Pharmahealthblog. Health and medical information

Are your lips chronically dry, cracked, peeling or swollen? Do mascaras irritate your eyes? Do deodorants leave your underarms itchy? Do certain creams or face powders irritate your face or your hands?

If so, you could be one of the millions of people – primarily women – with allergies to something in their cosmetics. And ‘cosmetics’ means face creams, lotions, rouge, blusher, powder, eyeliner and shadow, lipstick, nail polish and polish remover, as well as nail lengtheners, shampoos, hair dyes, hair waves, hair straightness, hair removers (depilatories), shaving cream, perfumes, cologne, sachets, bubble baths, douches, mouthwash, toothpaste – even dentures!

It’s easy to see why cosmetics and other personal grooming products are the most common cause of skin reactions. They’re usually applied daily, directly to the skin. And, as we mentioned in earlier chapters, chronic exposure breeds allergy. Also, over 5,000 different chemicals and compounds go into these products – as bases, dyes, fragrances, preservatives and the like – multiplying the odds that something is going to disagree with you, no matter how minuscule the amount.

No wonder one doctor estimates that 85 per cent of people who are allergic to cosmetics don’t even realize which substances are causing the problem. Where do you start?

With creams and lotions. These accounted for almost half of all allergic reactions in a study of seventy people sensitive to cosmetics, according to Dr Schorr. It’s not that creams and lotions are any more allergenic than other products, he says. People simply tend to apply them to already irritated skin -which is more prone to react. And they use them all over their body.

An American study of cosmetic reactions found that the most frequent reactions were to: deodorants/antiperspirants, depilatories (hair removers), moisturizer lotions, hair spray, mascara, bubble bath, eye cream, hair colour, dye or lightener, facial creams or cleansers and nail polish – in that order.

Is a woman with cosmetic allergies dreaming if she hopes to wear makeup? Must men swear off all grooming aids? Not at all. They merely have to choose products carefully and apply them with extra care.

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The most effective insect repellents contain Deet (diethyltoluamide). Repellents do not actually repel flies and mosquitoes, they simply fog their radar. Mosquitoes are guided to their victims by the sensations of moisture, warmth and carbon dioxide – exactly the qualities people exude while exercising or working outdoors on a hot, humid day. Repellent sprays or lotions give off fumes which block the bugs’ sensory pores on their antennae. So as bugs approach you, they get confused and hover out of striking range.

Sounds great. Except for two problems. While repellents turn off biting insects, they attract some bees and stinging insects. And some people may be more sensitive to the chemicals in repellents than they are to mosquito bites themselves.

To get around those problems, some doctors recommend taking tablets of thiamine (à Â vitamin) as an internal insect repellent. It seems that when we consume large quantities of thiamine, some is excreted in our perspiration, creating an odour that repulses bugs. (Humans can’t smell it.)

In addition, you can wear light-coloured clothing (such as khaki or tennis whites), with long trousers and sleeves to expose as little skin as possible. Put up good screens, Discourage mosquitoes from breeding by eliminating, filling in or draining watery areas around your house: rain barrels, old cans and tires, stagnant puddles, ditches, hollow trees and stumps, and marshy ground. Install an electronic bug zapper near your front door or in the garden. Or buy non-toxic insect traps.

Delayed reaction to stings or bites

Headache. Malaise (general uneasiness). Hives. Aching joints. Lymph gland involvement.

Psychological reaction

Rapid heartbeat. Rapid, shallow breathing. Weakness. Dizziness.

You should consult a doctor without delay -

• when a local reaction exhibits undue swelling covering two joints of leg, arm or hand, or when a sting causes swelling in the throat, nose or eye, particularly the latter. A sting close to the eye should be seen by a doctor because resulting complications can threaten eyesight.

• when a sting results in symptoms of a generalized systemic reaction, no matter how mild.

• when multiple stings produce signs of a toxic reaction.

• when the swelling accompanying a normal or local reaction persists. (Infection may have set in.)

• when symptoms of a delayed reaction appear.

