Nonprescription antihistamine medication such as diphenhydramine (Benadryl) by mouth reduces the itch and watery eyes. Caution - these medications may make you too drowsy to drive or operate machinery safely. They can interfere with concentration or with children’s learning at school. They are to be used for a few days only. If symptoms do not improve, your physician may prescribe one or more medications. The medications do not cure the allergy, but relieve symptoms.

Antihistamines include older antihistamines, also called first-generation antihistamines, and newer second-generation antihistamines.

First-generation antihistamines most of these antihistamines are available without a prescription, such as diphenhydramine (Benadryl), clemastine (Tavist), and chlorpheniramine (Chlor-Trimeton Allergy). These older antihistamines are more likely to cause drowsiness. Depending on the product, the duration of action is often shorter than newer antihistamines and may necessitate taking the drug 3-4 times each day. These older antihistamines are more likely to cause dry mouth, urinary retention, constipation, and blurred vision.

Second-generation antihistamines, these antihistamines are also referred to as nonsedating antihistamines. Most are only available by prescription, such as cetirizine (Zyrtec), desloratadine (Clarinex), and fexofenadine (Allergra). The original second-generation antihistamines are now becoming available without a prescription (over the counter [OTC]), such as loratadine (Claritin).

They can be taken over the long term with minimal side effects and are unlikely to cause sleepiness. The nonsedating antihistamines are convenient to take since they are taken once or twice daily. They may allow you to carry on with your normal activities more easily than older first-generation antihistamines.

Decongestants are also available to decongest the nose when it is stuffy. Do not use decongestant nose sprays (such as Afrin) for more than 3 days, otherwise nasal congestion will reoccur. Antiallergy eye drops: These may relieve severe itching, tearing, redness, or swelling of the eyes.

Corticosteroid nasal spray usually works better than do antihistamines. Corticosteroid nasal sprays relieve the congestion and swelling of the lining of the nose. These sprays take a few days to work and are best used every day to be most effective. They are safe to use because so little medicine is necessary for relief. Corticosteroids (such as prednisone, methylprednisolone) are prescription medications taken by injection or by mouth that reduce inflammation and symptoms such as swelling.

The treatment of lupus greatly differs from a patient to another, lupus sufferers receiving a certain type of medications according to their experienced symptoms and the seriousness of the disease. Thus, the treatment of lupus is often personalized, comprising many different types of medications and therapies. Lupus patients (especially patients diagnosed with systemic lupus erythematosus) are commonly administered combination treatments, targeted at countering the occurrence and aggravation of the multitude of symptoms characteristic to this type of autoimmune disease.

Although at present there is no specific cure for lupus, the existing treatments can greatly ameliorate the symptoms of the disease and minimize the risk of complications. Lupus often has an unpredictable pattern of progression, producing symptoms that come and go over time. Thus, most lupus treatments are aimed at prolonging the periods of remission and ameliorating the phases of relapse. Once a patient is diagnosed with lupus, he/she will receive a treatment according to age, gender, overall health condition, symptomatic intensity, as well as lifestyle. With the right medication plan, patients can keep the disease under control and even live normal and healthy lives. Today’s treatments are efficient in easing the symptoms of lupus and they also allow patients to carry on with their usual daily activities. Most patients with lupus don’t require prolonged hospitalization and bed confinement is rarely needed.

The treatment of lupus is individualized, aiming to meet the needs and symptoms of the patient. For instance, for patients who suffer from musculoskeletal conditions due to lupus, doctors commonly prescribe treatments with medications that reduce inflammation and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively administered to patients confronted with symptoms such as joint swelling, stiffness and pain, muscular weakness and fever.

Nonsteroidal anti-inflammatory drugs can either be administered alone or in combination with similar medications. Due to the fact that such medications can produce serious side-effects, it is recommendable to avoid long-term use. Nonsteroidal anti-inflammatory drugs should be administered only during the periods of relapse, when the symptoms of lupus suddenly increase in intensity. Popular NSAIDs are: ibuprofen, naproxen, sulindac, diclofenac, ketoprofen, diflunisal, nabumetone, indometacin and oxaprozin. In order to minimize their side-effects, you should respect your doctor’s exact instructions when using such medications.

Another type of commonly used medications are antimalarials. Originally prescribed in the treatment of malaria, these medications are also efficient in the treatment of lupus, as they tend to suppress a series of processes at the level of the immune system, neutralizing some of its undesirable effects on the organism. Antimalarials used in the treatment of lupus include: hydrochloroquine (Plaquenil), quinacrine (Atabrine) and chloroquine (Aralen). These commonly used lupus medications are prescribed to ease fatigue, joint inflammation and pain, skin rashes and inflammation of the lungs and heart. Unlike NSAIDs, antimalarials have less serious side-effects, rendering them appropriate for long-term treatments. Ongoing treatment with antimalarials can efficiently prevent the occurrence of flares.

