• CORRESPONDENCE PAGE ON ASTHMA. The correspondence page on food allergy and anaphylaxis has been a success, so we have started one on asthma. The first letter is about depression in asthma. We will be interested to receive e-mail on this subject or other aspects of asthma.
  10 May 1998

• Value of adrenaline for nut allergy questioned. A group of paediatricians is starting a research project aimed at showing that it is not necessary to issue adrenaline injection kits to nearly as many children as now receive them. To read more about this controversial idea, click here.
  28 April 1998

• New Asthma Treatment. Montelukast (Singulair®) is a new kind of treatment for asthma.

• The European Allergy Congress, Rhodes, June 1997. New drug for asthma in the pipeline. Your nose and your asthma. Latex allergy. Terfenadine.

• Is peanut oil dangerous? Not nearly as dangerous as a lot of people thought.

Montelukast (Singulair®) and Zafirlukast (Accolate®): new asthma treatments

Montelukast: what is it?

Together with zafirlukast, it is new kind of treatment for asthma, and works by blocking the effect of substances called leukotrienes, which are important in asthma.

Montelukast is an add-on treatment which improves the health of people with asthma who are already using inhaled steroid 'preventer' treatments but are not getting enough help from those and the other usual treatments.

How does montelukast work?

Leukotrienes are important in asthma because their release from cells in the lungs causes narrowing of the air passages, for example by making the muscles around the air tubes contract. So one benefit of montelukast is that it acts against this muscle contraction, and so against narrowing of the air passages.

But leukotrienes act in quite a number of ways to help produce asthma. We now know that in asthma the air tubes are not just narrowed by contracting muscle fibres, but that the lining membrane of the air tubes is inflamed, looking red in colour. The microscope shows that the inflamed lining membrane is also full of cells we normally think of as white blood cells, including cells called eosinophils. Over the longer run these cells cause damage in the lungs, which is why older people with asthma generally don't get such good results from treatment as younger people. Leukotrienes play an important part in bringing about this inflammation, and montelukast should help alsthma in the longer term by helping to minimise inflammation and the damage it causes.

How well does it work in practice?

Some people claim that montelukast may be specially useful for some kinds of asthma, such as asthma brought on by exercise or by aspirin.

Time will tell how much montelukast will contribute to the life of people who have asthma. It seems that we are not looking at a dramatic cure, but at a medicine which will make a very positive difference for many people.

Who makes it?

How expensive is it?

Top of page - Table of Contents

European Allergy Congress, Rhodes, June 1997
European Academy of Allergy and Clinical Immunology

Accolate is one of a set of new asthma medicines which block the effect of subtances called 'leukotrienes' which are released in the lungs during asthma, playing a large part in producing the symptoms of asthma (Singulair , official name montelukast, also belongs to this group). Just how useful Accolate will be for most patients with asthma remains to be seen. One hope is that it will turn out to be particularly helpful for patients with asthma which is caused by aspirin and similar substances. Such asthma is commoner than most doctors think, and the treatment does need to be different from other kinds of asthma. Despite astonishing advances in asthma treatment over the last thirty years, the results are not all we would wish, and a totally new type of treatment is welcome. There are several other drugs in development or in the process of becoming available which interfere with the production or effect of leukotrienes.

Can you make your asthma better by getting your nose treated? Several lecturers spoke about this, and they produced evidence that indeed you can. Lots of people with asthma have allergy affecting their noses, but this usually does not get much attention because all the time with the doctor or asthma nurse is spent on the asthma. A bit of time and treatment devoted to the nose could make a lot of people a lot happier and, it seems, make their asthma better as well.

The reason is probably that if your nose functions well it acts as an efficient filter, removing allergy-producing dust and pollutants and stopping them from getting to your lungs.

So remember to tell the doctor about your nose as well as about your asthma.

Top of page - Table of Contents  

Latex allergy has been the subject of a lot of research. Latex allergy is a serious condition of health care workers, mainly nurses, and of children and other people who have a lot of surgery or other treatment involving latex gloves and catheters. Part of the research consisted of doing blood and skin tests, with surprisingly high percentages of positive results. What was often not clear was how many of the people with positive results would really have a dangerous reaction if they came into contact with latex.

Terfenadine. Is it safe?

Top of page - Table of Contents  

If you are allergic to peanuts,
Is peanut oil dangerous?

Good news from the research team in Southampton, at the University Department of Child Health. This team has done more research on nut allergy than any other group in Britain. They have now tested peanut oil on people with peanut allergy more thoroughly than anyone else. They gave 62 adults with peanut allergy refined peanut oil, up to 10 ml. None of the volunteers had allergic reactions to refined peanut oil.

But crude unrefined peanut oil did cause reactions in 6 out of the 62 peanut allergic volunteers. These reactions were not severe, but clearly people with nut allergy must avoid such oils.

The team write that products should be labelled so that crude unrefined oil, which is potentially dangerous, can be distinguished from refined oil, which seems to be safe. Who could argue with that?

Some 'gourmet oils' have had peanut material added to provide a peanut flavour; these are obviously dangerous if you are allergic to peanut.

COMMENT:

Although the refined oils did not cause dangerous reactions, this may not quite be the whole story. Theoretically it is possible that traces of peanut protein which cannot cause a reaction would nevertheless sensitise someone, or increase the sensitivity of someone who is already allergic. To find out if this happens, a quite separate research project would be needed, but this might not be possible. We recommend that if you are allergic to peanuts you should avoid any peanut oil if possible, but not get too worried if you make a mistake about refined peanut oil. The advice is an attempt to play safe, just in case undetectable traces of protein in refined oil can increase allergy. We emphasise, this is a theoretical point with no practical evidence to support it. All the evidence is that refined peanut oil does not cause dangerous reactions.

Click here to go to section on peanut oil in the nut allergy page.

Top of page - Table of Contents