Dr Costa: Private Children's Allergy Clinic
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Allergy Articles & Updates

incidence of food allery in the middle east

5/23/2022

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Incidence of food allergy
I was recently invited to write an article for Arab News, focusing on the increased incidence of allergies in the 𝐌𝐢𝐝𝐝𝐥𝐞 𝐄𝐚𝐬𝐭.⁣

This included the significant growth of 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 and 𝘢𝘭𝘭𝘦𝘳𝘨𝘪𝘤 𝘢𝘴𝘵𝘩𝘮𝘢 and its 𝘴𝘰𝘤𝘪𝘰𝘦𝘤𝘰𝘯𝘰𝘮𝘪𝘤 𝘪𝘮𝘱𝘢𝘤𝘵.⁣

It was published on the 14th of May under the name “𝐌𝐢𝐝𝐝𝐥𝐞 𝐄𝐚𝐬𝐭 𝐦𝐮𝐬𝐭 𝐚𝐝𝐝𝐫𝐞𝐬𝐬 𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞 𝐨𝐟 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬”.⁣

If you want to read it, please go to

arab.news/mvdh4

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food allergy labelling

1/13/2022

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Food allergy labelling
Also known as⁣

𝐏𝐫𝐞𝐜𝐚𝐮𝐭𝐢𝐨𝐧𝐚𝐫𝐲 𝐀𝐥𝐥𝐞𝐫𝐠𝐲 𝐋𝐚𝐛𝐞𝐥𝐥𝐢𝐧𝐠 (𝘗𝘈𝘓)⁣

This is of extreme importance to improve the quality of life of allergy sufferers.⁣ ⁣
Despite its existence, often, there are still episodes of allergic reactions.⁣

Almost half of adult patients have suffered moderate to severe allergic reactions to pre-packed food.⁣

Recent research has shown both allergic and non-allergic sufferers struggle to understand what the different 𝘗𝘈𝘓 mean.⁣
In fact, they incorrectly associate different wording to different risk levels.⁣

The higher the health education of people in the study, the more they would give different risk levels to various food labels.
Interestingly, non-allergy sufferers give a higher risk to food labels than allergy sufferers.

According to the research, consumers felt “𝐏𝐫𝐨𝐝𝐮𝐜𝐞𝐝 𝐢𝐧 𝐚 𝐟𝐚𝐜𝐭𝐨𝐫𝐲” was associated with less risk than “𝐌𝐚𝐲 𝐜𝐨𝐧𝐭𝐚𝐢𝐧” or “𝐓𝐫𝐚𝐜𝐞𝐬 𝐨𝐟”.⁣

To make matters worse, a high proportion of allergy sufferers do not read 𝘗𝘈𝘓 and rely on their own previous experience.⁣

The problem is that there are 𝐧𝐨 𝐠𝐮𝐢𝐝𝐞𝐥𝐢𝐧𝐞𝐬 on 𝘗𝘈𝘓 wording or when they should be used.⁣
It is also not compulsory in the 𝐄𝐔, being of voluntary use by producers.⁣
In the 𝐔𝐊, it became compulsory due to 𝘕𝘢𝘵𝘢𝘴𝘩𝘢’𝘴 𝘓𝘢𝘸.⁣

There is an urgent need to enforce legislation, making the wording better and clearer.⁣

It would start with the sole use of “𝐌𝐚𝐲 𝐜𝐨𝐧𝐭𝐚𝐢𝐧” in 𝘗𝘈𝘓, this way levelling the information, potentially decreasing the risk for all allergy sufferers.

www.facebook.com/permalink.php?story_fbid=336565208470697&id=100063516604410

14 main allergens
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shellfish allergy

12/15/2021

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Shellfish Allergy
Shellfish Allergens
Often 𝐬𝐞𝐚𝐟𝐨𝐨𝐝 is what is named to anything coming from the sea.⁣⁣

But this name seems to be mixed or interchanged with 𝐬𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡.⁣⁣

