Quotes of the Week
The Top Three

Antihistamines and Alcohol
At a recent meeting of our Journal Club, Dr. Steve Eppstein presented some very interesting and provocative articles. One of these was by Dr. S. Yusuf, a Canadian investigator, and it was originally published in the January 20th issue of The New England Journal of Medicine. This was a multi-center study looking at the effect of an ACE inhibitor (Ramipril) on cardiovascular mortality and morbidity in high-risk adults. The study was stopped early because of the identified beneficial results. Those adults taking Ramipril had a lower rate of cardiovascular events such as heart attacks and strokes and also a lower mortality rate than the adults taking the placebo. An editorial comment thought that ACE inhibitors should likewise be prescribed for patients with type 2 diabetus.
     Ed. This was a large trial (9541 adults) and the identified benefit is impressive.

Dr. M. Dwain McDonald presented an article from the February 2000 issue of The Southern Medical Journal that reviewed the question of how common are the various causes of dizziness. The authors Kurt Kroenke et al from the Indiana School of Medicine, University of New Mexico School of Medicine, and Case Western University researched medical literature from 1966 to 1996 and concluded that 70% of the cases of dizziness were due to vestibular (inner ear) or psychiatric causes. Serious causes such as tumors were uncommon; therefore extensive diagnostic testing could be reserved for a small subset of patients rather than routinely utilizing the more costly procedures.
     Ed. I was surprised by the estimated number of clinic visits (7 million) in the United States each year. The authors further stated that dizziness was one of the most common referrals to neurologists and otolaryngologist (ear nose and throat doctors).

Fact or myth??? Abstinence prior to interventional treatment for substance abuse is a predictor of successful outcomes. ---Myth. Dr. Ed Furber reviewed an article by David B. Rosengren PhD, et al published in Addiction (2000) 95(1), 65-76.In this article they reported their results from Project STOP in Seattle, Washington. They concluded that abstinence prior to treatment for substance abuse was not indicative of entry into the program, completion or outcome.
     Ed. One would logically think that if an individual could abstain prior to treatment then this would more likely indicate a successful outcome. This research from Seattle does not support that belief.

Dr. Lazarus Loeb presented a very interesting article from the Ann Intern Med. 2000; 132:354-363. This research paper by John M. Weiler M.D. et al looked at the effects of certain antihistamines and alcohol on driving performance. As a background to this study the statistics relating to the treatment of allergic rhinitis are quite interesting. It is estimated that more than 39 million persons in the United States are bothered by allergic rhinitis and only 4.8 million (12%) take prescription medication for it. Most people go without treatment or self medicate with over-the counter drugs, which generally contain a first-generation antihistamine. These medicines can cause drowsiness and interfere with the performance of every day tasks. The authors wanted to compare automobile driving efficiency after a person doses with various antihistamines and then combines this with alcohol consumption. Their conclusions were as follows: "Participants had similar performance when treated with fexofenadine (allegra) or placebo. After alcohol use, participants performed the primary task well but not the secondary tasks; as a result, overall driving performance was poorer. After participants took diphenhydramine (benadryl), driving performance was poorest, indicating that diphenhydrarnine had a greater impact on driving than alcohol did. Drowsiness ratings were not a good predictor of impairment, suggesting that drivers cannot use drowsiness to indicate when they should not drive."
     Ed. This is a very important study. Benadryl in half prescription strength is available over-the-counter and many times is used as a sedative to promote sleep especially on long airplane flights. The effect when it is combined with alcohol, which is available on airplanes, should be noted. The combination should be avoided especially since the partakers can't use drowsiness as a measurement of their motor skills.

My weekly review of some of the current medical literature resulted in some interesting articles. This is another report dealing with vascular problems, which unfortunately make up a major portion of Preventive Medicine. This paper by Brigit C. Van Jaarsveld M.D. et al from the Erasmus University Hospital in Rotterdam was published in the April 6th issue of The New England Journal of Medicine. They found that in patients who were hypertensive because of narrowing of the artery that supplies a kidney, treatment by angioplasty (coring out the blockage) had no advantage over antihypertensive medications.
     Ed. At first these cases were treated by surgery however later percutaneous balloon angioplasty became the preferred and less invasive method. This study was small (106 patients) but then this cause represents a small segment of the patients who have hypertension. I think it is a significant report.

"Even though a number of people have tried, no one has yet found a way to drink for a living."
     - Jean Kerr, US dramatist, Poor Richard

"Who could have foretold, from the structure of the brain, that wine could derange its functions?"
     - Hippocrates (c.460-c.377BC)

This week I interviewed Dr. Lazaus Loeb who is a Fort Worth Allergist. Since spring is a major allergy season, I was interested in reporting his impression of the top three allergens currently causing problems in the Metroplex. His answer was:
  1. Oak pollen
  2. Fungus
  3. Cedar pollen
He also stated that grass pollen would come into play later this spring.

Take care until next time,
RJT, Editor.

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