Allergic rhinitis is a symptom complex that consists of paroxysms of sneezing itching of the eyes, nose, and palate rhinorrhea and nasal obstruction. It is often associated with post-nasal drip, cough, irritability, and fatigue. This patient clearly has allergic rhinitis however, this is not a cause of her wheezing and shortness of breath. Goldman Cecil Textbook of Medicine, 21st ed. Chapter 274 - Allergic Rhinitis Richard D. deShazo, pp 1445. 2000, W.B. Saunders Company
So where does our discussion leave Jake Will he ever find the best way to prevent a cold or reduce its effects In the United States over one billion cases of the common cold are reported per year, costing billions of dollars in medical visits, treatment, and lost work days. Consequently, there is an enormous effort to find effective protection from the different viruses that cause colds. Despite all of the research and the emergence of some promising possibilities, the best prevention method is still the old standby keep your hands clean. Numerous studies have indicated that rates of common-cold infection are 20-30 lower in populations who employ effective hand-washing procedures. Cold viruses can survive on surfaces for many hours if you pick them up from a surface on your hands and transfer them to your mouth, eyes, or nose, you may inoculate yourself with a seven-day sniffle. Of course, not everyone gets sick when exposed to a cold virus. The reason Jake has more colds than his lab...
At the first sign Can effectively shorten the duration of a Vitamin C 250-500 mg to protect against colds. 1 g to Can help reduce severity and shorten the treatacold duration of a cold12,13 Fig. 5.18 Zinc supplements and the common cold. 100 adults with acute onset of cold symptoms were given lozenges containing 13.3 mg zinc and told to dissolve a lozenge in their mouth every 2 hours while awake. Treatment with zinc significantly accelerated healing and resolution of symptoms. Median time to resolution of all symptoms was 4.4 days in the zinc group compared with 7.6 days with placebo. (Adapted from Mossad S, etal. Ann Intern Med. 1996 125 81) Viruses that cause colds and influenza can survive for several hours on the skin and other surfaces (such as clothes, towels, and dishes). The virus is usually picked up on the hands and then transferred to the nose, mouth, or eyes where it causes the infection. To help prevent colds, wash the hands thoroughly...
The statements made by Jake's friends and family about what actions will help him remain healthy (for example, his mother's advice to wear a hat) are in some part based on the advice-giver's understanding of how our bodies resist colds. Ideas about how things work are called hypotheses. Or, more formally, a hypothesis is a proposed explanation for one or more observations. All of us generate hypotheses about the causes of some phenomenon based on our understanding of the world (Figure 1.1). When Jake's mom tells him to dress warmly in order to avoid colds, she is basing her advice on her belief in the following hypothesis Becoming chilled makes an individual more susceptible to becoming ill. The hallmark of science is that hypotheses are subject to rigorous testing. Therefore, scientific hypotheses must be testable it must be possible to evaluate the hypothesis through observations of the measurable universe. Not all hypotheses are testable. For instance, the statement that colds are...
Triceuticals on the market whose active ingredient is the adrenergic agonist ephedrine. Pseudoephedrine, the threo diastereomer, has virtually no direct activity on adrenergic receptors but acts by causing the release of norepinephrine from nerve terminals, which in turn constricts blood vessels. Although it too crosses the blood-brain barrier, pseudoephed-rine's lack of direct activity affords fewer CNS side effects than does ephedrine. Pseudo-ephedrine is widely used as a nasal deconges-tant and is an ingredient in many nonprescrip-tion cold remedies. The imidazolines naphazoline (29), oxy-metazoline (30), tetrahydozoline (31), and xy-lometazoline (32) are all selective a,-agonists, widely employed as vasoconstrictors in topical nonprescription drugs for treating nasal congestion or bloodshot eyes. Naphazoline and oxymetazoline are employed in both nasal decongestants and ophthalmic preparations, whereas tetrahydrozoline is currently marketed only for ophthalmic use and...
Hospital visitors should not be permitted to visit if they have any fever or respiratory illness. Visitors should wash their hands before and after leaving the patient's room. In outbreak settings such as respiratory viruses in the community, it may be prudent to restrict visitation to immediate family members.
Cause the common cold in humans and induce sarcomas in newborn hamsters and rats and (4) such herpesviruses as Herpes saimiri, which is indigenous in the New World squirrel monkey and may induce lymphosarcomas and leukemias when inoculated into certain species of monkeys. Table 2-4 lists some of the different types of RNA and DNA oncogenic viruses.
