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A tasty drink made with chocolate and caffeine can improve your thinking — here's how to make it

Howard G. Smith, M.D.


The next few months are challenging for most of us. High school and university students have mid-term and final exams, papers to submit, and thesis studies to document. At work, many of us have year-long projects to complete.

Success in all of these depends upon quick thinking, and a recent study shows there's a tasty drink that could help clarify our thinking.

Disclosure: The Hershey Company is a sponsor of the study written about in this post.

The cocktail that improves your thinking

A collaborative research team from New York's Clarkson University, the University of Wisconsin, and the Oregon Science University studied a group of 24 students at the University of Georgia. Each test subject took a mental energy test battery before and 3 times after consuming a series of three test drinks. One contained only caffeine, one contained only cocoa, and the third contained both cocoa and caffeine.

All drinks were provided in unlabeled packets by The Hershey Company, a commercial partner in the study. The study was randomized and double-blinded as neither the test subjects nor the investigators knew which drink produced which results during the testing sessions.

After the codes were broken and results tabulated, the researchers found that the cocoa-caffeine cocktail significantly boosted cognitive performance and attention to task.  

Comparing test results from drinking the cocktail to drinking caffeine alone revealed that the the cocoa with its flavanols reduced the subjects' anxiety levels during the test sessions permitting better performance.  

The results did not reveal improvement in the subjects' motivation and energy levels. Other studies, though, have shown that the flavanols in cocoa and dark chocolate do have a positive effect on mood and problem-solving.

The study cocktail contained 70 mg of caffeine and 455 mg of flavanols. The researchers specifically avoided sugar and dairy additives. Sugar would add another variable to the test drinks, and dairy ingredients have been shown to reduce the bioavailability and effectiveness of the flavanols.


You can make your own version of what I call the "CocoCaf cocktail" whether you prefer warm or cold drinks.  Coffee lovers can brew up a batch of "high test" coffee, and about 3 to 4 ounces of it contains most of the necessary caffeine.  Prefer tea? About 8 ounces of black tea or Tazo Chai will also do.

If you’re like me and like cold, caffeinated drinks, you can use 13 ounces of Diet Coke or 11 ounces of Diet Mountain Dew. The remainder of the caffeine comes from the cocoa.


Your source of cocoa is important in order to provide the necessary flavanols.  Choose unsweetened, 100% cocoa powder from either Ghirardelli or Hershey. These are prepared without alkalization or "dutching," which reduces the flavanol content. The Ghirardelli product comes in pre-measured sticks for convenience. You'll want about three tablespoons of cocoa to make a thick, brain-igniting drink.


To aid in mixing your cocktail, gradually add small amounts of the coffee, tea, or soft drink to the powder as you mix. Drink the CocoCaf about an hour and a half before your brain calisthenics are due to begin. Refresh your drink as needed.

The bottom line: Drink a CocoCaf drink 90 minutes before you need to put your brain power to the test.


Here are all the health benefits you get from drinking pomegranate juice

Howard G. Smith, M.D.  

Apr 15, 2017, 10:30 AM

Just how wonder is POM Wonderful? Well, it turns out pomegranate can have some very beneficial health effects, including lowering the blood pressure.

Let’s take a look at the facts.

The evidence comes from a meta-analysis of eight randomized placebo controlled studies — and those are the gold standard in terms of investigational clinical research. All of this was published in the journal Pharmacological Research.

The researchers took a look at the average systolic and diastolic blood pressure levels in those who were either drinking pomegranate juice or not drinking it. The systolic blood pressure levels are the higher number — the one around 120 millimeters of mercury (mmHg)— and the lower number is the diastolic number (80mmHg on average).

What they found was drinking pomegranate juice reduced systolic blood pressure by nearly 5mmHg, and diastolic blood pressure by 2 mmHg. It’s a lot harder to bring that diastolic blood pressure down.  Now, interestingly enough, systolic blood pressure — the easier one to reduce with dietary changes of all sorts, including salt reduction — occurred in both drinkers who were drinking the pomegranate juice for a shorter period of time (less than 12 weeks) and those drinking for more than 12 weeks, as well as those drinking either fewer or more than three glasses a day.  In order to get the diastolic blood pressure down though, you actually had to drink more than 3 glasses a day, and for a sustained period of time.

