Abstract
This essay regards a case of a patient, a farmer, who potentially has hay fever, which influences his work abilities; in this patient’s case, it is studied the physiology of this allergic reaction, the type of drugs that may be prescribed or preferred, the causes of such, consequences of the use of sedative drugs and, in case such are chosen, what suggestions the nurse should give the patient for his safety.
Keywords: allergy, antihistamine, sedation, driving.
- Physiology of an allergic response.
An allergic response is a hypersensitive response that the body has, which is caused by processes of the immune system, which can be done by Immunoglobuline E (IgE) related processes, or Non-IgE related processes. When in an allergy situation the body is exposed to allergenic antigens, which are gathered by Antigen-presenting cells and presented to the immune cells – lymphocytes – that produce IL-4. They also interact with B lymphocytes, which produce a specific kind of antibody – IgE. The IgE bind with plasma cells called the mast cells and basophils, which on their turn degranulate and free histamine and other inflammatory mediators; these will cause the signals and symptoms of an allergic reaction: dilation of blood vessels, increase of mucus, nerve function and smooth muscle contraction, leading to dyspnea, rhinorrhea and all the mentioned symptoms of the patient.
- Disadvantages of antihistamines when using machinery or driving.
When treating an allergy situation, the use of first generation antihistamines brings some disadvantages, because these have a depressing effect on the nervous system, which means that the neural function is decreased; this leads to impairment of both cognitive and psychomotor functions. Thus, the use of machinery or driving, which imply a strong base of both of these functions, is also impaired when this kind of drugs are used to treat allergies. Furthermore, the clinic has to analyze the work routine of the patient to conclude if there is any possible adaptation of medication intake to the patient’s schedule, or if some other kind of medication may be better indicated.
- Cost and effect consideration.
If the patient is concerned about the cost of the drugs he has to take and wants to know if Benadryl (an OTC diphenhydramine) has the same effect that prescription antihistamines have, the nurse should not lie; thus, it must be informed that the main effect is the same, to stop the allergic reaction from happening, but also emphasized that an allergic reaction is very specific, according to the situation and that it should be medicated accordingly, with the medication that the clinic sees as fit for it; furthermore, the nurse should also explain the somnolence that Benadryl will cause and the dangers that this represents for the patient, since he uses heavy machinery and is required to drive and, thus, being for the sake of his safety also that it is more wise to take the prescribed drugs.
- Second generation antihistamines and non-sedative effect.
The second generation antihistamines are potent inhibitors of H1 histamine receptors, which prevent the histamine that is released when degranulation of mast cells and basophils occurs from binding and provoking the allergic reactions’ known signals and symptoms. These antihistamines, however, do not have a sedative effect, because its different chemical structure keeps them from passing through the blood-brain barrier and, thus, not interacting with neural cells and not causing a decrease on their function.
- Generic name: Azelastine, Fexofenadine, Loratadine, Cetirizine;
- Brand name: Allegra, Telfast, Aventis Behring, Aventis Pharma (Fexofenadine); Claritin (Loratadine); Zirtek, Reactine, Voltric (Cetirizine).
- Azelastine prescription – why?
For this particular situation, the clinic has prescribed Azelastine to the patient, because it is a second generation antihistamine; thus, it will not have sedative effects, which in this case is important to keep in mind, since the patient has a profession that requires constant cognitive and psychomotor functions to operate at their best, to be able to drive and operate the farming heavy machinery.
- Nurse’s suggestions in case of sedative antihistamines use.
In case the patient opts for sedative antihistamines, the nurse should explain in detail those sedative side effects to the patient and how they endure even after sleeping at night. Furthermore, the nurse should help the patient establish the best time during the day, according to his schedule, for the antihistamine intake, in order to minimize those sedative effects when he is working.
Conclusion
In the end of the study of this patient’s case, understanding the physiology behind an allergic reaction, the effects and the disadvantages of the available antihistaminic drugs, both sedative and non-sedative, one can consciously choose which kind of drug is better for this patient, regarding both his health condition and life security – second generation antihistamines that do not have a sedative effect.
Of course, the nurse must also be alert to the situations in which the patients consider the cost-effect factor and might opt for OCT antihistamines. In these cases, the nurse should be able to provide both an explanation of why it is best to follow the clinic’s prescription and a plan, if the patient insists on taking the sedative antihistamines, so that he is aware of that side effect and how it can be minimized for his safety.
References
Green, Robin J. .(n.d.). Allergy Pathophysiology. Retrieved from http://www.allergysa.org/images/friday23/Green_Lecture_Allergy_Pathophysiology_ALLSA_2010.pdf
Popescu, Florin-Dan. (n.d.). H1 Antihistamines and Driving. Retrieved from http://www.medandlife.ro/medandlife102.html