2.3,2.1.1 AC7088 and Peptidyl Michael Acceptors. A series of peptide-derived Michael acceptors, based on the X-ray structures of HRV-2 3C inhibitors complexes, have been reported by investigators of Agouron Pharmaceuticals (257-263). Their investigations have led to the development of AG7088 (98), a potent and broad-spectrum anti-HRV compound currently in human clinical trials (administered as intranasal spray) for the treatment of common colds caused by the rhinovirus infection (Agouron press release, November 4, 1999).
Clonidine (Catapres) is an imidazoline which is an agonist to a2-adrenoceptors (postsynaptic) in the brain, stimulation of which suppresses sympathetic outflow and reduces blood pressure. At high doses it also activates peripheral a2-adrenoceptors (presynaptic autoreceptors) on the adrenergic nerve ending these mediate negative feedback suppression of noradrenaline release. In overdose clonidine can stimulate peripheral a -adrenoceptors (postsynaptic) and thus cause hypertension by vasoconstriction. Clonidine was discovered to be hypotensive, not by the pharmacologists who tested it in the laboratory but by a physician who used it on himself as nose drops for a common cold.24 The is 6 h.
The A-a gradient is normally 4 to 20 mm Hg. A widened A-a gradient indicates that the patient may have a V Q mismatch, a diffusion defect, or a shunt.5 In simple terms, this means that there is something wrong with the patient's lungs that need an explanation, such as pneumonia or another complicating respiratory illness.
Summary A 44-year-old healthy man presents with sudden onset of shaking chills, fever, and productive cough. One week ago. he developed mild nasal congestion and achiness. Last night, he became fatigued and feverish, and he developed a cough associated with right-side pleuritic chest pain. He has a 15-pack per year smoking history. His vital signs are normal except for a temperature of I02 F. His oxygen saturation on room air is 100 . He is comfortable, except when he coughs. His physical examination is unremarkable except for bronchial breath sounds and end-inspiratory crackles in the right lower lung field.
Much of the research on common cold prevention and treatment is performed by scientists employed or funded by drug companies. Often these companies do not allow scientists to publish the results of their research for fear that competitors at other drug companies will use this research to develop a new drug before they do. Should our society
There is a wide spectrum of clinical presentations, from subclinical or inap-parent inflammation, to the classic presentation of acute pericarditis with chest pain, to subacute or chronic inflammation, persisting weeks to months. Most patients with acute pericarditis seek medical attention because of chest pain. The classic description is a sudden onset of substernal chest pain, which worsens on inspiration and with recumbency, that often radiates to the trapezius ridge and is improved by sitting and leaning forward. Other clinical features vary according to the cause of the pericarditis, but most patients are thought to have viral infection and often present with low-grade fever, malaise, or upper respiratory illness symptoms.
Summary A 2-year-old boy had acute onset of coughing, choking, drooling, and wheezing while eating grapes. He is unable to speak and his cough is weak. He was in a good state of health prior to the incident and has no history of respiratory illness. Physical examination reveals decreased breath sounds, wheezing, and stridor. There is no chest rise on ventilation attempt. No foreign object could be seen on his mouth.
Prior to the availability of effective therapeutic regimens, most infections were attributed to deficiencies in immunoglobulin production associated with the disease process. There are few data regarding the frequency, sites, and causes of infection prior to the advent of chemotherapy. In early reports, about 15-25 of patients were infected at the time of diagnosis (40). An early study of 102 patients treated with radiation reported infection in 30 of patients, and 10 died of infection (41). Most of the infections were pneumonias, upper respiratory tract infections, and septicemias. These infections were caused predominantly by encapsulated bacteria, especially S. pneumoniae and H. influenzae. S. aureus was also a frequent pathogen in some series. Urinary tract infections were common in some series, often associated with ureteral obstruction owing to enlarged abdominal lymph nodes.
Sensitization for Type I immediate hypersensitivity reactions occurs when antigen exposure leads to the production of IgE and subsequent binding to FceR on mast cells and basophils. The effector phase of Type I hypersensitivity reactions is caused by inflammatory mediators, (histamine, prostaglandins, leukotrienes, and platelet activating factor) released from mast cells and basophils following antigen binding to cell bound IgE. Skin testing identifies antigens causing immediate hypersensitivity reactions. Patients with severe reactions may be at risk when tested in this manner, and for these, an antigen specific radioallergosorbent (RAST) test is more appropriate. Clinical manifestations of immediate hypersensitivity reactions include allergic rhinitis, asthma, and anaphylaxis. Treatments include (i) minimizing the exposure to the antigens that trigger the reaction, (ii) pharmacological intervention, and (iii) desensitization.
