An Antihistamine Discovery

[tex]

Hi All,

Thanks to a kind soul (a pharmacist who successfully treated his wife's MC with antihistamines after reading chapter 14 in the book) who wrote an awesome review of my MC book on Amazon (review number 30, in case anyone wants to read his treatment story), I decided to check for the availability of the best antihistamine (for allergy symptoms at least) that I have ever found, and lo and behold, it is once again available, and I found it on Amazon. This product used to be known as Chlor-Trimeton, but the new version is called Chlorphen-12. He used an Allegra in the mornings, and 2 tablets of the 4 mg version of Chlor-Trimeton (which has always been available) in the evenings, to treat his wife's MC symptoms.

I used Chlor-Trimeton (chlorpheniramine maleate), 12 mg, for decades, for pollen allergies, but in recent times, every time that a new antihistamine enters the market, chlorpheniramine maleate mysteriously disappears. Presumably this happens because chlorpheneramine maleate is relatively cheap, and works great, so the pharmaceutical companies have to get it off the market in order to create a need for whatever new product is scheduled for launch. I was afraid that it was gone for good this time, but thank goodness it is back. How long it will be available may depend on future product launches, so I plan to stock up before that happens again.

Chlor-Trimeton, 12 mg, (which is the 24-hour version) is a first generation antihistamine, and it always worked great for me. The 4 mg version has always been available, but the problem is that it simply does not contain enough punch to do much good. I find that in general, Allegra works marginally for me, and Claritin is pretty much ineffective, so the modern antihistamines leave a lot to be desired, as far as I can tell. The only thing that they have going for them is a relative immunity to the drowsiness issue. While chlorpheniramine maleate does cause some degree of drowsiness, that never seemed to be a major problem for me, and apparently drowsiness is less of a problem with this antihistamine than with most other first generation antihistamines. And while the rebound effect seems to be a relatively significant problem with the modern antihistamines, if that ever happened with Chlor-Trimeton, I was never aware of it. So I'm very glad to have a supply of it again, in case I ever need an antihistamine.

I'm not promoting this stuff, because I have no financial interest in it (other than as a satisfied customer), but in case anyone else is a chlorpheniramine maleate fan (or is disappointed with the performance of the newer antihistamines they have tried), here are links to where I just found it on Amazon.

Chlorpheniramine Maleate Extended Release, 12 Mg , 60 Tablets

Chlorphen Chlorpheniramine Maleate, 12 Mg Extended Realease, 24 Tablets

The product has been renamed, presumably so that the manufacturer would have an excuse to raise the price. It's labeled for 12-hour relief of symptoms, but it has typically lasted for 24 hours for me, even when treating a severe pollen allergy, provided that I take it before the symptoms appear (IOW, early enough in the morning, before pollen begins to drift). I can't find an ingredient list, so I'm anxious to see what's in it when it arrives. The original version contained a long list of dyes, and even lactose, so I'm hoping that the new version will have a much shorter list (and will lose the lactose).

http://www.chlorphen12.com/

Tex

[Leah]

Hi Tex. Thanks for the info. What is the difference from this to Benadryl?
Leah

[tex]

Leah,

They're both old antihistamines (first generation), which means that both can cause drowsiness, but there seems to be little difference in their effectiveness or safety. The main difference between Chlorphen-12 (chlorpheniramine maleate) and Benedryl (diphenhydramine) that I am aware of is a difference in the tendency to cause drowsiness. Benedryl is more likely to cause a more severe drowsiness problem for most people. But of course as always, YMMV.

Most "official" medical websites claim that second generation antihistamines are just as effective as the older first generation antihistamines, and the newer antihistamines have the advantage of a greatly reduced drowsiness risk. But if you review posts on discussion boards where the relative effectiveness of these 2 classes of antihistamines are discussed, you will see many examples of people who insist that second generation antihistamines are not effective for them, whereas first generation antihistamines (such as Benedryl and Chlor-Trimeton) are effective.