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Air filters range from small, inexpensive desktop models to whole-house air conditioning systems. Some do you a lot more good than others. Some, in fact, are worthless. The ones that work are a real blessing, though.

‘I almost always prescribe air filtration,’ says Dr Boxer. ‘I feel it’s helpful. I’ve seen asthma patients who were helped immensely by just using an air filter.’

‘Air filtration is certainly a very natural way of controlling symptoms,’ says Dr Falliers. There are dozens of products, and each has to be examined for what it does and doesn’t do.’

Air filters may be installed in the ductwork of either your warm-air furnace or air conditioning system. Or you can buy portable models that sit anywhere in the room. Or even hook up to the cigarette lighter in your car. Portable units can sometimes be rented.

Activated Charcoal Filters. The odour-eating capacity of activated charcoal varies with the humidity and temperature of the air in the room, the concentration of fumes and the type of odours in the air. Dr Guy O. Pfeiffer, of Mattoon, Illinois, studied activated charcoal filters and found that they’re generally pretty good for absorbing cooking and food odours (even from burned dinners and foods such as garlic, onions, cheese and citrus); cigarette and tobacco odours; diesel and petrol fumes; smog and ozone; and the odours from pets, mothballs and perfume. Charcoal is slightly less powerful against pollen, coal smoke, mildew, chlorine, fish odour and some noxious gases. And it’s useless against carbon monoxide and formaldehyde. Installed piggyback with another type of filter, however, charcoal can be helpful; one catches what the other misses.

Electronic Air Cleaners. The most common type of electronic air cleaner is the electrostatic precipitator. Until a few years ago, electronic air cleaners were standard equipment for treating asthma and respiratory allergy. They act much like an electromagnet for air pollution: a fan draws in particles, zaps them with an electric charge and collects them on a plate. The charged particles are supposedly taken out of circulation. However, J. Gordon King, a consultant in air contamination, writes that although electrostatic precipitators are popularly advertised as being 95 to 99 per cent efficient, they’re not. In reality, says Mr King, electrostatic air cleaners available for home use rarely trap more than 80 per cent of the particles in the air. What’s worse, efficiency can drop to as low as 20 per cent within a short period of time – especially for bigger particles like pollen (Respiratory Care).

That means electrostatic air cleaners are no more effective than putting a sheet of gauze over your mouth. And the charged particles that escape the filter build up on walls and furniture faster than if no cleaner was used at all. To top it all off, all electronic air cleaners produce ozone, a highly toxic gas which causes headaches in some people. So you may not want to bother with them at all.

HEPA (High Efficiency Particulate Air) Filters. These filters work a lot better than electronic air cleaners. Air that’s been cleared by a HEPA is free of 99.97 per cent of all contaminating particles, according to the US National Bureau of Standards. That’s about as clean as you can get in today’s environment. And they maintain their efficiency throughout their operating life of two to five years. HEPA filters work well against pollens, moulds, yeast and other fungi, bacteria and viruses – a boon to allergy sufferers prone to frequent colds and flu attacks. HEPA filters have been known to relieve hay fever and asthma symptoms within ten minutes to half an hour. When potassium permanganate or activated charcoal is added, an HEPA filter can clear the air of jumbo particles like dust and pollen as well as minute chemical odours.

HEPA units with metal casings are better for chemically sensitive people than units with casings made of pressboard (which contains formaldehyde) or plastic.

HEPA filters did wonders for reducing nightly asthma attacks for asthmatic children at a summer camp in West Virginia, according to the camp’s medical director Dr Merle S. Scherr. In his report, Dr Scherr emphasized that HEPA units are an important part of treatment of allergic asthma (West Virginia Medical Journal).

HEPA units are also a godsend for preventing nightly asthma attacks for asthmatic children at home in winter. Normally, cold nights require furnaces to work harder, so furnace fans circulate more dust – and trigger more asthma. But when HEPA filters were tested on eighteen children with hard-to-control asthma, the children collectively logged 140 nights of undisturbed sleep with use of the filter, as compared with only forty-five peaceful nights without the filter. ‘This … not only relieved the parents of having to get up in the night and care for these children,’ say the researchers who conducted the study, ‘but we feel that the child, if well rested, felt better, performed better during the day and was probably more resistant to illness.’ Several of the children were also able to cut down on their asthma medicine, and they no longer missed any school (Annals of Allergy).

