged 55–72 years)
❝The GoChi group showed a statistically significant increase in the number of lymphocytes and levels of interleukin-2 and immunoglobulin G compared to pre-intervention and the placebo group, whereas the number of CD4, CD8, and natural killer cells or levels of interleukin-4 and immunoglobulin A were not significantly altered. The placebo group showed no significant changes in any immune measures.
Whereas the GoChi group showed a significant increase in general feelings of well-being, such as fatigue and sleep, and showed a tendency for increased short-term memory and focus between pre- and post-intervention, the placebo group showed no significant positive changes in these measures.❞
“GoChi” here is a brand name for goji berries, and it’s not clear from the abstract whether the company funded the study:
Here’s another study, this time n=150, and ages 65–70 years old. This time it’s with a different brand (“Lacto-Wolfberry”, a milk-with-goji supplement drink) and it’s also unclear whether the company funded the study. However, taking the data at face value:
❝In conclusion, long-term dietary supplementation with Lacto-Wolfberry in elderly subjects enhances their capacity to respond to antigenic challenge without overaffecting their immune system, supporting a contribution to reinforcing immune defense in this population. ❞
In other words: it allowed those who took it to get measurably more benefit from the flu vaccinations that they received, without any ill effects.
Anticancer potential
This one’s less contentious (the immune benefits seemed very credible; we’d just like to see more transparent research to say for sure), so in the more clearly-evidenced case against cancer we’ll just drop a few quick studies, clipped for brevity:
- Goji berry (Lycium barbarum) inhibits the proliferation, adhesion, and migration of oral cancer cells
- A closer look at immunomodulatory properties of goji berries extract in human colon cancer cells
- Lycium barbarum polysaccharides induce apoptosis in human prostate cancer cells and inhibits prostate cancer growth
- Identification of goji berry cyclic peptides and anticervical carcinoma activity
- Antiproliferative effects of Lycium barbarum’s (goji berry) fractions on breast cancer Cell Lines
You get the idea: it helps!
Bonus benefit for the eyes
Goji berries also help against age-related macular degeneration. The research for this is in large part secondary, i.e. goji berries contain things x, y, and z, and then separate studies say that those things help against age-related macular degeneration.
We did find some goji-specific studies though! One of them was for our old friends the “Lacto-Wolfberry” people and again, wasn’t very transparent, so we’ll not take up extra time/space with that one here.
Instead, here’s a much clearer, transparent, and well-referenced study with no conflicts of interest, that found:
❝Overall, daily supplementation with Goji berry for 90d improves MPOD by increasing serum Z levels rather than serum L levels in early AMD patients. Goji berry may be an effective therapeutic intervention for preventing the progression of early AMD.❞
- MPOD = Macular Pigment Optical Density, a standard diagnostic tool for age-related macular degeneration
- AMD = Age-related Macular Degeneration
(that whole paper is very compelling reading, if you have time)
If you want a quicker read, we offer:
How To Avoid Age-Related Macular Degeneration
and also…
Where to get goji berries?
You can probably find them at your local health food store, if not the supermarket. However, if you’d like to buy them online, here’s an example product on Amazon for your convenience
Enjoy!
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To Nap Or Not To Nap; That Is The Question
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Is it good to nap in the afternoon, or better to get the famous 7 to 9 hours at night and leave it at that? I’m worried that daytime napping to make up for a shorter night’s sleep will just perpetuate and worsen it in the long run, is there a categorical answer here?❞
Short version: generally considered best is indeed the 7–9 hours at night (yes, including at older ages):
Why You Probably Need More Sleep
…and sleep efficiency does matter too:
Why 7 Hours Sleep Is Not Enough
…which in turn, is influenced by factors other than just length and depth:
The 6 Dimensions Of Sleep (And Why They Matter)
However! Knowing what is best in theory does not help at all if it’s unattainable in practice. So, if you’re not getting a good night’s sleep (and we’ll assume you’re already practising good sleep hygiene; fresh bedding, lights-off by a certain time, no alcohol or caffeine before bed, that kind of thing), then a first port-of-call may be sleep remedies:
Safe Effective Sleep Aids For Seniors
If even those don’t work, then napping is now likely your best back-up option. But, napping done incorrectly can indeed cause as many problems as it solves. There’s a difference between:
- “I napped and now I have energy again” and you continue with your day
- “Darkness took me, and I strayed out of thought and time. Stars wheeled overhead, and every day was as long as the life age of the earth—but it was not the end.” and now you’re not sure whether it’s day or night, whose house you’re in, or whether you’ve been drugged.
These two very common napping experiences are influenced by factors that we can control:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
If you still prefer to not risk napping but do need at least some kind of refreshment that’s actually a refreshment and not just taking stimulants, then you might consider this practice (from yoga nidra) that gives some of the same benefits of sleep, without actually sleeping:
Non-Sleep Deep Rest: A Neurobiologist’s Insights
Take care!
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Keep Inflammation At Bay
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How to Prevent (or Reduce) Inflammation
You asked us to do a main feature on inflammation, so here we go!
Before we start, it’s worth noting an important difference between acute and chronic inflammation:
- Acute inflammation is generally when the body detects some invader, and goes to war against it. This (except in cases such as allergic responses) is usually helpful.
- Chronic inflammation is generally when the body does a civil war. This is almost never helpful.
We’ll be tackling the latter, which frees up your body’s resources to do better at the former.
First, the obvious…
These five things are as important for this as they are for most things:
- Get a good diet—the Mediterranean diet is once again a top-scorer
- Exercise—move and stretch your body; don’t overdo it, but do what you reasonably can, or the inflammation will get worse.
