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Over the last two decades, there has been a significant rise in the number of couples experiencing fertility problems:
•    Sperm counts have dropped by 50 per cent in the last ten years.’
•    Men are showing an increasing number of sperm abnormalities.
•    A quarter of all couples planning a baby have trouble conceiving.
•    It is not uncommon for a couple without any fertility problems to take two to three years to conceive.
•    One in four women miscarry. Some experience repeated miscarriages – as often as ten times.
•    More and more couples are turning to fertility treatments to enable them to have a family.
•    Of the couples who seek medical help, 30 per cent are told they have ‘unexplained infertility’ for which the doctors can offer no treatment.
If you are reading this book, you or your partner may have experienced problems trying to have a baby. You may have gone through fertility treatments that failed. Or you may just be worried that nothing is happening. I see hundreds of couples every year who are trying to conceive and I fully understand their unhappiness and frustration at not being able to achieve something that most of us grew up believing would happen whenever we wanted.
But, as the above statistics reveal, you are not alone. There is an epidemic of infertility and subfertility – and in many cases the doctors do not know the answers.
But, before we discuss these issues, I want to say:
Don’t lose heart
I believe that getting yourself and your partner into optimum health, usin the four-month programme outlined in this book, will give you the best possible chance of having that longed-for, healthy baby.
I don’t just believe it — I know it. By the time you have finished readin), this book, I hope I will have inspired you and your partner to take contrd of your health and fertility.
Nature is wonderfully clever. At this particular moment you may not think so, because on the most fundamental level, reproduction, it seems to have let you down. But the purpose of this book is to encourage you to restore your own and your partner’s fertility to its proper ‘natural’ state by simple lifestyle and dietary changes that eliminate toxins from your bod i and ensure that you have the level of nutrients needed for conception.
Fundamentals of Health
In the animal world, fertility is paramount for the survival of any specie However, the human race today has a number of fertility problems. Men are showing sperm abnormalities (such as sperm with two heads or sperm tha-:
are so sluggish they cannot reach the egg). Some women have a number Or menstrual cycles during which they do not ovulate; or, when fertilisation happens, the embryo does not implant in the womb.
To explain these anomalies, we have to go back to the foundations 0: health.The egg and sperm are only as healthy as the man and woman who produce them. If there are any problems with either the egg or the sperm. however subtle, nature will either try to stop fertilisation occurring or, if i does take place, a miscarriage may follow.
One reason why so many couples are diagnosed with ‘unexplained infer - tility’ is that doctors cannot put it down to a specific, observable medical cause. But I believe that infertility is a multi-factorial problem and should be investigated that way. That means looking at a variety of issues, such a, nutrition, alcohol and smoking habits, levels of lead and other toxic metals pesticides, food additives, genito-urinary infections, allergies, stress and other hazards of modern life.That means your partner taking a close look a: his health and nutrition as well (in four out of ten cases of infertility, the problems are on the male side). The fact is that our modern ‘unnatural lifestyle, combined with the nutrient depletion of much of our food, ha;
left many of us deficient in the vitamins and minerals we need for successful babymaking.
Any specialist who works in a zoo, or breeds champion dogs, cattle or racehorses, will tell you that optimum nutrition is essential. But, while the fertility clinic business is booming (with desperate couples lining up for treatment), there isn’t much incentive to look at whether simple factors, like a deficiency of zinc for instance, may be the main reason for unexplained infertility.
Learning From the Past
We should learn from the folic acid story, which really demonstrates the importance of nutrition and how a crucial deficiency identified by researchers as being responsible for birth abnormalities was ignored by doctors for years.
In 1991 the Medical Research Council (MRC) finally published a study which showed that supplementing with folic acid during preconception and pregnancy could prevent the reccurrence of spina bifida in babies.’ Yet the damaging effects of a folic acid deficiency had been recognised three decades earlier, after rats were born with malformations (including neural tube defects) and other problems (such as club foot and cleft palate) in folic acid trials.’
This knowledge, which could have prevented a great deal of heartache, had been around for over 30 years and yet women were not told to take folic acid for decades.These early findings were confirmed again in humans in 1981 trials that looked at the effects of folic acid on the prevention of spina bifida.’
Even as recently as 1993 the Daily Mail ran an article asking ‘Could this vitamin save your baby?” It said, `The fact that a supplement which can stop women having spina bifida babies remains the best kept secret of preconceptual care has now prompted sharp criticism from the medical world: ‘
Cynically, one might suppose that if folic acid had not been a simple easy-to-obtain supplement but a highly profitable pharmaceutical drug we would all have known about it years ago. You cannot patent a nutrient so there is no commercial incentive to investigate and promote it.
But the big lesson we should learn from the folic acid story is that our diet — what we eat or don’t eat — is absolutely crucial to our fertility.
How to Use This Book
Folic acid is only the tip of the iceberg. Medical and scientific literature contains a great deal of information that call help couples who are having difficulty conceiving or who have had previous problems such as miscarriages and malformations. This book presents that information in an easyto-understand form so that you call use it yourself. Having this knowledge will help you gain control of your own health and fertility.
By following the advice in this book you can increase your fertility anc reduce the possibility of miscarriage. liven if you have a condition like blocked fallopian tubes (which means that you need IVF treatment in order to have a chance of conceiving), this book will increase your chance of success. With assisted conception techniques it is still vital for the sperm anc the egg to be as healthy as possible.
As you read the recommendations, you’ll realise that the changes you make to increase your fertility are the same as those that will protect you from miscarriage and help you produce a healthy baby. They are also, quite simply, recommendations that will improve your general health. The advice
is so logical and makes such sense that you will probably wonder why nc one has told you all this before.
Finding that you can’t conceive when you want is a real shock and it is not something that many of us want to talk about even to our close friends and families. GPs and consultants are busy people and, all too often, overworked. The minute you come out of the consulting room you think of .1 dozen other things you wanted to discuss. There just isn’t time to talk in as much depth as you would like. Yet you want to find out as much as you can.This book is designed to answer your specific queries as well as present a comprehensive self-help programme that will give you and your partner the best chance of conceiving.
•    Section 1 outlines the different aspects of your life and health that could be causing your and your partner’s problem. This will help you identify what may be going wrong.
•    Section 2 explains how you can help improve your and your partner’s fertility, concentrating particularly on good nutrition and Supplementing your diet.This is one of the most crucial sections in the book because it could be the key to solving your infertility problem by making some simple changes that are entirely within your own control.
•    Section 3 explains what tests are available to help you identify any medical cause of infertility. It is important that your partner understands that lie must also be involved in this process.
•    Section 4 describes the different fertility treatments available in the UK and reveals some heartening evidence that you and your partner can dramatically improve your chances of having successful fertility treatment, if you should need it, by following the advice in this book.
•    Section 5 discusses the problem of miscarriage in depth and shows how you can help yourself overcome it.
•    Section 6 puts it all into practice – and shows you how to organise your self-help programme for those vital months of preparation.This is really the most essential part of the book.
•    Section 7 tells you how to care for yourself in pregnancy so as to ensure that you Krill have a healthy baby.
I believe that any couple planning to have a baby would benefit from following the kind of recommendations outlined in this book – not just Couples who have had problems conceiving.
If all this sounds too hard to stick to, just think how important it is … We plan our holidays and we train for a career so why should we expect to just have babies without any proper planning or preparation.- This preconception care period of three or four months shapes your baby’s future, both physically and mentally, so it could be the most important bit of planning you ever do in your life. My aim is to help you and your partner to optimum health to give you both the best chance of having a healthy baby. As a bonus, following these recommendations will make you both feel better, fitter and more energetic.
Self-help Strategies
Most couples who seek fertility treatment find out a great deal about sophisticated medical technologies but very little about the relatively simple measures they themselves can take to improve their chances of conceiving. These highly effective self-help strategies include easily implemented dietary and lifestyle changes. Such measures cost little or nothing, their success has been scientifically documented, and yet most of these couples will not have been told about them.Why on earth is this–
The cynical answer is that infertility has become `big business’.As Professor Robert Winston points out in his book Making Babies, there are now at least 21 IVF units in London alone. And more and more units are opening because they are ‘highly profitable in the private sector’. Couples who desperately want to have a baby are very vulnerable. Even though some IVF units have extremely low success rates, such couples are still willing to gamble a great deal of time and money in order to try to conceive.
In contrast, there are no big financial gains to be made in helping couple to look at their lifestyle or to correct their vitamin and mineral deficiencies Yet this approach makes such sense, and has been shown to give an unprecedented success rate.
Over the last 20 years, Foresight has pioneered an approach to fertility that looks at the fundamentals of health, including lifestyle, diet, pollutants, infections and environmental and occupational hazards and gives an unprecedented 80 per cent success rate. Researchers from the University of Surrey followed the progress of 367 couples over a period of three years (1990-3). The women were aged between 22 and 45, and the men were aged 25 to 59. In all, 37 per cent of the couples had a history of infertility, and 38 per cent had experienced between one and five miscarriages (others had had other problems, including still births, malformations and low birth-weight babies).
Many of the couples were older, coming to the trial as a1ast resort’.They were all asked to eliminate smoking and alcohol, and to follow the recommendations outlined in this book (such as buying organic food, having infections checked and having mineral analysis). All the couples were given personal supplement programmes and were then re-tested to make sure their levels had returned to normal.
By the end of the three-year trial, 89 per cent (327 of the couples) had given birth. Out of those couples with a previous history of infertility, 81 per cent conceived and had babies. Out of those who had experienced a previous miscarriage, 83 per cent had a baby within the three years of the Study, without experiencing another miscarriage.
Of the 327 babies born to the couples in the study, no baby was born before 36 weeks and none was lighter than 51b 2oz (2.368kg).There were no miscarriages, perinatal deaths or malformations. The national average for miscarriages is one in four so one could at least have expected 80 miscarriages, but there were none. No baby was admitted to a special care baby unit.
A number of the couples had already tried IVF – sometimes two or three times – without success.Yet 65 per cent of this group conceived naturally on the Foresight programme without needing another IVF cycle.
These results are undeniably impressive and speak for themselves. Yet sceptics maintain that they are ‘too good to be true’.To date, the results have been published in the Journal of Nutritional and Environmental Medicine but not in a standard medical journal.’ This is because, in order to be accepted by a medical journal, there must be a control group.
Ina normal double-blind placebo controlled trial, to assess the efficacy of a headache remedy, for example, volunteers are randomly assigned to either a control group (placebo) or a treatment group (headache remedy). The volunteers don’t know if they are taking the placebo or the remedy, and nor does the scientist running the trial. All the volunteers in the treated group get the same dose of headache remedy.
However, in this study each person was given an individual supplement programme according to their needs. So they were all taking different dosages and supplements, depending on how deficient or toxic they were.
This is an important point because the double-blind placebo controlled trial is the ‘gold standard’ in medicine but it cannot take into account that we are all unique and that we may need different treatments to increase our fertility. And it is this ‘individually tailored’ approach which I believe is the key to finding a natural solution to infertility. The fact is that 37 per cent of the couples in this study had an established history of fertility problems and had undergone medical investigation. They did something different – changed their dietary habits and lifestyle – and then conceived. The information contained in this book explains in detail my enhanced version of this preconception programme.
It worked for them. It could work for you.

Type of Drug
corticosteroids, Oral (kor-tih-koe-STER-oids)
Brand Names
Betamethasone Celestone
Gerzq(t St D?Pdient: Budesonide Entocort EC
Cortisone Acetate &I
Dexamethasone EQ Mymethasone
Fludrocortisone
Hydrocortisone Cortef
Methylprednisolone 19 Medrol
Prednisolone 10
Orapred    Pediapred
Orapred ODT    Prelone
Prednisone 0 Prednisone Intensol    Sterapred
Prescribed For
A wide variety of disorders from rash to cancer, including adrenal disease, adrenal hormone replacement, bursitis, arthritis, severe skin diseases including psoriasis and other rashes, severe or disabling allergies, asthma, drug or serum sickness, attacks of multiple sclerosis, severe respiratory diseases including pneumonitis, blood disorders, gastrointestinal (GI) disease including ulcerative colitis and Crohn’s disease, and inflammation of the nerves, heart, or other organs. Dexamethasone is also used to treat mountain sickness, vomiting, bronchial disease in premature babies, excessive hairiness, and hearing loss associated with bacterial meningitis. Fludrocortisone is used to treat Addison’s disease and for symptomatic orthostatic hypotension. Prednisone is used to improve strength and function of some muscular dystrophy patients. Methylprednisolone is used to decrease mortality in some patients suffering from severe alcoholism and chronic active hepatitis.
General Information
Produced by the adrenal gland, natural corticosteroids are hormones that affect almost every body system. The major dMeyences among corticosteroid drugs are potency and variation in secondary effects, 0OZ10r preference and past experience with a Mftosferoid usually determine which drug to prescribe for a specific disease.
Cautions and Warnings
Do not use an oral corticosteroid if you are allergic or sensitive to any of its ingredients.
Corticosteroids may mask symptoms of an infection. Because these drugs compromise the immune system, new infections may occur during corticosteroid treatment; when this happens, a relatively minor infection that would respond to ordinary treatment can turn serious. Corticosteroids may impair immune response to hepatitis B, prolonging recovery. They may reactivate dormant amebiasis (a parasitic infection). Corticosteroids should not be taken if you have a fungal blood infection, because they can allow the infection to spread more easily. They should be used with caution by people with herpes eye infection, tuberculosis or in any other bacterial, fungal, or viral infections.
Long-term use of any corticosteroid may increase the risk of developing cataracts, glaucoma, or eye infections, especially viral or fungal.
When stopping a corticosteroid, dosage must be reduced gradually under a doctor’s supervision—otherwise you may experience adrenal gland failure.
If you are taking large corticosteroid doses. you should not receive any live virus vaccine because corticosteroids interfere with the body’s reaction to the vaccine.
Hydrocortisone and cortisone may lead to high blood pressure. Other corticosteroids are less likely to affect blood pressure.
Corticosteroids should be used with caution if you have severe kidney disease.
High-dose or long-term corticosteroid therapy may aggravate or worsen stomach ulcers. This may occur when total dosage reaches 1000 mg of prednisone, 150 mg of betamethasone or dexamethasone, 5000 mg of cortisone. 4000 mg of hydrocortisone, 1000 mg of prednisolone, or 800 mg of methylprednisolone.
People who have recently stopped taking a corticosteroid and are going through a period of stress may need small doses of a rapid-acting corticosteroid, such as hydrocortisone, to get them through this period. Call your doctor if you think you might be experiencing this kind of stress reaction.
Use corticosteroids with caution if you have had a recent heart attack or have, Colitis, heart failure, high blood pressure, blood-clotting tendencies, thrombophlebitis, osteoporosis, antibiotic-resistant infections, Cushing’s disease, myasthenia gravis, metastatic cancer, diabetes, underactive thyroid disease, cirrhosis of the liver, or seizure disorders.
corticosteroid psychosis (symptoms include euphoria or feeling “high,” delirium, sleeplessness, mood swings, personality changes, and severe depression) may develop in people taking dosages greater than 40 mg a day of prednisone. These symptoms may also develop with other corticosteroids taken in equivalent doses (see “Usual Dose” for relative equivalencies). Symptoms of corticosteroid psychosis usually develop within 15-30 days of beginning treatment. These symptoms may also be linked to other factors—women and those with a family history of psychosis are more at risk.
Corticosteroids can cause loss of calcium, which may result in bone fractures and aseptic necrosis of the femoral and humorai heads (a condition in which the large bones in the hip degenerate from loss of calcium).
Prednisone may aggravate emotional instability.
Corticosteroids do not cure multiple sclerosis (MS) or slow its progression, though they may speed recovery from attacks of the disease.
. Corticosteroid products often contain tartrazine dyes and sulfite preservatives. Many people are allergic to these chemicals.
Possible Side Effects
✓    Most common: headache, respiratory infections, acne, and bruising.
✓    Common: water retention (swollen ankles), back pain, heart failure, upset stomach (possibly leading to stomach or duodenal ulcer), potassium loss, dizziness, fatigue, insomnia, weight gain, increased appetite, nausea, stomach gas, abdominal pain, general pain, muscle weakness, loss of muscle mass, slowed healing of wounds, increased sweating, allergic rash, itching, convulsions, excess hair growth, and worsening of a pre-existing psychiatric condition.
✓    Less common: irregular menstruation; slowed growth in children, particularly after lengthy periods of corticosteroid treatment; adrenal or pituitary gland suppression; diabetes; drug sensitivity or allergic reactions; blood clots; moon face; feeling unwell; euphoria; mood swings; personality Changes; and severe depression.
♦    Rare: Rare side effects can appear in any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Tell your doctor if you are taking any oral anticoagulant (blood-thinning) drug. If you begin taking a corticosteroid, your anticoagulant dosage may have to be adjusted.
•    Combining a corticosteroid and a diuretic such as hydrochlorothiazide may cause loss of blood potassium. Low blood potassium may increase the side effects of digitalis drugs.
•    Contraceptive drugs, estrogen, erythromycin, azithromycin, clarithromycin, and ketoconazole may increase the risk of corticosteroid side effects.
•    Barbiturates, aminoglutethimide, phenytoin and other hydantoin anticonvulsants, rifampin, ephedrine, colestipol, and cholestyramine may reduce the effectiveness of corticosteroids.
•    Corticosteroids may decrease the effects of aspirin and other salicylates, growth hormones, and isoniazid.
•    Combining a corticosteroid and a theophylline drug may require a dosage adjustment of either or both drugs.
•    Corticosteroids may interfere with laboratory tests. Tell your doctor if you are taking any of these drugs so that tests are properly analyzed.
•    Limit your intake of alcohol while on oral corticosteroids.
Food Interactions
Take corticosteroids with food or a small amount of antacid to avoid stomach upset. If stomach upset continues, notify your doctor. Grapefruit juice doubles the amount of some oral corticosteroids absorbed into the blood.
Usual Dose
Once-daily doses should be taken in the morning. Dosages vary greatly and depend upon the specific disease being treated. Dosages for infants and children should be individualized according to severity of disease and response to treatment.
Betamethasone: starting dosage-0.6-7.2 mg a day. Maintenance 1609age-0.6-7.2 mg a day.
Budesonide: 9 mg a day.
Cortisone: starting dosage-25-300 mg a day. Maintenance dosage-25-300 mg a day.
Dexamethasone: 0.75-9 mg a day. Daily dosage sometimes exceeds 9 mg. A temporary dosage increase may be necessary it you are experiencing emotional stress. In alternate-day therapy, twice the usual daily dose is taken every other day.
Hydrocortisone: 20-240 mg a day.
Methylprednisolone: starting dosage-4-48 mg or more a day. Maintenance dosage varies. A temporary dosage increase may be necessary if you are experiencing emotional stress. in alternate-day therapy, twice the usual daily dose is taken every other day.
Prednisone and Prednisoione: 5-60 mg a day. Daily dosage sometimes exceeds 60 mg. A temporary dosage increase may be necessary if you are experiencing emotional stress. In alternate-day therapy, twice the usual daily dose is taken every other day.
Equivalent doses: Using 5 mg of prednisone as the basis for comparison, equivalent doses of other corticosteroids are 0.6 mg-0.75 mg of betamethasone, 25 mg of cortisone, 0.75 mg of dexamethasone, 20 mg of hydrocortisone, 4 mg of methylprednisolone, and 5 mg of prednisolone.
Overdosage
Symptoms of overdose are anxiety, depression or stimulation, joint or muscle pain, blurred vision, stomach bleeding, increased blood sugar, high blood pressure, and water retention. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking this medication without your doctor’s knowledge. Suddenly stopping any corticosteroid drug may have severe consequences; the dosage must be gradually reduced by your doctor.
G& your doctor if you develop unusual weight gain, black or tarry stools, swelling of the feet or legs, muscle weakness, vomiting of blood, menstrual irregularity, prolonged sore throat, fever, cold or infection, appetite loss, nausea and vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar.
If you take several doses a day and forget a dose, take the dose you forgot as soon as possible. It it is almost time for your next dose, skip the one you forgot and double the next dose. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
If you take a corticosteroid every other day and forget a dose, take it immediately if you remember it in the morning of your regularly scheduled day. If it is much later in the day, skip the dose you forgot and take it the following morning, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Studies have shown that long-term corticosteroid therapy at high dosages may cause birth defects, as may chronic corticosteroid use during the first 3 months of pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Corticosteroids taken by mouth may pass into breast milk. Most nursing mothers who must take a corticosteroid should use infant formula, though low dosages of some of these drugs may be taken for short periods while breast-feeding. Consult your doctor.
Seniors: Seniors are more likely to develop high blood pressure while taking an oral corticosteroid. Older women are more susceptible to osteoporosis (a condition characterized by loss of bone mass due to depletion of minerals, especially calcium) associated with high dosages of oral corticosteriods. Lower dosages are just as effective in seniors and cause fewer side effects.