Biosafety levels are needed because some bacteria and viruses are more infectious and deadly than others. Common colds are infectious that is, the viruses that cause them are easy to get but they are not deadly to most people. Ebola virus, however, is not only infectious but deadly. It and other deadly viruses must be studied in Biosafety Level 4 labs. Less dangerous diseases could also be studied in Biosafety Level 4 labs, but it would cost too much. Biosafety levels are meant to make it less likely that a dangerous agent will infect a person working in the lab or escape to the outside world.
Dysmenorrhea Medicine for curing tuberculosis Powder for curing wind-cold type of common cold its preparation method CN1089851 Spray for preventing and curing common cold and liquid medicine for pyrogenic common cold and method for producing the same JP6287144 Pharmaceutical preparation for common cold
Vitamin C, at doses of 1 g or more, increases body temperature slightly (enhancing white blood cell function), and is beneficial in lowering blood histamine. High levels of body histamine are associated with decreased immune response and increased nasal and bronchial congestion in colds and flu.8 Vitamin C stimulates acti-vitity of white blood cells9 and enhances their ability to destroy bacteria and viruses. Allergic disorders. Because of its ability to lower body and blood histamine levels, vitamin C may be beneficial in bronchial asthma, exercise-induced asthma, food allergy, allergic rhinitis (hay fever), and other allergies.12
The modified recipe could also be used to treat many fever diseases. For example, in treatment of 3 patients with unclear cause, 16 patients suffering with the common cold, and 15 children whose fever appeared at night, all had remarkable effects. In addition, with fevers caused by infection of the biliary tract, pneumonia, influenza, leptospiral infection, and immunopathy, where temperatures were between 38 to 40 C, people took many medicines such as antibiotics, antipyretic drugs, and analgesic with no effect, whereas after administration with Xiao-Chaihu-Tang, their fever decreased in 2 to 10 days. Common cold with higher fever and fever without clear cause can be treated with the recipe, which may have an ideal effect. When using Da-Chaihu-Tang to treat 39 cases of pediatric higher fever that had not responded to antibiotics, 37 patients were healed after taking the recipe for 1 to 6 doses (Zhang, 1990).
In utero infection by Treponema pallidum usually occurs after the 16th week of gestation and affects virtually all fetal organs. If it is not treated, 25 of infected babies will die before birth and another 30 shortly thereafter. Signs of illness appear in survivors within the first month of life. Facial stigmata shown here include bulging of the frontal bones and nasal bridge depression (.saddle nose), both due to periostitis rhinitis from weeping nasal mucosal lesions (snuffles) and a circumoral rash. Mucocutaneous inflammation and fissuring of the mouth and lips (rhagades), not shown here, may also occur as stigmata of congenital syphilis, as may craniotabes tibial periostitis (saber shins) and dental dysplasia (Hutchinson's teeth see p. 205).
Mary is a 25-year-old telemarketer who presents to the emergency room for evaluation of shortness of breath. It started 1 week ago, right after a dust storm. She states that she starts coughing, but then she can't stop, so she feels like she can't breathe after a while. The coughing is so bad that she has vomited afterward. The cough is nonproductive. She denies fever or chills. She has noticed nasal congestion and a clear runny nose. She feels like her ears are stopped up and she has noticed increased sneezing in the past 3 days prior to the onset of the shortness of breath. She also has itchy, watery eyes. She has a childhood history of asthma, which she has outgrown. The last time she had an asthma attack, she was 15 years old.
Poisoning cannot be overlooked in the evaluation of a child with vomiting and abdominal pain. Among the multiple agents most commonly associated with hospital visits are over-the-counter (OTC) analgesic drugs, cold remedies, insecticides, pesticides, personal care products, and fumes. In a child who presents with vomiting and abdominal pain, a cholinergic syndrome is likely. It is characterized by salivation, lacrimation, diarrhea, vomiting, diaphoresis, intestinal cramps, and seizures. Insecticides and nicotine are among the agents that may induce these symptoms. Antihistamines or tricyclic antidepressants produce dry skin, dry mucosae, urinary retention, and decreased bowel sounds (anticholinergic syndrome). Some medications and substances are radiopaque, such as iron tablets, mercury, lithium, tricyclic antidepressants, Play-Doh. and enteric-coated aspirin. Finding the likely agent of poisoning will mostly depend on the history given.
