Tuesday, April 15, 2014

1970-1985: No antihistamines for asthmatic boys

As I look back on my asthma past, which I've done a lot lately considering I'm writing a history of asthma, the thing that irritates me the most is that I wasn't allowed to take anything for my allergies.  I had severe allergies, and I was forced to sufferer through every one of them.

The reason this irritates me so much is there were antihistamines available since the 1950s, and there were even antihistamines in the bathroom cabinet at our house, yet I wasn't allowed to take them.  Now I don't know if it was my mom's fault or my doctors, but the reason my mom gave me was because the box states not to use if you have asthma as it "may cause wheezing."

I have severe allergies.  I'm allergic to a variety of molds, dust, fungus, and you name it.  Today I know that when my allergy symptoms are controlled, so controlled is my asthma.  The thing it when you're an adult it's easier to stay away from your allergens.  It's still no fun to avoid them, yet it's possible  

Kids, on the other hand, are under constant pressure of their siblings and friends to play on the ground, the dirt, the woods, etc.  Kids are closer to the ground, where allergens hang out.  Kids roll on the carpet.  Kids play in the basement.  Kids play in old, dusty, worn out forts.  Kids play hide and seek in bushes.  Kids are all over.  It's just what kids do.  

So you can see how it would be hard for a kid to avoid allergens.  As a kid who tried to be as normal as possible, I usually did whatever my brothers and friends wanted to do.  I paid little attention to my allergies, and I usually suffered as a result (although this changed as I got older).  And, when the sniffling and sneezing came about, I was forced to suffer.  When I got older I'd sometimes request a medicine for it.  Yet I was allowed none of it.  I was forced to suffer (My parents had empathy, they just weren't allowed to use antihistamines for me).  

I remember more than once playing with my brothers, and all of a sudden my eye would be swollen shut.  My mom would have me sit in my room, or on the couch, for hours with a hot, washcloth over my eye.  I remember this would happen often while on vacation. If my asthma acted up, that was an added dilemma.  Yet my allergies were something that there was nothing I was allowed except avoidance and warm wash cloths, and sitting like a moron on the couch while everyone else was having fun.  At school I got picked on.

Benadryl was a medicine in the bathroom medicine cabinet also that was marketed as a cure for allergies.  It was available as a prescription since 1946.  But I wasn't allowed to use it.  Perhaps the reason for this goes back to 1949, 21 years before I was born, when the Food and Drug Administration (FDA) cleared Neohetamine as the first antihistamine for sale over the counter without a prescription.  This medicine and a variety of others, including Benadryl, were advertised in magazines all over the U.S. as a remedy for allergies and colds that could be purchased without a prescription.  (1, page 227)

By 1950 there were over 21 over the counter antihistamine products, "packaged under one hundred different trade names in tablets, nasal sprays, eye drops, and creams."  (1, page 216-17) and they were advertised heavily, in what was called by many the "Cold War," according to historian Gregg Mittman.  Consumers started purchasing various antihistamine products believing that they were buying a cure for allergies and colds.  Mittman says that sales of antihistamines boomed.  

People were taking the medicine without reservation, and they were giving it to their kids.  Yet it didn't take long before parents realized antihistamines didn't cure hay fever, and had little effect on colds.  In fact, some were even noticing side effects, especially in children.  In the process of drying out the nasal passages and stopping the nasal drip, the medicine caused dehydration of the respiratory tract, especially if used in excess.  This caused wheezing, and possibly other asthma symptoms.

Mittman explains that "The initial attack on OTC antihistamine drugs came not from consumers or the FDA but from the AMA (American Medical Association)."  So while some were claiming antihistamines were the new miracle drug for colds, "Austin Smith, editor of the Journal of the AMA, declared that 'no one yet knows what harmful effects (antihistamines) may produce on the body in general, or on specific tissues, when taken over prolonged periods of time." (1, page 227)

Various groups started calling for the FDA to force manufacturers of the medicine to list potential side effects.  Mittan quotes the New England Journal of Medicine:  "This is the most striking example to date of the advertising methods of manufacturers and promoters who are steadily going over the heads of the medical profession in attempts essentially to force physicians through their trumped-up public demand to accept remedies before their usefulness has been adequately substantiated and ill effects determined." (2)

Mittman adds:  "While the FTC (Federal Trade Commission) deliberated over whether drug companies had violated federal trade laws, physicians stepped up their attack by alerting the public to the inherent dangers of antihistamines, particularly for children."  Voila.  That's what I was getting at.  I was a child, a direct recipient of this scare. As far as I know the scare may have saved lives, but it forced me to suffer (note: I may have suffered even with antihistamines, although, considering they help me today, I'm going to assume they'd help me back then).  (1, page 230)

Herman Bundesen, president of the Chicago Board of Health, warned that some children had died after "indiscriminate antihistamines use."  Likewise, "Children taking antihistamines for allergy or colds, advised Bundesen, needed to be placed under a physician's care.  Bundesen also advised caution and restraint in embracing antihistamines as the magical cure for children's allergies.  As much as parents might wish it, antihistamines did not eliminate the need for shots, special diets, or environmental control of the home.  The therapeutic effectiveness of antihistamines varied, Bundesen insisted, according to place -- in this case, the body of an individual child" (3)

A June 1950 compromise by the FTC allowed advertisers to continue advertising the products, although they could no longer say that they would "cure, prevent, abort, eliminate, stop, or shorten the duration of the common cold."  In other words, nothing changed.  There was nothing in the FTC decision regarding safety of the medicine. Advertisers, according to Mittman, were allowed to continue as they were already doing. (1, page 230)

The AMA was unhappy by the ruling.  However, an editor in Collier's was "cynical" the way I'm cynical regarding the medical industry (at times). The editorial suggested the AMA was merely hoping "to give the prescribing physician a monopoly on the first promising remedy that ever came along."