Tex

[Gabes-Apg]

Tex
lactose free (and other ingredient free) version is in Aus, albeit it has paracetamol with it

http://www.pharmacyonline.com.au/chemis ... 20ALLERGY)


if your new version is not lactose free and you are interested in this one, let me know

[Gabes-Apg]

Found Pure, with no lactose

http://www.puritanspride.com.au/anti-al ... 02960.html

[tex]

Hi Gabes,

Thanks for the links. The first product is interesting, in that it also contains a decongestant and an analgesic. The problem though is that it only contains 2 mg of chlorpheniramine maleate. The second product is the version that I mentioned that has always been available (at 4 mg of the active ingredient). There's something about the 12 mg version that makes it work so much better for most users. The original Chlor-Trimeton label doesn't say anything about timed-release though, so it's possible that one could just triple the dose of the 4 mg product and achieve the same effect. I have no idea if that's safe or practical, though.

Tex

[Gabes-Apg]

I will keep investigating, i might be able to get the 12mg via the compound chemist.
the 4mg on its own with no lactose is still a good option and I am going to get some.

(At the moment we are surrounded by huge amount of smoke haze from bush fires and it is causing me to react)

and Congrats on the reviews and people benefiting from your book!

[tex]

That's bad news about the smoke. Are you having a dry spring? We've been doing much better on rainfall around here this year.

Thanks. That review was so glowing that it almost scared me to read it. That's the sort of review that authors dream about, but rarely ever see. It's truly gratifying.

Tex

[wmonique2]

Tex,

for you

Love,

Monique

[tex]

Hi Monique,

Many thanks.

I noticed your post about your thyroid. Has a procedure to check it out been scheduled yet, or do you think it will be a while?

Love,
Tex

[humbird753]

EXCELLENT review, Tex!!!

Curious - would this work for someone with Mastocytosis along with high level of D and a corticosteroid, or is the antihistamine protocol here for MC symptoms only?

It gets a bit confusing for me with the different types of autoimmune skin issues. Common sense would tell me it should work for all of them. But... common sense probably has nothing to do with any of this. Although, while typing this, I am reading what I printed out from the other thread I put out there on chronic skin issues, and see you recommended a totally different protocol for DH compared to Mastocytosis. Looks like I should read Chapter 14 again... Seems like if mast cells are in the picture the antihistamine protocol used would be beneficial for skin issues as well??? Or am I heading in the wrong direction in my thinking on this?

You see, the friend I mention in the other thread is a pharmacist. Would it be helpful to recommend your book and Chapter 14, even though there are no MC issues (at least that I know of)?

I hope my rambling thoughts make sense to you. Unfortunately, it's not real clear to me. I did not do well with Science when in school!

Paula

[wmonique2]

Hi Tex,

I had an ultrasound followed by a biopsy and it came back saying that it is "suspicious for papillary carcinoma". My endo wants me to have surgery and remove the half were the nodule is. I am so overwhelmed by all this I cannot begin to tell you. I've been on search mode for the last two days looking for a surgeon that can do the surgery. Apparently, it is more complicated than it sounds. There are parathyroids and nerves and the vocal cords to be concerned about. It can easily be botched and there are specialists that deal exclusively with parathyroids which can be easily severed in the hands of the wrong guy. It takes hundreds of surgeries in parathyroid to get good at it. My endo recommended a specialist in parathyroid surgery but the online reviews of him were anything but favorable.
So, this came out of the blue. Wasn't on my radar. Found accidentally. I was just beginning to enjoy my remission when this happened. But at least I won't have to deal with my gut while this is going on. (One way of looking at it I guess).
I scheduled an appt with a specialist at Emory for the 17th.

Love,

Monique

[tex]

Paula,

The treatment for dermatitis herpetiformis is completely different than the treatment for mastocytosis. DH is a symptom of gluten sensitivity, whereas mastocytosis is caused by excess numbers of mast cells and overactive mast cells. So yes, IMO mastocytosis should be treated with plenty of vitamin D and antihistamines. It's also possible that a GF diet might help, because gluten sensitivity is a common cause of skin issues. But remember that I am not a doctor, so this is just my opinion, it's not medical advice.

I'm not sure whether the Microscopic Colitis book would be helpful for your friend, but here's what I say about mastocytosis and vitamin D on pages 52–54 of the vitamin D book:

Is it any wonder that so many people, including physicians, are confused about how the immune system actually works?
It's a very complex and sophisticated system. And it can do wonderful things for us, provided that we just do our part to help keep it functioning properly. What this interdependent relationship implies then, is that vitamin D receptors must be present in adequate quantities in order for the active form of vitamin D to be able to prevent the production of excess numbers of mast cells when an inflammatory event is in progress. This is a mechanism that the immune system utilizes to prevent reactions from getting out of hand. Baroni et al. (2007) also demonstrated that VDR-deficient mice experience faster mast cell maturity rates than normal mice, and the mast cells that are produced are more easily-activated, compared with those produced by normal mice.