Type of Drug
Corticosteroids, Topical
(kor-tih-koe-STER-oids)
Brand NameS
CLASS 1–Super-potent topical products
Betamethasone Dipropionate gel, ointment 0.05% 91
Diprolene gel/ointment
C/obetasol Propionate 0.05% cream, foam, gel, lotion, shampoo, ointment 19
Clobex    Olux
Cormax    Olux E
Embeline    Temovate Embeline E
Difforasone Diacetate ointment 0.05% RE Olux-E Foam    Psorcon E
Fluocinonide cream 0.1 % 0 Vanos
Flurandrenolide tape 4 MCgICM2 Rfl Cordran Tape
Halobetasol Propionate cream/ ointment 0.05%
Ultravate
CLASS 2—High-potency topical products  Amcinonide ointment 0.1 % (0
Betamethasone Dipropionate cream 0.05%
Diprolene AF
Generic Ingredients: Betamethasone Dipropionate (0.064%) + Calcipotriene (0.005%) ointment
Taclonex
Desoximetasone Cream, ointment 0.25% and 0.05%; 0.05% gel DG
Topicort    Topicort LP
Generic 10gVEOUnt.- Diflorasone Diacetate cream, ointment 0.05% 91
Apexicon    Florone E
Apexicon E    Maxiflor
Florone    Psorcon
Fluocinonide cream, gel, ointment,
solution 0.05% 9
Lidex    Lidex E
Halcinonide cream, ointment, solution 0.1 % Halog
Mometasone Furoate ointment 0.1 % 91 Elocon
Triamcinolone Acetonide ointment 0.5% RE
CLASS 3—Upper mid-strength topical products  Amcinonide lotion 0.1 % 0
Betamethasone Dipropionate cream 0.05% (a
Diprolene    Teladar
Maxivate
Generic Ingredient.- Betamethasone Valerate ointment 0.1 %
Fluocinofone Acetonide [’61 Capex Shampoo
Fluticasone Propionate cream 0.05% 9 Cutivate
Triamcinolone Acetonide cream 0.5%
Delta-Tritex    Kenonel
Flutex    Triacet
Kenalog Cream    Triderm Kenalog-H
CLASS 4—Mid-strength topical products  Amcftnide cream 0.1% D3
Betamethasone Dipropionate lotion 0.05% and foam 0.12%®
Diprosone    Maxivate Lotion
Luxiq Foam
Desoximetasone cream 0.05% 19 Topicort
Fluocinolone Acetonide
Synalar Ointment 0.025%    Synalar-HP Cream 0.2%
Flurandrenolide ointment 0.05% Cordran
Fluticasone Propionate lotion 0.05% Cutivate
Hydrocortisone Valerate ointment 0.2% ED Westcort
Mometasone Furoate cream, lotion, solution 0.1
Elocon
Prednicarbate ointment 0.1 % 10 Dermatop E
Triamcinolone Acetonide 0.1 %
Aristocort A    Delta-Tritex Cream
Aristocort Cream and    Kenalog
Ointment    Triderm
CLASS 5—Lower mid-strength topical products  Betamethasone Valerate cream, lotion 0.1
Beta-Val    Dermabet
Betatrex    Valnac
Clocortolone Pivalate cream 0.1 % Cloderm
Desonide ointment 0.0511/0
Desonate    Tridesilon
UnOwen    Verdeso Foam Lokara
Fluocinolone Acetonide cream 0.025% 91 Synalar
Flurandrenolide cream, lotion M Cordran Lotion 0.05% Cordran SP 0.05% Cordran Ointment 0.25%
Fluticasone Propionate ointment 0.005% Cutivate
Hydrocortisone Butyrate Cream, ointment, solution 0.1 0
Locoid
Hydrocortisone Probutate 0.1% Pandel
Hydrocortisone Valerate cream 0.2% RE Westcort
Prednicarbate Cream 0.1 % RE Dermatop E
CLASS 6—Mild topical products
Alclometasone Dipropionate cream, ointment 0.05% 91
Aclovate
Desonide cream, lotion 0.05% DesOwen    Tridesilon Lokara
Fluocinolone Acetonide cream, shampoo, solution 0.01%
Derma-Smoothe/FS Oil    FS Shampoo
Flurosyn    Synalar
Flurandrenolide cream DG Cordran SP 0.025%
Generic Ingredient., Triamcinoione Acetonide cream 0.1 % MS10cort
Triamcinolone Acetonide cream 0.025% Flutex    Triacet
Kenalog
CLASS 7—Least potent topical products  Hydrocortisone A
1% HC    HydroSkin
Ala-Cort    HydroTex
Ala-Scalp    Hytone
Alcortin    Ivy Soothe
Analpram-HC    Maximum Strength Bactine
Anusol-HC    Maximum Strength Cortaid
Cetacort    Maximum Strength Cortaid
Cortaid Intensive Therapy    Faststick
Cortizone-5    Maximum Strength
Cortizone-10    KeriCort-1 0
Cortizone-10 Plus    Nutracort
Cortizone-10 Quickshot    Procort
Cortizone for Kids    Proctocream-HC
Delcort    Proctofoam-HC
Extra Strength CortaGel    Stie-cort
Hemril    Synacort
Hi-Cor 1.0    Tegrin HC
Hi-Cor 2.5    Texacort Hycort
Hydrocortisone Acetate cream, ointment 0.5% and 1%G
Cortef Feminine Itch    Lanacort
Corticaine    Maximum Strength Caldecort
Cortifoam    Micort-HC
Dricort    U-Cort Gynecort Female Creme
Prescribed For
Inflammation, itching, eczema, dermatitis, vitiligo (patchy loss of skin color), blistering skin diseases, lupus and other connective tissue diseases, psoriasis, and many other specialized skin problems; may also be used to Weal severe diaper rash.
General Information
Topical corticosteroids do not cure the underlying cause of skin problems, but they can relieve symptoms of rash, itching, or inflammation by interfering with the body mechanisms that produce them. You should never use a topical corticosteroid without your doctor’s knowledge because it could mask a symptom important in diagnosing your condition. Also, improper use of a topical corticosteroid could lead to unwanted and sometimes permanent side effects. In general, ointment forms of topical steroids are more potent and usually more effective than cream or lotion forms. Ointments are also less likely to cause allergic reactions because they contain fewer inactive ingredients.
Generic products in this group can vary in potency and produce different results from their brand-name counterparts, even though they contain the identical quantity of active ingredient. Topical steroids are rated from 1 (most potent) to 7 (least potent). Generally, products within a potency class are interchangeable. Ask your doctor or pharmacist which products are interchangeable. The lowest potency products are available without a prescription. Ointments tend to be more potent than creams and solutions and different product concentrations affect their classification.
Super-potent topical corticosteroids (class 1) should not be used on the face, neck, under the arms, or in the groin area. These products are generally reserved for situations in which less potent products have not worked. They should be used with caution, and should only be applied to the areas that are affected with the rash. Using a product in this category for longer than 2 weeks at a time increases the risk of permanent skin damage.
High-potency topical corticosteroids (classes 2 and 3) are best for the trunk, arms, and legs, but should not be used on the face, neck, under the arms, or in the groin area. Using a product in this category for longer than 2 weeks at a time increases the risk of permanent skin damage.
Intermediate-potency topical corticosteroids (classes 4 and 5) can be used in children for up to 1-2 weeks at a time. This type of medication is best for the trunk and extremities. It is safer for use on thin skin, and less effective on thicker skin.
Low-potency topical corticosteroids (classes 6 and 7) can be used on any part of the body, and can be used in children. They are the best choice for the face, uadera~m area, groin, neck, and i ftl Occluded areas such as skin folds.
Cautions and Warnings
Do not use a topical corticosteroid if you are allergic or sensitive to corticosteroids or to any ingredients of the aerosol, cream, gel, lotion, ointment, or solution. Do not use a topical corticosteroid as the sole treatment for bacterial skin infections such as impetigo, viral skin diseases such as herpes, fungal skin infections such as athlete’s foot, or known tuberculosis of the skin. These drugs should not be used in the ear if the eardrum is perforated. Do not use a topical corticosteroid on ulcerated skin, or to treat acne.
Skin problems can become less responsive with time if a product is applied continuously over a long period of time. This can re-
sult in a flare-up of the problem when the medication is stopped.
Using a less potent product may avoid this problem.
Rectal corticosteroid products should not be used if you have any serious bowel condition, including bowel perforation, obstruction, abscess, and systemic fungal infection.
The rectal foam is not expelled after it has been applied and may result in higher drug blood levels than those associated with rectal enema products. The risk of systemic (whole-body) side effects is greater when more of the drug enters the blood. If there is no improvement after 2 or 3 weeks of using a rectal corticosteroid, contact your doctor.
Using a topical corticosteroid around the eyes for prolonged periods may cause cataracts, glaucoma and/or permanent thinning and fragility of skin around the eyes where the corticosteroid is being applied.
Children may be more susceptible to serious systemic side effects from topical corticosteroids, including growth retardation, Cushing’s syndrome, and suppression of natural corticosteroid production, requiring a tapering of the medication, especially if the medications are applied to large areas over long periods. Super-potent topical corticosteroids are not recommended for children.
Possible Side Effects
♦ Most common: burning; itching; irritation; “steroid” acne; skin thinning, tightening, or discoloration; stretch marks; dry cracked skin; bruising; and secondary i0ection. These effects are more likely when the treated area is covered Stith al) occlusive bandage (one that prevents contact with water and air). Side effects are more likely with extended use of high-potency topical corticosteroid products and when the treated area is covered with a bandage that completely prevents skin contact with water and air.
Possible Side Effects (continued)
V Significant amounts of corticosteroids may be absorbed into the bloodstream if large amounts are used for long periods. This can result in systemic effects and may cause serious problems, particularly in people with liver disease. Systemic side effects include lightheadedness, hives, growth suppression, and adrenal suppression.
Drug Interactions None known.
Usual Dose
Adult
Cream, Ointment, Solution, Foam, and Aerosol: Apply a thin film to the skin 2-3 times a day. High- and super-potent products should be applied no more than twice a day, and should be used for short-term treatment, usually 2-3 weeks at a time. Some may have to be applied only once a day.
Rectal Enema: 100 mg nightly for 21 days.
Rectal Foam: 1 applicator’s worth, 1-2 times a day for 2-3 weeks.
Child: Dosages for children should be limited to the lowest possible potency.
Overdosage
Serious adverse effects are unlikely after accidental ingestion. Excessive use of large amounts of topical corticosteroids may cause overdose symptoms and require gradual discontinuation of the drug. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the prescription bottle or container.
Special Information
To prevent secondary infection, clean the skin before applying the drug. Apply a very thin film and rub in gently—effectiveness depends m contact area, not the thickness of the layer applied.
Do not wash, rub, or put clothing on the area until the medication has dried.
Topical corticosteroids have an additive effect: with continuous use, 1 or 2 applications a day may be as effective as 3 or more. Once the drug begins to take effect, your doctor may recommend reducing the dose to the minimum level needed to control the
condition.
Flurandrenolide tape comes with specific directions for use-, fol-
low them carefully.
If your doctor instructs you to apply plastic wrap or any other occlusive dressing, follow directions carefully. These dressings can increase the penetration of the drug into your skin by as much as 10 times, which may be a crucial element in the medication’s effectiveness. Occlusive dressings should not be used with any of the super-potent topical products.
If you are using one of these products for diaper rash, do not use tight-fitting diapers or plastic pants, which can cause too much drug to be absorbed into the blood.
Your doctor may prescribe a specific form of the product with good reason. Do not change forms without your doctor’s knowledge: a different form may not be as effective.
If you forget to administer a dose, do so as Soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not administer a double dose.
Special Populations
Pregnancy/Breast-feeding: Large amounts of corticosteroids applied to the skin for long periods of time may increase the risk of birth defects. When your doctor considers any of these drugs crucial, its potential benefits must be carefully weighed against its risks. Do not use any over-the-counter hydrocortisone product for more than a few days without your doctor’s knowledge.
Nursing mothers who must use a topical corticosteroid should consider using infant formula. If you apply a corticosteroid to the nipple area, be sure to completely clean the area prior to nursing. Nursing mothers should never use the highest potency corticosteroids (classes 1, 2 or 3) because of the risk of absorbing large amounts of drug into the system that could find its way into breast milk. Nursing mothers should discuss toqkoa1 corticosteroid use with their doctor befQ(e,applying any product.
Seniors: Seniors are more susceptible to high blood pressure and osteoporosis (a condition characterized by loss of bone mass due to depletion of minerals, especially calcium) associated with large dosages. These effects are unlikely with topical corticosteroids unless a high-potency medication is used over a large area for an extended period.

Brand Name
Cortisporin Otic
Generic Ingredients
Hydrocortisone + Neomycin Sulfate + Polymyxin B Sulfate RE
Other Brand Names
AK-Spore H.C. Otic    Octicair
Antibiotic    Otic-Care
Cortatrigen Ear Drops    Otocort
Drotic    Pediotic
Ear-Eze    UAD LazerSporin-C
Type of Drug
Antibiotic and corticosteroid combination.
Prescribed For
Superficial ear infection, ear inflammation or itching, and other outer ear problems.
General Information
Cortisporin Otic contains a corticosteroid to reduce inflammation and 2 antibiotics to treat local ear infections. This combination can be quite useful for local ear problems because of its dual method of action and its relatively broad applicability.
Cautions and Warnings
Do not use Cortisporin Otic if you are allergic or sensitive to any of its ingredients.
Cortisporin Otic is designed for use in the ear. It can be very damaging if placed into the eye.
Cortisporin should not be used if you have herpes simplex, vaccinia, or chickenpox. It also should not be used by patients sensitive to sulfite.
Cortisporin Otic should not be used iAyou have a perforated eardrum,
Possible Side Effects
V Local irritation, such as itching or burning, may occur as a drug sensitivity or allergic reaction.
Drug Interactions None known.
Usual Dose
3-4 drops in the affected ear 3-4 times a day. Treatment should not last beyond 10 days.
Overdosage
The amount of drug contained in each bottle is too small to cause serious problems. Call a hospital emergency room or your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Use only when prescribed by a physician. Overuse of this or similar products can result in the growth of new organisms, such as fungi. If new infections or problems appear, stop using the drug and contact your doctor.
Before administering drops, wash your hands, then hold the Closed bottle in your hand for a few minutes to warm it to body temperature. Shake well for 10 seconds. For best results, drops should not be self-administered, but given by another person. The person receiving the drops should lie on his or her side with the affected ear facing upward. Fill the dropper and instill the required number of drops directly in the ear canal.
If the drops are being given to an infant, hold the earlobe down and back to allow the drops to run in. If the drops are being given to an older child or adult, hold the earlobe up and back to allow them to run in. Do not put the dropper into the ear or allow it to touch any part of the ear or bottle. Keep the ear tilted for about 5 minutes after the drops have been put in or insert a soft cotton plug, whichever is recommended by your doctor.
If you forget to administer a dose of Cortisporin Otic, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedQ%e. Do not apply a double dose.
Special Populations
Pregnancy/Breast-feeding: There are no studies of Cortisporin Otic in pregnant women but it does contain a corticosteroid, which when used over long periods of time in other formulations may increase the risk of birth defects. This drug should only be used during pregnancy after carefully weighing it potential benefits against its risks. Nursing mothers who must take this drug should use in-Pant formula.
Seniors: Seniors may use this product without special restriction.