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Do you feel worse after smelling:

- the odour of household cleaning products and detergents such as bleach, ammonia and polishes?

- the fumes from furnaces, car or bus exhaust, tarred roads, kerosene heaters, floor wax, petrol, coal smoke or other petroleum products?

– the fumes from recently cleaned clothing, upholstery or rugs?

– the odour of lighter fluid, moth balls or insect repellent?

– the vapours from chlorinated water?

– the fragrance of soaps, shampoos or bath oils?

– scented candles or decorations?

If you answered yes to any of those questions, you may be allergic to various chemical odours and fumes.

Some people, for instance, are allergic to the odours of trees, grass, weeds and flowers, rather than to the pollen itself. For some, the smell of pine panelling or a Christmas tree is enough to set off an attack. Other people are so allergic to fish, eggs or other foods that even the smell of those foods can make them sick.

What’s the link between odours and sensitivity?

‘The nose provides a direct route to the brain for odours,’ explains Iris R. Bell, a psychiatrist in San Francisco who has a keen interest in environmentally induced health problems. In fact, the smell receptors in the brain are located right behind the uppermost cavities of the nose. And, for people who are sensitive, when the chemical fumes reach the brain, they tend to affect thinking and behavior.

‘Most toxic gases work in one way or another to reduce oxygen availability to the tissues,’ says Francis Silver, an engineer from Martinsburg, West Virginia, who specializes in the effect of gases on health. ‘With oxygen deficiency, the brain and nervous system is affected first and foremost, impairing judgment and causing other behavioral problems.’

But when it comes to being affected by chemicals, even the experts can’t always tell whether a reaction is allergy or out-and-out poisoning. To complicate the matter, some people seem immune to a substance that makes other people ill, says Kendall Gerdes, an allergist in Denver, Colorado. ‘On one end of the scale are people who could live in a chemical factory and never have any trouble,’ he points out. ‘On the other end of the curve are the people who can’t live twenty miles away from that factory because they’d get sick. Most of us fall somewhere in between.’

So-called moderate exposure is where the real trouble starts.

‘Many of our modern advances expose us to substances which are not lethal in small doses,’ says Dr McGovem. ‘But when you add up the amount of the chemicals you’re exposed to daily in the pesticide sprays, the formaldehyde, the photocopier, et cetera, it often approaches toxic levels. Even though these may be small amounts, they add up to enormous doses in the course of the day. Once you exceed your tolerance for these chemicals in your system, your immune system becomes impaired. And you’re stuck with allergies.’

Dr Gerdes told us, ‘The highly sensitive people are the front line as we move into a more and more polluted society. The things that bother chemically sensitive people are no different from the things that, with a greater degree of exposure, will eventually bother the majority.’

Sensitivity sometimes goes unnoticed until an individual is blasted by a single large exposure that finally triggers a breakdown in health.

‘A person may have only a slight sensitivity to chlorine, for example, and one day a tank accidentally ruptures in his or her town,’ says Dr Gerdes. ‘The toxic exposure may then change that moderately sensitive individual in some way so that from that time on, he or she can no longer tolerate chlorine – or any other chemical, either. The stress is additive.’

Doctors we spoke to agree that it’s not all that important whether you label the chemical reaction ‘allergic’, ‘sensitivity’ or ‘toxicity’. The critical thing is to find out what bothers you and to do something about it.

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Coffee. Doctors such as Theron Randolph feel that coffee should be eliminated entirely if an allergic person is to find any relief at all from food allergies. The caffeine alone will make your heart race, your blood pressure climb, your nerves jangle and your kidneys and adrenal glands work overtime – allergies or no.