- Reduce (or ideally eliminate) alcohol consumption. When in pain, it’s easy to turn to the bottle, and say “isn’t this one of red wine’s benefits?” (it isn’t, functionally*). Alcohol will cause your inflammation to flare up like little else.
- Don’t smoke—it’s bad for everything, and that goes for inflammation too.
- Get good sleep. Obviously this can be difficult with chronic pain, but do take your sleep seriously. For example, invest in a good mattress, nice bedding, a good bedtime routine, etc.
*Resveratrol (which is a polyphenol, by the way), famously found in red wine, does have anti-inflammatory properties. However, to get enough resveratrol to be of benefit would require drinking far more wine than will be good for your inflammation or, indeed, the rest of you. So if you’d like resveratrol benefits, consider taking it as a supplement. Superficially it doesn’t seem as much fun as drinking red wine, but we assure you that the results will be much more fun than the inflammation flare-up after drinking.
About the Mediterranean Diet for this…
There are many causes of chronic inflammation, but here are some studies done with some of the most common ones:
- Beneficial effect of Mediterranean diet in systemic lupus erythematosus patients
- How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis
- The effects of the Mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease
- Adherence to Mediterranean diet and 10-year incidence of diabetes: correlations with inflammatory and oxidative stress biomarkers*
*Type 1 diabetes is a congenital autoimmune disorder, as the pancreas goes to war with itself. Type 2 diabetes is different, being a) acquired and b) primarily about insulin resistance, and/but this is related to chronic inflammation regardless. It is also possible to have T1D and go on to develop insulin resistance, and that’s very bad, and/but beyond the scope of today’s newsletter, in which we are focusing on the inflammation aspects.
Some specific foods to eat or avoid…
Eat these:
- Leafy greens
- Cruciferous vegetables
- Tomatoes
- Fruits in general (berries in particular)
- Healthy fats, e.g. olives and olive oil
- Almonds and other nuts
- Dark chocolate (choose high cocoa, low sugar)
Avoid these:
- Processed meats (absolute worst offenders are hot dogs, followed by sausages in general)
- Red meats
- Sugar (includes most fruit juices, but not most actual fruits—the difference with actual fruits is they still contain plenty of fiber, and in many cases, antioxidants/polyphenols that reduce inflammation)
- Dairy products (unless fermented, in which case it seems to be at worst neutral, sometimes even a benefit, in moderation)
- White flour (and white flour products, e.g. white bread, white pasta, etc)
- Processed vegetable oils
See also: 9 Best Drinks To Reduce Inflammation, Says Science
Supplements?
Some supplements that have been found to reduce inflammation include:
(links are to studies showing their efficacy)
Consider Intermittent Fasting
Remember when we talked about the difference between acute and chronic inflammation? It’s fair to wonder “if I reduce my inflammatory response, will I be weakening my immune system?”, and the answer is: generally, no.
Often, as with the above supplements and dietary considerations, reducing inflammation actually results in a better immune response when it’s actually needed! This is because your immune system works better when it hasn’t been working in overdrive constantly.
Here’s another good example: intermittent fasting reduces the number of circulating monocytes (a way of measuring inflammation) in healthy humans—but doesn‘t compromise antimicrobial (e.g. against bacteria and viruses) immune response.
See for yourself: Dietary Intake Regulates the Circulating Inflammatory Monocyte Pool ← the study is about the anti-inflammatory effects of fasting
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Physical Sunscreen or Chemical Sunscreen – Which is Healthier?
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Our Verdict
When comparing physical sunscreens to chemical sunscreens, we picked the physical sunscreens.
Why?
It’s easy to vote against chemical sunscreens, because it has “chemical” in the name, which tends to be offputting PR-wise no matter how healthy something is.
But in this case, there’s actual science here too!
Physical sunscreens physically block the UV rays.
- On the simplest of levels, mud is a physical sunscreen, as you can see widely used by elephants, hippos, pigs, and other animals.
- On a more sophisticated level, modern physical sunscreens often use tiny zinc particles (or similar) to block the UV rays in a way that isn’t so obvious to the naked eye—so we can still see our skin, and it looks just like we applied an oil or other moisturizer.
Chemical sunscreens interact with the UV rays in a way that absorbs them.
- Specifically, they usually convert it into relatively harmless thermal energy (heat)
- However, this can cause problems if there’s too much heat!
- Additionally, chemical sunscreens can get “used up” in a way that physical sunscreens can’t* becoming effectively deactivated once the chemical reaction has run its course and there is no more reagent left unreacted.
- Worse, some of the reagents, when broken down by the UV rays, can potentially cause harm when absorbed by the skin.
*That said, physical sunscreens will still need “topping up” because we are a living organism and our body can’t resist redistributing and using stuff—plus, depending on the climate and our activities, we can lose some externally too.
Further reading
We wrote about sunscreens (of various kinds) here:
And you can also read specifically about today’s topic in more detail, here:
What’s The Difference Between Physical And Chemical Sunscreens?
Take care!
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Veg in One Bed New Edition – by Huw Richards
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We all know that growing our own veg is ultimately not only healthier on the plate, but also a very healthy activity. Cheaper too. So why don’t more of us do it?
For many of us, it’s a matter of not having the skills or knowledge to do so. This book bridges that knowledge-gap.
Richards gives, as promised, a month-by-month well-illustrated guide to growing a wide variety of vegetables. He does, by the way, assume that we are in a temperate climate in the Northern Hemisphere. So if you’re not, you may need to make some adjustments.
The book doesn’t assume prior knowledge, and does give the reader everything we need from an initial basic shopping list onwards.
A particular strength of this book is that it’s about growing veg in a single raised bed—this ensures keeping everything very manageable.
Bottom line: if you have ever thought it would be good to grow your own veg, but didn’t know where to start and want something practical for a beginner, this is an excellent guide that will get you going!
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