Brand Name
Cosopt
Generic Ingredients  Dorzolamide + Timolol
Type of Drug
Carbonic anhydrase inhibitor and beta blocker combination.
Prescribed For
Open-angle glaucoma and ocular hypertension.
General Information
Cosopt contains 2 glaucoma drugs that work in different ways. It is intended for people whose glaucoma does not respond to either drug used alone. Small amounts of dorzolamide and timololthe active ingredients in Cosopt–enter the bloodstream.
Cautions and Warnings
Do not use Cosopt if you are allergic or sensitive to any of its ingredients or cannot take sulfa drugs or beta blockers. Cosopt should not be used by people with bronchial asthma, severe chronic obstructive pulmonary disease, slow heart rate or heart block, heart failure, or who are in shock.
People with diabetes or an overactive thyroid should use Cosopt with caution since beta blockers can mask the signs of low blood sugar or hyperthyroidism.
Small amounts of both ingredients enter the bloodstream and can produce the same kinds of systemic (whole-body) reactions associated with larger dosages of either a sulfa drug or beta blocker. Stop using the drug at once and call your doctor if a serious reaction develops.
4lt?18b)ockers may have to be discontinued prior to major surgery because they can affect the heart’s ability to respond normally. Some people taking a beta blocker experience severe reductions in blood flow while undergoing general anesthesia.
Dorzolamide should not be used by people with kidney disease and has not been studied in people with liver disease.
People with a history of severe allergic reactions who take a beta blocker may be at increased risk of experiencing a reaction because the drug blocks part of the body’s natural allergic
response.
Timolol can worsen the muscle weakness that accompanies myasthenia gravis.
Possible Side Effects
♦    Most common: changes in sense of taste, especially bitterness or sourness; increased sensitivity to light; and a burning or stinging sensation in the eye.
♦    Common: eye redness, irritation, or itching, and blurred vision.
♦    Less common: abdominal pain, back pain, eyelid inflammation, bronchitis, cloudy vision, eye discharge or swelling, conjunctivitis (pinkeye), corneal erosion, corneal staining, lens cloudiness, cough, dizziness, dry eye, upset stomach, drug particles in the eye, eye pain, tearing, eyelid scaling, eyelid pain or discomfort, sensation of something in the eye, headache, high blood pressure, influenza, lens discoloration, nausea, sore throat, cataracts, sinus irritation, respiratory infection, urinary infection, visual problems, and retinal detachment.
•    Rare: slow heartbeat, heart block or failure, chest pain, stroke, depression, diarrhea, dry mouth, breathing difficulties, low blood pressure, stuffy nose, rash, tingling in the hands or feet, kidney stones, and vomiting. Contact your doctor if you experience any side effect not listed above.
See Dorzolamide, page 200, and Timolol, page 1129, for fur-
ther side effect information.
Drug Interactions
•    If you use more than 1 eyedrop medkc;a~mn, separate doses of these drugs tai z& Y@ast 10 minutes.
•    COSOpt can increase the effect of other carbonic anhydrase inhibitors.
•    Combining Cosopt with an oral beta blocker or another calcium antagonist may increase the risk of side effects, especially changes in heart rhythm and low blood pressure.
•    Do not combine Cosopt and another beta-blocking eyedrop.
•    Combining Cosopt and reserpine can lead to low blood pressure, slowing of heartbeat, and dizziness or fainting.
•    Combining Cosopt with digitalis and a calcium antagonist, or with quinidine, can slow heartbeat.
See Dorzolamide, page 200, and Timolol, page 1129, for further drug interactions.
Usual Dose
Adult: 1 drop in the affected eye twice a day. Child: not recommended.
Overdosage
Little is known about the effects of Cosopt overdose or accidental ingestion. Possible overdose symptoms include dizziness, headache, shortness of breath, slow heartbeat, breathing difficulties, heart attack, and nervous system effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Conjunctivitis (pinkeye) and eyelid reactions can occur due to an allergic reaction or as the result of local irritation. If you experience either of these problems, stop using the drug and call your doctor so that your condition can be evaluated.
To prevent infection, do not allow the eyedropper to touch your fingers, eyelids, or any surface. Wait at least 10 minutes before using any other eyedrops.
Cosopt contains benzalkonium chloride (a preservative), which may be absorbed by soft contact lenses. Remove your soft contact lenses before using the eyedrops; you may put them back in 15 minutes after a dose.
If you forget a dose of Cosopt, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Store Cosopt away from sunlight.
Special Populations
Pregnancy/Breast-feeding: The safety of using Cosopt is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if dorMlamidle passes into breast milk, though timolol does. Nursing mothers who must use Cosopt should use
infant formula.
Seniors: Seniors may use Cosopt without precaution.