Corticoid steroids are often prescribed in the treatment of lupus. Corticosteroided hormones such as prednisone, hydrocortisone, methylprednisolone and dexamethasone are usually prescribed in small doses to reduce inflammation. Due to the fact that these medications can produce serious side-effects, they are only prescribed in short-term treatments. For patients confronted with severe forms of lupus, doctors usually prescribe immunosuppressive drugs such as azathioprine and cyclophosphamide. The main action of immunosuppressive medications is to minimize the damage caused by the impaired, overactive immune system at cellular level. Although immunosuppressive drugs are very efficient in easing the symptoms of lupus, they are known to cause dependency and thus they shouldn’t be prescribed in long-term treatments.

So if you want to find more about Lupus or more details about discoid lupus please follow this link http://www.lupus-guide.com

How did the symptoms begin?
When did they begin?
What joints are involved?
How long does the stiffness in the morning last?
How has your level of fatigue changed?
What do you have difficulty doing that you could do without trouble before your symptoms began?

are very helpful.

Valuable diagnostic laboratory tests include the rheumatoid factor, anti-CCP, erythrocyte sedimentation test (ESR), and C-reactive protein (CRP).

Imaging tests such as magnetic resonance imaging and ultrasound are helpful. X-rays are of limited use because significant damage can occur before it shows up on x-ray.

It’s important to realize that progression of RA is closely associated with the development of disability. It is also associated with the development of other potential problems such as early cardiovascular events such as heart attacks and strokes.

Before discussing treatment, lets look at the goals of treatment. These include: control of signs and symptoms, prevention of deformity, maintenance of joint function, control of co-morbidities (other associated disease such as hypertension, diabetes, etc.), and restoration of normal activities of daily living.

Current treatment options involving medications include:

Non-steroidal anti inflammatory drugs help reduce pain and improve function. They do not have an effect on slowing the underlying disease. Examples include ibuprofen (Motrin), naproxyn (Naprosyn), sulindac (Clinoril), etodolac (Lodine), nabumatone (Relafen), ketoprofen (Orudis), meloxicam (Mobic), and celecoxib (Celebrex).

These drugs are effective but they have potential side effects including peptic ulcer disease, kidney and liver damage, rashes, and fluid retention, and possibly a slight increase in cardiovascular events such as heart attack and stroke. These drugs require careful monitoring.

Corticosteroids suppress inflammation but also have no effect on the underlying disease. Examples include prednisone, methylprednisolone, and prednisolone. They have potential side effects including ulcers, cataracts, osteoporosis, adrenal gland suppression, thinning of the skin, and diabetes.

Disease-modifying anti-rheumatic drugs (DMARDS slow down the progression of rheumatoid arthritis. Examples would be medicines such as methotrexate, sulfasalazine (Azulfidine), leflunomide (Arava), and hydroxychloroquine (Plaquenil).

DMARDS act slowly. They may also not stop the progression of RA.

All DMARDS have potential side-effects and must be monitored slowly.

Most recently, biologic therapies such as etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and anakinra (Kineret) have helped tremendously.

These drugs target the cells and cytokines that are the primary cause of rheumatoid arthritis. Etanercept, adalimumab, and infliximab block tumor necrosis factor- the primary cytokine responsible for the damage in RA

Potential side-effects of anti-TNF therapy include an increased susceptibility to infection, the reactivation of latent tuberculosis, and the development of lupus-like or MS-like syndromes.

A second wave of biologic therapies are available and offers hope for patients who fail anti-TNF treatment. The two newest drugs are abatacept (Orencia) and rituximab (Rituxan).

Abatacept is a co-stimulatory blocker. It prevents T cells from being activated to produce cytokines. Rituximab is a B-cell depleter. It removes B cells from a patients system. B-cells are felt to play a big role in the development of RA by some experts.

Both drugs are given by intravenous infusion. Side effects include infusion reactions and rashes.

Potentially helpful new drugs such as Actemra and Cimzia are on the horizon as this article is written.