Pomegranate juice is rich in antioxidant polyphenols, which can reverse atherosclerosis as well as vascular inflammation, and thereby lower blood pressure. But it has other anti-inflammatory effects, and most of the effects can occur quickly, after drinking as little as 5 ounces a day for only two weeks.  


The anti-inflammatory properties can also inhibit the growth of cancer cells, including breast and prostate, and also control the inflammation associated with arthritis. The juice also controls the inflammation around the dental gingival border, which reduces gingivitis and periodontitis, in part because pomegranate juice also has an anti-bacterial capability as well.

Last but not least, pomegranate juice also seems to help verbal and visual memory in the elderly, who are drinking as much as eight ounces of juice daily over a period of time.

Talking about lowering blood pressure: You can do it with a group of lifestyle changes, such as losing weight, exercising regularly, eating a healthy diet with fruits and veggies, reducing your sodium intake as well as the intake of alcohol and caffeine, quitting smoking, and reducing stress.

So the answer is that pomegranate juice actually does seem to help. It lowers the blood pressure, reduces inflammatory reactions in joints around your teeth, can help limit cancer cell growth, and can even help your mind.

Gluten-free diets may contain poisonous agents — here's how to protect yourself

Howard G. Smith, M.D.  

Mar 5, 2017, 10:00 AM


Gluten free diets have become increasingly popular in America, but unfortunately, it sounds like they may harbor some awfully nasty substances: arsenic, and mercury.

Here’s the story:

This study was done by epidemiologists at the University of Illinois at Chicago.

Maria Argos, assistant professor of epidemiology at the UIC's School of Public Health, and her team looked at data from the National Health and Nutrition Examination Survey. They examined 73 subjects who were eating gluten-free diets and they measured the amount of arsenic in their urine and mercury in their blood. These people were six to 80 years of age.


Here's what the researchers found: Compared to the non-gluten-free controls, those eating gluten-free diets had twice as high levels of arsenic in their urine, and the gluten-free subjects had 70% more mercury in their blood.


The backstory on this is that gluten-free diets are increasingly popular.  About 25% of Americans now admit to being on a gluten-free diet — that’s a 67% increase between 2013 and 2015. Interestingly enough, only 1% of Americans have Celiac disease and actually must pursue a gluten-free diet.


The excess arsenic and mercury found in subjects eating a gluten-free diet seems to originate in rice flour. Studies have shown that rice accumulates these toxic metals from fertilizers, pesticides, the soil, the rocks and the water from which it is grown.


Although it is a deadly poison in huge quantities, arsenic in small quantities can still increase the risk of bladder, lung, and skin cancers, as well as heart disease and Type 2 diabetes. Mercury, on the other hand, produces neurological, psychological, and hearing issues.


My two cents: You should minimize the ingestion of rice products. In particular, keep the amount of rice product ingestion down for children: a maximum of one serving of rice pasta, and avoid rice milk altogether for kiddies.

White rice seems to have fewer of these impurities, including arsenic and mercury, compared to brown rice, because the impurities are contained within the rice’s brown coating, which is eliminated by washing and bleaching the rice. Brown rice contains about 30-80% more arsenic on average. The safest rice of all is white basmati rice from California, India, or Pakistan.

By cooking rice in an abundance of water, you can get rid of some of these impurities. But some of the best ways of avoiding the exposure to arsenic and mercury is, frankly, to use alternative grains often — quinoa, amaranth, corn, buckwheat, or millet — or simply not use grains at all, to just eat fruits and vegetables.


Mercury, on the other hand, is contained in seafood, so you want to avoid an abundance of swordfish, shark, ahi tuna, marlin, orange roughy, or tilefish.

So, a gluten-free diet can be wonderful for those with Celiac disease, but be careful about the potential exposure to arsenic and mercury. Thankfully, you can avoid those things.