FEVERFEW
Feverfew (Tanacetum parthenium) has a history of use by healers that goes back to the ancient Greeks propranolol public speaking . Seventeenth-century English settlers brought it with them to the colonies and used it to treat fever, vertigo, depression, and headaches desogen causing depression . Although it fell out of favor by the 19th century, it has experienced a revival in the last decade or so itraconazole vs fluconazole winston antifungal . Studies have shown
that it can indeed help headaches, but it is used primarily for migraine prevention rather than for treatment sildenafil infrared .
Feverfew is used more often in Europe and Canada than in the United States, perhaps because their regulatory bodies have authority over herbal products will theophylline help my dogs cough . In Canada, feverfew prod
** Feverfew
A feverfew extract with at least 0 effexor withrawal .1 percent parthenolide might be helpful in preventing migraines verapamil cluster . It is taken daily molecular weight of enalaprilat not enalapril . Look for a standardized product such as the Canadian nonprescription medicine Tanacet wellbutrin sunburn .
Side effects: Canker sores, mild indigestion, and flatulence Downside: May interact with anticoagulant medicines flagyl stomach problems . Pregnant women should avoid this herb synthroid drip . Discontinuation should be done gradually; stopping abruptly has been associated with a “rebound effect” of severe migraines and steep disturbance side affects of zetia .
Cost: Approximately $3 to $4 for a month’s supply
ucts must by law contain a minimum of 0 verapamil 240mg .2 percent parthenolide imodium ad for children dosage . In France, the minimum is 0 dangers of cirrhosis and levitra .1 percent is tramadol an anti inflammatory .Animal studies have confirmed that parthenolide is the active ingredient get tadalafil . 311 For migraine prevention, the herb is taken daily for at least 2 months getting off lipitor .
A rigorous review of double-blind, placebo-controlled trials involving feverfew found that the results were mixed sertraline and hair loss . Not all the studies supported the efficacy of the herb as a migraine preventive cheapest viagra online . 331 The reviewers did conclude, however, that feverfew appears to be safe effexor side effects not working . A more recent German study demonstrated that a supercritical carbon dioxide extract of feverfew was more effective than placebo in reducing the frequency of migraine headaches caffeine amounts in monster energy drink .337 In this study, side effects were equally uncommon with the feverfew extract and the placebo paxil and cannibus .
Feverfew is generally thought not to be effective for treatment once a migraine headache has begun, but a small preliminary study had patients take a product called GelStat Migraine under their tongues as soon as they had an inkling that a migraine WaS aW111 10 occur digoxin in treating dogs . This nonprescription product contains both feverfew and ginger hydroxyzine 25 mg . A majority of patients who used it got relief, but the study was not placebo-controlled, and further research is needed to confirm these results zion energy solutions exelon .
BUTTERBUR
Butterbur (Petasites hybridus) is another old-fashioned herb that has just resurfaced lithium n cell batteries . In Europe, it is sometimes referred to as “plague plant,” despite a lack of any evidence that it was effective against the plague diovan generic substitute . There is evidence that butterbur can be useful in preventing migraine headaches, but only a few randomized, double-blind studies have been reported cellulitis and clindamycin . 331,11 One study without placebo control found that butterbur root extract can reduce migraine frequency in children and adolescents atenolol side effects prostate problems . 341
Questions have been raised about the long-term safety of some butterbur products because the plant contains pyrrolizidine alkaloids, which are toxic to the liver wellbutrin and xanax for social anxiety .The manufacturer of the patented butterbur root extract used in one of the trials, Petadolex, has reported that the studies conducted on this product confirm its safety for humans cephalexin great dane . 142 The supercritical carbon dioxide extraction process leaves behind the dangerous pyrrolizidine alkaloids discontinuation of wellbutrin xl .343
A product intended for prevention is taken on a daily basis for a long time zelnorm class action . If you decide to try butterbur, we suggest you stick with one that is extracted with supercritical carbon dioxide and check in with your doctor oxybutynin drug .
Acupuncture
Quite a few studies have evaluated acupuncture for treating migraine headaches trazodone stories . The majority of them demonstrate that acupuncture is helpful in alleviating the pain, whether it is used as a preventive measure or in treating an acute headache fosamax total bilirubin .-344 In one large British study, patients undergoing acupuncture took fewer sick days and used less pain medication than they had before treatment pediatric chlorzoxazone dosage .345
Oddly enough, acupuncture seems to achieve these goals even though a properly randomized trial, with sham acupuncture serving as the placebo treatment, couldn’t distinguish between the benefits of real Chinese acupuncture and those of fake acupuncture cardizem la prostrate .346 Both “acupuncture” treatments were clearly superior to doing nothing, as shown by the results from patients in a second control group, who received no treatment during the study ld 50 of omeprazole . Both were also equal to standard preventive drug treatment in another well-designed study is caffeine a dieurectic .347
Not everyone responds to acupuncture, but for those who do, it appears to be a reasonable way to cope with migraine headaches, with a minimal risk of side effects appetite metformin . For treating an acute headache, acupuncture is better than placebo, but not quite as good as sumatriptan (Imitrex) dizziness coumadin atrial fibrillation .348
*** Acupuncture
In general, acupuncture seems to be a safe way to reduce the frequency of migraines and help sufferers cope with them better celebrex deths . Despite research showing that sham acupuncture works just as well, we suggest that you consult a doctor who has been formally trained in acupuncture technique and is experienced in its use for migraine coumadin overdose suicide .
Side effects: Serious side effects are rare mesalamine and diarrhea .349 Minor pain or bruising at the needle site is fairly common soma tabs . 1,0
Downside: Not everyone responds to acupuncture lipitor clinical trials . Some studies suggest the effect is essentially a strong placebo reaction manufacture of penicillin .
Cost: Approximately $60 to $120 per session zyprexa zydas . May be covered by insurance,
Other Nondrug Approaches
As limited as it is, the research literature on herbal products like butterbur and feverfew is almost extensive in comparison to a few other approaches that pop up in medical journals here and there side effect of amoxicillin anxiety . A Brazilian study suggests that melatonin (3 milligrams daily) is effective in preventing migraines yasmin interaction amoxicillin fluconazole .3′ Another study, this one carried out in Switzerland, found that coenzyme Q,,), given at a dose of 100 milligrams three times a day, was supenor to placebo does predisilone effect despo provera .-12 Both of these treatments are readily available without a prescription and reasonably safe cymbalta commercial song . Coenzyme Q , probably should be avoided by people taking the anticoagulant Coumadin (warfarin), however, because of the potential for interaction between the two vasopressin citalopram .
Since the age of 231 have had frequent migraine headaches methotrexate in use for ectopic pregnancy . Over the years, many doctors have prescribed medicines to prevent them, but none has worked prednisone during pregnancy and large baby . Drugs can stop the migraine if I take them early enough, but they shouldn’t be taken too often nolvadex for pct .
I was told the headaches would disappear at menopause, but instead they got worse 10mg of accutane effectiveness . For the past 10 years I have awakened three or four times a week between 2 and 4 a buy topamax online canada .m side effects aripiprazole . with a migraine celebrex celecoxib capsule . I look at my bedside clock when the headache wakes me fluoxetine average doses .
I read an article about people taking melatonin for jet lag and wondered if my headaches were due to a body clock problem imitrex and rebound headache . The article didn’t say anything about migraines, but I tried an experiment keflex antibotic . I started taking one 3-milligram melatonin tablet each evening, and I stopped waking up with a headache in the wee hours vytorin side effects muscles .
For years I have been avoiding all sorts of foods that might be migraine triggers abstracts on caffeine tear production . The success with melatonin made me brave and I ate some of them h pylori doxycycline . No headache, as long as I take the melatonin naproxen long term use . I consider myself lucky and want to share my discovery thyroxine diet supplements .
Another treatment that seems to be both safe and fairly effective is biofeedback to help people learn to warm their fingers floxin otic in perforated eardrum . Presumably this activity also affects the blood vessels in the head that are believed to be involved in migraine altace and bloodpressure . This type of biofeedback has been studied and found helpful in children and adolescents mobic alternatives .-”‘ Finding a professional to supervise biofeedback training and maintaining practice in the biofeedback technique might be a challenge for families oral estradiol for ivf .
We have heard from a number of people who have used hot, spicy soup to stop a migraine quickly when they feel one coming on pepcid ac alcohol . There’s not much research on this approach but no harm in trying it, either mebendazole indications for treatment .
0 0 *
Q zyrtec liquid tablet . I have enjoyed reading about spicy gumbo and hot and sour soup for migraine and cluster headaches sumatriptan imitrex prescription . No one can imagine how terrible cluster headaches can be patient information on wellbutrin sr . Anything that could help stop the cycle of pain would be a blessing images of simvastatin .
A testosterone level . People have described cluster headaches as feeling like a blowtorch applied to the eye or a red-hot poker being thrust into the skull tetracycline does not effect eukaryotes . To make the agony worse, cluster headaches may recur a few times a week or even several times in a day discounted celebrex .
People tell us that hot peppers in a variety of forms can be helpful in cutting the cycle short recreational viagra use . One fellow prefers a spicy Chinese tofu dish called mapo dofu, but he says anything with enough hot sauce works for him medical lexapro .
Another man relies on Tabasco sauce under his tongue citalopram para agorafobia . He chases this “strong medicine” with a glass of ice water and reports relief “in 5 minutes max anti anxiety buspar treating com .”
The active ingredient in hot pepper is capsaicin coumadin versus warfarin .
Though it may not work for everyone, sipping spicy soup seems worth a try ultram coupons .
0 0 0
None of these approaches is a substitute for regular medical care effects of glucophage on weight . A person with migraines should be under the care of a health-care provider, usually a physician, who can diagnose the problem and supervise the treatment how long to take prilosec . That is doubly true for anyone whose headaches are so frequent that prevention is an appropriate strategy digitek computer products . If you are interested in nondrug approaches to headache prevention, find a doctor or nurse practitioner who ho is comfortable discussing them with you and keep that person informed of what treatment you are using and how well it is working atenolol and migraine umaxppc .35′ There are a number of drugs that can be effective both for preventing and treating migraine headaches energiser aa lithium .
Migraine Medications
There are no advantages to having migraine headaches apotex generic plavix . By all accounts, it is a miserable experience cephalexin cellulitis . But a person who is tuned in to her body may have an advantage in outflanking the migraine: Sometimes there are early warning signs—the so-called aura—that tip a person off that a migraine is on its way herbal doxycycline . These sensations can range from “little blinky lights” (as one caller described them on our radio show), to tingling in the fingers, to a hint of nausea photo phenergan 12.5 mg . (Full-blown nausea and even vomiting are frequent components of a migraine orexis as good as viagra .)
If you arc a migraine sufferer, get to know your own warning signals of an oncoming headache and act immediately provera barr . Any kind of medicine used to treat a migraine works best if it is taken at the earliest possible stage, before the headache has really taken hold paxil cr availability . Don’t wait to see if your early warni~gwas accurate; assume it was and lake action acyclovir teva .
Over-tire-Counter Painkillers
Because migraines are heavy-duty headaches, we tend to think of treating them with prescription medicine-s elavil dosage no prescription . That may be completely appropriate for people whose headaches often include nausea or frequently drive them to take to their beds azithromycin sun . But for less incapacitating headaches, an OTC combination This widely available nonprescription medicine contains acetaminophen, aspirin, and caffeine zoloft works wonders . The caffeine may help it take effect quickly doxycycline and cacner . It works better than placebo and also better than nonprescription ibuprofen and prescription sumatriptan pills going off fosamax .
This medicine is not intended for the most severe migraines celexa 4741 . The dose of two tablets should be taken as soon as a migraine sufferer suspects a headache is on its way overdose of amitriptyline in cats .
Side effects: Uncommon, but nervousness and nausea have been reported otc paroxetine .
Downside: If this medication is overused, an occasional migraine could become chronic how did penicillin lead to warfare . At that point, the potential side effects of liver and kidney problems would be worrisome cialis non generic . If you find you are using this medicine more than twice a week, seek professional help for your headaches esomeprazole magnesium buy .
Cost: Approximately 10 to 15 cents per dose
drug containing acetaminophen, aspirin, and caffeine (Excedrin Migraine) is surprisingly effective dexamethasone chemotherapy university chicago 2004 .
OTC ibuprofen has also been tested for the treatment of migraines altace rampiril tingling . Randomized, double-blind studies have shown that both Advil Migraine liquigels and Motrin Migraine Pain tablets are better than placebo albuterol inhaler dose .”"” But Excedrin Migraine outperformed ibuprofen in a head-to-head trial zoloft with sudafed .357 What’s more, the acetaminophen-aspirin-caffeine combination also beat out the prescription drug sumatriptan (Imitrex) in reducing pain and associated symptoms and reducing the amount of additional pain medication that study subjects needed celexa depakote .3-58
Prescription Migraine Medicines
The biggest advance in the treatment of migraines has been the development in the last decade and a half of medicines called “triptans hydroxyzine hcl 25 mg tab .” These selective serotonin receptor agonists are now the mainstay treatment for severe migraine headaches prednisone doesage amount for cat . Taken early in an attack, they reverse the chemical changes that lead to migraines and actually stop the headache pain in many cases generic equivalent to zyprexa .
The first triptan to be developed was a self-administered injection of sumatriptan (Imitrex), but before long both Imitrex and other triptan compounds became available as oral medicines singulair in children .The injection may still be very helpful for some individuals who become so nauseated at the onset of a migraine that pills won’t stay down prednisone withdrawl itching .
The triptans are available only by prescription valtrex $89.00 500 mg . In studies that have compared them to the older migraine medicine, ergotamine and caffeine (Cafergot), the triptans have done well, relieving the headache pain more quickly and effectively without significant side effects canine use of loratadine .359,3W
The doctor will need to know about certain aspects of your health and medical history that might make one of these medications too dangerous ultram and information . For example, there have been some unanticipated heart attacks among people taking one of these drugs during a migraine, so the prescriber will want to know about your risk of heart attack theraputic dose of generic wellbutrin . Do you have high blood pressure, diabetes, or high cholesterol? Is there a family history of heart attack or stroke? Such serious reactions, fortunately, are rare, but make sure your physician gets all the relevant details new york celebrex versus vioxx . It’s your life at stake nystatin and triamcinolone cream .
One possible benefit of the extremely high price tags on most of the triptans is that it would discourage anyone from overusing these medications prozac depressions . Of course, without insurance that covers prescription drugs, a migraine sufferer might find it difficult to afford them at all guaranteed lowest price on norvasc . If cost is an issue, ask your doctor whether an older, less expensive drug such as ergotamine and caffeine (Cafergot) might work for you zanaflex drug abuse . Ergotamine
TRIPTANS
• Almotriptan (Axert)
• Eletriptan (Relpax)
• Frovatriptan (Frova)
• Naratriptan (Amerge, Naramig)
• Rizatriptan (Maxalt)
• Sumatriptan (Imitrex, Imigran)
• Zolmitriptan (Zomig)
WHAT THE FDA KNEW
After a woman in Kansas City died following an injection of Imitrex, we followed up on a lead from reporter Kelly Garbus in the Kansas City Star prozac herbal . Through a Freedom of Information Act request (Number F95-00866), we discovered that the FDA was aware of this risk even before the drug was - approved water retention lovastatin . These lines were included in a memo from Paul Leber, MD, who headed the section that reviewed the drug, to Robert Temple, MD, director of the FDA’s Office of Drug Evaluation I:
‘Used appropriately, Imitrex is reasonably safe; used in the patient with pre-existing cardiovascular disease, however, it may be dangerous, even deadly fertility clomid . atomic spectrum for lithium . cialis weight loss silagra cumwithuscom . ropinirole and approval and parkinson .
‘The division’s recommendation to approve the Imitrex NDA (New Drug Application) reflects a risk benefit assessment which, in common with all such determinations, turns as much on personal values and implicitly held private assumptions as it does on evidence and reason dangers of prednisone tablets . medicine lookoup cap davis dilantin . fioricet carisoprodol . prednisone schering pl .
‘In sum, a case can be made that, from the viewpoint of the public health, the benefit accruing to the population of migraineurs is outweighed by the injury and fatalities that Imitrex’s marketing seems certain to cause recommended dosage cipro .” 361
Dr singulair 4mg tablets . Leber had advanced this argument just for the sake of thorough consideration of every angle and titled it “Alternative Perceptions of Imitrex’s Risks and Benefits lithium codeine .” This memorandum makes clear, however, that the FDA knew before approval that the drug was likely to kill some patients is there caffeine in faygo soda .
is not appropriate for people with a history of heart disease and should not be taken by pregnant women because of a risk of birth defects lipitor outcomes .
TOPAMAX
A migraine sufferer who discovers that she needs to use her migraine medicine to stop a headache more than 2 days a week on a regular basis s should definitely schedule an ap- pointment with the doctor caffeine curbs appetite .’6′ Frequent use of any migraine medicine has risks, not the least of which is a “rebound” that makes headaches more frequent medical drug vytorin . If headaches are coming that fast and furious, a preventative medicine could make more sense amlodipine besylate pill .
The most recent drug to be approved for migraine prevention is topiramate (Topamax) testosterone supplement side effects . It was originally developed as an anticonvulsant, but the FDA has approved it for preventing migraine headaches as well triamcinolone diacetate for poison ivy . It works better than placebo to ward off migraines in children and teenagers is cymbalta an maoi inhibitor . 363 Adults who take 100 milligrams of Topamax daily have roughly two fewer migraines per month cannondale 29 er caffeine .364 This is similar to the results achieved with other preventive medicines and significantly better than placebo viagra psuedo .365 Side effects with Topamax include tingling and numbness (paresthesia), confusion or mental fuzziness, and
weight loss ibuprofen for allergies .366
There are other, older medications that the doctor may prescribe for migraine prevention if topiramate is not appropriate risperdal consta side effects . A different anticonvulsant, divalproex, is prescribed for this purpose doxycycline and weight loss . Even before doctors started using anticonvulsants to prevent migraines, though, they had found that betablockers could be helpful overnight shipping of generic cialis . Propranolol and atenolol are the two that are most often used, and because they are available
*** Triptans
These prescription medications usually work well at stopping a migraine attack, especially if they are taken early in the process amiodarone lung pleural effusion . Sometimes a second dose is needed a few hours later albuterol relaxes esophageal sphyncter .
These medications (which come as pills, nasal spray, and injection) are the standard treatment now for the most severe migraines lipitor for alzheimer’s disease . There are some important differences among them what does generic cialis . You and your doctor will have to work together to find one that works well for you with a minimum of side effects caffeine coffee consumption statistics .
Side et WSI caffeine and electrolyte . Dizziness, flushing, tingling, nausea, drowsiness Downside: Expensive; in rare cases, serious reaction may include a lack of bloodflow to some parts of the body, including the heart asacol and kidney problems . Notify the doctor immediately if you faint or experience chest pain or pain in the jaw or left arm after taking this drug diflucan ingrediants gluten .
Cost: Varies; most run $15 to $20 or more per tablet Topiramate (Topamax)
Topamax is taken on a daily basis to prevent migraines acyclovir vomiting . In clinical trials, nearly half of the patients taking Topamax were able to cut their migraine frequency in half prednisone for treating acne . This averages out to reducing migraines by two per month bijwerking misoprostol .
Side effects: Numbness (paresthesia), cognitive dysfunction, weight loss, tiredness
Downside: In rare cases, topiramate can cause a serious metabolic problem, with a buildup of ammonia in the body clomiphene not working . It may also cause visual problems and glaucoma nolvadex and .
Cost: Approximately $150 to $175 per month
in generic form, they are quite affordable will prednisone get you high . This use is distinct from their use for heart problems or high blood pressure synthesis of tramadol and analogous .
In addition, a small study found that people who have both frequent migraine headaches and elevated blood pressure can benefit from the blood pressure medicine olmesartan (Beni-car) cymbalta patient assistance .3″ A few patients felt dizzy, but the drug was well tolerated otherwise duloxetine buy online .
Headache specialists are experimenting with Botox injections for migraine prevention cyclosporine 0.2 for dogs . Double-blind studies have been somewhat promising no prescription clomiphene with overnight delivery . -168,161 zocor tablets .3′0 Although the experts have still not figured out exactly who is the best candidate for this type of preventive treatment, it is generally well tolerated and far less invasive than a type of heart surgery that is also now being studied as a way of preventing persistent, recurrent migraines coca-cola caffeine .
For Women Only: Menstrual Migraines
Women far outnumber men as migraine sufferers, and menstrual migraines might be part of the reason imitrex butalbital . Within the past few decades, clinicians have recognized that many women’s periodic migraines are tied to their menstrual cycles and are presumably triggered by regular hormonal fluctuations hives and femara . Estrogen and progesterone both affect the brain chemicals that are believed to be important in the development of migraine headaches only plant testosterone .371 Migraine attacks, especially migraines without aura, are about twice as common during the first few days of -menstruation as at other times of the cycle fluconazole interactions . 372
Knowing when the migraine is likely to strike can allow for a preventive strategy coumadin clinic in magan az . Women susceptible to menstrual migraines are often advised to take a nonsteroidal anti-inflammatory drug (NSAID) such as mefenamic acid (Ponstel) for several days prior to the expected start of menses and continuing for a few day& 371 An OTC NSAID such as naproxen (Aleve) or ibuprofen (Advil, Motrin) might also work aleve commercial rollergirl . The most common side effect of such pain relievers is digestive upset is prednisolone an immuno supresant .
Another treatment that may be useful in preventing menstrual migraine is the mineral magnesium propecia tablet . A placebo-controlled study found that taking 360 milligrams of magnesium daily starting on day 15 of the cycle through the start of menstruation reduced the number of headache days and the severity of pain clopidogrel definition .374 There are also a few small studies showing that soy isoflavones taken daily can help prevent menstrual migraines drug interaction fluconazole and xanax . 375,376
I
Doctors have also experimented with longer-acting triptans, particularly Amerge, Frova, and Naramig effects of zelnorm during pregnancy . These drugs are frequently used to stop a headache once it has begun, but they also can be used when a headache is anticipated to prevent the
-177
menstrual migr aine _ tramadol roomed online . In some women, oral contraceptives will help prevent menstrual migraines, especially those that limit the number of menstrual periods to just a few each year vytorin adverse reactions . 171
Not Tonight, Dear: Sex Headaches
The term sex headache sounds like an elaborate excuse or maybe a setup for a stand-up comic, but they are no laughing matter interaction of paxil and general anastesia .These are headaches, often severe, that occur at or just before orgasm neurontin side effects treatment of fibromyalgia .
For the last few years I have been plagued with migraine headaches during the last week of my cycle, when my birth control pills contain no hormones amlodipine in pediatrics .
I discussed this problem with my doctor, and she prescribed Mircette erythema multiforme bupropion . This brand of birth control pill is supposed to have hormones during the last week oxycodone decreased testosterone . Unfortunately, I still suffered terrible headaches during that week how to raise estradiol levels . I was at my wits’ end because I could hardly function lexapro and elderly .
I bought soy isoflavones containing “natural hormones soma atp .’ I began taking these capsules three times a day during the last week of my next packet of pills walmart sertraline . For the first time in many years, I had no headache! I dreaded the next month, fearing the success of the soy isoffavones had been a fluke, but it has worked for 3 months in a row medication called requip .
Q lotensin hct 20 12.5mg . I have a problem my doctor and neurologist can’t help testosterone levels morning afternoon evening graph . I am hoping you can give me a hint as to what to
do aztrazeneca arimidex .
Whenever I strain in heavy lifting or in hanky-panky (don’t laugh), I get severe pounding headaches lasting 5 to 15 minutes nortriptyline warnings . They are incapacitating zetia and acne . My neurologist says they are “benign sex headaches” caused by my blood pressure going high, but I’m on Accupril for hypertension seroquel the drug . Do you have any ideas?
A testosterone therapy women dose hair loss . Two kinds of headache are associated with sexual activity and exertion how to withdraw from celexa . One develops gradually with a dull, throbbing ache at the back of the head dilantin and coumadin . The other type is explosive and excruciating, starting just before or during orgasm and lasting 5 to 15 minutes voltaren reactions .
Neurologists often prescribe NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin 115), naproxen (Aleve), or indomethacin (Indocin) to be taken prior to lovemaking mexico fluconazole . An alternate approach is the blood pressure pill propranolol (Inderal) as a preventive measure pamelor for headaches . Consult a headache specialist to find out if such treatment would be appropriate in your case dosage for cipro .
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The first important step to take if such a headache strikes is to schedule an appointment with the doctor without delay seroquel forthe dope non prescript . There are several potential causes of sex headache, and some of them require treatment to prevent great harm irbesartan without lactose . If a workup eliminates the possibility of a serious underlying problem, a nonsteroidal anti-inflammatory drug such as ibuprofen, naproxen, or the prescription drug indomethacin usually works well for preventing or relieving the pain of a sex headache accutane penis bumps .
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Q testgen testosterone . My doctor thought I was nuts when I complained of a sex headache metronidazole suspension ingredients . It happens only when I’m on top sugar in infant ibuprofen . This position gives me the most pleasure, but I have been avoiding it for fear of a stroke taking celexa with 5-htp . The only other time I had such a headache was after going down a steep water slide manufacturers of lithium . My kids and husband were terrified I was dying aa rechargable lithium .
I have high-normal (130/80) blood pressure viagra experiences . I take naproxen for arthritis and Zyrtec for allergies metronidazole ciprofloxacin manufacturer . The headache is explosive and excruciating exelon rivastigmine . Your article on sex headaches vindicates me and assures me I am not alone!
A yerba mate caffeine . Have a specialist evaluate your headaches low testosterone high blood pressure . If they are “benign sex headaches,” there are a number of treatments pile au lithium . For example, the naproxen you use for arthritis may prevent such headaches if taken before lovemaking propecia hair loss .
It is extremely important to rule out other potential causes of severe headaches revia neurotransmitter . One woman responded to the same article:
“I read with great concern your column about the man who asked for help with headaches that occurred with exertion or sexual activity cr discount paxil .
“When my husband was 25, he had a very similar headache while having sex subaction showcomments viagra start from remember . The doctors told him it was viral uroxatral cost . After a week of bed rest and Tylenol he felt better and went back to work bupropion vs budeprion . The next week while having a bowel movement it recurred, but this time the headache was fatal risperdal granular . He had a ruptured aneurysm in his brain liqid nolvadex . Please tell your readers to rule out all possibilities of problems with blood vessels zoloft sexual side effects .”
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FENUGREEK
Fenugreek is a seed used to spice Indian food compare diovan and cozaar . It has also been used in traditional medicine to treat symptoms that indicate diabetes saturday delivery tramadol . Studies done in humans suggest that it can be used in
well
type 1 as as type 2 diabetes in addition to,prescribed medi-
cation women excess testosterone . The powdered seed lowered blood sugar and HbAlc feline hypertrophic cardiomyopathy prednisone . 249
There are potential side effects, however zovirax insert . Fenugreek can cause diarrhea, flatulence, and allergic reactions celexa testimonies . It might, in theory, interact with warfarin (Coumadin) or other anticoagulant medicines and probably should be avoided by people who take them trazodone for bipolar . There is always a possibility of hypoglycemia when blood sugar–lowering botanical medicines are added to prescription drugs for blood sugar control, so careful monitoring is essential rx neurontin . The usual dose is around 1 or 2 grams of seeds three times a day, but it may also be taken as a tea 250
* 0 *
G atenolol personality changes . I found a spice in my spice rack that I had never heard of, and I had no instructions on how to use it lack of response to furosemide . I looked up fenugreek as a spice and found that it is a medicinal herb celebrex chemotherapy colon cancer .
It is used to lower cholesterol and control blood sugar provera for bodybuilders . The only side effect I found is nausea if you take too much specific heat lithium . What do you know about this herb? -
A adderall and selegiline together . Studies in animals and humans show that fenugreek can lower cholesterol and blood sugar methyl prednisone acetate . If diabetics take fenugreek, they should monitor their blood sugar to make sure it doesn’t fall too much xeno lithium .
Fenugreek seeds are rich in soluble fiber and can be used to treat constipation paroxetine heart rate . At high doses, this herb can cause digestive distress evista floaters in eyes .
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GYMNEMA SYLVESTRE
This herb comes from India and has been used in traditional Ayurvedic medicine for centuries ms avoiding caffeine . Animal studies have demonstrated that it is capable of lowering blood sugar viagra lasting .”‘ No serious side effects have been reported, but perhaps the scarcity of well-controlled clinical trials explains that to some extent canadian pharmacy bupropion .
NOPAL (Opuntia sp caffeine in tea bags .)
One interesting botanical treatment has only a little bit of research to support it, but it is becoming increasingly popu-far viagra photo woman . We heard several years ago from a physician who said one of his diabetic patients had improved his blood sugar control with prickly pear tea side effects of stopping tamoxifen . This cactus, called nopal in Mexico, has been studied primarily in animals beta celexa citalopram interferon lyrica pregabalin . That research indicates that the cactus can help lower blood sugar fosinopril solium . 252,253 Research in humans is preliminary, but it suggests that nopal may also be useful in helping to control blood sugar in type 2 diabetes united states wellbutrin bupropion hcl . 254 Close monitoring and medical supervision are advised zithromax ear book .
lama family practitioner and want to share an herbal remedy with you allopurinol and blood pressure . A 60-year-old male Hispanic diabetic patient has had trouble controlling his blood sugar ovulation pain with clomid . Despite intensive diet changes and a prescription for Glucovance, his blood sugar still ran around 160 to 100-plus testosterone treatment and prostate cancer .
One day he came in with his diary showing consistent blood sugars of 90 to 100 fexofenadine solubility in isopropylalcohol . I asked what he was doing differently and he said in a low voice, “I’ve got a new girlfriend from Mexico online fexofenadine . She makes me tea from nopalito [prickly pear> cactus and has me drink it three times a day advil motrin recalls . Now my sugars are doing better buy celecoxib low cost . -
Finding fresh nopal cactus outside of Mexico or the desert of the southwestern United States could be tricky loratadine 180 . When we shared the story about nopalito tea (nopalito is a young stem segment from the cactus), we were inundated with questions from readers who wanted to know how they could get some nopal cactus leaves does prednisone cause sterility . Short of moving, you might try looking for this natural plant product in your local health-food store (or on the Web) voltaren info . Although it is unlikely you will find fresh leaves, you will be able to locate capsules labeled prickly pear cactus (Opuntia) or nopal cactus avandia zantac .
Careful blood sugar monitoring is essential age testosterone . One reader who blended cactus with apple juice kept careful track of his cholesterol levels, triglycerides, and glucose bladder infection ibuprofen . In 6 months, his triglycerides dropped from 191 to 139 and his total cholesterol went from 202 to 169 web md doxepin . More interesting, his blood glucose drifted down as well seafood allergies and atrovent . Here is his account:
I read your article about nopalito tea, so I started using cactus in April and had good results what’s the main resources of caffeine . My doctor knows about it zithromax for oral suspension . I blend one bag of cactus and 3 112 cups of apple juice into a drinkable liquid effexor memory . I drink 4 ounces three times a day mens viagra . Here are my results why is caffeine bad in pregnancy .
Blood Glucose (average)
Jan 147 no cactus
Feb 143 no cactus
Mar 158 no cactus
Apr 142 with cactus
May 132 with cactus
Jun 126 with cactus
Jul 135 with cactus
Aug 128 with cactus
I write down every food I eat every day and take my test every morning and keep a record of it natural alternative to caffeine . I can see which food does what, and I take my medicine as always and my doctor has been kept informed battery lithium watch .
This gentleman is the poster child for responsible blood sugar control doxycycline burns treatment . Not only is he tracking his sugar levels carefully, he is also working closely with his physician to make sure what he does is safe and effective amsterdam nederlands sildenafil .
STEVIA
Stevia (Stevia rebaudiana) is a nonsugar sweetener derived from the leaves of a South American shrub phenytoin effects lab values . It is not approved as a sugar substitute in the United States but is frequently used in Japan didanosine causing lipoatrophy . Some preliminary research suggests that using stevia instead of sugar might have a benefit beyond simply not consuming sugar on levoxyl but still having symtoms . A small study in Brazil found that stevia tea could improve glucose tolerance in nondiabetic individuals simvastatin 80mg tablet . 255 The plant can also lower blood pressure celexa twice normal dose . No significant toxicity has been reported do cardiologists order toradol .
Stevia is a natural sugar substitute fosinopril side effects . In addition to sweetening food and drinks without raising blood sugar, stevia may be capable of improving glucose tolerance 1 2 aa lithium 3.6v battery . Be sure to monitor your blood sugar when adding this sweetener to a medication regimen automobile lithium ion battery .
Downside: In laboratory tests, high doses of stevia interfered with animals’ reproduction ketorolac pediatric .
Cost: Approximately 10 or 20 per serving Easing Stress
There is a direct connection between your level of stress and your blood sugar paroxetine and . For someone without diabetes, this is probably no big deal, unless you are always under stress warfarin metallic taste . But for a diabetic, anxiety, fear, depression, and emotional pressure will boost blood sugar and make the condition harder to control lyrics for lithium .211,2″ Giving a speech, having a fight with your partner, or going in for your annual performance review at work can all affect your stress level and your blood sugar singulair and weight loss . Doctors often look at diet, exercise, and other physical factors ibuprofen crush . They are less likely to consider emotions, even though they have such a profound impact on a diabetic’s health novartis v pfizer zithromax .
How can a diabetic learn how to manage stress successfully? There is no cookie-cutter answer to this question is cipro sulfa based . Everyone handles stress differently phenergan sudaphed contraindication . For some, the only effective strategy might be to quit a highly demanding job and move to a cave decadron for oral surgery . Doing that would stress others out even more preparation of ethinyl estradiol . Finding the right approach may take trial and error xenical caps orlistat roche .
Avoiding people who make your hands cold is a good place to start hartford zyprexa attorneys . Buy a mood ring (a relic of the 1970s) aluminum lithium etchant . It reacts to skin temperature viagra side effects diarrhea . Whenever your hands get cold as a response to stress, you should do something different from your current activity to warm them up decadron contain only t4 . Relaxation tapes can be helpful if you can carve out time to listen lithium arizona . Our favorites are by Emmett Miller, MD chemical composition of neuronal soma . Dr felodipine reaction . Miller has been in this business a long time and has a soothing voice 7 day doxycycline symptoms disappear . We guarantee that if you listen to his Letting Go of Stress, you will be more relaxed afterward viagra levitra cialis comparison .
Some people may benefit from individual psychological counseling or biofeedback training to learn to cope with stress prednisolone hot flashes . But others may be able to find a group that is learning stress management techniques accutane colitis . 251 If you need a guide to doing it yourself, we suggest you look for a copy of Richard Surwit’s book, The Mind-Body Diabetes Revolution requip and compulsive gambling . It has some good
DR what does bactrim treat . MILLER’S SOOTHING SOUNDS
To purchase Dr metformin 500 571 . Miller’s CDs or tapes, you can visit his Web site, www topical oinment chloramphenicol .DrMiller methotrexate how long .com, or call 800-52-TAPES omnicef stomach . Letting Go of Stress or the Ten-Minute Stress Manager is a good starting place celebrex docing information .
tips on learning to relax and overcome stress as well as background on the importance of psychological issues in diabetes citalopram hydrobromide capsules .
When all else fails, an antianxiety agent can be surprisingly effective at controlling blood sugar in the short term remeron childrens studies . If, for example, you know that traveling makes you anxious and throws your blood sugar out of kilter, you may want to ask your doctor whether a short course of diazepam (Valium), alprazolam (Xanax), or some similar medicine might help you deal with the hassle of travel no prescription claritin .259 Such drugs can be habit-forming, however, so relying on them for long periods of time is not desirable veetids expire .
Depression also has a major impact on diabetes and messes up efforts to keep blood sugar where it should’be information about nexium . Everything feels much harder to manage when you’re down in the dumps, and your attention to exercise, diet, medication, and self-care may well suffer viagra doseages effects . Changes in brain biochemistry associated with depression might also contribute directly to a higher risk of diabetes complications lithium battery explosions . MO Blood clots leading to heart attacks or strokes are more likely when diabetics are depressed; so are irregular heart rhythms and inflammation methotrexate factoids . It’s just as crucial for a diabetic to be evaluated regularly for depression, and to get treatment when it is needed, as it is for her to get regular eye exams and foot care prostatitis and flomax .
Pills to Lower Blood Sugar
Quite often, diet and exercise alone are not enough to control blood sugar glyburide 2 mg . There is a bewildering array of medicine the doctor may prescribe: metformin, which also is dispensed under the brand name Glucophage; medicine with “glitazone” in the generic name, like pioglitazone (Actor); and old-fashioned blood sugar—lowering drugs similar to chlorpropamide or tolazamide, or their newer cousins glyburide (Micronase), glimepiride (Amaryl), or glipizide (Glucotrol) zoloft causing cardiac arrythmias . Newer drugs that stimulate insulin secretion, called nateglinide (Starlix) and repaglinide (Prandin), might be used instead of one of the older blood sugar—lowering drugs levaquin diflucan interactions . Eventually, if blood sugar and glycosylated hemoglobin can’t be brought down to acceptable levels, even type 2 diabetics may end up using insulin bacterial vaginosis flagyl did not work . But it usually makes sense to try oral medicines first metaloproteinase cipro .
It is difficult to tell which of these pills would work best for any given patient hold dose metoprolol . As with everything else pertaining to diabetes, people vary in their responses salbutamol and hyperstimulation . Some do well on a single drug, while others need a complicated regimen class action lawsuits against provera . Only you and your doctor can determine which medication(s) are likely to be safest and most effective for you amoxicillin dental work .
To try to sort out the patterns and give doctors some guidance, scientists at Kaiser Permanents, an enormous HMO in northern California, reviewed the organization’s vast database efficacit gel testosterone 50mg j . First they created a registry of the diabetic patients, and then they examined the data to see which drugs were most effective over time male devo provera . Even though most patients are started on one of the medicines like chlorpropamide or glyburide, this was the least effective treatment for getting HbAl down to
target personal experiences of people on wellbutrin .261
The most effective treatment was triple therapy: a
“glitazone”-type drug in combination with metformin and a drug like glyburide onset action lamictal days . Next best after that was metformin together with insulin pepcid indication gi protect .
One of the most interesting features of the Kaiser Permanents study was that patient behavior could be used to predict success, aside from the drug used hydroxyzine helps withdrawls of opium . Patients who monitored their blood sugar frequently and those who kept all or nearly all of their appointments were significantly more likely to get their blood sugar under control and keep it there clomipramine hcl tablets and alcohol . 262 Making sure that you are on top of your diabetes treatment, taking your medication, monitoring your blood sugar, keeping track of HbA, following a sensible diet and exercise regimen, and controlling your weight as much as possible may be nearly as important as which drugs your doctor prescribes atomoxetine medication diaes .
Metformin (Glucophage)
A review by the Cochrane Collaboration of most of the world’s diabetes literature shows that metformin (Glucophage) alone, if used to keep blood glucose under tight control, is an excellent treatment inderal la medicine .263 Metformin improves blood sugar control by improving the cells’ response to insulin and reducing the amount of sugar that the liver makes risperidone weight gain . Unlike some other oral diabetes drugs, it doesn’t lead to weight gain and may even help people get their weight under control amitriptyline mylan .
It can be dangerous, however, for people with kidney disease testosterone replacement therapy cycles . They should not take the drug, and everyone on metformin should have their kidney function monitored regularly (at least once a year) altace absorption . People with congestive heart failure should not take metformin, either sulfamethoxazole ds tabitp .
SYMPTOMS OF LACTIC ACIDOSIS
• Muscle aches or weakness
• Shortness of breath
• Stomachache, nausea, or vomiting
• Lethargy or drowsiness
• Irregular heartbeat
• Feeling generally awful
Metformin has two nasty side effects that patients must know about drugs and norvasc . One, lactic acidosis, is rare, but it is a medical emergency if it occurs villa allegra . Lactic acidosis can be lethal estrace homrmone . People with kidney disease or congestive heart failure are more susceptible to this problem, which is why they must not take metformin hormone replacement therapy weight premarin . Otherwise healthy diabetics might also develop lactic acidosis on metformin, especially if they drink alcohol watermellon viagra .
What makes metformin so tricky is that patients frequently experience digestive tract distress when they first start taking this medicine tramadol ships next day apo . Side effects can include diarrhea, nausea, vomiting, indigestion, and stomachache accutane atlanta attorney . After several weeks, however, these side effects should fade away strattera testimonies . If digestive symptoms
*** Metformin (Glucophage)
Metformin improves insulin sensitivity caffeine and hunger . It may control blood sugar alone or be combined with other diabetes drugs to improve blood sugar control attack heart ibuprofen . Common side effects include diarrhea, nausea and vomiting, flatulence, fatigue, indigestion, and headache intas strattera for sale online .
Avoid guar gum in low-fat foods (salad dressing, frozen desserts, etc depo provera transexual drug .), because it reduces metformin’s absorption and effectiveness is prevacid an nsaid .
Downside: Lactic acidosis, a rare reaction, requires emergency medical attention and can be fatal nifedipine ointment preparation .
Cost: Approximately $90 to $120 per month; generic $65 to $100
recur, they must be brought to the doctor’s attention immediately since they might be symptoms of lactic acidosis ct scan heart and lopressor .
The other side effect is depletion of vitamin B12 snorting bupropion . Because this vitamin is stored in the body, the depletion is gradual and the symptoms either may not be noticed or may be attributed to some other cause can lovastatin subscriptions cause cough . The physician should test for methylinaIonic acid (MMA) as well as for vitamin B,2 levels compare kytril and zofran . Fortunately, it is easy to treat vitamin B12 deficiency with supplements birth defect imuran . The vitamin does not need to be injected in such cases; oral supplements of around 1 milligram daily (a large dose of vitamin B12) will work prednisone before surgery . Do check with your doctor to find out if this is appropriate for you sten testosterone .
I am a retired physician with type 2 diabetes metoclopramide and dialysis . Metformin has kept my blood sugar in the normal range for 10 years malassezia ketoconazole dog . Despite good control of my blood glucose and glycosylated hemoglobin, my foot numbness was getting worse warfarin back pain . I was also a tilde unsteady on my feet though it was very subtle flomax pseudoephedrine .
I reviewed the medical literature and discovered that metformin interferes with vitamin B1, absorption fertility insemination estrace uterine lining . I suspected I might be deficient in this vitamin, and I started taking oral vitamin B,
Within a week, I noticed that my mental capacity was sharper combivir and other antivirals . I had not realized before this that I was having any cognitive problems new england journal of medicine lipitor . I stopped having any trouble walking, and my foot numbness has decreased effects effexor alcohol .
Many older diabetics take metformin doxycycline cellulitis . ff they developed subtle neurological and mental deficits as a result of lack of vitamin B,, these problems could be treated but may well be overlooked zoloft vs xanax .
Pioglitazone (Actos)
Pioglitazone (Actos) is a newer diabetes medicine that increases insulin sensitivity and decreases insulin resistance aldactone for treating acne . These actions reduce the amount of insulin in the bloodstream and should lower HbAl rash from paxil . Not only can this medication bring fasting blood sugar down, it can also help control blood sugar levels after meals 1 4 propecia .” In the Kaiser Permanents study mentioned above, drugs in this class were the medications most likely to get HbA,, down to normal range by themselves lithium ion battery car fire .
Actos has received a lot of attention from doctors who specialize in treating diabetes es because it has a favorable im- pact on some blood lipids vytorin side effects muscle pain . It doesn’t seem to do much for Pioglitazone (Actos)
Pioglitazone improves insulin sensitivity’and decreases insulin resistance reference range estradiol . It lowers triglycerides and raises HDL, which might result in a lower risk of cardiovascular problems viagra and reduced ammunity . It is taken once a day escitalopram with titration .
Downside: May interact with oral contraceptives to make them less effective
Cost: Approximately $100 to $115 per month
bad LDL cholesterol, but it raises good HDL cholesterol (no mean feat) and lowers triglycerides atrovent peanut . 265
No one knows if these improvements in blood fats will result in a lower risk of heart attack or other cardiovascular complications in the long run gabapentin gaba . That, after all, is the really important issue, since diabetics are at such high risk of cardiovascular catastrophes ibuprofen versus rofecoxib . But Actos is fairly effective in preventing the closing up of a cardiac stent after it is put into a coronary artery study volunteers for topamax and alcohol .266 And a head-to-head study of Actos and Avandia (a similar medication) showed that Actos has a better effect on several measures of cholesterol and blood lipids ibuprofen liquid mg per ml . 261 If this translates down the road into reducing the likelihood of a heart attack or stroke, it would certainly be worthwhile allopurinol lab hahnemann .
Pioglitazone can cause fluid retention and as a result is not appropriate for use by patients with congestive heart failure lotrel azor . Side effects include a greater susceptibility to sore throats, colds, bronchitis, and the like; headaches; toothaches; sinusitis; and muscle pain allegra beach resort . A competing drug, rosiglitazone (Avandia, Avandamet), has also been linked to fluid retention celexa cs zoloft . More worrisome, though, is the possibility that this drug may contribute to fluid accumulation in the back of the eye purpose of flagyl .This macular edema could lead to blurred vision and eye damage claritin and cold medicine .
Repaglinide (Prandin)
The goal of treating diabetes is to keep blood sugar within the normal range, because that reduces the likelihood of serious complications prozac overdose nuerological damage . If you can’t achieve this with metformin or one of the “glitazones,” the doctor may add a medicine to stimulate the secretion of insulin lamictal and sunburn . Two drugs, nateglinide (Starlix) Repaglinide (Prandin?
Repaglinide lowers blood sugar by stimulating insulin release and is especially effective for reducing blood sugar following a meal cellcept indications . Repaglinide is taken before meals, usually within 15 minutes before beginning to eat can zovirax treat epstein barr virus .
Downside: Blood sugar may fall too much (hypoglycemia) brompheniramine and pseudoephedrine extended release . Repaglinide may contribute to weight gain caffeine memory .
Cost: Approximately $130 to $140 per month
and repaglinide (Prandin), make beta cells in the pancreas pump out more insulin at mealtime edward drummond m d and cymbalta . 268 This helps keep blood glucose levels from going too high after eating effexor ejaculation .
Some studies have compared these two medicines alone or in various combinations scarring accutane . The results aren’t definitive, but comparing nateglinide alone to repaglinide alone suggests that there is an advantage to repaglinide whats stronger than ultram .269 Prandin lowered HbA, signifi- cantly more than Starlix did; it brought down fasting blood sugar better; and more than half (54 percent) of the patients on Prandin were able to get their HbA below 7 percent, whereas fewer than half (42 percent) of those or Starlix managed that osteoporosis lamotrigine . Of course, there’s a price amitza or zelnorm . Patients on Prandin were more likely to suffer from hypoglycemia (low blood sugar) rimonabant effect on abdominal fat . They also gained more weight (almost 4 pounds in 4 months), a discouraging side effect patient assistance program for accutane . -
These drugs are more effective in combination with metformin than they are on their own memory loss zoloft . 270 tricor cholesterol statin .27L272 Side effects of repaglinide include headache, joint or back pain, and tipper respiratory infection no prescription needed glyburide . Drugs such as ketoconazole (Nizoral) and clarithromycin (Biaxin) boost blood levels of repaglinide, and that could increase the likelihood of unpleasant reactions 2cialis compare levitra . Grapefruit affects the same enzyme (CYP3A4) and might have a similar effect side effects of mircette .
Exenatide (Byetta)
Exenatide (Byetta) is another treatment option for type 2 diabetics prograf pronounced . It has an interesting history zoloft user review . because it got started with research into the saliva of a poisonous Southwestern lizard called a Gila monster what is lexapro medicine . Byetta is injected and is used in combination with metformin or a blood sugar–lowering drug like glyburide claritin d warnings . Byetta reduces the bump in blood sugar after meals and can help diabetics lose weight kidney infection cipro .
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Conclusions
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• If you are diagnosed with diabetes, learn to monitor your blood sugar can toprol cause chronic abdominal distress . Keep track of how exercise and food affect it prozac and nerve receptors . Consider cinnamon or vinegar to help smooth out blood sugar in reaction to a carbohydrate meal nexium and indications .
• If you’re considering using herbs or dietary supplements such as chromium, bitter melon, fenugreek, Gymnema sylvestre, or nopal, check with your health-care providers before taking them zofran wafer . Monitor your blood sugar carefully ultram nopain .
• If medication becomes necessary, make sure that you and your physician find the safest and most effective option for you viagra nils . You shouldn’t have to suffer with dreadful side effects to keep your blood sugar under control iv ampicillin .