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Indiana
Case report. On September 30, 2006, a girl aged 10 years had pain in her right arm, and her parents noticed a skin eruption on her trunk and extremities. On October 3, she began vomiting and had increased arm pain and occasional arm numbness. During her initial visit to her family’s primary health-care provider on October 4, radiographs of her arm and clavicle were normal. Three to five days after her initial symptoms began, the patient’s speech became difficult to understand, and she had a decreased appetite, sore throat and neck pain, and temperature of 101[degrees]F. She became irritable and agitated. A rapid Group A streptococcal antigen test and slide heterophil antibody assay were negative on October 6. The patient was hospitalized on October 7 at a community hospital, where she was found to have difficulty swallowing secretions. Her tongue had a whitish coating and was protruding from her mouth. Her complete blood count and electrolytes were normal. She was prescribed methylprednisolone for possible glossitis and fluconazole for mucosal candidiasis.
On October 8, neurologic involvement became more evident, and the attending physician arranged for transfer to a university-affiliated tertiary care pediatric hospital. On arrival at the pediatric hospital, the patient was irritable, with intermittent moments of alertness, altered mental status, and lethargy. She had slurred speech and difficulty swallowing secretions and complained of a drowning sensation. Because of difficulty breathing, low oxygen saturation, and excess secretions, the patient was intubated and placed on a mechanical ventilator. A lumbar puncture was performed, indicating a white blood cell (WBC) count of 26 cells/[mm.sup.3] (normal: 0-7 cells/[mm.sup.3]), a red blood cell (RBC) count of 1 cell/[mm.sup.3] (normal: 0 cells/[mm.sup.3]), a protein level of 28 mg/dL (normal: 15-45 mg/dL), and a glucose level of 89 mg/dL (normal: 40-70 mg/dL). Vancomycin, cefotaxime, and acyclovir were administered for the presumptive diagnosis of meningoencephalitis. On the second day of hospitalization, the patient experienced episodes of lethargy, somnolence, generalized skin flushing (associated with vancomycin administration), and hypersalivation.
Initial interviews of family members indicated that the patient frequently was exposed to healthy-appearing household cats and dogs but to no other animals. On the third day of hospitalization, the patient’s primary-care physician told staff members at the pediatric hospital that a babysitter suggested the patient might have sustained an animal scratch or bite during June 2006. Family members did not know what type of animal might have scratched her. However, in spite of her endotracheal intubation, the patient was able to indicate that a bat had scratched or bit her. On the same day, serum, saliva, cerebrospinal fluid, and a skin biopsy from the nape of the neck (nuchal sample) were sent to CDC for rabies virologic testing, and a serum rabies-virus-specific antibody test was positive. Reverse transcription-polymerase chain reaction (RT-PCR) performed on saliva and skin samples also were positive for rabies virus amplicons, and direct fluorescent antibody (DFA) staining of the skin biopsy was positive for detection of rabies virus antigens. The patient had not received a rabies vaccine or rabies PEP.
After rabies was confirmed, the Wisconsin rabies treatment protocol (1) was initiated, including antiexcitatory and antiviral therapy with phenobarbital, midazolam, ketamine, and amantadine with aggressive supportive care. On the sixth day of hospitalization, ribavirin was administered intravenously, under a Food and Drug Administration (FDA) emergency use investigational new drug protocol. ([dagger]) Coenzyme Q10, L-arginine, tetrahydrobiopterin, and vitamin C also were administered in an attempt to replenish neurotransmitter substrates. During hospitalization, the patient experienced multiple complications, including increased intracranial pressure, bouts of diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), reversible pancreatitis secondary to ribavirin, intracranial venous sinus thrombosis, and cerebral and cerebellar herniation. In spite of a reduction in sedation drugs, the patient never regained consciousness. Because of a deteriorating clinical condition and poor prognosis, life support was withdrawn. The patient died on November 2, 2006, on the twenty-sixth day of hospitalization. Rabies virus antigen was detected in brain tissue collected postmortem.