I think the same can be said of Ventolin of 2012.  Could you imagine how much business doctors would lose if Ventolin was available over the counter. Asthmatics with little money wouldn't be forced to pay for a doctor to get their hands on one, and they wouldn't have to pay $75 a pop, because the price would undoubtedly go down.  Patients, and parents, could decide how to treat asthma, as opposed to physicians.

I'm not petitioning for OTC Ventolin, I'm just making an example here.  Although, I think instead of scaring parents and doctors away from antihistamine use, the OTC should have provided doctors and parents with a warning such as:  "Use this medicine with caution for young asthmatics.  Consider the benefits with the risks, which are.... if you absolutely need to use this medicine, stop using it if your child appears to have an asthmatic attack as a result of taking the medicine."

Such a warning would have prevented abstaining use for asthmatic/ allergic children such as myself, patients who truly needed the medicine.

So in the 1950s and 1960s there was an ongoing battle:  doctors wanted allergy sufferers to see a doctor, and FTC and FDA wanted patients to be able to treat their own allergies, much like they treat their own colds.  (1, page 231)

To add to the scare, it must be added here that by that Mittman notes that by the mid 1950s it was observed that antihistamines did not do anything to stop an asthma attack, that was a job for bronchodilators.  (1, page 231) This must have been an added disincentive for doctors to prescribe antihistamines for young asthmatics.

Adults could do whatever was needed to get the medicine that allowed them to function in life.  Yet a child, as I was in the 1970s, had to rely on his physician and parents to not only observe the allergy and cold symptoms, but to do something about it.  I was basically at the whim of the warning on the box that warned against using on children and especially children with asthma. As a result I had to suffer despite the remedy in the medicine cabinet.

Instead of doing that, instead of scaring physicians from prescribing a medicine that might have taken the edge off the suffering of a boy with allergies and asthma, they should have warned physicians to weigh the possible advantages with possible side effects.  Physicians should have been warned to trial patients on the antihistamines, although monitor them closely.

Parents should not have been scared into not giving antihistamines to the one person in the household who would truly benefit from them.  Because, I can honestly say, while antihistamines don't take away all the symptoms of allergies, they sure do help.  Today I use Claratin every day, and it's a wonderful medicine.  Claritin is nice not only because it relieves and prevents allergy symptoms, it doesn't make you drowsy like Benadryl.

I also have to add here that when I was a patient at National Jewish Hospital/ National Asthma Center in Denver in 1985, my doctors there prescribed a daily dose of Drixoral.  Yet when I returned home my mom told me I didn't need it so she quit buying it for me. The irony is I probably needed the Drixorol more at home where the entire house was full of allergens, as compared to at the hospital where the only allergens was pollen and whatever other pollution was in the outside air (and only when I was outside, considering most windows were sealed).

So I suppose there was ignorance on both sides of the isle here.  Still, it frustrates me as I look back.  It frustrates me as I see myself suffering, and out of ignorance I wasn't treated. Although, as the old saying goes, do the best you can with the knowledge you know today, and as you learn better you do better.

My parents were also told to get rid of the dog.  My parents were also told to get rid of the plants.  My parents were told lots of things, and they didn't do much.  They did do some.  They replaced the wood heating vents in my room with steam heating vents.  Yet they still burned wood in the basement, and stored wood down there, because it was a cheaper way to heat the house.  Lord knows wood holds mold, and wood smoke triggers asthma by itself.

I empathize with my parents not doing much, however, because they were simply trying to live within their means  Plus neither of the had asthma or allergies, so even while they witnessed my suffering, they may not have fully understood it

I think of those years every time a young asthmatic passes through the ER when I'm working.  I treat patients with a heavy heart when they are in the ER because they can't afford Advair, which costs $220 a pop , or even Ventolin, which costs $73 a pop.  Lacking health insurance, lacking a good paying job, many of these asthmatic/ allergy sufferers have no option but to go to the ER when their asthma acts up.  They have to treat exacerbations as opposed to preventing symptoms. (Prices are in 2012 values)

References:
  1. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
  2. Mittman, op cit, page 229, quoted from: "MDs Hit Unlimited Antihistamine Use," Drug Trade News, 9 January, 1950, page 35
  3. Mittman, op cit, page 230, quoted from:  Herman Bundesen, "Dangers for Youngsters in Antihistamines," Ladies' Home Journal, June 1950, pages 192, 194

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