Switching to a decaffeinated brew may not help. Some doctors report that certain people are allergic to the chemicals used to remove caffeine from coffee beans. Which just goes to show that coffee, like any processed food, has its share of additives and pesticide residues. To add fuel to the fire, most coffee beans are roasted with gas heat – a growing source of allergy problems. And coffee drinkers tend to take their brew several times a day, every day – a sure sign of allergic addiction. Add it all up, and it comes as no surprise that coffee wreaks havoc with so many allergy diets.

Cola drinks and other soft drinks, which also contain caffeine, can aggravate allergy. So can chocolate. Your wisest step is to wean yourself not only from coffee, but its cousins, too.

Chocolate. Just what is it about chocolate that puts it on so many allergists’ blacklists? For one thing, chocolate sweets, sauces, icings, puddings and cakes are full of sugar, which may cause problems on its own, as we’ve just mentioned. But there’s more to chocolate’s bad reputation than sugar. One doctor in particular – Joseph H. Fries, affiliated with Methodist Hospital in Brooklyn, New York – feels that the many additives that embellish chocolate are the real culprits (Annals of Allergy).

Even ‘pure’ chocolate is a highly complex product. Like coffee, it contains methylxanthines and other drug-like substances. Plus it’s loaded with phenyl-ethylamine, a substance that produces a giddy response comparable to an amphetamine high.

If you are truly allergic to chocolate, you’ll also have to be careful to avoid its close relatives – not only cocoa, but cola and karaya gum (often listed as ‘vegetable gum’). Luckily, nature has given us carob – a dark, sweet powder that can be substituted for chocolate. Carob powder and carob snacks can easily be found in all health food stores and many supermarkets.

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A debilitated person, one suffering from a chronic disease, is more likely to suffer from infections. Some of these have already been mentioned, such as the skin rashes that develop in hot, sweaty places that are not kept clean and the infection that can occur in the urinary tract, causing cystitis and frequently incontinence of urine. There are many other infections, the most important of which is probably pneumonia. There may well be little outward sign of pneumonia because many old people don’t have a rise in temperature or produce phlegm as younger people do when they develop the infection. It can only be diagnosed by a doctor’s careful examination. Often the only clue to the presence of any infection may be a worsening of the level of confusion. If this happens without there being an obvious cause, it is important to ask the doctor to come and assess the situation.

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Some people with dementia are very unpleasant to those around them. They may accuse a spouse of trying to harm them, of stealing their belongings, of plotting against them, and so on. This type of behaviour is really very upsetting and often causes deep hurt. There is little one can do about it, as no amount of reasoning will make any long-term difference. In the short term, however, reassurance can sometimes be helpful, as the outburst may really be a means of saying ‘I don’t feel loved’ or ‘I am angry because I am frightened.’ If this kind of emotional insecurity is responsible, loving reassurance and a hug may well be the answer, but don’t feel rejected if this doesn’t work. There must be many other reasons for a reaction of this nature and the underlying cause is often not apparent.

Very often all that one can do is to try to ignore such comments and remember that they are not really the expression of a considered thought, but the results of brain damage. The sufferer is probably as upset and distressed about the situation as the person to whom the remarks are directed.

Above all, don’t try to react by justifying yourself or arguing. This could well result in a catastrophic reaction. If the situation has arisen because the sufferer has forgotten who a person is, even though they should know him quite well, and mistakes him for a stranger who, for instance, could be a thief, try to explain to the person or persons involved and at the same time reassure the sufferer.

If things get lost, it is very likely that they have either been put down in a strange place or that they have been deliberately hidden. You will soon learn about the favourite hiding-places. This will help you to recover things quickly when the sufferer begins to complain that they have disappeared and has forgotten that he or she has hidden them. If a lockable drawer or cupboard is the hiding-place have duplicate keys made or remove the existing key in case objects are locked away and the key in turn is hidden elsewhere or lost. It is also a good idea to keep objects such as jewellery, cash, legal documents, and so on, safely away from a demented person in case they too disappear.