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**********
Case Report
A 38-year-old HIV positive African-American male presented with a 1-week history of a progressive, pruritic skin eruption, malaise, fevers, severe abdominal pain, and dysuria. He had been started on nevirapine 4 weeks previously as part of an antiretroviral regimen. Upon admission, the patient had a temperature of 38.5[degrees]. On physical examination, he was noted to have hepatosplenomegaly, oral ulcers and cervical lymphadenopathy. His skin examination was significant for a widespread, morbilliform eruption, and scattered pinpoint pustules on the chest. His initial laboratory evaluation, as summarized in Table 1, was significant for eosinophilia and elevated liver enzymes. Atypical lymphocytes were noted on a manual differential. His serum chemistries were normal.
A skin biopsy at that time revealed a mixed perivascular infiltrate and scattered eosinophils which was consistent with a drug reaction. The patient was treated with 4 days of intravenous methylprednisolone, 60 mg every 12 hours, with slight improvement in his liver function tests and rash. Methylprednisolone was subsequently discontinued. However, he redeveloped fevers (up to 39[degrees]) with rapid worsening of liver function tests. His cutaneous eruption became more raised and erythematous, and prednisone was then started at 40 mg twice a day. By day 7 of hospitalization, his AST and ALT were 723 and 978, respectively (Table 1). Abdominal ultrasound and CT scan were significant for mild periportal edema. A liver biopsy showed changes which were consistent with hepatocellular injury. Given his progressive deterioration and concern for hepatic failure, he was treated with Intravenous Immune Globulin (IVIG), 1g/kg/day for 2 days, which he tolerated well without side effects. He had prompt resolution of the skin eruption and improvement of the elevated liver function tests by day 2 of treatment (Figure 1). He was discharged in good condition on a 4-week prednisone taper. He remained asymptomatic 1 month thereafter. His liver function tests returned to baseline by that time. He has not had any recurrence during 3 years of follow-up.
Discussion
The constellation of signs and symptoms in this patient is consistent with nevirapine-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. The management of DRESS syndrome should include the immediate withdrawal of the offending drug and the initiation of supportive therapy. Systemic corticosteroids, though considered controversial, are frequently administered in severe cases of DRESS syndrome. (2) There are a few reports of successful treatment with N-acetylcysteine, although this treatment carries its own risks, such as angioedema. (2) When the above modalities fail, as in our patient, adjunctive treatment with IVIG may be useful.
Recently, 4 cases of DRESS syndrome secondary to anticonvulsants that responded to IVIG have been reported. (6,7,8) These were initially treated with corticosteroids. IVIG was dosed 1 g/kg/d for 2 days in a pediatric patient, (6) while in an adult the dose was 0.4 g/kg given in one infusion. (7) The dose of IVIG was unspecified in the other 2 cases. (8) Our patient received 1 gm/kg/day for 2 days, based on the available literature at that time.
Intravenous Immune Globulin (IVIG) is pooled purified human immunoglobulins, composed mostly of immunoglobulin G, but with small amounts of the other globulins present. (9) IVIG, which was first used in the 1950s to treat Bruton’s agammaglobulinemia, is now FDA approved in the treatment of primary immunodeficiencies, immune-mediated thrombocytopenia, Kawasaki disease, bone marrow transplantation, pediatric HIV infection, and chronic B-cell lymphocytic leukemia. IVIG has also been shown to be effective in dermatologic disorders, such as dermatomyositis and immunobullous disorders. (10) In addition, it has been shown to be efficacious in the management of toxic epidermal necrolysis, likely by inhibition of binding of Fas (CD95) to Fas ligand. (11)

Increased shortness of breath or wheezing
Disturbed sleep caused by shortness of breath, coughing or wheezing
Chest tightness or pain
Increased need to use bronchodilators medications that open up airways by relaxing the surrounding muscles
A fall in peak flow rates as measured by a peak flow meter, a simple and inexpensive device that allows you to monitor your own lung function

Children often have an audible whistling or wheezing sound when exhaling and frequent coughing spasms.
Causes
Asthma is probably due to a combination of environmental and genetic factors. You’re more likely to develop asthma if it runs in your family and if you’re sensitive to environmental allergens or irritants. Early, frequent infections and chronic exposure to secondhand smoke or certain allergens may increase your chances of developing asthma.
Exposure to various allergens and irritants may trigger your asthma symptoms. The following are common things that trigger asthma symptoms:

Allergens, such as pollen, animal dander or mold
Cockroaches and dust mites
Air pollutants and irritants
Smoke
Strong odors or scented products or chemicals
Respiratory infections, including the common cold
Physical exertion, including exercise
Strong emotions and stress
Cold air
Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
Sulfites, preservatives added to some perishable foods
Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your esophagus. GERD may trigger an asthma attack or make an attack worse.
Sinusitis

Approximately 14 million adults and 6 million children in the U.S. have asthma. In fact, asthma is the most common chronic illness of childhood and a common reason for missed school days. Asthma is more common in boys than in girls. But after puberty asthma is more common in females.
A number of factors may increase your chances of developing asthma. These include:

Living in a large urban area, especially the inner city, which may increase exposure to environmental pollutants
Exposure to secondhand smoke
Exposure to occupational triggers, such as chemicals used in farming and hairdressing, and in paint, steel, plastics, and electronics manufacturing
Having one or both parents with asthma
Respiratory infections in childhood
Low birth weight
Obesity
Gastroesophageal reflux disease (GERD)

Diagnosis
Diagnosing asthma can be difficult. Signs and symptoms can range from mild to very severe and are often similar to those of other conditions, including emphysema, early congestive heart failure or vocal cord problems.
In order to rule out these and other possible conditions, your doctor will likely use several tests to arrive at a diagnosis. In most cases you’ll be asked to give a complete medical history and have a physical exam. You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe.
The two most common tools to measure lung function are:

Spirometer. A spirometer is used by a medical professional to measure narrowing of your bronchial tubes. This device measures the volume of air you can exhale after you’ve taken a deep breath. A spirometer also shows how quickly you can get air out of your lungs.
Peak flow meter. A peak flow meter can be used at home to help detect subtle increases in airway obstruction before you notice symptoms. If the readings are lower than usual, it’s a sign your asthma may be about to flare up. Your doctor can give you instructions on how to deal with low readings.