The ABC’s of Conquering the Common Cold


Howard G. Smith, M.D.

Business Insider medical science, health, and wellness contributor


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The common cold season is upon us, and, each year, millions of us become afflicted.  Colds are caused by more than 200 varieties of viruses and should only last about 5-8 days as these viruses are usually rapidly killed by our bodies’ immune systems.  Unfortunately, in many cases, the damage caused by poorly managed colds permits the growth of bacteria that cause sinus and ear infections which drag on for weeks.


Most of us receive little guidance about how to manage our colds or those of our children in order to end these illnesses quickly.  Internet searches for common cold treatments yield advice such as drinking lots of fluids and getting lots of sleep. No one can argue with this general advice, but it will not keep you or your children comfortable or your noses clean, clear, open, and dry.  Unruly, lingering colds do lead to sinus and ear infections that often require oral antibiotics.


There is a better game plan for weathering colds that has been time-tested on thousands of children and their parents.  A strategy that requires no prescription medications and mainly relies on agents applied to the nasal linings rather than taken orally.  The method is as simple as ABCDE and is contained in 6 simple tips:  FIVE things that you should do and ONE thing that you should avoid.


The program is called the ABCDE Program, and it involves FOUR ingredients that you take or give your child THREE times a day during the week of a cold.  You begin the program immediately at the first signs of a common cold: nasal congestion, runny nose, sneezing, and some sniffling.  The FIFTH set of ingredients is helpful for managing lingering "colds." 


The SIXTH tip is DON'T BLOW YOUR NOSE.  The nose is an air intake and not a horn or a sewer outlet for snot.  When you blow your nose, you force infected material up into the sinuses and the ears.  


The ABCDE Program is easy to follow.  At the first sign of a cold, you begin four daily treatments: morning, mid-day, afternoon, and evening.  Each treatment consists of: 


A -- a dose of an ANTI-INFLAMMATORY medication such as ibuprofen = Advil for those under 21 years or aspirin in a stomach-safe form for those over 21.  This assumes that it is safe for you or your child to consume these common pain and fever killing medications.  They are available in liquid form for infants and toddlers, in chewable form for children, and in tablet form for a adolescents and adults.  It is NEVER safe for persons under 21 to consume aspirin due to its association with the deadly Reye’s Syndrome.


Ibuprofen and aspirin, both NSAIDS, neutralize many of the effects of cold viruses on your nasal and throat linings reducing not only congestion and mucus drainage but also suppressing sneezing and coughing. 


B -- instillation of a BACTERIA-KILLING topical triple antibiotic ointment such as Neosporin™ or a store brand equivalent.  This can be placed on the tip of a finger and rubbed inside the nostril.  For babies, a Q-tip may be coated with the ointment and rolled around inside.  It is amazing, though at what young ages infants find that their nostrils are an ideal receptacle for their fingertips.  The triple antibiotic ointment suppresses bacterial growth and eliminates crusting thus reducing intranasal swelling and eliminating the bacteria that could lead to later nasal, sinus, and ear infections.


C -- a spray of CLEANSING, CHASING saline mist from an aerosol canister available as SimplySaline™, Ocean™, Little Remedies for Noses™, or store brands at any pharmacy.  This puff of saline chases the antibiotic ointment back through the nose while cleansing the nasal cavities.


D -- DECONGESTANTS are the heart of the ABCD program as they are the agents that open the nasal airway and reduce the flow of nasal secretions allowing you and your child to breathe freely and stop sniffing and coughing.  The choice of decongestant agent is age-dependent:

6 mo-2 yrs: Little Remedies for Noses (0.125% phenylephrine HCL). 

2-6 yrs: Mild Neo Synephrine Nasal Spray (0.25% phenylephrine HCL). 

6 yrs-adult: Afrin Nasal Spray (oxymetazoline HCL 0.05%) . 


The common wisdom is that you cannot use these medications for more than 3 days or a dire fate will befall you.  You will allegedly become addicted to the medication.  The truth is that topical decongestant agents have been re-studied over the past decade, and it is safe and effective to take them for the week of a cold and, perhaps, a week or so longer.


