risks of anti-histamine medication

28

Central Health Services Council, which was intendedto play a really important part as the accessory

. brain and the voice of the service. Somehow or bysomeone, the large view must be taken, and we mustall be made to feel (as we should) that, amidunavoidable confusion and disappointment and hard-ship, we are progressing towards a service of highquality, soundly balanced. In the words of Prof.I. G. DAVIES 3 :

" Looking back on 1948 and the year subsequent,there is discernible a vast national system of medico-social services administered bv a number of differenttypes of authority and run by different kinds of adminis-trative machinerv. Not even the kindliest critic of thismachine could say that it worked smoothly or that itscomponents were properly synchronised with each other.. Is it too much to hope that some method will bedevised of integrating these different parts into one of thefinest national medico-social services yet seen ? The

parts are all there-it would be a pity to leave them asthey are."

Risks of Anti-histamine MedicationTHE introduction and development of anti-histamine

drugs in the last dozen years has been a notableadvance in theraputics, and their success in

allergic diseases has naturally led to their trial inailments on or beyond the borders of the allergicgroup. Since they have been particularly valuable inparoxysmal rhinorrhoea, it was inevitable that theyshould be tried in the common cold. In medicine,we are told, sensible experimentation is preferableto speculation, so such trials were obviously desirable.The aetiologies of the two conditions are generallyagreed to be quite different-the one allergic and theother a virus infection-but it was argued that thesymptoms of the early coryzal and congestive phasesof a cold might be allergic in origin and that at thisstage an anti-histamine drug might abort the coldbefore secondary infection had occurred.4 Individualpractitioners who have experimented on themselvesseem to agree that the anti-histamines afford some

symptomatic relief, and BREWSTER’s 5 trial in theU.S, Navy was encouraging so far as it went, thoughthe plan was subject to serious criticism. 6 On theother hand, PATON, FuLTON, and ANDREWES,7who emphasised the difficulty of assessing " coldcures," reported a small but carefully controlled

experiment to test the value of Anthisan’ andconcluded that the results did not show any dramaticeffect of this drug on the common cold. They addedthis rider concerning their findings :

" We do not bring them forward as evidence thatthere is no beneficial action, but only to draw attentionto the necessity for rigorous control of any test of aremedy for colds ; the need to depend on subjectivejudgmen,ts; by patient and clinician alike make suchtests particularly difficult."A cautious attitude on the part of doctors

is highly desirable, if only because the Poisons Boardhas not, so far, taken steps to prevent the publicfrom buying these toxic drugs over the counter.It is said. that by the Monday evening after an articlehad appeared in a Sunday newspaper on the virtuesof anti-histamines as a cold cure, stocks of them inthe chemists’ shops were almost exhausted. It seems

3. Medical Press, Dec. 14, 1949, p. 555.4. Cort, F. Brit. med. J. 1948, i, 758.5. Brewster, J. M. Nav. med. Bull., Wash. 1949, 49, 1.6. Annotation, Lancet, 1949, i, 489.7. Paton, W. D. M., Fulton, F., Andrewes, C. H. Ibid, p. 935.

likely that of the thousands of people who boughtthese drugs at least a third would experience sometoxic effect, such as drowsiness, giddiness, or the

peculiar psychological states of unreality and disorienta-tion. Trivial as this may appear, there will certainlybe tragic consequences if drivers of cars and publictransport dose themselves indiscriminately withanti-histamines. The decision not to include these

drugs in the Poisons Schedules was doubtless made ata time when it could reasonably be assumed that thepeople taking them would normally be under imme-diate medical supervision. Today this applies onlyto a minority, and the change of circumstances hascreated a potential danger which merits immediateintervention by the Ministry of Health. The possi-bility that a labyrinthitis may develop on withdrawalof anti-histamine therapy, of which three examplesare reported by CHERRY 8 for South Australia, alsodeserves consideration.

According to reports reaching this office severalchildren have died from eating sugar-coated anti-histamine tablets as sweets. In cases of acute

poisoning by anti-histamines the obvious antidote ishistamine acid phosphate, injected subcutaneouslyin doses of 0’1 mg. per kg. of body-weight. Tabletswhich are vividly coloured and sweet to taste canscarcely be resisted by a normal child, and we havethe unfortunate experience with ferrous sulphatetablets as evidence of this fact. Responsibility forsafe disposal of poisons in the household rests withits adult members ; but manufacturers might con-sider whether the time has not come to incorporateinto the coating of these tablets a trace of some bittersubstance which would discourage a child without

causing undue hardship to adults.

Prognosis in Myocardial InfarctionTHE mortality from coronary disease appears to be

increasing. In his Harveian oration of 1946, CASSIDY 9voiced his conviction that the increase could not be

explained by more accurate certification ; and hepointed out that relatively few cases were seen by thegreat physicians of the past, such as MACKENZIE andOSLER, or by the astute morbid anatomists of thosedays, though they were fully alive to the existenceof the condition. According to the Registrar-General’sreturns, deaths in England and Wales from coronarydisease numbered 1880 in 1926, 25,012 in 1945, and33,168 in 1947. This is a startling increase ; andRYLE and RussELL., after allowing for changingfashions in diagnosis, amendments to the inter-national classification of causes of death, and thelengthening span of life, conclude that the increase isreal. Similar figures have in fact been publishedin the U.S.A., where 28,286 fatal cases were recordedin 1930; 101,467 in 1940, and 113,636 in 1942."And at the Royal Adelaide Hospital,12 in Australia,the proportion of necropsies showing cardiac infarctionrose from 1-1% in 1935 to 45% in 1946

In myocardial infarction death often follows imme-diately on the onset of symptoms, or it may comewithout any warning at all; probably some 30%of all natural sudden deaths are due to coronary-

8. Cherry, A. Med. J. Aust. 1949, ii, 540.9. Cassidy, M. Lancet, 1946, ii, 587.

10. Ryle, J. A., Russell, W. T. Brit. Heart J. 1949, 11, 370.11. U.S. Bureau of the Census : Vital Statistics 1942, Part I.

Washington, 1944.12. Cleland, J. B. Med. J. Aust. 1949, ii, 733.