This phenomenon appears to explain why so many IBD patients tend to have mast cell activation disorder.
Mast cell activation disorder (MCAD) is a condition marked by inappropriate mast cell activation that results in the excessive release of histamine, cytokines, and other proinflammatory mediators by mast cells, for no legitimate (or at least no apparent) reason. It can cause many of the symptoms of mastocytosis or mastocytic enterocolitis, even though mast cell populations might be normal, or only slightly elevated.

The intestines are known to have relatively high populations of mast cells. MCAD can result in additional symptoms (due to IgE-based reactions) that cause complications, and add confounding issues to certain types of autoimmune diseases, such as IBDs.

In the case of microscopic colitis (of which lymphocytic colitis and collagenous colitis are the most common types) for example, MCAD appears to be capable of causing virtually any of the clinical gastroenterological symptoms traditionally associated with the disease, plus the addition of classic IgE-based allergy symptoms such as nasal discharge, watery eyes, and itching skin or tongue. These symptoms are usually somewhat attenuated (compared with classic allergic reactions), and they may even be overlooked, unless the patient is aware of this possibility, and remains alert, in order to notice the symptoms. But whether these symptoms are relatively minor, or severe, the additional mast cell activity typically results in increased severity of gastrointestinal symptoms normally associated with an IBD, and in some situations, this type of mast cell activity can even trigger a flare when an IBD has been in remission.

Presumably, this may also apply to the other IBDs, including Crohn's, ulcerative colitis, and celiac disease, although this possibility certainly hasn't yet been verified by random, double-blind research trials. Not all IBD patients experience these IgE-based symptoms, but for those who do, this observation should answer a lot of questions.

So a deficiency of either vitamin D receptors, or vitamin D in it's active form can lead to a hypersensitive condition where not only are mast cells more likely to degranulate (releasing proinflammatory agents), but additional mast cells are produced more rapidly, and more of them are ultimately produced, so that a state of severe hypersensitivity (resulting in massive inflammation) may be the result.

This condition appears to meet the definition of at least mast cell activation disorder, and it might possibly be the primary cause of mastocytic enterocolitis. It also may be associated with mastocytosis, which is a serious systemic form of mast cell disorder.

Here's the reference mentioned in that quote (Baroni et al. [2007]), since your friend might be interested in reading that reference:

12. Baroni, E., Biffi, M., Benigni, F., Monno, A., Carlucci, D., Carmeliet†, G., . . . D’Ambrosio, D. (2007). VDR-dependent regulation of mast cell maturation mediated by 1,25-dihydroxyvitamin D3. Journal of Leukocyte Biology, 81(1), 250–262. Retrieved from http://www.jleukbio.org/content/81/1/250.full

Mastocytosis is very difficult to treat effectively. The leading experts on the treatment of this condition are located at Brigham and Women's Hospital in Boston (or they were trained there). The only doctors we have any information on who are qualified are listed here:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=14421

But if your friend doesn't have digestive system issues, then there would be no point in seeing a gastroenterologist. An immunologist trained at Brigham and Women's Hospital (under the direction of Dr. Mariana Castells) would be the best choice. Of course, it's also possible that your friend might be able to self-treat by using vitamin D and antihistamines (along with a GF diet for at least a few months, to see if it helps).

One thing to keep in mind though is the likelihood that even the experts at Brigham and Women's Hospital in Boston will not be aware of the role of vitamin D in mast cell suppression, because I doubt that they have read my book (or stumbled across the research that I based my observations on).

Tex

[tex]

Monique,

I'm glad that you spent some serious time checking out surgeons, because that surgery definitely calls for some skill. It's good to see that you have already set up an appointment to see a specialist.

Here's hoping that it will turn out to be benign.

Please keep us posted.

Love,
Tex

[humbird753]

Thank you, as always, Tex for your very informative response. I will be seeing my friend in a week or 10 days, and will have a lot to show her.

Your explanation of how DH and Mastocytosis differ does make more sense to me now. Thank you for specifying which pages would be most beneficial, and also the reference you provided.

Love,
Paula