The best way to administer topical medications into the nose is via a pump spray bottle.  Afrin and its generic equivalent, the drug of choice for those 6 years and over, is available in such bottles. Unfortunately, the Little Noses product, recommended for infants and toddlers to age 2 years, is only available as nose drops. Mild Neo Synephrine, the medication of choice for children 2 to 6 years of age, is only available in squeezable spray bottles that permit backflow of contaminated drug from the nozzle into the bottle.  Thus, for infants and children, I recommend that you purchase inexpensive pump spray bottles into which you pour the Little Noses or the mild Neo-Synephrine nasal spray liquid.    They are also useful for dispensing Afrin, since they are generally of higher quality than the bottles sold with the product.


The pump spray bottles are sold in batches of 6 for a reasonable price.  Often the cost of shipping is higher than the produce price itself.  These may be found here:


Often, during the first days of a cold more decongestion horsepower is necessary.  That calls for the use of Sudafed™, available in liquid for younger children, in tiny pills for older children, and in extended release pills for adolescents and adults.  This oral medication may be used once to three times a day as needed.  The sign that it is necessary is cough due to post-nasal drip.


Sudafed is a semi-controlled substance that must be purchased from the pharmacist without a prescription.  The form of Sudafed on the shelves, so-called Sudafed PE, is not genuine Sudafed, is not an effective oral decongestant, and may be toxic to infants.  Don’t buy Sudafed PE in any form.  Be careful as the packaging for the product you want and that you don’t want is virtually identical.


Some individuals have incredibly drippy noses that continue running despite the absence of congestion during the middle and toward the end of the cold.  For those patients, I recommend the use of EXIT MEDICATIONS.


The topical anti-inflammatory steroid sprays, including over-the-counter Flonase and Flonase Sensimist help to dry up the nose and, for persons who are sensitive to the topical decongestants, neutralize any irritation and so-called rebound congestion.  Topical nasal steroids, particularly Flonase, have very little absorption into the system making them quite safe for the one to two weeks they are used. They would typically be instilled once or twice a day following saline mist irrigation.


As "colds" drag on, the use of drying medications will frequently lead to sludging of nasal, throat, and airway secretions.  This frequently leads to cough.  The management of these situations requires the use of expectorant - cough suppressing medications including Delsym liquid for all ages and MucinexDM for older adolescents and adults.  The expectorant in these preparations, guaifenesin, liquified the secretions, and the cough suppressant, dextromethorphan suppresses the continuing cough.  These medications are given once or twice a day.


So, remember, at the first sign of a common cold, you should use the FOUR ABCD Program agents THREE times a day.  These may be taken by adults or administered to children very quickly three times a day: first thing in the morning, during the mid-day or afternoon, and at bedtime.


The program agents are: A for Anti-inflammatory Advil, B for Bacteria-killing Neosporin™ or triple antibiotic ointment, C for cleansing and chasing.  Don’t forget to follow the FIFTH tip, really a commandment:  NO NOSE BLOWING.   Remember, you can “play” the common cold like a virtuoso musician.  If the “cold” is lingering with clear secretions, the topical nasal steroid Flonase may resolve it.  The cough is ongoing, an expectorant-cough suppressant would be useful.  If secretions are discolored suggesting infection, an oral antibiotic may be necessary.





Room Humidifiers Keep You Healthy


Howard G. Smith, M.D.

Business Insider medical science, health, and wellness contributor


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If you live the northern United States or its dry western regions you need a bedroom humidifier. Dry air is the enemy of your body, especially your respiratory linings.  It doesn’t help your skin orhair either.


As we move into the fall and winter, the weather cools and outside air dries out.  Then, when we turn on our furnaces, whatever moisture remains in the air departs.  The average heated home is twice as dry as the Sahara Desert! The humidity level may be only half of that considered to be comfortable and that is 40-50%


Nasal and throat linings are excellent barriers against invasion by viruses and bacteria when moist, but this protective function falters as these linings dry out.  Dry winter air facilitates upper respiratory infections such as the common cold, sinus infections, sore throats, tonsillitis, laryngitis, and bronchitis. 