Lung function tests often are done before and after taking a medication known as a bronchodilator to open your airways. If your lung function improves with use of a bronchodilator, it’s likely you have asthma.
If there is uncertainty about a diagnosis of asthma, your doctor may also recommend a methacholine bronchial challenge. If you have asthma, inhaling a known asthma trigger called methacholine will cause mild constriction of your airways, which can be measured with a lung function test. A positive methacholine test supports a diagnosis of asthma.
How asthma is classified
The results of your physical exam and diagnostic tests can help your doctor classify how severe your asthma is, which helps guide how it should be treated. The four main classifications of asthma are:

Mild intermittent. This is the mildest form of asthma. Generally, people with mild intermittent asthma have mild symptoms up to two days a week and up to two nights a month.
Mild persistent. You have mild persistent asthma if you have asthma symptoms more than twice a week, but no more than once in a single day.
Moderate persistent. If you have asthma symptoms once a day and more than one night a week, you may have moderate persistent asthma.
Severe persistent. This is the most severe form of asthma, causing symptoms throughout the day on most days and frequently at night.

Complications
Asthma accounts for millions of missed school days and workdays each year. It’s also a common reason for emergency room visits and hospitalizations. You can reduce your risk of severe attacks by making sure your asthma is well controlled and by knowing how to recognize and treat attacks before they occur.
Controlling your asthma can also help you avoid serious side effects from long-term use of some medications used to stabilize severe asthma. Using inhaled corticosteroids, which have fewer side effects than oral corticosteroids, can help you reduce the need for emergency treatment of asthma.
Treatment
There are several types of medications available for treating asthma. Most people use a combination of long-term control medications and quick relief medications. Your doctor can help you decide which option is best for you based on your age and the severity of your symptoms. In general, the main types of asthma medications are:

Long-term-control medications. These are used regularly to control chronic symptoms and prevent asthma attacks.
Quick-relief medications. You use these as needed for rapid, short-term relief of symptoms during an asthma attack.
Medications for allergy-induced asthma. These decrease your body’s sensitivity to a particular allergen and prevent your immune system from reacting to allergens.

Long-term control medications
These medications are usually taken every day on a long-term basis, to control persistent asthma.

Inhaled corticosteroids. These anti-inflammatory drugs are the most effective medications for asthma. They reduce inflammation in your airways and prevent blood vessels from leaking fluid into your airway tissues.
Corticosteroids help decrease the frequency of your attacks and reduce the need for other medications you may use to control your symptoms. Because inhaled corticosteroids control most forms of asthma by delivering medication directly to your airways, they have a lower risk of side effects than are associated with oral corticosteroids. Inhaled corticosteroids include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone (Qvar). Advair Diskus is a combination inhaler containing fluticasone and salmeterol.
Side effects associated with inhaled corticosteroids can include hoarseness or loss of voice, oral yeast infections (thrush), and cough. Long-term use of inhaled corticosteroids may slightly increase the risk of skin thinning, bruising, osteoporosis, eye pressure and cataracts. In children, inhaled corticosteroids may slow growth.
If you’re using a metered-dose-inhaler form of corticosteroid, be sure to use a spacer and rinse your mouth with water after each use. This reduces the amount of drug that can is swallowed and absorbed into your body. It also reduces side effects, such as mouth and throat irritation and oral yeast infections (thrush).
Long-acting beta-2 agonists (LABAs). These medications are part of a group of medications called bronchodilators, which open up constricted airways. Long-acting beta-2 agonists, such as salmeterol (Serevent Diskus) and formoterol (Foradil), last at least 12 hours. They’re used to control moderate and severe asthma and to prevent nighttime symptoms. Salmeterol or formoterol are used on a regular schedule along with inhaled corticosteroids and should not be used as the main treatment for asthma.
On Nov. 18, 2005, the Food and Drug Administration (FDA) issued a public health advisory for three LABA medications, stating the medications may increase the risk of severe asthma episodes and possibly death if a severe asthma episode occurs. The three asthma medications included in the advisory are: Advair Diskus, Foradil Aerolizer and Serevent Diskus. If you experience asthma attacks and you’re taking one of these medications, you’ll need to talk with your doctor to determine the best course of action.
Leukotriene modifiers. These drugs reduce the production or block the action of leukotrienes substances released by cells in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. Leukotriene modifiers include montelukast (Singulair) and zafirlukast (Accolate).
Leukotriene modifiers are used with other medications such as inhaled corticosteroids to help prevent asthma attacks. Although generally not as effective as inhaled corticosteroids, leukotriene modifiers are an option if you have mild asthma and want to avoid corticosteroids.
Cromolyn and nedocromil. Although they’re not effective for everyone, daily use of inhaled cromolyn (Intal) or nedocromil (Tilade) may help prevent attacks of mild to moderate asthma. They may also be used to help prevent asthma triggered by exercise.
Theophylline. You take this bronchodilator in pill form every day. It may be helpful for relieving your nighttime symptoms of asthma. But theophylline may cause side effects, such as nausea and vomiting, severe abdominal pain, diarrhea, acid reflux, confusion, fast or irregular heartbeat, and nervousness. If you’re taking theophylline, get regular blood tests to make sure you’re getting the correct dosage.