The simplest and most certain test for any sensitivity reaction is to expose the person concerned to the substance under suspicion and see what happens. This is known as a

challenge test. With true allergies, challenge tests are powerful tools, but they are also alarmingly close to reality. The risk of provoking a severe reaction requires a very

cautious approach.
By comparison, an indirect test – a roundabout way of seeing how the body responds, such as the skin-prick test (see p. 91) – has the advantage of rarely producing dangerous

reactions. The downside is that indirect tests can be misleading, precisely because they are not like the real-life situation. No indirect test is perfect – there are always

false positives and false negatives (see box on p. 91).
Challenge tests
If you undergo a challenge test with food or an airborne allergen, you will also be given dummy challenges with an innocuous substance which is indistinguishable from the item

being tested. Neither you, nor the tester who is scoring the reaction, should know which is which. This is called a double-blind trial because, to eliminate all possible bias,

both of you are in the dark. (The full name is a ‘double-blind placebo-controlled trial’ – the dummy challenge is also called a ‘placebo challenge’ or ‘control challenge’.)
The double-blind trial is a standard medical procedure and does not imply that the doctors think you are faking symptoms. Psychological forces are powerful things, and just

thinking that you might react to a test can be enough to produce a reaction – the process that generates the symptoms is largely unconscious.
Food challenge
A food challenge – eating the food that is under suspicion – is a key test for food intolerance (see p. 197). It is sometimes used for food allergy and other forms of food

sensitivity too, as a follow-up to skin tests. Some allergists use a food challenge only if the skin test is at odds with actual events reported by the patient. Other allergists

use food challenge more readily, to confirm skin-test results, and to assess the severity of the reaction.
Extreme caution must be exercised with immediate food allergy, because of the considerable risks involved. The test must be done under medical supervision with resuscitation

equipment to hand. A challenge test should never be done for true food allergy without some careful preliminary tests on the face and the lips (see box on p. 23). Even if these

tests produce no reaction, only tiny amounts of the food should be eaten to begin with.
Bronchial challenge
This type of test involves inhalation of an airborne allergen – such as pollen – suspected of causing asthma. Bronchial challenge carries the risk of provoking a severe asthma

attack, and few doctors use it unless there are compelling reasons to do so – such as demonstrating that someone’s asthma is due to an allergen encountered at work.
Skin-prick tests
This is an indirect method of detecting true allergic reactions. It is one of a family of skin tests that use a similar approach. The three different tests in this family are

known as: skin-prick tests or prick tests, puncture tests, and scratch tests.
For the skin-prick test – the technique used in Britain – a small drop of liquid containing an allergen, such as grass pollen, is placed on the arm. The doctor makes a small

prick in the skin, under the drop of liquid, allowing a minuscule amount of the allergen to get into the skin. A positive reaction is recorded if a red bump develops soon

afterwards. For accuracy, the bump must be compared to positive and negative controls (see below).
The puncture method is very similar to the skin-prick test but uses a slightly different technique for breaking the skin. The term prick-puncture test covers both techniques.
With the scratch method, the skin is scratched lightly, and the allergen solution is then applied over the scratch. This method gives less consistent results than prick-puncture

testing.
It is important to include a negative control in the test – a skin-prick test with plain salt water (saline). This should not produce much of a bump – if it does, the skin is

clearly over-reactive and the tests more difficult to assess. The doctor should also include a positive control – a skin-prick test with histamine, the substance that plays a

central role in allergic reactions. This should always produce a bump. If it does not, the skin is decidedly under-reactive, and the tests are invalid.
Taking antihistamines will make the skin under-reactive, and you should stop taking them before the testing, for a period ranging from a day to several weeks – it varies

depending on the particular antihistamine. Ask your doctor for specific instructions about stopping these and other drugs before testing.
Skin tends to be over-reactive to testing in people with dermatographism (see p. 52). Blood tests for specific IgE,
such as RASTs (see p. 92), are needed for anyone who has this condition. Eczema sufferers with a rash over large areas of the body may also require blood tests, if there is too

little clear skin for testing.
Skin-prick tests can produce both false positives and false negatives (see box below). Some allergic diseases will give a lot of false negatives and relatively few false

positives, while for others the reverse is true. The allergen itself influences the rates of misleading reactions: for example, tests for soya allergy are notoriously

unreliable, whereas those for peanut are far more accurate. The age of the person being tested also makes a difference. With all these influences at work, interpreting the test

responses is a real art, and the doctor’s experience counts for a lot.
All sorts of people offer skin-prick tests, including alternative practitioners. Get them done by a qualified doctor, preferably by an allergist, who will know how to make sense

of the reactions.
Note that the purpose of these tests, and of blood tests for specific IgE, is to identify the allergens that are bringing on your symptoms, not to predict how strongly you will

react to those allergens. The tests may give some Indication of the intensity of your reaction, but they cannot be regarded as a good guide to how you will respond to the

allergen in the future.
The safety record of skin-prick tests is very good. Occasionally a systemic reaction (anaphylaxis) occurs with these tests, but there are no records of any deaths. Nevertheless,

if you suffer from severe asthma or have experienced anaphylactic shock in the past, it is advisable for the doctor to have adrenaline and resuscitation equipment available.

