When I first
connected histamine to autism, I did not realize that this might be a common
problem. The most frequently viewed post
on this blog is one on histamine and autism; so at least 10,000 people out
there have googled “autism and histamine”.
Two years
later, the therapy is still evolving and it should be said that, what works best
for one person may not help in another person.
The main point is that in some people with autism, they face a
summertime regression due to the effect of allergy. So bad behaviours and aggression increase and
good behaviours and indeed cognitive function decrease. This appears to be the result of histamine and a pro-inflammatory cytokine called IL-6.
For the 2015
pollen season, which started early where we live, this is what we are using:-
Azelastine nasal spray, this is an H1
antihistamine that is also inhibits mast cells from “degranulating” and
emptying their load of pro-inflammatory substances. Once a day.
Quercetin is a cheap flavonoid that has
numerous actions including on histamine H1 receptors, mast cells, and
inflammation. 125mg two or three times a day.
Verapamil is an L-type calcium channel blocker
and also a mast cell stabilizer. 40mg three times a day
Fluticasone propionate 50 µg (micrograms) – see below. It is a steroid that has recently been shown to have some unexpected effects on mast cells.
I have found
that oral antihistamines were effective for only a couple of hours, but their
effect varies widely from person to person.
In theory,
Rupatadine should be the most effective anti-histamine, since it is also a potent
mast cell stabilizer. The old first
generation antihistamines (that make you drowsy) could in theory be better than
the new ones like Claritin, Zyrtec, since they can also cross the blood brain
barrier (BBB).
Ketotifen
and cromolyn sodium should also be useful, but if the allergy is pollen related,
you really need the nasal spray (nasalcrom etc) to get the most effect. In some countries they sell eye drops and not
the nasal spray. Usually the eye drops
are more diluted than the nasal spray.
For example, the Azelastine eye drops contain 50% less Azelastine than
the nasal spray, but are otherwise the same.
Where we live they have run out of the nasal spray but not the eye
drops, so you could refill the spray with eye drops and double the number of
sprays to get the same dose.
Drugs like
Claritin and Zyrtec are H1 antihistamines and also partial mast cell stabilizers; they have a positive behavioral
effect in some people with ASD, who are apparently allergy free.
New for 2015
I expect
that two recent anti-inflammatory therapies, the Tangeretin flavonoid and the
Miyairi 588 bacteria/probiotic may have a beneficial, indirect, effect on our
usual summertime regression.
A more
convention approach is to add fluticasone propionate to
reduce the inflammation caused by allergy.
This drug is a steroid and widely used either as an inhaler to control
asthma and COPD, or as a nasal spray to treat allergies.
As Flixotide inhaler, Monty, aged
11 with ASD and asthma, has already been taking fluticasone propionate for a
few years. We now use a tiny dose (50 µg), since his autism therapies have greatly reduced any asthma tendencies.
Fluticasone propionate nasal
spray (Flixonase, Flonase etc) is widely sold as a treatment for hay fever and
rhinitis and was recently combined with Azelastine (see above) as a treatment for moderate to
severe allergies in a product call Dymista.
The
combination of H1 antihistamine, mast cell stabilizer and anti-inflammatory all
in one spray does seem a good idea. The
steroid dose using Dymista is actually lower than the usual dose of steroid
when using Fluticasone propionate nasal
spray alone. You want to minimize the
amount of steroid absorbed in the blood. When used as a spray/inhaler the amount
is tiny, but still should be considered.
Dymista (Azelastine + Fluticasone
propionate) does indeed work better than Azelastine alone.
There is no sign of allergy at all (no red eyes, sneezing, itchy nose),
with Azelastine you still have an itchy nose.
In our case, the allergy symptoms, even minors ones, do correlate with the change in behaviour and cognitive function; so the target is no allergy symptoms at all.
If anyone has other therapies for
summertime flare ups, feel free to share them.