Quick-relief medications
Short-acting bronchodilators often called “rescue” or “quick-relief” medications stop the symptoms of an asthma attack in progress. You take these medications when you begin to have symptoms, such as coughing, wheezing, chest tightness or shortness of breath. You may also use short-acting bronchodilators to prevent an asthma attack when your peak flow meter shows that your readings are lower than normal.

Short-acting beta-2 agonists. These bronchodilators begin working within minutes and last four to six hours. But they can’t keep symptoms from coming back. The most commonly used short-acting bronchodilator for asthma is albuterol.
Ipratropium (Atrovent). Your doctor might prescribe this anticholinergic for the immediate relief of your asthma symptoms.
Oral and intravenous corticosteroids for asthma attacks. These corticosteroids including prednisone, methylprednisolone, hydrocortisone and others may be taken to treat acute asthma attacks or very severe asthma. They may take a few hours or a few days to be fully effective. Long-term use of these medications can cause serious side effects, including cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin. Asthma attacks can be life-threatening and should be managed by a doctor.

Medications for asthma triggered by allergies
Other medications focus on treating allergy triggers for asthma and include:

Immunotherapy. Allergy-desensitization shots (immunotherapy) may help if you have allergic asthma that can’t be easily controlled by avoiding triggers. You’ll begin with skin tests to determine which allergens trigger your asthma symptoms, followed by a series of therapeutic injections containing small doses of those allergens. You generally receive injections once a week for a few months, then once a month for a period of three to five years. Over time, you should lose your sensitivity to the allergens. Immunotherapy isn’t for everyone, though. You’re most likely to benefit if it’s clear you have allergic asthma. In addition, immunotherapy carries the risk of an allergic reaction to the shot. Life-threatening reactions are rare but possible.
Anti-IgE monoclonal antibodies. If you have allergies, your immune system produces allergy-causing IgE antibodies to attack substances that generally cause no harm, such as pollen, dust mites and pet dander. If you have allergic asthma that’s difficult to control, omalizumab (Xolair) may reduce the number of asthma attacks you experience by blocking the action of these antibodies. That way your immune system isn’t prompted to react and cause the inflammation that makes breathing difficult.
Xolair is used in children over 12 years old and adults with moderate to severe asthma caused by an allergy, if all other treatments have failed.
Xolair is delivered by injection every two to four weeks. Risks include the possibility of a severe reaction within two hours of receiving the shot, blood-clotting problems, and a possible link to cancer. That link is currently being studied. Also, if you’re pregnant or breast-feeding, tell your doctor beforehand.
Treatment by severity for better control
Treatment based on asthma severity can help you control your asthma. According to guidelines from the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology, asthma therapy should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly.
For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits.

Prevention
The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants. That’s easier said than done because thousands of outdoor allergens and irritants ranging from pollen and mold to cold air and air pollution can trigger your attacks. A number of indoor allergens, including dust mites, cockroaches, pet dander and mold, can do the same. A common asthma irritant is tobacco smoke.
Even if you reduce indoor and outdoor allergens and irritants, managing asthma can be challenging. It often takes ongoing communication and teamwork with your doctor. But by working together, you and your doctor can design a step-by-step plan for living with your condition. In addition to knowing and avoiding your triggers, develop an action plan, monitor your breathing and treat attacks early.

Develop an action plan. With your doctor and health care team, write a detailed plan for taking maintenance medications and managing an acute attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.
Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure your peak airflow with a home peak flow meter.
Treat attacks early. If you act quickly, you’re less likely to have a severe attack. You also won’t need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an impending attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.

