Ask Dr. Etingin: Antihistamines; Ablation for varicose vein; Dyspnea

What are antihistamines, and how do they work?

Antihistamines are medications that reduce or block production of a hormone called histamine. Histamine is produced by mast cells, specialized types of white blood cells found in connective tissue throughout the body. Mast cells function as part of the immune system. When the body releases a high amount of histamine, an allergic reaction may result.

Antihistamines are the main ingredients in many products that treat allergy symptoms, and they are also found in some cold and cough remedies. Some antihistamines have a sedating effect some of these are used as sleep aids. Most antihistamine drugs are available over the counter; they come in various forms, including tablets, liquids, nasal sprays, gels, and eye drops.

Allergy symptoms, including sneezing and itchy, watery eyes, occur when your body is trying to rid itself of an allergen. Common allergens include pollen, stings or bites from insects, pet dander, and certain foods (the most common are milk, eggs, fish, shellfish, peanuts, tree nuts, wheat, and soybeans).

More severe allergic reactions may produce flushing, itching, and/or hives, and may cause swelling of the tongue, lips, throat, and/or face, which can make it difficult to breathe; the term for this is anaphylaxis. If severe symptoms occur, seek medical care immediately, as they may be fatal if they are not treated quickly.

There are two types of antihistamines: “firstgeneration,” such as diphenhydramine, which may cause drowsiness, and “second generation,” which usually do not cause drowsiness. Examples of medications that contain first-generation antihistamines include Benadryl, Dimetapp, Chlor-Trimeton, and the sleep aids Nytol, Unisom, NyQuil, and Sominex. Second-generation antihistamines include loratadine (Claritin), ctirizine (Zyrtec), and fexofenadine (Allegra).

Antihistamines can interact with other medications, and they can make some health conditions worse. If you have heart disease, high blood pressure, kidney or liver disease, an overactive thyroid (hyperthyroidism), or glaucoma, ask your doctor or pharmacist if it’s safe for you to take antihistamines.

My doctor has recommended a procedure called ablation to remove a painful varicose vein in my calf. Can you explain what’s involved?

Ablation is minimally invasive surgery carried out using a catheter inserted through a small incision into the affected vein. In radiofrequency ablation, an electrode is inserted into the catheter and heated; the heat causes the vein to collapse. Laser ablation is similar, but instead of an electrode, a laser fiber is introduced through the catheter. Both procedures are performed under ultrasound guidance and typically take about one hour.

You’ll be given a local anesthetic, and, while you may feel some pressure as the catheter is inserted, you shouldn’t feel any pain as the veins are destroyed. You’ll need to wear a compression stocking after the procedure to help reduce any swelling and decrease the risk of blood clots. You should be able to resume normal activities within a few days.

I recently received a diagnosis of dyspnea. What does it mean?

“Dyspnea” is the medical term for shortness of breath. Signs of dyspnea include labored breathing, tightness in the chest, rapid, shallow breathing, wheezing, coughing, and a feeling of being smothered or suffocated.

Dyspnea is a normal response to strenuous physical activity. But it is also a symptom of many medical conditions, including asthma, chronic obstructive pulmonary disease, COVID-19, pneumonia, heart failure, abnormal heart rhythms, heart attack, anxiety, anemia, and carbon monoxide poisoning.

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