Let’s clarify this.⁣⁣

𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 is made of 𝘴𝘦𝘢 𝘮𝘰𝘭𝘭𝘶𝘴𝘤𝘴 and 𝘤𝘳𝘶𝘴𝘵𝘢𝘤𝘦𝘢𝘯𝘴⁣⁣

Both groups are very different.⁣⁣
  • 𝐂𝐫𝐮𝐬𝐭𝐚𝐜𝐞𝐚𝐧𝐬 are from 𝘗𝘩𝘺𝘭𝘶𝘮 𝘈𝘳𝘵𝘩𝘳𝘰𝘱𝘰𝘥𝘢⁣⁣
  • All others are from 𝘗𝘩𝘺𝘭𝘶𝘮 𝘔𝘰𝘭𝘭𝘶𝘴𝘤𝘢⁣⁣

The most important allergen is a protein called 𝐭𝐫𝐨𝐩𝐨𝐦𝐲𝐨𝐬𝐢𝐧, and it can be found in the muscle of any of those species.⁣⁣
This is the main reason for cross-reactivity between them.⁣⁣

















The incidence of 𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 allergy depends on diet habits:⁣⁣
  1. 𝘈𝘴𝘪𝘢𝘯 𝘤𝘰𝘶𝘯𝘵𝘳𝘪𝘦𝘴 have the highest⁣⁣
  2. In 𝘗𝘰𝘳𝘵𝘶𝘨𝘢𝘭, it represents 35% of food allergy⁣⁣
  3. In 𝘚𝘱𝘢𝘪𝘯 is on the rise⁣⁣
  4. It is roughly 5 times higher in adults⁣⁣

Cross-reactivity:⁣⁣
  1. 𝐕𝐞𝐫𝐲 𝐬𝐦𝐚𝐥𝐥 𝐛𝐞𝐭𝐰𝐞𝐞𝐧 𝐟𝐢𝐬𝐡 𝐚𝐧𝐝 𝐬𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡⁣⁣
  2. 𝐌𝐨𝐫𝐞 𝐥𝐢𝐤𝐞𝐥𝐲 𝐭𝐨 𝐛𝐞 𝐟𝐨𝐮𝐧𝐝 𝐰𝐢𝐭𝐡𝐢𝐧 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞 𝐠𝐫𝐨𝐮𝐩𝐬⁣⁣
  3. Often found between 𝘤𝘳𝘶𝘴𝘵𝘢𝘤𝘦𝘢𝘯 and 𝘮𝘰𝘭𝘭𝘶𝘴𝘤𝘴⁣⁣
  4. Common between 𝘤𝘳𝘶𝘴𝘵𝘢𝘤𝘦𝘢𝘯𝘴 and 𝘩𝘰𝘶𝘴𝘦 𝘥𝘶𝘴𝘵 𝘮𝘪𝘵𝘦𝘴, 𝘤𝘰𝘤𝘬𝘳𝘰𝘢𝘤𝘩𝘦𝘴, and 𝘱𝘢𝘳𝘢𝘴𝘪𝘵𝘦𝘴⁣⁣
  5. Possible between 𝘴𝘯𝘢𝘪𝘭𝘴 and 𝘩𝘰𝘶𝘴𝘦 𝘥𝘶𝘴𝘵 𝘮𝘪𝘵𝘦𝘴⁣⁣