Those with strong allergic reactions to latex may also react badly if they are tested with an allergen that cross-reacts with latex (e.g. cypress pollen), not just when tested

with latex itself. Taking beta-Mockers (see box on p. 150) increases the risk of a life-threatening reaction for anyone in these higher-risk categories.
False positives and false negatives
Apart from challenge tests, none of the tests used for allergy works with 100% accuracy. Most give both false positives and false negatives.
A false positive means that there is a positive test but no actual reaction when the allergen is encountered (e.g. eaten or inhaled). A false negative means that there is a

negative test result despite a genuine reaction (as shown by a challenge test, for example).
A test that gives relatively few false positives has good positive predictive value – in other words, if it suggests you are allergic to something, you probably are.
A test that gives relatively few false negatives has good negative predictive value. If it comes up negative, you are probably not allergic to that allergen.
Some tests for allergic reactions show good positive predictive value but poor negative predictive value, while for other tests the reverse is true.

When Leonard Noon reported his first tentative experiments with immunotherapy for hayfever, in 1911 (see p. 164), he believed that pollen contained a toxin. Most people were

‘immune’ to this toxin, he said, in the same way that people might be immune to measles or diphtheria, but hayfever sufferers lacked this immunity. Noon thought that his

steadily increasing doses of pollen, injected just under the skin, were inducing immunity to the pollen toxin, in the same way that a smallpox vaccine could induce immunity to

smallpox.
Noon’s theory was all wrong, as we now know, but the important thing was that the treatment seemed to work. In fact it transformed the lives of some patients, especially those

who were very severely affected by hayfever. One spoke of a ‘marvellous cure’, another of going for walks to kick my old enemy the hay’.
So doctors kept using Noon’s treatment, and in time — when it became clear that Noon’s theory was flawed — medical researchers began trying to figure out how the injections

really worked.
Surprisingly, they have still not succeeded, even though a great deal is now known about the changes that can occur in people undergoing immunotherapy. Despite a wealth of

detailed knowledge (see p. 166), it remains impossible to say exactly how conventional immunotherapy reduces allergic reactions. Surprising discoveries about the effects of

conventional immunotherapy are being made all the time.
New methods of immunotherapy are still being devised today, and there are three different approaches being taken.
Firstly, there are doctors experimenting with modifications of the technique devised by Noon. For example, instead of injecting the allergen extract, some doctors are giving it

to their patients in capsule form. to be swallowed. Others are giving it as a liquid, to be placed under the tongue and held there for a few minutes, then swallowed (see p.

169). Sound scientific trials show that both these methods work well, at least with some allergens.
There are also experiments with speeded-up immunotherapy
(see p. 166), called ultrarush techniques — at the outset, injections are given at hourly intervals, or even more frequently (in hospital, of course, where severe reactions can

be dealt with immediately). Doctors have found that they can induce a remarkably rapid tolerance of the allergen in this way.
The second approach is to apply modern medical knowledge about allergic reactions and so develop entirely new methods of immunotherapy (see p. 168-9). Such research involves

working out, from first principles, novel ways of modifying the immune response in general, or the reaction to one allergen in particular.
This theory-led approach is certainly successful for classical allergies such as hayfever and perennial allergic rhinitis, where there is a good understanding of the basic

mechanism (i.e. the malfunctions of the immune system that produce the disease). But for those diseases where the underlying mechanism is only partially understood, such as

atopic eczema, this approach is not necessarily the best one. And for diseases such as food intolerance, where the cause of the illness remains largely unknown, it is a complete

non-starter.
The third type of approach is to devise a technique by trial and error, and then puzzle out the ‘how’ question later. This is the same sort of path as Noon originally took, and

some believe that this kind of pragmatic experimental approach — practising a method which seems to be effective, even though it’s a mystery how it works — is as valid now as it

was in 1911. Others disagree.
210 complementary therapies The two most widely used methods that have been developed in this way are Provocation-Neutralisation and Enzyme- Potentiated Desensitisation.

Although these techniques are practised by doctors with a conventional medical training, they remain ‘outside the pale’ as far as orthodox medicine is concerned. The

controversies that surround them are discussed below.
Enzyme- Potentiated Desensitisation (EPD)
This technique has been developed by a British doctor, Dr Len McEwen, who began work on it in the 1960s. It is now practised in many parts of the world, as well as Britain,

including the United States, Germany and Italy.
EPD is used for a far wider range of problems than conventional immunotherapy, being given to people with food intolerance and chemical intolerance, as well as to those with

true allergies. This — along with the fact that it is unclear how it works —contributes to the controversies that surround it, because these conditions do not have the same

basic causes.
Dr McEwen began with the observation that, when immune cells are aroused during inflammation — whether caused by allergy or some other stimulus — they release large amounts of

an enzyme called beta-glucuronidase. This enzyme increases the immune response to the allergen or antigen that provoked the inflammation.
Dr McEwen experimented with injecting beta-glucuronidase into the skin, along with very small amounts of allergen, believing that in such circumstances the enzyme might have the

opposite effect, and reduce the immune reaction to the allergen. Eventually he discovered a combination of enzyme and allergen which seemed to have the desired effect.
EPD has been tested, in a rigorous scientific manner, and the results suggest that it can work for hayfever and asthma, as well as for childhood migraine and hyperactivity in

children when these are triggered by foods.
In one trial with hayfever patients, researchers measured the levels of anti-pollen IgE following EPD treatment, and it did not rise during the pollen season as it normally does

in those with hayfever. This kind of finding is impressive because it is unlikely to be due to placebo effect. Not all studies have produced positive results, however.
In addition, doctors using EPD claim that it is very effective for patients with allergies who have not done well on the standard course of immunotherapy injections (see p.

164). This fits in with other studies suggesting that the immune changes brought about by EPD are fundamentally different from those induced by traditional immunotherapy.
Patients with true food allergy have been given EPD, and while it does not enable them to eat their culprit food, it does
seem to reduce their reaction to accidental exposures.
Doctors in the Netherlands are using EPD as a treatment for people with Chronic Fatigue Syndrome (CFS), and report that it helps about 50% of patients.
One point in favour of EPD is that it uses very small amounts of allergen, and is therefore very safe — anaphylaxis has never occurred with this technique.
Provocation-Neutralisation
‘After following conventional methods [of immunotherapy] for thirteen years, I heard Carleton H. Lee deliver a paper on provocative testing in 1965, at a meeting of the American

College of Allergists in Chicago. I was naturally sceptical, but tried his suggestions when I returned to my office. The results can only be described as astounding. Many

patients with unresolved allergic problems responded markedly and rapidly. Many with resistant asthma or perennial allergic rhinitis improved greatly or cleared completely when

food injection therapy was added to their inhalant injection therapy.’ So wrote Dr Joseph B. Miller — a distinguished allergist and paediatrician, and a Professor of Medicine at

the University of Alabama, in 1972.
The technique which he learned from Carleton H. Lee was controversial then and, although Miller developed it with great care and precision during the years that followed, it

remains controversial now.
There are two elements in provocation - neutralisation: testing and treatment. Both are used for a wide range of problems — not just classical allergic diseases, but also food

intolerance and chemical intolerance. As with EPD (see left), this is one of the controversial aspects of the technique.
Although provocation-neutralisation involves an injection technique that looks, superficially, very much like conventional immunotherapy (see p. 164), there are several

important differences. Firstly, the allergen extract used (in the case of true allergies) is a very dilute extract, so that far less of the allergen is injected than in

conventional immunotherapy. Likewise, in the case of food intolerance and chemical intolerance, the extracts of the offending substance are used in highly dilute form.
Secondly, the idea of the neutralising dose — which is the central plank of provocation-neutralisation — is quite different from anything in conventional immunotherapy. Broadly

speaking, the conventional technique (see pp. 165-6) works by slowly reeducating the immune system with a gradually increasing dose of the allergen. Only after a succession of

injections does the immune system start to behave differently on encountering the allergen. By contrast, in provocation-neutralisation treatment, the neutralising dose is

claimed to have an instantaneous and direct effect on the body, ‘turning off’ symptoms that have already begun. This is the neutralisation aspect of the technique. The doctors

who practise this technique do not claim to know how the neutralising dose might work.
According to the theory of provocation-neutralisation, the strength of the extract that acts as a neutralising dose is specific for a particular allergen and a particular

person. It can only be worked out by a rather slow procedure involving a series of injections. These are intradermal injections – they place the allergen extract in the skin, at

a slightly deeper level than a skin-prick test. (For treatment, rather than testing, subcutaneous injections are used – these go deeper than intradermal injections, placing the

allergen extract just underneath the skin. Neither hurts very much.)
Ideally, the neutralising dose should be decided on by measuring the size of the wheal (a raised area of skin around the injection site), and whether it grows, stays the same

size, or disappears. The doctor or nurse carrying out the procedure can, in theory, work out the neutralising dose just by careful examination of the skin wheals.
However, it is part of the tradition of provocation-neutralisation techniques that verbal feedback from the patient is also taken into account – so if the patient says that an

injection has turned off the symptoms, that reinforces the belief that the neutralising dose has been found.
The problem with this aspect of provocation-neutralisation is that expectations, and the power of suggestion, can become involved. So if the doctor or nurse says ‘you may find

that this next injection makes the symptoms go away’, that is often exactly what happens – because the forces of placebo effect (see p. 233) come into play. Unfortunately,

verbal interactions such as this are a key aspect of the provocation-neutralisation procedure in many clinics.
Just the same hazard besets provocation - neutralisation if it is used to test for the existence of allergy or intolerance, because it is quite common for practitioners to tell

patients which allergen (or other offending substance) is being injected and to ask if any symptoms are provoked by the injection. This is not good practice – if someone expects

to react to a particular substance, they are quite likely to produce symptoms through purely psychological mechanisms (see pp. 232-3).
Quite apart from this, the question of allergy testing with provocation-neutralisation techniques is contentious, because the pioneers of the technique, such as Professor

Miller, never advocated using provocation - neutralisation in this way. Using it as a routine test for sensitivity reactions was a later development, and there are many doctors

today who, while they practise provocation-neutralisation as a treatment, say that it does not work well as a test for sensitivity reactions. While they agree that injecting a

dose
which is either stronger or weaker than the neutralising dose may provoke actual symptoms (this is the provocation aspect of the technique) they don’t think the reaction is

reliable enough to form the basis of a test for allergies. Nor do they think that using skin-wheal measurements alone (i.e. silent testing) turns the technique into an accurate

test for allergies. That is not what the provocation-neutralisation technique was designed for – it is about treatment, not testing.
The evidence from research
Recent research from the Nova Scotia Environmental Health Centre in Canada confirms that testing by provocation injections is not reliable. The subjects in this study were all

suffering fr= multiple chemical intolerance, a condition which – for one reasor or another – makes patients liable to develop symptoms at an,, time. No less than 70% of these

patients experienced symptoms in response to a dummy injection which contained none of the offending substance. Indeed, 15% of patients also produced a skin wheal in response to

some of the dummy injections, confirming that even this reaction may be subject to the power of suggestion (see pp. 232-3).
Looking just at the patients who did not react to the placebo injection (i.e. those least susceptible to suggestion) the test still did not yield any reliable result – a person

might react to one injection with a particular substance, but fail to react to a subsequent injection with the same substance. The authors concluded that their patients were ‘in

a state of heightened sensitivity as the result of the chronic irritation by various environmental components and other external and internal stressors’. In this state of

sensitivity. patients are so close to the brink all the time that the smallest thing can trigger symptoms. So the apparent reactions to the test injections were actually

determined by other factors – some psychological factors (including a psychological response to the prick of the needle) and some external ones, such as exposure to smells or

very small amounts of airborne chemicals.
Another recent research study, carried out by scientists at the University of California, confirmed the finding of the Nova Scotia team as regards testing. Although this study

did not set out to look at the use of the neutralising dose for treatment, some of the patients were given neutralising doses during the testing process and the researchers

observed that ‘in most cases a single neutralising injection relieved the symptoms’. This casual observation clearly needs to be confirmed by more rigorous testing. Oddly

enough, despite this positive observation about the neutralising doses, the overall conclusion of the researchers was to completely dismiss all aspects of

provocation-neutralisation as ‘the result of suggestion and chance’. This conclusion has been widely publicised in the United States as part of a general campaign against

provocation-neutralisation and doctors who practise it.
Other researchers have looked at treatment with neutralising doses, using stringent scientific methods (a double-blind placebo-controlled trial — see p. 90), and found that they

do work. In one such trial, patients with asthma. and allergies to dogs or cats, were treated with injections of the neutralising dose. They showed a reduction in the

sensitivity of their airways, as measured by objective tests. In another experiment, patients with perennial allergic rhinitis and an allergy to house-dust mite were studied,

and the neutralising dose was given as drops of allergen extract placed under the tongue (sublingual drops) – an alternative to injections. The blockage of the nose, as measured

by scientific tests, was reduced by the neutralising dose.
A great many more trials of this kind would be required to convince most doctors that provocation-neutralisation works.
Furthermore, the recent study from California – which observed a number of practitioners of provocation-neutralisation at work with their patients — showed that these

practitioners need to be a lot more rigorous and objective in their approach. However, the fact that provocation-neutralisation is often practised badly does not necessarily

mean that the basic technique is without any value. There are a great many level-headed doctors and patients who, while initially very sceptical about

provocation-neutralisation, have found it surprisingly effective – just as Professor Miller did back in 1965.
Deciding for yourself
So is provocation-neutralisation an option that is worth trying for your condition?
As regards testing, the answer is probably ‘no’. The most reliable tests are skin-prick tests or FAST blood tests for true allergies (see pp. 91-2), an elimination diet for food

intolerance (see p. 194), and avoidance followed by re-exposure (a challenge test) for chemical intolerance.
As regards treatment for true allergies, conventional immunotherapy has been far more thoroughly tested and, if you can get it (not easy in Britain — see p. 164), is probably a

better bet. It is definitely the best treatment for allergy to insect stings.
The major advantage that provocation-neutralisation has over conventional immunotherapy, in the case of true allergies, is that it is far safer. Because such small amounts of

allergen are used, anaphylactic reactions (see p. 58) don’t occur.
When it comes to treatment for food intolerance, complete avoidance of the problem food(s), for a period of a year or two, is usually a very effective treatment (see p. 77).

Other forms of treatment are only needed for people who find that they have
intolerance to a great many different foods (on the basis of an elimination diet, not kinesiology, blood tests and the like — see p. 93) and cannot devise an adequate diet from

the foods they are able to eat. For such people, provocation-neutralisation may be worth a try. Many patients feel that they have gained considerable help from this treatment.

They report suffering fewer symptoms and being able to return to a more nutritionally balanced diet.
In the case of chemical intolerance, the first line of treatment should be to avoid the substances concerned as far as possible, eat a good balanced diet, and take a vitamin and

mineral supplement if nutritional deficiencies are suspected. Treating any underlying hyperventilation (see pp. 226-9) can also help considerably. Only if there are persistent

symptoms, and you are sure these are not due to psychological causes, might provocation-neutralisation be worth a try. Some people with chemical intolerance do find it is

helpful, but whether this is a real effect, or simply placebo, remains uncertain.
If you decide to give provocation-neutralisation a try, find a practitioner who has good medical qualifications, who seems objective and sensible in their approach, and who

doesn’t make implausible claims for the technique. Take note of what other treatments the practitioner offers, and whether these seem rational or not – this is often a good

guide to the care and objectivity with which provocation - neutralisation is carried out.
Ask the doctor how he or she assesses the neutralising dose. and avoid anyone who does not use the traditional method of a series of injections combined with wheal measurement.

When the neutralising dose is being assessed, say that you would like it to be done ’single-blind’ – that is, you don’t want to be told anything about what is being injected.