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There have been many studies of the inheritance patterns of Alzheimer’s disease in families. Some of these studies are more reliable than others; in many, the criteria upon which the diagnosis has been made have been rather loosely defined. The most important studies are those whose data is based on post-mortem confirmation of Alzheimer’s disease. Studies that rely on the correct diagnosis being made during life are less satisfactory, not being backed up by pathological confirmation. In the best centres the diagnosis is probably only made with an accuracy of around 80 per cent, and in some it is no better than 50 per cent.

The results of many of the studies that have been undertaken are conflicting. There is, however, little doubt that in some families, where the disease strikes predominantly younger people, there is a very strong hereditary factor. Whether or not a person develops the disease is dependent upon the genetic material that is present within the cells of the body. This genetic material is divided up into small sub-units called genes; the more powerful genes are described as dominant and the less powerful ones as recessive. Even if the Alzheimer’s disease is controlled by a dominant gene in a family with a strong pattern of the illness, the risk of a child of an affected individual developing this type of dementia is less than 50 per cent. In many cases it is considerably less than this and once the gene becomes diluted even further, to grandchildren, nephews and nieces, etc., the risks are even smaller.

In most instances the disease is not caused by a single dominant gene. In practical terms this means that someone who is a member of a family in which several people have suffered from Alzheimer’s disease, even if the onset was before the age of sixty-five, faces a risk of developing the condition almost certainly less than 50 per cent, maybe very much less.

In most cases of Alzheimer’s disease it is very probable that heredity doesn’t play any part at all. If the family history contains only a single older person who has had this diagnosis made, there is virtually no increased risk for others in the family.

The risk is further diminished if it turns out to be true that it is not the inheritance of the gene itself that matters, but whether the gene makes us more sensitive to outside agents. An example of this is the relationship between smoking and lung cancer. We all know of people who smoke sixty cigarettes a day and yet manage to survive into their nineties without developing cancer. On the other hand we know also of other smokers who succumbed to lung cancer in their fifties or sixties. It is possible that within the genetic make-up of all of us, our genes determine how sensitive we are to the action of the chemicals in tobacco smoke. If we inherit a gene that makes us very sensitive, then we are more likely to develop lung cancer than another person who has inherited a gene that makes him resistant to the chemicals in cigarettes.

It could well be the same with Alzheimer’s disease, and for that matter the other dementias. Whether we do or do not develop the condition may depend not just upon the inheritance of a particular gene, but whether we are also exposed to something which that gene makes us particularly sensitive to. This external agent could be anything from the chemicals that we put in our food or spray on our crops to a particular virus or the way in which we react to a particular virus.

My own feeling is that the increased risk of a person developing Alzheimer’s disease is very small if the only member of the family with this diagnosis is an elderly grandparent. If two grandparents have been affected the risk rises but is not of undue concern. On the other hand, if three or four members of the family have developed the disease before the age of sixty-five there is indeed a significant risk of other members of the family being affected. The odds are, however, still likely to be better than 50 per cent in favour of any individual not contracting the condition.

It is possible that in some families a single dominant gene may be responsible for Alzheimer’s, but in most cases, if there is a genetic basis at all, it will more likely result from the interplay of several genes or the interaction between a person’s genetic makeup and other factors in the environment.

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Most doctors think of Alzheimer’s disease as being characterized by abnormalities of cortical function which they call amnesia, aphasia, and agnosia. This is not as complicated as it sounds. The cortex is of course the outer layer of grey cells which lie on the surface of the brain and the three terms refer, respectively, to general memory failure, difficulty in remembering or understanding the names of objects, and failure to recognize people or objects. The symptoms are, however, very much more complicated than this and the disease often progresses along a different path in different individuals, although the later stages of the different courses of the disease tend to resemble each other. For this reason 1 am going to describe the symptoms caused by the malfunction of the three major lobes of the brain — the temporal lobe, the frontal lobe, and the parietal lobe – although there is some overlap in the relationship between structure and function.