Important notes:⁣⁣
  • 𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 can cause 𝘧𝘰𝘰𝘥-𝘥𝘦𝘱𝘦𝘯𝘥𝘦𝘯𝘵 𝘦𝘹𝘦𝘳𝘤𝘪𝘴𝘦-𝘪𝘯𝘥𝘶𝘤𝘦𝘥 𝘢𝘯𝘢𝘱𝘩𝘺𝘭𝘢𝘹𝘪𝘴⁣⁣
  • 𝐒𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 can lead to 𝘰𝘳𝘢𝘭 𝘢𝘭𝘭𝘦𝘳𝘨𝘺 𝘴𝘺𝘯𝘥𝘳𝘰𝘮𝘦 (𝐎𝐀𝐒)⁣⁣
  • 𝘍𝘪𝘴𝘩𝘦𝘳𝘮𝘦𝘯, 𝘳𝘦𝘴𝘵𝘢𝘶𝘳𝘢𝘯𝘵 𝘸𝘰𝘳𝘬𝘦𝘳𝘴 and 𝘧𝘢𝘤𝘵𝘰𝘳𝘺 𝘸𝘰𝘳𝘬𝘦𝘳𝘴 can develop 𝘰𝘤𝘤𝘶𝘱𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴, 𝘳𝘩𝘪𝘯𝘪𝘵𝘪𝘴 and 𝘤𝘰𝘯𝘫𝘶𝘯𝘤𝘵𝘪𝘷𝘪𝘵𝘪𝘴 induced by 𝐜𝐫𝐮𝐬𝐭𝐚𝐜𝐞𝐚𝐧𝐬⁣⁣
  • 𝘖𝘤𝘤𝘶𝘱𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘢𝘴𝘵𝘩𝘮𝘢 can happen to workers in 𝐬𝐡𝐞𝐥𝐥𝐟𝐢𝐬𝐡 𝐟𝐚𝐜𝐭𝐨𝐫𝐢𝐞𝐬⁣⁣

As with fish, if you have reacted, but the tests are negative, think of 𝐀𝐧𝐢𝐬𝐚𝐤𝐢𝐬 allergy.⁣⁣

Remember, if you have reacted to 𝐜𝐫𝐮𝐬𝐭𝐚𝐜𝐞𝐚𝐧𝐬, you need to be tested for 𝐡𝐨𝐮𝐬𝐞 𝐝𝐮𝐬𝐭 𝐦𝐢𝐭𝐞𝐬!⁣⁣

www.facebook.com/permalink.php?story_fbid=319900496803835&id=100063516604410


Prawn and Shrimp differences
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fish allergy

12/15/2021

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Fish Allergy
Fish allergens
Although 𝐟𝐢𝐬𝐡 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 is common, fortunately, it is not as common as other allergies.⁣

Its incidence varies from country to country, and around 40% of people with fish allergy had their first reaction when they were adults.⁣

In 𝘌𝘶𝘳𝘰𝘱𝘦, less than 0.1% of children have a fish allergy.⁣


  • The protein causing most of the allergic reactions is called 𝐏𝐚𝐫𝐯𝐚𝐥𝐛𝐮𝐦𝐢𝐧, and it exists in the fish’s muscle.⁣
  • Some species will have other allergens, which might also lead to allergic reactions.⁣

















𝐂𝐨𝐝 has been the primary source of studies and information regarding fish allergy.⁣

Though most fishes contain this protein, this 𝐃𝐎𝐄𝐒 𝐍𝐎𝐓 mean that an allergy to a fish will lead to an allergy to all fish.⁣
  • Expect to have cross-reactions between fish in the same family (see the tables I made) but to a lesser extent between fish from different groups.⁣
  • Studies show that, in this case, the cross-reactivity is moderate or small.⁣

If there were no specific allergens on the table I made, it is because none has been identified yet, though some proteins have been.⁣

Some main aspects to note are the following:⁣
  1. 𝐄𝐞𝐥 and 𝐜𝐨𝐝 likely cross-react⁣
  2. 𝐀𝐧𝐜𝐡𝐨𝐯𝐲 and 𝐜𝐨𝐝 cross-sensitivity is found in nearly 35% of children⁣
  3. 𝐀𝐧𝐜𝐡𝐨𝐯𝐲 has a high content of 𝘩𝘪𝘴𝘵𝘢𝘮𝘪𝘯𝘦, so some reactions might not be allergic⁣
  4. 𝐅𝐢𝐬𝐡 𝐠𝐞𝐥𝐚𝐭𝐢𝐧𝐞 is used in medication, like in 𝘷𝘢𝘤𝘤𝘪𝘯𝘦𝘴, but generally do not lead to a reaction in people who are allergic to fish⁣
  5. Fish allergies typically are 𝐥𝐢𝐟𝐞𝐥𝐨𝐧𝐠⁣