Your skin too, is healthier and more protective against germs, when it is moist.  Your hair looks glossier, is frizz-resistant, and is considerably more manageable when it isn’t dried out.


Fortunately, there are readily-available and cost-effective humidifiers that can help us moisturize the air.  The problem is that some of them can spread more disease than they prevent.


Choosing the proper type of humidifier is critical.  There are 2 basic types of humidifiers: hot and cold.  Simply stated….you want the hot type.  The reason is that the hot and most warm humidifiers disperse moisture into the air by forced evaporation.  Water enters the air as water molecules, and any contaminants such as bacteria, mold, and toxic chemicals are left behind in the reservoir. 


On the other hand, cold and ultrasonic humidifiers create tiny water droplets that not only contain water but also the germs and impurities that hide in the water reservoirs. These dirty droplets will get into the nasal passages, throat, wind pipe and the lungs as well as spread a white haze over the room.  The ultrasonic humidifiers are the most dangerous since they create microscopic droplets that can pass into the farthest reaches of the lungs and cause pneumonias.


Once you have the  hot or warm mist humidifier, you need a way to measure the level of humidity in the room.  Humidity meters, better known as hygrometers, are cheap and readily available at most hardware stores or online.  They cost about $8 to $10 and are either mechanical or electronic.  These instruments usually have a thermometer incorporated in them.  


Place the humidifier up on a dresser or strong shelf with a metal pan or tray under it.  All humidifiers leak some, and the tray will protect your furniture. Place a fan behind the unit in order to mix room air with the heated, humidified air, to distribute the mix, and to prevent a “hot spot” on the ceiling about the unit.


To use them, place the meter away from the humidifier, crank up the unit to full, and wait until the room humidity reaches 40%.  When it does, dial back the humidistat dial until the unit clicks off.  Thereafter, you will only need to keep the reservoirs full and clean the heating chamber every 2 to 3 weeks to remove mineral deposits.  


Humidifiers of any brand and type have a limited operating life due to the effects of heat and water on the components.  A 3 year life is about average.  Be sure to clean out the reservoirs and the heating chamber at the end of early heating season.


You should use the humidifier when your home’s furnace is operating.  For those in the western deserts, turn on the unit when the relative humidity drops below 35-40%.



Do-It-Yourself Allergy Treatment

Howard G. Smith, M.D.

Business Insider medical science, health, and wellness contributor


Allergies to pollen and other chemicals in our environment are extremely common. They affect from 10-30% of people around the world. Chances are good that you or a member of your family is an environmental allergy sufferer who sneezes or wheezes either seasonally or all year round.


The good news is that, over the years, more and more medications that doctors prescribe to treat these allergies can be purchased without a prescription. The bad news is that a roadmap telling you how to use these drugs has not been available — until now.


I call my environmental allergy treatment strategy The IPA Gameplan. No, beer will not control your allergies, but IPA stands for Identification, Prevention, and Aid, both first and lasting.


There are other allergies besides environmental allergies, and many of them are severe or even life-threatening. Such allergies to foods or medications are not the subject of this guide. They should and must be managed carefully by your personal physician or your child's pediatrician.


Do you have an allergy?

The first question that you must answer is "do I have an environmental allergy?" The most common dilemma along this line is whether the nasal symptoms you're experiencing are due to allergy or due to a common cold.  Let's look at the differences.

Allergies typically begin in association with exposure to an identifiable environmental trigger. In the spring, that trigger is typically grass or tree pollen, and in the autumn the trigger is weed pollen or mold.


Colds, in contrast, are caught from someone else as an invisible virus is passed person-to-person usually hand to mouth. Allergy symptoms continue for a longer period of time than cold symptoms. Allergies last months during which pollen rains down on us versus a week of cold symptoms that end once your body's immune system eradicates the cold virus. Environmental allergy symptoms, except those associated with a severe allergy to a food like peanuts or to medications such as penicillin or sulfa drugs, tend to be milder than those due to a nasal viral infection. Finally, allergies rarely have associated bodily symptoms such as fever and body ache, while those are hallmarks of colds.