Reporting how you feel to the doctor or nurse during the assessment is fine, but only mention really significant symptoms, or a very definite clearance of the symptoms, if this

occurs. These precautions will help you to be sure that you are getting something which is of genuine benefit, rather than just a very expensive form of placebo treatment.
I always wanted to be a doctor, and I enjoyed
medical school immensely, but once I became a
ell GP, I no longer felt quite so sure about what I was doing. It seemed clear to me that there were a lot of people coming to my surgery who I couldn’t do much for. And there

were others who, while I could treat their obvious medical problems with some success, remained distressed and were not coping well with life. Once I became a senior partner in

this practice, I experimented with having a counsellor come in for one session a week, and then an osteopath for the bad backs. It was popular with the patients, and I saw some

people improve enormously. Now we have stress-management classes too, and one of my colleagues has trained in acupuncture, which he uses for selected patients. We also use

elimination diets for patients with a lot of long-term problems like migraine. Overall, I think of it in terms of having more tools at our disposal - being able to tackle things

from a different angle when standard medicine isn’t hitting the spot.’
Geoffrey, a GP in the north of England, is typical of the reconciliation that is now beginning to occur between conventional medicine and alternative medicine. But he also has

plenty of criticisms to make of the alternative scene. ‘The idea that alternative medicine is “holistic” while conventional medicine isn’t, really raises my hackles. Most GPs

could be magnificently holistic if they had an hour with each patient as alternative therapists usually do. We have just 15 minutes, on average, and we have to pack a lot into

that - including our basic duty to eliminate the possibility of serious organic disease such as cancer. Time pressure is everything now, and it has squeezed the humanity out of

medicine, to a very large extent. But the potential for a holistic approach is there - most doctors have a tremendous store of wisdom and life
experience at their disposal, which could form the basis of a holistic approach to treatment if only there were more time to spend with each patient.’
It is in search of a more unhurried and all-embracing approach to treatment that many people turn to alternative medicine. Frequently, what they get out of the therapy has less

to do with the actual methods used, and still less with the theories behind those methods, but everything to do with spending a quiet hour with someone supportive and caring who

listens to all the complex concerns that surround any illness, gives reassurance or advice, or just offers a `safe space’ in which to talk about life’s difficulties.
Other people turn to alternative therapies due to a more serious disillusionment with orthodox medicine. When patients with inscrutable medical problems -such as persistent

unexplained diarrhoea, joint pain or chronic urticaria - are given a succession of different diagnoses by different doctors, they often lose faith entirely in modern medicine

and reject orthodox treatment in favour of alternatives. This is a great mistake. Modern medicine isn’t perfect, but that is only to be expected, because it is not a fixed body

of knowledge but a process - a continuing journey of questioning, investigation, discovery and improvement. Scientific medicine has come a tremendously long way from the state

of ignorance that prevailed two centuries ago, and it will undoubtedly go farther.
Conventional medicine has a great deal going for it - ask anyone over 50, with severe life-long asthma, what they think of treatment now compared to treatment in the 1950s or

early 1960s. You will hear a hymn of praise to the improvements in both drugs and drug delivery systems. Asthma is just one example -conventional medicine has a lot to offer for

all the classical allergic diseases. Alternative medicine should always be regarded as an adjunct to conventional treatment, not a replacement. That is why many doctors prefer

the term complementary medicine.
A third reason for using alternative medicine is a more philosophical one, a need to understand illness in some larger sense, often part of a general search for meaning in life.

Some types of alternative treatment attempt to offer metaphysical reasons for allergy -rather than the mundane explanations of antibodies and immune cells that are given in this

book - and this can be attractive to some people. There is no harm in this approach, which can prompt you to make a critical review of your life, look at unresolved emotional

issues, or reassess choices that are making you unhappy.
But not all illness, or worsening symptoms, can be explained by emotional causes, and the rigid belief that every illness must have a meaning can be damaging. It easily

degenerates into the wholesale psychologisation of illness, the kind of blame-the-victim mentality which can attribute hayfever to ‘Emotional congestion; fear of the calendar; a

belief in persecution; guilt’ and asthma in babies to ‘Fear of life; not wanting to be here’. Both these diagnoses are taken from the best-selling You
can Heal your Life by Louise Hay, which is very influential among some alternative therapists. This compulsive psychologisation of illness can be profoundly damaging, and if

your complementary therapist is preoccupied by ideas of this kind, you could find yourself on a very long guilt trip indeed.
Apart from the psychological aspects of alternative medicine, there is the question of whether it actually works in a practical sense - whether it provides more than just

emotional support and placebo effect (the benefit that comes from any treatment which you believe in). This is always the central question for scientific medicine in relation to

its own treatments,
and conventional doctors naturally apply the same criteria to alternative medicine. Most of this chapter is concerned with trying to answer that question.
Unfortunately, there are so many different kinds of alternative therapy available today that it is impossible to cover all of them in this book. To complicate matters further,

many complementary therapists now practise two or more different techniques, mixing them to
produce their own unique cocktail of diagnosis and treatment. This eclectic approach can span a remarkable range - you may find a therapist doing distinctly whacky stuff such as

iridology (looking at the eye to diagnose all illness - it has been tested and definitely doesn’t work), combined with something perfectly rational such as an elimination diet.

(The elimination diet might be presented as a ‘detox diet’, but it is actually being used to detect food intolerances.)
With new forms of therapy springing up all over the place, a healthy scepticism is a distinct asset for the consumer. Be sceptical about any diagnostic test or treatment that is

only being practised by one person in the country, or in the world - when doctors hit on something that works, they want other doctors to try it out. World exclusives in

medicine are usually suspect.
Avoid any practitioner who tells you to stop using your drugs without your doctor’s consent. Likewise, avoid those with a messianic gleam in their eye, an evident disregard for

logic or reasonable discussion, or an amazing cure that fixes everything from acne to AIDS. Very few of those who sell bogus cures and phoney diagnostic tests are complete

rogues. Most are nice people who are quite genuinely convinced that they have indeed found the answer to people’s problems. The powers of placebo effect (see p. 233) can sustain

such a conviction for a very long time.

Acupuncture
Acupuncture shot to fame in the West in 1972, when James Reston, a correspondent for the New York Times, fell ill with appendicitis while covering President Nixon’s historic

trip to China. Following the removal of his appendix, he received acupuncture treatment for pain, and was highly impressed with its effects.
His Chinese doctor invited Reston to witness the use of acupuncture in anaesthesia, and he reported the remarkable fact that patients undergoing surgery could be free from pain

with just a few tiny needles inserted into carefully chosen points on the body. They remained alert and talkative throughout the operation.
Traditional Chinese medicine has enjoyed a good reputation in the West ever since, but what few people realise is that acupuncture anaesthesia is a very new invention. Surgery

was not traditionally practised in China and it was only in the 1950s, after Chairman Mao had urged Chinese doctors to unify Western and Chinese medicine, that the anaesthetic

potential of acupuncture was discovered.
The remarkable effects of acupuncture anaesthesia made a huge impression on doctors in the West – a high-profile success that has had both good and bad results. On the positive

side, conventional medicine has been prepared to take acupuncture seriously, and to undertake some research into its effects. On the negative side, most
of that research has concerned pain control – the effects of acupuncture on the endorphins. These are natural painkilling compounds produced by the body (their effects are

mimicked by opiate drugs such as morphine and heroin).
Western researchers have paid little attention to how acupuncture affects most other aspects of health, including the immune system and allergic diseases. One exception to this

is asthma, where certain nerves do play a large part in producing the symptoms (see box on p. 235).
Treating the person
Diagnosis and treatment are far more orientated towards the individual patient-, in traditional Chinese medicine, and diagnostic labels such as ‘allergy’ or `hayfever’ are less

important than the particular character of a person’s Qi (see box on p. 215), as detected by the acupuncturist. A traditional Chinese acupuncturist pays great attention to the

quality of the different pulses and takes them at the start of every appointment, and at intervals during treatment, to check how the Qi flow has changed. Each treatment session

is unique and tailored to the individual’s condition at that particular moment.
This makes it very difficult to carry out conventional scientific research into traditional acupuncture.
In an effort to make acupuncture accessible to research, a more Westernised and formulaic approach has been developed, using orthodox medical diagnosis and needling a set of

acupuncture points that are prescribed for that medical condition. Experts in traditional acupuncture feel that this approach – first name the disease, then apply a standard

remedy – will often fail, and is missing the whole point of acupuncture.
That is not the only problem with Westernised acupuncture, as Dr David Eisenberg of Harvard University, a leading expert on acupuncture, points out. He describes a typical

acupuncture session in China: ‘Each time the acupuncturist inserts a needle, he or she asks the patient, “Do you have it or not?” referring to the patient’s “obtaining the Qi”

(de Qi). The question asks whether the patient has felt a sensation of fullness, distension, pins and needles, or the like, from the insertion of the needle in the spot being

used… Most Chinese have experienced acupuncture and they understand the phenomenon of de Qi… By contrast, most Western patients seeking acupuncture therapy know nothing of

the phenomenon of de Qi. Not knowing what sensations they should anticipate, they cannot tell the acupuncturist whether a needle is in the right place. When both therapist and

patient know little about de Qi, as frequently occurs in Western acupuncture clinics, the result is bound to be disappointing.’ Fortunately it is possible to find acupuncturists

who have been properly trained, and the sensation of ‘obtaining the Qi’ is perfectly detectable, even to a sceptical Westerner, so look for someone who pays attention to this.
There can be emotional and psychological reactions to acupuncture, so make sure that you also feel relaxed with your acupuncturist and that there is a certain empathy between

you.
Does acupuncture work for allergies?
According to Chinese theories, acupuncture can have some benefits in any illness – if you are ill, your flow of Qi must be disturbed, and it will help to put that right. Indeed,

most people do feel a sense of well-being after an acupuncture session.
To look at this from a Western scientific perspective, acupuncture can stimulate your body to increase its production of endorphins (see p. 214). This gives you a mild high,

similar to that you’d get from running for a couple of hours. Feeling relaxed and confident helps most people to cope better, and gives them a new perspective on life’s

problems. Since the mind plays some part in almost all illness (if only to aggravate the effects of an underlying physical problem), inducing a more positive state of mind can

be of benefit.
As regards more specific effects, several studies show that acupuncture can have a small, short-term effect in opening up the airways of asthmatics. This is not surprising

because acupuncture affects the autonomic nervous system, the ‘auto-pilot’ section of the nervous system (see box on p. 235) which can tighten or relax the muscles around the

airways. A short-term effect is just that – it doesn’t treat the real problem. What matters more in asthma is the long-term impact of any treatment on the underlying

inflammation of the airways (see p. 36). Although some studies of acupuncture treatment have found a reduction in inflammation, other studies have not. However, only one study

to date used an individualised approach to acupuncture, as opposed to a same-for-everyone formula. It is interesting that this study did find good long-term effects on airway

inflammation.
The larger picture
Acupuncture is just one element of Chinese medicine, which has several other techniques available. In China (and in some Chinese clinics in the West) these techniques are used

together, as different ways of tackling the same problem. No traditional Chinese doctor would dream of trying to treat every patient with acupuncture alone and, in the case of a

patient with allergies, herbal remedies would usually be a central part of the treatment.
A recent and very careful scientific study from Germany took this combined approach with hayfever, and showed some benefit. The patients were treated with both acupuncture and

herbal treatment, using a standardised regime but with additional acupuncture points and herbs chosen to suit the individual. Those treated reported a substantial improvement in

how they felt generally –but not in the specific symptoms of hayfever.
The flow of energy
Acupuncture is rooted in ancient Chinese ideas of the human body. which are radically different from those of Western medicine:
•    Vital energy. called Oi or Chi (and always pronounced ‘thee’). is what distinguishes living bodies from dead ones. It should flow easily and harmoniously thrOLIC11011i

the body nourishing and protecting the organs. When the flow of Qi is blocked, or becomes unbalanced. then illness develops. - Channels called meridians are the conduits for Qi

in the body. They mostly run vertically (i.e. from head to toe) and the points where acupuncture needles are inserted all lie on these meridians.
•    The flow of Qi can be measured by carefully taking pulses — not just one pulse as in Western medicine, but several different kinds of pulse.
•    By detecting disturbances in the flow of Qi, and correcting them, existing illness can be cured, and incipient illness prevented, before there are any obvious symptoms.
The nature of the meridians and the acupuncture points remains a mystery to Western doctors. Some parts of the meridians run roughly along the lines of certain nerves or blood

vessels, but they do not follow them exactly. The acupuncture points have no anatomical reality — there is nothing to see either on the surface or under the skin. However, many

are located near major nerve endings or over deep pressure receptors.

Yeast-free Diets
Sultana, hazelnut and rosemary bread
In terms of its traditional use, yeast is not really a food — it is a microscopic but hardworking

domesticated creature that has helped us with the business of food preparation for many thousands of

years. The ability of yeast to turn sugar into alcohol and carbon dioxide gas has long made it a

valuable ally in the manufacture of both bread and alcoholic drinks.
In addition to this traditional use, yeast has, in the past 50 years, found a role as a true foodstuff

in the form of yeast extract. This derivative of yeast, with its strong flavour, has also become an

ingredient of stock cubes and ‘meat extracts’.
These are the most concentrated sources of yeast — foods to which yeast has been deliberately added

(such as bread and wine), plus the modern extracts of yeast.
People with an intolerance reaction to yeast usually need to avoid only these concentrated sources of

yeast.
In addition to foods containing domesticated yeasts, there are many foods which become naturally

colonised by wild yeasts, invisible scavengers whose spores are in the air all around us, like

microscopic wasps, just waiting for a pot of jam to be opened.
Wild yeasts quickly multiply on fruit, fruit juice, jam or any other sweet food, but unless the food is

obviously fermenting (i.e. it smells ‘yeasty’) the levels of yeast it contains are relatively low.

However, there are also some foods that contain wild yeasts in quite significant numbers even before

you buy them. They include dried fruits, such as raisins and sultanas,
and manufactured foods that are fermented or which take a while to mature, such as soy sauce, yoghurt

and cheese. In all cases, the slow production process inadvertently encourages the growth of wild

yeasts. Again, the amount of yeast in the food is far less than that in bread, wine or yeast extract.
Do these wild yeasts matter? For people with yeast intolerance, probably not. In the case of true

allergies to yeast, however, wild yeasts might be sufficiently numerous in some foods to evoke a

reaction from the most highly sensitive individuals.
Wild yeasts may also be significant for anyone with the controversial condition known as yeast

overgrowth (see p. 82). Some of those suffering symptoms which suggest this condition, and who are

following a no-yeast-nosugar diet (see p. 205), may need to avoid all sources of yeast for a while,

including foods containing wild yeast.
Concentrated sources of yeast include:
•    beer, wine, cider and vinegar
•    Marmite, Vegemite, or any other brand of yeast extract
•    yeast-based vitamin tablets; also most B-complex vitamin tablets unless specified as

‘yeast-free’
•    stock cubes, gravy powder, Oxo, Bovril and other ‘meat extracts’
•    bread (except unleavened breads such as soda bread, matzos, pitta bread and chappatis)
•    all other forms of leavened dough, including breadsticks, pizza, bread rolls, croissants,

teacakes, doughnuts, Danish pastries and Chelsea buns
•    some packaged food labelled with synonyms for yeast (see p. 174).
Low-level sources of yeast include:
•    distilled drinks such as whisky, gin, brandy and vodka
•    spirit (distilled) vinegar
•    yoghurt, sour cream, buttermilk, cheeses
•    dried fruits and vegetables
•    sauerkraut (pickled cabbage) and possibly other pickled vegetables
•    soy sauce, miso, tofu
•    tea (but not green tea, jasmine tea etc.)
•    any fruit if unpeeled; very ripe fruit even though peeled
•    jam, fruit juice or wine that has been open for a while; many commercial fruit juices also

contain a significant amount of yeast – dead but still allergenic – at time of purchase
•    leftovers that have been in the
refrigerator for more than two days. Note that some of the ingredients in the recipes that follow, such

as raisins, yoghurt and sun-dried tomatoes, may contain wild yeasts and therefore not be suitable for

those on a strict yeast-avoidance diet. You should adjust the recipes to suit the kind of diet you are

following.
Home-made stock
A good stock is essential for many recipes. As well as being yeast-free, this home-made stock tastes a

great deal better than most ready-made stock cubes.
PREPARATION TIME: 10 minutes
COOKING TIME: about 2 hours (or 45 minutes in a pressure cooker) MAKES: 850ml (1112 pints)
1 carrot
1 onion
1 stick of celery
fresh thyme or other herbs, or a bouquet gami of dried herbs
the remains of a carved roast chicken
1.5 litres (2314 pints) water
salt and pepper
dry sherry (optional)
Peel and slice the vegetables. Tie the fresh herbs together with fine string. Put the chicken into a

large saucepan, cover with the water, and add the other ingredients.
Bring to the boil, cover and simmer for 2 hours. Or cook in a pressure cooker, at high pressure for 45

minutes; in this case, use only 1 litre (12/3 pints) water.
Allow to cool a little, then pass through a coarse sieve and discard everything except the liquid. When

cold, skim off the fat from the surface. Heat through until liquid again, then add salt and pepper to

taste, and a dash of sherry.
This stock will keep in the refrigerator for 2-3 days, or in the freezer for three months. When

freezing, allow room in the container for expansion. If space is limited In the freezer, simmer the

stock further until very concentrated, then freeze in an ice-cube tray, to make frozen stock cubes.