Rituximab is a chimeric anti-CD20 mAb (Figure 33.1), containing the mouse variable domains of the mAb 2B8 grafted to the human IgG1 constant domains. Rituximab kills CD20+ cells by several mechanisms, including (1) complement-dependent cellular cytotox-icity, (2) antibody-dependent cellular cytotoxicity, and (3) induction of apoptosis.32 Both early phase II testing and phase II pivotal testing of rituximab at 375 mg m2 per week X 4 in relapsed low-grade NHL demonstrated overall response rates of up to 48 (6 CR). The majority of toxic events were infusion related (hypotension, bronchospasm, rhinitis, pruritis, rash, urticaria, and tumor pain) and decreased with repeated dosing. Human antimouse antibodies (HAMA) were not observed. This led to Food and Drug Administration's approval of rituximab for indolent NHL. Its effect against indolent NHL was greatly enhanced by combining the drug with chemotherapy, with 95 overall response rates and 55 CR in patients receiving CHOP...
1 The sense of smell is not highly developed in man and is easily disturbed by conditions affecting the nasal mucosa generally (e.g. the common cold). However, unilateral anosmia may be an important sign in the diagnosis of frontal lobe tumours. Tumours in the region of the uncus may give rise to the so-called 'uncinate' type of fit, characterized by olfactory hallucinations associated with impairment of consciousness and involuntary chewing movements.
However, even the common cold or flu can be associated with some degree of pain, such as headaches or more generalised body aches involving muscles and joints. Sometimes the headache can be quite localised and intense. Headaches can occur with symptoms other than those of a cold however, as in migraine, where it is more associated with stress. Here the pain can be much more debilitating as it disturbs the ability to concentrate and think. It can seem to the sufferer to have a particular 'shape' or configuration inside the head which may reflect the route of blood vessels or other structures (see Schoenen et al. 1994 for a discussion).
Coronaviruses are classified on the basis of several fundamental characteristics, including nucleic acid type, a lipid envelope, and their distinctive morphology 42, 64, 79 . All members have characteristic petal-shaped proteins extending from the virion surface. Coronaviruses infect numerous vertebrate hosts including humans, chickens, pigs, and mice, causing a wide variety of disorders involving a number of different organ systems however, there are specific tropisms for the CNS, lungs, gastrointestinal tract, and liver 42,64,79 . Receptor use among the varied coronaviruses is restricted to several well-defined proteins. Human coronavirus infections result in acute enteritis as well as 15 of common colds indistinguishable from those caused by other viruses 42, 64, 79 . More recently, a human coronavirus has been indicated to be the etiologic agent for severe acute respiratory syndrome (SARS). SARS is a potentially lethal disease and is recognized as a health threat internationally...
British Medical Journal 317 935-938 Ware L B, Matthay M A 2000 The acute respiratory distress syndrome. New England Journal of Medicine 342 1334-1349 Weiner J M, Abramson M J, Puy R M 1998 Intranasal corticosteroids versus oral Hj-receptor antagonists in allergic rhinitis systematic review of randomised controlled trials. British Medical Journal 317 1624-1629
If symptoms are limited to rhinitis, a glucocorticoid (beclomethasone, betamethasone, budesonide, flunisolide or triamcinolone), ipratropium or sodium cromoglicate applied topically as a spray or insufflation is often all that is required. Ocular symptoms alone respond well to sodium cromoglicate drops. When both nasal and ocular symptoms occur, or there is itching of the palate and ears as well, a systemic nonsedative Hj-antihistamine is indicated. Sympathomimetic vasoconstrictors, e.g. ephedrine, are immediately effective if applied topically, but rebound swelling of the nasal mucous membrane occurs when medication is stopped. Rarely, a systemic glucocorticoid, e.g. prednisolone, is justified for a severely affected patient to provide relief for a short period, e.g. during academic examinations.7
Respiratory tract infections are common, usually mild, and self-limiting, although they may require symptomatic treatment with paracetamol or a nonsteroidal antiinflammatory. These include the common cold (80 rhi-noviruses and 20 coronaviruses), adenoviruses, influenza, parainfluenza, and, during the summer and early autumn, enteroviruses. Special attention should be given to detainees with asthma or the who are immunocompromised, because infection in these people may be more serious particularly if the lower respiratory tract is involved.