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A lot of confusing terminology has arisen, which can lead to misunderstanding, not only in the minds of lay people but also among the medical and associated professions. The term dementia means simply a reduction in or impairment of mental powers. It does not mean that a person is mad — indeed often the only early sign is an exaggeration of the memory loss that so many of us suffer as we grow older, though most people who are forgetful are not suffering from, and will never develop, dementia. As is explained later, dementia eventually involves far more than memory loss; symptoms may include disorientation in time, a tendency to become lost in familiar surroundings, difficulty in recognizing objects or people, and eventually an inability to carry out previously familiar tasks. The fact that several mental abilities are affected is one of the hallmarks of dementia although of course, to begin with, the impairment of mental functioning is less.

It is important also to realize what is not dementia. Dementia is very definitely not a part of normal ageing, and can in fact occur in quite young people, although not as frequently as in those who are over the age of seventy-five. It is also not a diagnosis. The term dementia merely describes the state that a person’s mind is in; the way it is working or not working, a person’s behaviour pattern, and so on. It is rather akin to saying that one is short of breath. In the case of breathlessness something has usually affected the way in which the lungs or the heart work, and it is the underlying cause of this, for example pneumonia or a heart attack, that is the true diagnosis.

Many conditions cause dementia. The most common is Alzheimer’s disease and although it can occur in people who are old or young it very rarely occurs before the age of forty-five. The next most common cause of dementia is a series of small strokes, which cause the death of brain cells. Such small strokes may occur without any of the usual manifestations — the paralysis of an arm or a leg or part of the face that is so often the sign of a stroke. Some unfortunate people are affected both by Alzheimer’s disease and by dementia due to strokes.

Alzheimer’s disease is named after the German doctor Alois Alzheimer who first described it in detail in 1907. The changes in the brain, described in more detail in later chapters, are caused by a slowly progressive loss of the nerve cells lying in the cerebral cortex – the thin rim of grey matter on the outside of the brain — and in other collections of nerve cells lying more deeply within the brain. Dementia that is caused by small strokes usually results from a succession, often over many years, of blockages to small arteries affecting areas of the brain. When these are deprived of their blood the loss of oxygen and nutrient materials results in the death of the cells and their fibres. This type of dementia is often also called multiple infarct dementia – MID for short.

There are of course many other causes of dementia; some of them, albeit a minority, are treatable, which is why it is so important that a proper diagnosis of the underlying illness is always made. These causes will be described in later chapters.

Many other terms for describing the condition are in common use, among them chronic brain failure, organic brain failure, organic brain syndrome, hardening of the arteries, and senility. The latter is an unfortunate term and implies that the condition is associated with ageing, which in turn implies that it is inevitable and untreatable.

It is essential to realize that dementia is not the same as the more short-term episodes of confusion that are suffered by many old people as a result of infections such as pneumonia or urinary tract infection, the side-effects of drugs, or as a consequence of other medical conditions. These are more correctly called acute confusional states and don’t produce the gradual and relentlessly progressive deterioration in mental functioning that is a feature of dementia; on the contrary, the onset is usually fairly rapid and the sufferer is often in a state of semi-consciousness or subconsciousness. The most common example of this is the delirium associated with a high fever.

Finally, there is a lot of misunderstanding about the role of ‘hardening of the arteries’ or ‘arteriosclerosis’. These two terms essentially mean the same thing, and are often used to describe the condition that is causing a person’s dementia. This dates back to an extremely old-fashioned and incorrect belief that hardening of the arteries narrowed them to such an extent that the whole brain, or parts of it, had its blood supply slowly strangled and in consequence could not work properly. It has been known since the early seventies that this is not the case, yet it is still given as the diagnosis by many doctors. As mentioned above, the abnormality of the blood-vessel system that most commonly causes dementia is that a lot of small areas of brain suddenly die because their blood supply has been completely obstructed, thereby producing small strokes. ‘Hardening of the arteries’ and ‘arteriosclerosis’ are often incorrectly applied in a blanket manner to anyone with dementia without any thought about the real nature of the underlying condition. It is probable that the majority will have Alzheimer’s disease, and that the person applying the label is either not up to date in his or her knowledge or does not really understand the issues involved.

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