Enclose in a plastic bag once frozen.
Easy brown bread
This yeast-free brown bread is based on a traditional Irish soda bread recipe.
PREPARATION TIME: 10 minutes COOKING TIME: about 45 minutes MAKES: 2 small loaves
450g (11b) 100% wholemeal bread flour 225g (8oz) white bread flour
2 tsp bicarbonate of soda
1 tsp salt
2 x 284ml cartons buttermilk, or natural yoghurt, thinned with a little milk, to make the same quantity
Place the wholemeal flour in a large bowl. Sift the white flour, bicarbonate of soda and salt over it

and mix well. Stir in the buttermilk and enough cold water to make a fairly soft dough. Divide the

mixture between two 450g (I lb) buttered loaf tins and cook in a preheated oven at 200′C/400′F/gas mark

6 for about 45 minutes until risen and firm to the touch.
Remove from the tins and check that the loaves sound hollow when tapped on the base – if not, put back

into the tins and return to the oven for 5-10 minutes more. When ready, cool on a wire rack.
Corn bread with chillies    Seeded muffins    Layered potato pizza
Corn bread with chillies
If you need to avoid wheat as well as yeast, try replacing the wheat flour with rice flour or soya

flour - or use all cornmeal.
PREPARATION TIME: 20 minutes COOKING TIME: 45 minutes MAKES: 1 large loaf
150g (5Y2oz) plain flour, sieved
150g (5Y2oz) fine cornmeal (maize flour), sieved
40g (1 112oz) sugar
V2 tsp salt
4 tsp baking powder
2 large mild fresh chillies (red or green), de-seeded and finely chopped, or one dried chilli
4 tbsp olive oil
1 large egg, beaten
150ml (/4 pt) natural yoghurt
150ml (Y4pt) milk
25g (1 oz) Cheddar cheese, grated (optional)
Mix all the dry ingredients in a large bowl then stir in the chillies and remaining ingredients and mix

to a soft dough. Transfer the mixture to a buttered 20cm (8in) round cake tin, sprinkle with cheese if

desired, and cook in a preheated oven at 200°C/ 4007/gas mark 6 for about 45 minutes until risen,

golden and firm to the touch.
Leave in the tin for 15-20 minutes, then turn out onto a wire rack to cool completely.
Variations: add 100g (31/2oz) sauteed chopped bacon; or 1008 (31/2oz) sweetcorn kernels; or 4 finely

chopped spring onions.
Sultana, hazelnut and rosemary bread
This bread is delicious with cheese. It is best eaten within a day or two of making. Store in a cool

place.
PREPARATION TIME: 1 hour soaking time, plus 15 minutes
COOKING TIME: about 45 minutes MAKES: 1 large loaf
100g (3Y2oz) sultanas
150ml (’14 pint) hot tea
approx. I 75ml (6fl oz) natural yoghurt 50g (1-,14oz) skinned hazelnuts
250g (9oz) plain flour, sieved
250g (9oz) wholemeal flour, sieved 40g (1′12oz) sugar
2 tsp baking powder
1 tsp bicarbonate of soda
1 tsp salt
1 large egg, beaten
4 tsp freshly chopped rosemary
Soak the sultanas in the hot tea for about 1 hour then drain, reserve the tea and make up to 300ml (/2

pint) with the yoghurt. Roughly chop the hazelnuts and toast in a dry frying pan. Mix the dry

ingredients together in a large bowl then stir in the egg, yoghurt mixture, sultanas and rosemary, and

work to a firm dough. Knead lightly and shape into a long loaf. Cut slashes in the top of the loaf and

transfer to an oiled baking tray.
Cook in a preheated oven at 200°C/ 400′F/gas mark 6 for about 45 minutes until risen and firm to the

touch. Cool on a wire rack.
Mediterranean scones
Serve fresh with butter or cream cheese.
PREPARATION TIME: 15 minutes COOKING TIME: 15 minutes MAKES: 9
250g (9oz) self-raising flour, sieved 1 tsp baking powder
Y4 tsp ground black pepper
50g (13/4oz) butter
50g (~1,ioz) sun-dried tomatoes, chopped
50g (1314 oz) pitted green olives, chopped 1 tbsp freshly chopped basil or 1 tsp dried basil, or other

herbs to taste I large egg beaten with 5 tbsp milk milk for brushing (optional)
3 tbsp grated cheese - Parmesan or any other hard cheese (optional)
Sift the flour and baking powder together then add the pepper and rub in the butter until the mixture

resembles fine crumbs. Stir in the tomatoes, olives and herbs and mix to a fairly soft dough with the

egg and milk mixture.
Roll out to about 2.5cm (1 in) thickness on a lightly floured surface and stamp out 6cm (21/2in)

rounds. If wished, brush the top of each scone with milk and sprinkle with 1 tsp grated cheese before

baking.
Place on a baking tray and cook in a preheated oven at 220°C/425°F/gas mark 7 for about 15 minutes

until risen, golden and firm to the touch. Cool on a wire rack.
Seeded muffins
These seeded American-style muffins make an excellent breakfast.
PREPARATION TIME: 15 minutes COOKING TIME: 20 minutes MAKES: 12
300g (10%2oz) self-raising flour, sieved
2 tsp baking powder
pinch salt
100g (3Y2oz) soft brown sugar
50g (13/4oz) pumpkin seeds
50g (13/4oz)) sunflower seeds
25g (I oz) each sesame seeds and linseed
4 tbsp vegetable oil or 50g (13/4oz) butter,
melted
2 large eggs beaten with 200ml (7fl oz)
milk
To serve: marmalade or jam
Place all the ingredients in a large bowl and beat well until evenly mixed. Spoon into a muffin tray

lined with paper cases, or use paper cases on their own. Cook in
a preheated oven at 200°C/400°F/gas mark 6 for about 20 minutes until risen and just firm to the touch.

Serve warm -not hot - with marmalade or jam.
Spinach and cheese polenta
Polenta can be served warm with a ’sloppy’ consistency to go with stewed meat or vegetables, or left to

set firm (as here) then sliced and fried. It’s delicious served with cooked ham, bacon or tomatoes.
PREPARATION TIME: 30 minutes MAKES: 10-12 slices
250g (9oz) fresh spinach
25g (1oz) butter
1 small onion, finely chopped
175g (6oz) cornmeal, sieved
1 tsp salt
V2 tsp ground nutmeg
2 egg yolks
40g (1 Y2oz) each freshly grated Parmesan and mature Cheddar cheeses
Wash the spinach, remove the stalks, squeeze out the excess water and shred. Melt the butter and cook

the onion over medium heat for 5 minutes to soften. Increase the heat, add the spinach and cook until

wilted and there is no free liquid. Add 850ml (1 Y2 pints) boiling water then slowly stir in the

cornmeal, salt and nutmeg. Cook over a low heat for 10 minutes, stirring frequently until thickened.

Remove from the heat and stir in the egg yolks and cheeses. Allow to cool slightly then transfer to a

cling-film-lined 450g (11b) loaf tin. There should be sufficient cling film for it to be folded over

the top of the tin. Shape the mixture and cover with the cling film. Leave until cold, then slice, and

fry or grill.
Layered potato pizza
Layered sliced potatoes form the base for this ‘pizza’.
PREPARATION TIME: 40 minutes COOKING TIME: 25 minutes MAKES: 3-4 servings
1 kg (21b 4oz) waxy potatoes, peeled and thinly sliced
2 cloves garlic, crushed (optional)
1 tsp finely chopped fresh rosemary or thyme
3 tbsp olive oil
400g can chopped tomatoes
125g pack mozzarella cheese, thinly
sliced
salt and freshly ground black pepper
To serve:
fresh basil or rocket leaves
Toss the potatoes with the garlic and herbs, and season very generously with salt and pepper. Pour 2

tbsp of the oil into a 30cm (12in) non-stick frying pan and arrange the potatoes in overlapping slices.

Set over medium heat for 10 minutes until lightly browned. Do not move the potatoes around, but allow

them to stick together into a big circular ‘pizza’ base. Brush the remaining oil on a baking tray.

Place the pizza base on this and cook in a preheated oven at 230°C/450°F/gas mark 8 for 15 minutes

until tender.
Meanwhile, cook the tomatoes over medium heat until all the liquid has evaporated. Season generously

then spread over the potato base. Top with the mozzarella and return to the oven for about 10 minutes.

Serve sprinkled with fresh basil or rocket leaves.
Variations: after adding the mozzarella, top with classic pizza combinations, e.g. anchovies and

olives, or pepperoni, or mushrooms and ham.

Pollen

Do you ever wake up in the middle of the night with an attack of hayfever or pollen asthma? And do you ever wonder why this should happen? The explanation is that warm air, rising up from ground level on a summer’s day, takes pollen with it high into the Earth’s atmosphere. When the air cools down after sunset, this pollen slowly descends again — an invisible ‘pollen shower’.
This pollen shower falls quite quickly in the countryside, reaching ground level between 8 p.m. and 10 p.m., but hot city pavements and buildings keep upward air currents going, and pollen stays aloft for longer. Most pollen lands on the city between about midnight and 2 a.m. That’s why you wake up sneezing or wheezing – especially if you sleep with the windows open.
Understanding facts like these about pollen can help you to reduce exposure substantially. Pollen is by far the most difficult allergen to avoid, but don’t believe the defeatists who tell you ‘You can’t do anything about pollen.’
Pollen counts and forecasts
Pollen counts are based on the amounts of pollen collected at specific sites earlier in the day, or on the previous day.
Forecasts for the coming day are really just informed guesswork, based on the present pollen count, the time of year, the temperature and rainfall over the last few days, and the weather forecast for the next day. At best, pollen forecasts are only as good as the weather forecast.
Forecasts of pollen can be useful in deciding when to start taking antihistamines for hayfever or when to Increase your asthma preventer drugs (steroid or cromoglycate inhalers). The start of the grass-pollen season is now predicted quite accurately.
Avoiding pollen outdoors
One thing that really can help here is an air-conditioned car. In an ordinary car, closing the windows (and perhaps fitting a filter to the air intake) helps a lot, but the heat is terrible.
The size of the allergen particles
The pollen grains that cause allergies are between 10 and 40 microns in size, with the majority between 20 and 35 microns. An ordinary dust mask takes out particles larger than 5 microns, so it will be adequate for most pollens. However, a few plants — including rye grass — produce tiny allergenic fragments, some no bigger than half a micron. These are about the same size as cat allergen and will therefore need much better masks. For these fragments, it is worth using a HEPA air filter, and getting a high-quality vacuum cleaner.
A cycle mask, or special nose filters sold for hayfever, will keep out pollen at peak pollen times. Just wearing a scarf over the mouth and nose will also give some protection. Another option is to smear a little Vaseline just inside each nostril and breathe through your nose only. Much of the pollen coming into your nose will stick to the Vaseline. If you ’suffer symptoms in the eyes, sun- glasses will keep some pollen out. Even better are wrap-around shades, or safety goggles with side panels sold in DIY stores.
Pollen release occurs at different times of day for different plants. Grasses release pollen from about 7.30 a.m, onwards, but if the ground is damp the release will be delayed until the moisture has evaporated. Unfortunately, a few grass species wait until the afternoon, so there will be some pollen entering the air all day. If you get up at 6 a.m. for a walk or run, you can be safely home by 7.30 a.m. Alternatively, go out In the early evening, after grasses have finished releasing pollen, and before the ‘pollen shower’.
Birch is an afternoon pollen: release peaks between noon and 6 p.m. Unfortunately, there is no information at present for other types of plants.
All types of plants favour warm sunny days for releasing pollen, and they all avoid rainy weather. On cloudy days there is a build-up of pollen in the flowers, so a massive release of pollen occurs on the next day of good weather.
Avoiding pollen indoors
Pollen grains have one huge point in their favour: compared to other allergenic particles, they are big and heavy. This means that they settle more quickly from the air. In a room with 3m- (1 Oft-) high ceilings, all the pollen will settle within four minutes, as long as the air is completely still. In other words, if you close all the doors and windows, block off any draughts, and sit fairly still, within four minutes you will be breathing pollen-free air.
This does not mean that all your symptoms will instantly vanish, because the ‘Late Phase Reaction’ (see p. 13) can go on for up to 24 hours. But you should feel better and, by not starting a new cycle of allergic reaction, you are improving the prospects for the next day. Escaping from pollen for a few hours every day should produce a general improvement in the long run, with your nose and airways becoming less inflamed.
The bad news is that some plants produce allergenic fragments much smaller than the pollen grains themselves. Various grasses do this, as do birch trees and certain plants not generally found in Britain, such as ragweed. These tiny particles take much longer – up to six hours – to settle from the air.
Some plants even produce ‘volatiles’ – airborne chemicals that provoke symptoms. Birch trees release volatiles from their buds in early spring, weeks before the pollen itself is released, and they affect a great many people, including some who are not allergic to birch pollen. Volatiles can only be removed by masks or air filters if they contain an activated carbon filter (see p. 109).
The notorious effects of oil-seed rape on the nose are also due to volatiles, not pollen. These volatiles are simply irritants and there is no allergic reaction.
To cut down on the amount of pollen you inhale at home:
• Dry all your laundry indoors during the pollen season, to stop it collecting pollen.
• Pets bring in pollen on their fur, so keep them outdoors during the pollen season, and avoid stroking them or getting too close. Brushing them thoroughly before they come in is another option, but the allergic individual should not do this.
• Close the windows when your offending pollen is being released, and during the evening ‘pollen shower’ (see p. 126).
• Change your clothes when you arrive home, since they will be coated with pollen, and wash or rinse your hair. Keep some clothes for indoor use only.
• Aim for still air (no draughts, no fans and no vigorous movement) in the rooms where the allergic individual studies, sits or sleeps. Air currents stir up pollen from the floor and furnishings. (No draughts means poor ventilation, of course, which is acceptable during the pollen season – but ventilate again afterwards, to discourage moulds and dust mites.)
• If tranquil air is an impossibility, consider getting a high quality air cleaner, or air conditioning. Alternatively, wet-dust and vacuum every day (using a vacuum cleaner that keeps allergen particles in – see pp. 116-17) to reduce the amount of pollen residue. Those who are very sensitive may need to do this as well as having an air cleaner.
• Cover your armchair and bed with a dust sheet during the day. In the evening, fold this up very gently and wash it. This removes the layer of pollen that accumulates on furniture during the day, before it is disturbed and inhaled. If you are studying, cover your desk and books when not working.
Places to go, places to avoid
• For the grass-sensitive, mown grass is usually fine (it won’t flower) although some people react to skin contact with grass (see p. 43). Unmown grass does flower, and will cause symptoms. Wheat, barley and oats, although they are grasses, release little pollen and rarely cause problems. Rye and sugarcane do release pollen, and may affect some people, but maize (corn) has heavy pollen that does not travel far, so it rarely causes much trouble.
• The levels of most pollens do not differ much between town and country. In fact, high up in a tower-block may be one of the worst places, because of pollen rising on warm air.
• The seaside is often pollen-free thanks to onshore breezes. Mountain peaks and ridges are also good, but deep mountain valleys can be pollen traps.
Roses are not the problem
The pollens that cause allergic reactions almost all come from plants with inconspicuous greenish flowers. These plants are pollinated by the wind, which is why there is so much of their pollen wafting about in the air. Colourful and scented flowers are pollinated by insects and have big sticky pollen grains that don’t float about and rarely cause allergies. However, strong scents can irritate the nose of those who already have hayfever, and make their symptoms worse.

Many countries have special schools for children with severe asthma and other allergies. Italian children are sent to one in the Italian Alps, where there is no trace of pollen, house-dust mite, or animal allergens. After nine months these children are a great deal healthier and more active - all their lung function tests are vastly improved. Blood tests show that they are actually less allergic to common allergens than before.
You may not be able to do quite this well at home, but all allergens and irritants can be avoided to some extent. Even if you can’t eliminate them completely, you can certainly reduce your exposure.
Before you start, it is important to be clear about exactly what affects you, otherwise you will be wasting a lot of effort. For example, people who are allergic to dust mite often think that a dusty house will necessarily be worse for them than an apparently clean house, but this is not so (see p. 115). Or they may say ‘Oh, I got asthma on holiday, because the roads were so dusty and I’m allergic to dust,’ forgetting that only house dust contains dust mites. The road dust may have acted as an irritant, and helped to spark the asthma attacks, or it may have contained pollen or mould spores - but it does not contain dust mites or their allergens. Blaming the wrong thing for the asthma attack means that the real culprit is not identified.
If you are not absolutely sure what causes your allergies, skin-prick tests (see p. 91) can identify the allergen. These are especially recommended if your reactions to the presumed allergen are inconsistent, or you don’t respond to the anti-allergen programmes described here. For example, a few people who react to house dust are not allergic to dust mites, but to something else in the dust such as wool fibres or mould spores, or particles from cockroaches, house
flies, carpet beetles or a long-departed cat. Even pollen that has accumulated in house dust can provoke allergic reactions - if you are not an over-keen duster, it can still be there long after the pollen season.
If you have hayfever, knowing which pollens cause your symptoms (and learning to recognise the plants concerned) is useful. You will probably need skin-prick tests to be sure. ‘Hayfever’ can even be a seasonal mould allergy in some people (see p. 27).
Tackling allergens is now big business. There are a lot of people out there competing for your money and false claims are common, especially for anti-mite products. Only a few manufacturers are deliberately misleading, and most false claims probably stem from ignorance or wishful thinking, but be very sure you know the facts about your allergen before you buy.
Air cleaners are a good example. A really good quality air cleaner (which uses a HEPA filter - a High Efficiency Particulate Air filter) is an expensive purchase and, as the advertising tells you, it takes out very small particles with staggering efficiency. But this is entirely irrelevant if the source of those particles is no distance at all from your nose - your mite-infested pillow, for example, or the cat on your lap.
Something else that advertisements for air cleaners rarely mention is that unless you reduce allergen production - tackling mould growth in the house, for example, or keeping the dog outside - the filter can’t help much. In short, air cleaners do have their uses for some allergens, but they can’t work miracles.
The products mentioned here, if not available in your locality, can be bought mail-order from specialist suppliers of anti-allergy products (see p. 255). Note that some offer both very good products and distinctly doubtful products, so judge each item on its individual merits. Ask to see scientific evidence that it works.
Don’t be taken in by vague statements such as anti-allergenic’ - get the facts. This label is often used on pillows with synthetic filling, for example, and people assume that it refers to dust-mite allergy, whereas it simply means that the pillow does not contain feathers. But unless you are allergic to feathers, there is no reason to avoid feather pillows. (In fact, if not covered with mite-proof covers, synthetic pillows collect more dust-mites than feather pillows, because the fabric used for the cover is less tightly woven and the mites and skin particles get in more easily.)
Bad advice is also a hazard. Some of it just wastes your time and effort, but some could actually increase your exposure to the allergen. Advice to vacuum floors daily, or to vacuum beds, is commonplace but this achieves little and it means breathing much more allergen unless you have the right kind of vacuum cleaner. One health magazine even advised its readers with dust-mite allergy to ‘air mattresses by regularly turning them’. This will not affect mite numbers at all, but it will shoot massive amounts of mite allergen out of the mattress and into the nose and lungs.
Ridding your house of allergens and irritants is, in itself, a hazardous procedure because more of the offending substances will be released into the air during the work. If you take up carpets or remove mattresses, dust-mite allergens and mould spores will be churned up in their millions. Just bundling up a duvet will produce invisible clouds of dust mite allergen - and cat allergen, if your pet once slept on the bed.
Ideally, the allergic individual should not do the work, nor be in the house until it is 100% complete and the house has been very thoroughly aired. This is particularly important for those with chronic sinusitis and mould growth in the house, because of the risk of fungal infections in the sinuses (see p. 32).
If you are an allergy sufferer and have absolutely no choice but to do the work yourself, or to be present, then you should get a good quality dust mask and wear it throughout - only take it off when you go outdoors. Those with atopic eczema and sensitivity to airborne allergens should cover their skin carefully -with clothing, not barrier cream.
An ordinary hardware-shop dust mask is not adequate for most allergens - it only takes out really big particles and lets through all the common airborne allergens except pollen. You need a more serious sort of mask, designed for workplace use and conforming to official standards. Before buying one, ask what is the smallest size of particle that it filters out (at 90% efficiency, or better). Compare this with the particle size of your allergen (given in the articles that follow).
You must be able to breathe well through the mask when physically active, and it must fit tightly against your face, forming a seal at all edges. Beards and moustaches tend to prevent this - as does stubble.
Masks that combine an activated carbon filter with a dust filter will take out gases and chemical vapours as well as particles. Cycle shops now sell such masks -or try an industrial supplier. Such a mask can be useful if you are affected by traffic exhaust or industrial pollution as well as an allergen, for example, or if you are exposed temporarily to wet paint or other fumes at home. Activated carbon masks should also filter out the irritant substances from oil-seed rape plants.
Some people who try the anti-allergen programmes feel much better quite fast. But generally these are long-term strategies - you may not reap any benefits for a few weeks, and the improvement may be small at first. Sometimes it takes several months for the full effects to be felt, so be persistent.