RC is a 43-yr-old man who presented without complaints for routine care. His past medical history is notable for seasonal allergic rhinitis and erectile dysfunction but is otherwise unremarkable. He has never smoked and eats a typical Western diet. He has a sedentary job but recently started exercising several days a week. He is concerned that his father died suddenly from an MI at the age of 60 his mother survived a stroke at the age of 68. His medications include fexofenadine as needed for allergies, and sildenafil as needed. He wants to know if he should start taking an aspirin every day.
1.3 Is There a Cure for the Common Cold Jake's brand of science may eventually give him an answer to his question about how to prevent colds. But he won't know if it is the best answer unless he tries out all the potential treatments. We already know that Jake does not have time for that. Luckily for him, and for all of us, legions of professional scientists spend their time trying to answer questions like Jake's. Scientists use the same basic process of testing ideas about how the world works and discarding (or modifying) ideas that are inadequate. There are, however, some key differences between the ways scientists approach questions and the daily scientific investigations illustrated by Jake's quest for relief. This chapter will introduce you to the process of science as it is practiced in the research setting, and will help you understand how to evaluate scientific claims by following Jake's quest for relief from the common cold.
That alternative hypotheses could explain the results by randomly assigning subjects to treatment groups, using an effective placebo, and blinding both the data collectors and the subjects. Given such a well-designed experiment, this statistically significant result allows researchers to strongly infer that consuming zinc lozenges reduces the duration of colds. There is one final caveat however. A statistically significant result is defined as one that has a 5 probability or less of being due to chance alone. If all scientific research uses this same standard, as many as one in every 20 statistically significant results (that is, 5 of the total) is actually reporting an effect that is not real. An experiment with a statistically significant result will still be considered to support the hypothesis. However, the small but important probability that the results are due to chance explains why one supportive experiment is usually not enough to convince all scientists that a hypothesis is...
Which of the following is a prediction of the hypothesis Eating chicken noodle soup is an effective treatment for colds a. People who eat chicken noodle soup have shorter colds than people who do not eat chicken noodle soup. b. People who do not eat chicken noodle soup experience unusually long and severe colds. 10. A relationship between two factors, for instance between outside temperature and number of people with active colds in a population, is known as a(n)_.
I was extremely fit physically, and played a strenuous game of tennis regularly. My family and I had no psychiatric history. In particular, I had never suffered with depression. I developed what at the time seemed to be a minor upper respiratory tract infection. The only unusual symptom, which I had never had with previous viral infections, was muscle aches in my legs. In retrospect, I feel this was a very significant symptom as I believe the virus was causing damage centrally while manifesting peripherally in the muscle. This is my own personal belief which is based on my symptoms and not on any scientific fact. The viral studies mentioned so far have all been retrospective in design in that they investigated patients who already had CFS. To rule out convincingly the role of viruses in CFS, we need to turn to prospective studies. These studies investigate causes by studying people before they contract the illness of interest. Two prospective studies have shown that common viral...
Under the name of Chaihu (Saiko in Japanese and Shiho in Korean), the roots of several species from the genus have been frequently used in the prescriptions of Oriental traditional medicine for the treatment of common cold with fever, influenza, inflammation, hepatitis, malaria, and also menopausal syndrome in China for 2000 years. Chaihu was first recorded in Shen-Nong's Herbal, a pharmaceutical book published 2000 years ago in China. In it, Chaihu was described as the best medicine to treat diseases with fever. In 1058 a.d., an atlas of materia medica, Bencao Tu-jing, was published, which contained five illustrations of Chaihu (Figure 1.1) Zizhou Chaihu, Danzhou Chaihu, Shouzhou Chaihu, Jiangningfu Chaihu, and Xiangzhou Chaihu. According to the figures and descriptions, four (Zizhou Chaihu, Danzhou Chaihu, Jiangningfu Chaihu, and Xiangzhou Chaihu) belong to the Bupleurum genus. Prescriptions and their clinical applications (Chapters 10, 11, and 12), including Chaihu Oral Liquid...
Adverse effects are short-lived, dose-related, and comprise headache, flushing, nasal congestion and dyspepsia. High doses can inhibit PDE6 which is needed for phototransduction in the retina, and some patients report transient colour vision disturbance. (The more recently developed PDE5 inhibitors, cialis and vardenafil, appear less likely to cause visual upset.) Priapism7 has been reported.