There are cases in which an apparent allergic reaction to fish has normal investigations.⁣
  • In some cases, this might be due to the presence of a parasite called 𝐀𝐧𝐢𝐬𝐚𝐤𝐢𝐬.⁣
  • Investigation for this parasite should be done through blood tests.⁣

Final note:⁣
Think of the fish in a 𝘧𝘪𝘴𝘩 𝘵𝘢𝘯𝘬!


www.facebook.com/permalink.php?story_fbid=319899903470561&id=100063516604410

Frog legs allergy
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Contact dermatitis

11/27/2021

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Contact Dermatitis
Causes of Irritant Contact Dermatitis
Parents have asked me if a diagnosis of a food allergy can be made by placing the food on the skin.⁣

The answer is, not always.⁣
Why is that?⁣

Not all concentrations of the allergen can lead to a reaction.⁣
  • Some reactions might be due to a 𝘊𝘰𝘯𝘵𝘢𝘤𝘵 𝘋𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴.⁣

𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐃𝐞𝐫𝐦𝐚𝐭𝐢𝐭𝐢𝐬 happens when a substance gets in contact with the skin, causing a localised reaction.⁣

It can be either 𝘪𝘳𝘳𝘪𝘵𝘢𝘯𝘵 (80% of reactions) or 𝘢𝘭𝘭𝘦𝘳𝘨𝘪𝘤 (20% of reactions), leading to different reactions.⁣

It affects people that deal with the substances frequently, though it can happen to anyone.⁣
  • Most commonly, it affects people working in the 𝘤𝘩𝘦𝘮𝘪𝘤𝘢𝘭, 𝘱𝘩𝘢𝘳𝘮𝘢𝘤𝘦𝘶𝘵𝘪𝘤𝘢𝘭 or 𝘣𝘦𝘢𝘶𝘵𝘺 𝘪𝘯𝘥𝘶𝘴𝘵𝘳𝘺.
  • 𝘔𝘦𝘤𝘩𝘢𝘯𝘪𝘤𝘴 and 𝘩𝘦𝘢𝘭𝘵𝘩𝘤𝘢𝘳𝘦 𝘸𝘰𝘳𝘬𝘦𝘳𝘴 can also be affected.⁣

Treatment starts with avoidance of contact with the substance causing the reaction.⁣
Following this, the creams used are very similar to the ones used in eczema.⁣
It is not frequent the need for oral or intravenous medication.⁣

How to make a diagnosis?⁣
  • It is fairly easy, as there is a good association between the contact and the onset of the reaction.⁣
  • In some cases, when there is a mix of chemicals, patch testing can be used (I will speak about this in another post).⁣

There is also a difference in signs.⁣
  • 𝐈𝐫𝐫𝐢𝐭𝐚𝐧𝐭:⁣
  1. Blisters⁣
  2. Dry skin leads to cracking⁣
  3. Cracking leads to sores and crusts⁣ Swelling⁣
















  • 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐜:⁣
  1. Hives⁣
  2. Itching⁣
  3. Red skin⁣
  4. Dry and flaking skin⁣
  5. Swelling, especially if affecting mucosas⁣

Nickel can give irritant and allergic contact dermatitis.


www.facebook.com/permalink.php?story_fbid=305625454898006&id=100063516604410

Causes of Allergic Contact Dermatitis
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mental health and microbiome

11/27/2021

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Mental Health and Microbiome
Picture
Recent research showed an association between the decrease or absence of anti-inflammatory bacteria and the increase in some 𝐩𝐬𝐲𝐜𝐡𝐢𝐚𝐭𝐫𝐢𝐜 𝐝𝐢𝐬𝐨𝐫𝐝𝐞𝐫𝐬.⁣⁣