What is an allergy?

Allergies are abnormal immune reactions by your body to agents in the air or in food. Allergies have triggers in your surroundings and targets in your body.


Allergic individuals frequently are susceptible to many triggers while most of us fail to react to any of these. Triggers include airborne pollens from grasses, plants, and trees, irritants such as dust particles, flakes of animal skin from cats and dogs, or tiny airborne organisms such as mites or mold. Many triggers are only in abundance during certain times of the year while others are present year round.


When an allergic reaction occurs it affects one or more targets in our bodies. The common targets for environmental allergies are the nose, the eyes, the throat, and the lungs.


Do-it-yourself allergy treatments are most available for nasal allergy, so called allergic rhinitis. Since allergies affecting the eyes and the airway can escalate with serious consequences, the FDA has wisely restricted access to those medications necessary for their definitive treatment. However, some oral allergy medicines and other general duty medicines can effectively control allergic reactions in all target zones.


Allergic reactions occur when a trigger enters the body and meets sensitized immune cells that release chemicals to produce reactions at the target regions. A common example is grass allergy. Grass pollen is inhaled and contacts the nasal linings. Previous exposures have already produced grass-specific antibodies of the IgE type that help the grass pollen bind to immune system cells. When that binding occurs, mast cells release histamine and typtases while other white cells release leukotrienes and cytokines. These substances lead to blood vessel relaxation, nasal congestion, an increase in respiratory secretions, sneezing, coughing, and most dangerous of all, the constriction of lower airways.


The IPA Gameplan

The key to eliminating environmental allergy misery is to identify the triggers and targets, to institute measures to prevent exposures to the triggers, and to employ effective aid to reduce the impact of the allergic reactions. As with most medical problems, it is far easier to prevent disease than to treat it once it occurs.


Trigger identification involves a bit of detective work, and the operative principle is guilt by association. Seasonal environmental allergies may be the easiest to find, since they tend to occur at the same time each year. Spring seasonal allergies to pollens from trees and grasses most often begin in mid-April and continue through June. Late summer and fall allergies to ragweed pollen and mold typically begin in mid-August and finish with the first frost of the season that frequently coincides with Halloween. The reactions occur when you are outside and exposed to the airborne agents.


So-called perennial environmental allergies, typically due to dust, mites, and animal skin flakes or dander, can occur at anytime during the year. The clue is that the symptoms occur when dusting has occurred or when playing with a pet cat or dog.


To decide which treatment to use, you need to observe which parts of your body are targets for the allergic reactions.  The most common target for environmental allergies is the nose with the onset of drippy congestion and a feeling of facial fullness due to poor sinus ventilation. Often the ears feel blocked due to poor airflow through the eustachian tubes at the back of the nose and the development of negative middle ear pressure and/or fluid. Nasal lining swelling can prevent air entry into the eustachian tubes.


Your eyes may be affected as the pollens contact their sensitive conjunctival linings. The common eye allergy symptoms include itchiness, tearing, redness, and swelling of the eyelids.


When pollens are inhaled, airway reactions may begin. Coughing, wheezing, and shortness of breath with various levels of severity begin when allergic reactions occur in the throat, windpipe, and lungs. Isolated throat symptoms tend to be confined to itchiness, cough, and hoarseness.


Having identified the triggers and targets, therapy begins by preventing exposure to those triggers. To keep the pollens and other triggers away from your nose, eyes and airways is in theory easy but in practice much more difficult. To keep your immediate environments clean, keep your windows closed at home and when you are riding in the car. Use air conditioners at home and in the car, and don't forget to change their filters regularly.


While you or your children are out and about in pollen-infested zones, use saline mist nasal irrigation frequently to wash the pollens off the nasal linings before they can trigger the allergic reactions. Drink water or juice to clear the pollen triggers off the throat linings and wash them into the acid-filled stomach where they are destroyed.