When we get sick it often is due to invading microbes that destroy or damage cells and organs in our body. Cholera, smallpox, measles, diphtheria, AIDS, and the common cold are all examples of what we call an infectious disease. If we catch any of these diseases, our doctor may prescribe a drug that will, in some cases, remove the microbe from our bodies, thus curing the disease. Unfortunately, most of the diseases that we fall prey to are not of the infectious kind. In such case, there are no microbes to fight, no drugs to apply. Instead, we are faced with a far more difficult problem, for this type of disease is an ailment that damages a gene. Gene therapy attempts to cure these diseases by replacing or supplementing the damaged gene. Vectors used in gene therapy. Adenoviruses have a DNA genome contained in a crystalline protein capsid, and normally infect cells of the upper respiratory tract, causing colds and flulike symptoms. The protein filaments are used to infect cells....
Basil has traditionally been used for head colds and as a cure for warts and worms, as an appetite stimulant, carminative, and diuretic. In addition, it has been used as a mouth wash and adstringent to cure inflammations in the mouth and throat. Alcoholic extracts of basil have been used in creams to treat slowly healing wounds (Wichtl 1989). Basil is more widely used as a medicinal herb in the Far East, especially in China and India. It was first described in a major Chinese herbal around A.D. 1060 and has since been used in China for spasms of the stomach and kidney ailments, among others. It is especially recommended for use before and after parturition to promote blood circulation. The whole herb is also used to treat snakebite and insect bites (Leung and Foster 1996). Ocimum basilicum is known under the following local names in the Rift Valley in central Kenya (area in brackets) Chemishwa (Tugen), Chenekom Sipko (Pokot), Embuke Emboa (Bukusu), Lemurran (Samburu), Mwenye (Luhya),...
Preparation method CN1245699 Fatigue-eliminating body-nourishing pill CN1245695 Deodorant oral liquor CN1242208 Special efficacy drug abstinence medicine CN1240644 Face mask for eliminating maculae and wrinkles and whitening skin and its preparation process CN1240142 Compound longshou soluble granules CN1207311 Health drink for preventing and treating common cold myopia and its preparation process CN1188005 Chinese herbal medicine oral liquor for curing wind-heat common cold and its preparation method
Symptoms of acute bronchitis include sputum production, dyspnea, wheezing, chest pain, fever, hoarseness, malaise, rhonchi, and rales. Each of these may be present in varying degrees or may be absent altogether. Sputum may be clear, white, yellow, green, or even tinged with blood. On physical examination, the patient with acute bronchitis may or may not have fever and has tachypnea, as well as pulmonary signs such as wheezing, rhonchi, and prolonged expiration. In this case, the patient has no fever, and the cough is nonproductive. Although an acute bronchitis can result in wheezing, it is less likely in this scenario, especially when the patient also has features of allergic rhinitis.
Data on aging-related changes in the genesis of olfactory receptor neurons are limited and analysis of changes is complicated by the fact that the olfactory epithelium, by virtue of its exposed location within the nasal cavity, is uniquely vulnerable to damage from a variety of insults. There are substantial aging-related changes in the organization of the olfactory epithelium, including a decrease in the number of ORNs and patchy replacement of the sensory epithelium by respiratory epithelium (e.g., 66, 67 . It cannot be assumed, however, that loss of ORNs is the result of decreased genesis. A short report that noted decreased generation of ORNs in the olfactory epithelium of aged mice 68 was followed by a detailed study of Fisher-344 x Brown Norway rats from 7 to 32 months of age 69 . Significantly, in the latter study, the animals were maintained in a barrier facility to minimize the possible impact of rhinitis and other disease on the olfactory epithelium. Although the anterior...
It is essential to warn patients taking MAOIs not to use over-the-counter medication, as many simple remedies sold direct to the public, such as those for nasal congestion, coughs and colds, will contain sympathomimetics (ephedrine, phenylpropanolamine). Patients must receive detailed instructions about their diet and be made aware of the need to avoid the many foods containing substantial amounts of sympathomimetics, most commonly tyramine, which acts by releasing tissue-stored noradrenaline. For example, degradation of the protein 'casein' by resident bacteria in well matured cheese can produce tyramine from the amino acid tyrosine, hence use of the term 'cheese reaction' to describe provocation of a hypertensive crisis by orally administered sympathomimetics. Stale foods also present a danger, since any food subjected to autolysis or microbial decomposition during preparation or storage may contain pressor amines resulting from decarboxylation of amino acids.