This was associated with the increase in pro-inflammatory bacteria.⁣⁣

And what are the bacterias involved?⁣⁣
  • The anti-inflammatory bacteria (good):⁣⁣
  1. 𝘍𝘢𝘦𝘤𝘢𝘭𝘪𝘣𝘢𝘤𝘵𝘦𝘳𝘪𝘶𝘮⁣⁣
  2. 𝘊𝘰𝘱𝘳𝘰𝘤𝘰𝘤𝘤𝘶𝘴⁣⁣
 
  • The pro-inflammatory bacteria (bad):⁣⁣
  1. 𝘌𝘨𝘨𝘦𝘳𝘵𝘩𝘦𝘭𝘭𝘢⁣⁣

They believe this relates to the low production of 𝐁𝐮𝐭𝐲𝐫𝐚𝐭𝐞 from the absent bacteria, as this leads to an anti-inflammatory effect, mainly in the bowel.⁣⁣
  • The name 𝐁𝐮𝐭𝐲𝐫𝐚𝐭𝐞 comes from the 𝘓𝘢𝘵𝘪𝘯 𝐁𝐮𝐭𝐲𝐫𝐮𝐦, which means butter.⁣⁣
















But please don’t go and start eating it by the bucket load, as this is not the best way to increase 𝐁𝐮𝐭𝐲𝐫𝐚𝐭𝐞 in your system!⁣⁣

Take this research with caution, as the study did not take into account individual variables.⁣⁣

And despite the finding of this exciting relation, some studies directly aimed at this association have not yet proven the link.⁣⁣

What is important is that there starts to exist some evidence that might lead to a better understanding of the connection between gut health and mental health.⁣⁣

This study was done at 𝐊𝐢𝐧𝐠’𝐬 𝐂𝐨𝐥𝐥𝐞𝐠𝐞 𝐋𝐨𝐧𝐝𝐨𝐧, in association with the 𝐌𝐚𝐮𝐝𝐬𝐥𝐞𝐲 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥.


www.facebook.com/permalink.php?story_fbid=305625131564705&id=100063516604410

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neuritin

9/15/2021

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Neuritin
What is Neuritin
In March this year, researchers from the 𝘈𝘶𝘴𝘵𝘳𝘢𝘭𝘪𝘢𝘯 𝘕𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘜𝘯𝘪𝘷𝘦𝘳𝘴𝘪𝘵𝘺 made a fantastic discovery.⁣

They realised that a protein we produce in our bodies significantly influences our immune system’s reaction to allergens.⁣

People who produce less amount of Neuritin have a higher risk of dying of 𝐀𝐧𝐚𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 and developing 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬.⁣

Studies in mice showed some key components that mediate allergic reactions were substantially raised in mice lacking Neuritin.⁣
They proceeded to give Neuritin to those mice, and it managed to restore the lost function, decreasing the production of 𝐈𝐠𝐄 and other 𝐚𝐧𝐭𝐢𝐛𝐨𝐝𝐢𝐞𝐬.⁣

To make matters more important, it was also found that Neuritin also plays a vital role in decreasing 𝐚𝐮𝐭𝐨-𝐢𝐦𝐦𝐮𝐧𝐞 𝐝𝐢𝐬𝐞𝐚𝐬𝐞, 𝐚𝐬𝐭𝐡𝐦𝐚 and the control of 𝐜𝐚𝐧𝐜𝐞𝐫 cells.⁣




















This means we might have a chance to introduce a protein our body produces and give it to patients who are deficient in it, helping them either outgrow their 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬 and 𝐚𝐬𝐭𝐡𝐦𝐚 or decrease the severity of the symptoms.


www.facebook.com/permalink.php?story_fbid=253986310061921&id=100063516604410

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Histamine intolerance

9/6/2021

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Picture
Symptoms of Histamine Intolerance
It was first described more than 60 years ago but only recently started to be more noted and looked into.⁣

In 2011 the 𝘌𝘶𝘳𝘰𝘱𝘦𝘢𝘯 𝘍𝘰𝘰𝘥 𝘚𝘢𝘧𝘦𝘵𝘺 𝘈𝘨𝘦𝘯𝘤𝘺 raised concerns regarding the high levels of amines (histamine included) present in foods bought in supermarkets, which might be considered a health risk.⁣