When you return home, stop in the mud room and shed your clothes and shoes. Your pollen-coated clothing should go into the wash. Keep a robe handy to wear through the house on your way to the shower to wash pollens out of your hair and off your skin. This strategy prevents your and your childrens' bedrooms from becoming pollen-infested "meadows."


Remember too that airborne allergens of all sorts hang out in rugs and may be stored in mattresses. If possible, eliminate rugs in favor of hardwood floors and encase your mattresses in plastic. Use of HEPA air cleaners may also be useful for eliminating particulate matter in the home air.


AID for your all site allergies

If prevention alone fails and allergic reactions begin, you will need aid. Choice of treatment for multi-site environmental allergies is a blend of target coverage and simplicity.


The most readily available agents are non-sedating antihistamines including Claritin, Zyrtec, and Allegra and the sedating antihistamines such as Benadryl, ChlorTrimeton, or Tavist. These agents will block allergic reactions at all sites so that the use of additional nasal sprays, eye drops, and inhalers may not be necessary.


The non-sedating antihistamines are typically taken once daily or sometimes twice a day. The sedating antihistamines are usually designed for administration 3 to 4 times a day, but they may be taken only at night as a booster for the non-sedating agents.


Remember too other over-the-counter medications may enhance the response to the antihistamines, particularly when an isolated boost is necessary. The NSAIDs including the ibuprofen Advil or, for those 21 years and over, aspirin will be useful adjuncts. The antihistamines may also be taken with a decongestant Sudafed to open the nasal passages and for additional drying of secretions which will stop post nasal drainage and cough.


For the sake of simplicity, I use the brand names of the relevant medications. The original developers of these agents spent thousands of dollars creating names that will be easy for us as consumers to remember. Know, though, that most drug chains have their own generic equivalents available at slightly lower prices. These are usually found on the shelf nearby the brand-name drugs with similar packaging. 


My recommendation is to buy the brand-name drugs unless the no-name drugs have a significant price advantage.  The branded drugs are often superior to generics in terms of consistent potency and taste.


Remember to that Claritin, Zyrtec, Allegra, and many of the classic antihistamines are all available in liquid, chewable, and pill form for consumption by patients of any age.


Oral decongestants such as Sudafed may be a useful adjunct to anti-histamines in order to quickly open the nasal airway and dry up secretions. Antihistamines alone usually take longer to achieve these goals.


I don't recommend buying the antihistamine-decongestant combos for three reasons:

1) You won't always want to use an oral decongestant with the antihistamine;

2) If you need a decongestant, topical decongestants such as mild Neo-Synephrine or Afrin work more effectively than oral products; and

3) Oral decongestants only work well for 9 days in a row as the supply of neurotransmitters that mediate their action becomes exhausted.


When recommending therapy, I usually begin with the simplest first. I suggest a daily dose of Claritin selecting that over the others as it has fewer side effects. If that is insufficient, I recommend switching to the Zyrtec or Allegra. Even if the nose is the only target, a daily dose of oral liquid or a pill is still the easiest for most and particularly for children.


For stronger oral therapy, your doctor or your child's pediatrician may prescribe Singulair or oral corticosteroids. Singulair is a specific leukotriene blocker that works in tandem with the antihistamines. Corticosteroids effectively block most mediators of the allergic reaction. I mention these and other prescription only medications so that you will see how they fit into the treatment plan and know to ask for them when necessary.


AID for nasal-only allergies

If only your nose is affected, you have your choice of using the oral non-sedating antihistamines or a medicated nasal spray. The most effective and safe medicated nasal spray is one of the Flonase sprays: either regular Flonase or Flonase Sensimist. The latter is a slightly stronger version of regular Flonase which lacks the rose scent of the original product.


When using any medicated nasal spray, always cleanse the nasal linings first with an aerosol nasal saline spray such as Simply Saline. Then instill the Flonase or Flonase Sensimist by directing the nozzle inside the nose upward and outward so that the mist covers the side walls of your nose. 