Self-care
Although many people with asthma rely on medications to relieve symptoms and control inflammation, you can do several things on your own to maintain overall health and lessen the possibility of attacks:

Exercise. You don’t have to be sedentary if you have asthma. Regular exercise can strengthen your heart and lungs so that they don’t have to work so hard. Aim for 30 minutes of exercise on most days. If you’ve been inactive, start slowly and try to gradually increase your activity over time. Keep in mind that exercising in cold temperatures may trigger symptoms. If you do exercise in cold temperatures, wear a face mask to warm the air you breathe. And don’t exercise in temperatures below zero. Activities such as golf, walking and swimming are less likely to trigger attacks, but be sure to discuss any exercise program with your doctor.
Use your air conditioner. Air conditioning helps reduce the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don’t have air conditioning, try to keep your windows closed during pollen season.
Decontaminate your decor. Minimize dust that may aggravate nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dust-proof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds.
Maintain optimal humidity. Keep humidity low in your home and office. If you live in a damp climate, talk to your doctor about using a dehumidifier.
Keep indoor air clean. Have a utility company check your air conditioner and furnace once a year. Change the filters in your furnace and air conditioner according to the manufacturer’s instructions. Also consider installing a small-particle filter in your ventilation system. If you use a humidifier, change the water daily.
Reduce pet dander. If you’re allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.
Clean regularly. Clean your home at least once a week. Because cleaning stirs up dust, however, wear a mask or, if you can, have someone else clean.
Limit use of contact lenses. Try substituting eyeglasses for your contact lenses when the pollen count is high. Pollen grains can become trapped under the lenses.
Control heartburn and gastroesophageal reflux disease (GERD). It’s possible that the acid reflux that causes heartburn may damage lung airways and worsen asthma symptoms. If you have frequent or constant heartburn, talk to your doctor about treatment options.

Asthma can be challenging and stressful. You may sometimes become frustrated, angry or depressed because you need to cut back on your usual activities, to avoid environmental triggers. You may also feel hampered or embarrassed by the symptoms of the disease and by complicated management routines. Children in particular may be reluctant to use a metered dose inhaler in front of their peers.
But asthma doesn’t have to be a limiting condition. The best way to overcome anxiety and a feeling of helplessness is to understand your condition and take control of your treatment. Here are some suggestions that may help:

Identify the things that trigger your symptoms. This can be one of the most important ways to take control of your life. Also take peak flow measurements regularly and follow your action plan for using medications and managing attacks.
Pace yourself. Take breaks between tasks and avoid activities that make your symptoms worse.
Make a daily to-do list. This may help you avoid feeling overwhelmed. Reward yourself for accomplishing simple goals.
Talk to others with your condition. Chat rooms and message boards on the Internet or support groups in your area can connect you with people facing similar challenges and let you know you’re not alone.

If you have a child with asthma, be encouraging and supportive. Focus attention on the things your child can do, not on the things he or she can’t do. Involve teachers, school nurses, coaches, friends and relatives in helping your child manage an asthma condition.

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The randomized, placebo-controlled trial included adults older than 16 years with a Glasgow Coma Scale (GCS) score of 14 or less within eight hours of head injury. The trial only included cases where the physician was substantially uncertain whether or not to treat the patient with corticosteroids. Therefore, patients with clear indications or contraindications to corticosteroids were excluded. Eligible patients were randomized to receive intravenous methylprednisolone (Depo-Medrol) therapy or placebo. The groups were matched for sex, age, time since injury, GCS score, and pupil reactivity. The treatment group received a loading methylprednisolone dosage of 2 g over one hour followed by 0.4 g per hour for 48 hours. The primary outcomes were death within two weeks of injury, and death or disability within six months of injury.
More than 10,000 patients were enrolled from 239 hospitals in 49 countries. The 5,007 patients in the treatment group were comparable with the 5,001 patients in the placebo group in all important characteristics. The mean age was 37 years, and the average time from injury to randomization was three hours. Forty percent of participants had severe head injuries (GCS score of three to eight), and 23 percent had major extracranial injuries. A computed tomography (CT) scan was performed on 78 percent of patients, but only 23 percent were normal. Approximately 99 percent of treatment patients received a full loading dosage, and 83 percent completed at least 24 hours of therapy.
During week 2 follow-up, mortality data were collected for 9,964 patients. Twenty-one percent of the treated group died within two weeks of treatment compared with 18 percent of the placebo group (equivalent to 159 excess deaths in the treated group). The treated patients had a 1.18 percent higher relative risk of death compared with placebo patients. This number was not affected by severity of injury, time since injury, CT scan results, or extracranial injury. When the CRASH data were added to a meta-analysis of the effect of corticosteroids on death after head injury, the relative risk of death in steroid-treated patients was 1.12 percent higher in treated patients compared with placebo patients. The authors stopped the trial to publish their week 2 mortality data early (deferring the publication of month 6 disability data to a later article) because they believed that the CRASH results could substantially alter the suggested treatment of patients with head injury.
The authors concluded that, despite previous beliefs, corticosteroid therapy was associated with a significant rise in mortality within two weeks of a serious head injury. The study did not include cause of death data and, therefore, found only an association between steroid treatment and higher mortality rates, not a causal relationship. The authors suggest that corticosteroids should not be used routinely to treat patients with head injury, regardless of the severity of the trauma.
ANNE D. WALLING, M.D.
Roberts I, et al. Effect of intravenous corticosteroids on death within 14 days in 10,008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet October 9, 2004;364:1321-8.
EDITOR’S NOTE: In an associated editorial, (1) Sauerland and Maegele make the calculation that the treatment of patients with head injuries with corticosteroids could have been responsible for more than 10,000 avoidable deaths. The article and editorial call for more well-designed studies with adequate statistical power to provide reliable evidence on which to base the management of trauma patients.–A.D.W.
REFERENCE
(1.) Sauerland S, Maegele M. A CRASH landing in severe head injury [Editorial]. Lancet 2004;364:1291-2.
COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning

