Dr. Martin Skor: Will taking antihistamines harm me long-term?

I have had trouble sleeping for years but taking an antihistamine tablet (Cetirizine) twice a week really helps. But the pills leave me a bit unsettled, and can they do me any harm?

Tina Wools, Gloucestershire.

Dr. Martin Skor replied: Antihistamines target histamine receptors. Histamine is a chemical that the body produces in response to a perceived threat (in the case of an allergy, mistakenly perceiving a harmless substance as dangerous). Symptoms are the body’s way of trying to get rid of it (like sneezing).

But histamine also plays a role in wakefulness, so antihistamines can make you feel drowsy.

However, not all antihistamines are the same. There are two types: sedating and non-sedating.

The former have the ability to cross into the brain (thanks to the way they are carried in the blood) – this includes chlorphenamine (brand name Periton).

The cetirizine you are taking is a non-sedative, although some people find that it makes them sleepy, and you are among them.

Long-term use of antihistamines is associated with dementia. It is important to note that this is not a proven cause, but the risk appears to be because some antihistamines are anticholinergic.

This means they work on receptors in the brain that respond to the chemical messenger acetylcholine: low levels of acetylcholine are a hallmark of dementia.

Long-term use of other drugs that block these receptors, including antipsychotics and some antidepressants, is also associated with an increased risk of dementia.

In fact cetirizine is a weak anticholinergic, so your twice weekly doses are not a concern, although it is not good to feel depressed.

My advice would be: limit pills, go to bed only at bedtime, if you can’t sleep, get up, don’t read or watch TV in bed – it’s only for sleep, every Get up at the same time in the morning. Don’t sleep during the day.

I was diagnosed with a calcaneal spur in my foot after an x-ray. My GP referred me to a podiatrist – I’m waiting for an appointment but I’m in a lot of pain. I use chiropody felt and heel support in my shoes, but it reduces discomfort.

Owen Rees, Devon.

Dr. Martin Skor replied: Calcaneal, or heel spurs, are bony growths on the calcaneus, the heel bone. It can be asymptomatic and is often seen during an X-ray for other reasons. They can be extremely painful, even disabling.

They develop as a result of chronic stress on the ligaments of the feet – for example as a result of movement abnormalities, poorly fitting shoes, being overweight, osteoarthritis or plantar fasciitis (inflammation of the tissue that connects the bones of the foot). ball of the foot).

This causes inflammation, to which the body responds by building bone as a protective mechanism. Treatment includes padding – foot support may not help much, but a podiatrist will be able to provide a better prescription in the form of orthotic insoles.

Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID), such as diclofenac. You should continue with this treatment for at least six weeks. The next step is a corticosteroid injection, usually administered using ultrasound to pinpoint the problem area. But remember, it is given to prevent inflammation, rather than to destroy the sperm itself.

An orthopedic specialist may recommend Botox injections to ‘paralyze’ the muscles in the joint, taking pressure off the swollen area so it can heal.

In severe cases, patients may be offered surgery to remove the spur, although many find that their pain is resolved by more conservative methods, and the case for surgical intervention remains unproven.

I caution against other experimental treatments, including shockwave therapy and ultrasound – which are widely advertised for this type of problem, but in my opinion are a waste of money.