I typically recommend the Flonase for all but children under 4 years or for those who object to the rose scent. Children under 4 may use the Flonase Sensimist. The standard dose is one spray a day for the youngest children. For older children, adolescents, or adults the dose would be two sprays a day either together or one in the morning and one later in the day.


I recommend the Flonase products in preference to the other over-the-counter nasal steroids Nasacort (triamcinolone) or Rhinocort (budesonide) as Flonase is the safest. Only 0.5-1% of any absorbed Flonase steroid every circulates around in the body, and 99% is eliminated quickly in the liver. The other over-the-counter nasal sprays leak from 34-46% of their corticosteroid into the body.


By the way, there is no true infant or child version of either saline or of the Flonase products. You can use any version as the product labeled for children contains the same concentration of medication as that labeled for adults. However, Flonase Sensimist is considered safer for children than the original Flonase.


Another nasal spray option for those who dislike the idea of using any steroid is Nasalcrom. This spray contains cromolyn, an agent that prevents mast cells from releasing their histamine in response to the allergen. The downside is that the Nasalcrom must be administered at least three times a day.


Also useful for improving penetration of the nasal sprays are topical nasal decongestants like NeoSynephrine for younger children and Afrin for all those 6 years and over. These sprays shrink swollen nasal linings permitting the topical nasal steroids to reach tissues further back in the nose. The decongestant should be sprayed in after the saline mist irrigation. You should then wait at least 5 minutes between spraying the decongestant and spraying in the Flonase or Nasalcrom.


There are several prescription nasal sprays that you may request from your doctor if the topical nasal steroids alone are ineffective. These contain prescription-only topical antihistamines either alone as Astelin or Patanase or compounded with the steroid found in Flonase as Dymista.


AID for your eye allergy

If environmental allergies are making your eyes itchy, the oral antihistamines and topical saline eye drops are your best bets. Don't forget that oral NSAIDS will also help. Then, if your symptoms are poorly controlled, ask your doctor for prescription eye drops. Both cromolyn and antihistamine eye drops are available as Crolom and Patanol.


AID for your airway allergy.

Again, due to the potential danger of airway allergies, the only over-the-counter agent that is available to you is the oral antihistamine. Another non-prescription medication that could be useful is the Asthmanephrin inhaler. This racemic epinephrine spray can temporarily open a constricted, "tight" airway.


I cannot emphasize strongly enough that, if you have airway allergies often synonymous with asthma, your doctor or allergist should frame a program for you to follow. Use of over-the-counter medications for these disorders is ill-advised and dangerous.


GENERAL STRATEGIES for IPA Gameplan success

Don't irritate your linings by nose blowing, eye rubbing, throat clearing, or coughing. Use supportive care including NSAIDS, topical saline, nasal decongestants such as NeoSynephrine or Afrin, oral decongestants such as Sudafed, and expectorant cough suppressants such as Delsym and MucinexDM to keep these surfaces clean and clear.


Remember that effective prevention before the symptoms begin is far better than therapeutic aid after the fact. Begin with avoidance strategies and oral antihistamines early. Start at least 2 weeks before you expect pollen counts to rise. That would be early April for spring allergies and early August for fall allergies. Be sure to follow pollen counts online at and similar sites to know when you will likely need more preventive and therapeutic horsepower.


Be prepared by stocking your medications before the season begins. Don't forget to bring them when you travel.


Do it yourself allergy management is effective if you follow the IPA Gameplan. Aggressively identify allergens and their whereabouts, prevent confrontations with the allergens, and be prepared to aid yourself and your children with over-the-counter medications that can manage the symptoms should allergies occur.

If you have serious airway and eye allergies or allergies that never seem to take an intermission, see an allergist. In this situation, professional testing will pinpoint those triggers that bring on your reactions. This information will permit your doctors to formulate a comprehensive treatment plan using both over-the-counter and prescription medications.


The most important caveat is don’t suffer.  Help yourself using the IPA Program, and, if necessary, see an allergist for more “industrial strength” help.

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