Hives and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Hives and angioedema can happen at any age. Angioedema typically causes swelling of the lips, larynx (producing hoarseness or shortness of breath), or the lining of the stomach and intestines (causing abdominal pain). Symptoms include muscle soreness, shortness of breath, vomiting, and diarrhea. Urticarial disease is thought to be caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. Histamine causes fluid to leak from the local blood vessels leading to swelling in the skin. In rare cases urticaria and angioedema are accompanied by shock and difficulty breathing. This is called anaphylaxis. Ordinary hives may be widespread and disturbing to look at, but the vast majority of cases do not lead to life-threatening complications. Sometimes hives are caused by a physical stimulus like contact with heat, water, or pressure. Hives can also be caused by contact with substances that are irritating. Just about any substance has the potential to be irritating.

The treatment of hives depends on the severity of the symptoms. Psychological treatments such as stress management can sometimes lessen severity and occurrence. The most commonly used oral treatments are Non-sedating antihistamines, including Allegra, Claritin, Clarinex, and Zyrtec, are also used to treat hives, expecially hives that last longer than 6 weeks. Chronic hives may be treated with antihistamines or a combination of medications. When antihistamines don’t provide relief, oral corticosteroids may be prescribed. Oral steroids (prednisone, Medrol) can help severe cases of hives in the short-term, but their usefulness is limited by the fact that many cases of hives last too long for steroid use to be continued safely. Other treatments can sometimes include doxepin (Sinequan), an antidepressant that can work as a potent antihistamine, montelukast (Singulair), and medications such as ranitidine (Zantac) or cimetidine (Tagamet), which are more commonly used to treat reflux. To mangage hives and swelling avoid hot water (use luke warm), gentle or mild soap, apply a cool compress or wet cloths to the affected areas, enter a cool room, wear light weight clothes. Avoid irritating the area with tight-fitting clothing. Apply calamine lotion.

Home remedy for Hives Tips

1.Calamine lotion-applying this lotion it can grant you relief from the itchy feeling.

2.Milk of magnesia on the lesions, provides some relief. As milk of magnesia is an alkaline solution it helps in removing the irritating itchy sensation

3.Stop the itching get 1/2 a tub filled with warm water, add 1/2 cup cornstarch and 1/2 cup baking soda. Soaking yourself at least once a day can make a lot of difference.

4.Applying aloe vera gel or vitamin E oil to the affected area at least twice a day can benefit you a lot.

5.Have nettle tea which is made by 2 tsp. powdered stinging nettles. You can add honey or lemon to add flavor your tea.

6.Consume cayenne pepper capsules to help the healing procedure. You can also have vitamin C, vitamin E or zinc for quick relief.

7.Herbal tea is very good for health. To soothe your nerves, go in for peppermint or passionflower tea. Other good options include chamomile, valerian and catnip

8.To relieve pain, apply cool compression on the affected area.

9.Make a paste with 2 cups of oatmeal and 3 tablespoons of cornstarch. Add a little water to make it into a paste. Apply to affected area for 15-30 minutes. It dries the hives up within a couple of hours.

10.Take cayenne pepper in capsule form to aid the healing process.

11.Take an Ice cold shower or bath and sit in front of a fan on high for about five minutes.