  • It affects around 1% of the population, with nearly 80% of those being of middle age.⁣
  • It happens when there is an imbalance between the amount of histamine circulating and our capacity to degrade it.⁣

Symptoms can happen due to either deficiency of the enzymes that degrade histamine or medication, leading to decreased enzymatic activity.⁣


















The main symptoms depend on the organs affected⁣
  • When the problem is 𝐃𝐀𝐎 deficiency⁣
  1. Headaches⁣
  2. Nausea and vomiting⁣
  3. Diarrhoea, abdominal pain and problems with digestion⁣
  4. Blocked nose⁣
  5. Sneezing⁣
  6. Itchy skin, rashes, and hives⁣
  7. Asthma and difficulty breathing⁣
  8. Hypotension⁣
  9. Irregular heartbeat⁣
  10. Muscular and joint pains⁣

  • When the problem is 𝐇𝐍𝐌𝐓 deficiency, mainly it affects⁣
  1. Brain⁣
  2. Liver⁣
  3. Lining of lungs⁣

The best way to reduce symptoms is by either reducing or stopping eating foods containing histamine or taking antihistamines.⁣

The use of DAO (Diamine Oxidase) supplements is still debatable.

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Production of histaminase
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Antihistamines

8/3/2021

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Antihistamines - Are they all the same?
First and second generation antihistamines
They are the most used class of medication in the USA and the 07th in the UK.⁣⁣

The first one discovered in 1937 was a compound called 933F, followed shortly after by 929F.⁣⁣

The big problem is that both were very toxic to the human being.⁣⁣

In 1942 Antergan and in 1945 Diphynhidramine were discovered.⁣⁣

Second generation were only developed in the 1980s.⁣⁣

Currently, there are over 40 different ones.⁣⁣

  • Often people divide them between drowsy and non-drowsy.⁣⁣
  • Some others call them slow acting or fast acting.⁣⁣
  • The correct name is first generation and second generation.⁣⁣

  • Saying this, there is some debate about a potential third generation.⁣⁣





















To make matters slightly more confusing, some second generation also have first generation properties.⁣⁣

But we are only talking about the ones acting on H1 receptors.⁣⁣

These are used for all sorts of allergic reactions:⁣⁣
  • Food allergy⁣⁣
  • Hayfever⁣⁣
  • Insect venom allergy
  • Allergy to chemicals⁣⁣
  • Urticaria or angioedema⁣⁣
  • (etc)⁣⁣

What are the main differences?⁣⁣
  1. All 1st generation and a couple of second generation need to be metabolized in the liver, to become active.⁣⁣
  2. 1st generation have less afinity for the H1 receptors, than other generations.⁣⁣ 2nd generation reaches peak plasma level and onset of action much faster than 1st generation.⁣⁣
  3. 2nd generation are mainly excreted unchanged in urine (Cetirizine) or faeces (Fexofenadine).⁣⁣
  4. 1st generation are less specific for H1 receptors and pass the blood-brain barrier, leading to sedating effects.⁣⁣
  5. Some 2nd generation can also be used topically on the nose or eyes (Azelastine), having a faster effect than when taken by mouth, but must be applied several times a day.⁣⁣

In reality, there are 4 different types of histamine receptors (from H1 to H4).⁣⁣
  1. H1 was described in 1966⁣⁣
  2. H2 was described in 1972⁣⁣
  3. H3 was described in 1983⁣⁣
  4. H4 was described in 1994⁣⁣

We have antagonists (actual name is reverse agonists) for H1 and H2, but not for the others.⁣⁣

H1 are further divided into 7 different chemical groups.

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Histamine receptors
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How To Wean A Baby With Reflux

7/28/2021

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This was another blog post collaboration I have done for My Baba.

If you want to read the full article and find how to help your reflux suffering child, click on the link below.



www.mybaba.com/how-to-wean-reflux-baby/

​
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    Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.

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