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The Summary

Mizuho Morrison, DO and Mike Weinstock, MD
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No me gusta!

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Matt M., MD -

One thing about the common cold and OTC meds I am curious about - the antihistamines. I have thought for a long time now that they not only don't help (because the problem is infectious and not allergic, histamine has nothing do to with it), but that also they can be counterproductive due to the anticholinergic effect and tendency to thicken mucous (guaifenesin is mucolytic, antihistamines are the opposite - would that be mucotropic?). I am also sure that they are thrown into these preparations for the purpose of being able to market them as "multi symptom" or "complete cold relief", etc - and in the process, ignore the precision we try to always achieve with our treatment. I would like to hear more from the ENT and pharmacology gurus. Something I have done a lot in patients that I thought DID in fact have a sinus infection, that was precipitated by allergy, is to use steroids as the allergy treatment surrogate, and strictly avoid the antihistamines for a few days to allow the sinuses to drain. Am I crazy? Matt Mullen
PS Still working on the "what would I do next" about systolic murmurs...I actually have two illustrative cases....

Mizuho M., DO -

This is a great question Matt! We definitely will reach out to the pharm gurus! And we can't wait for you to be on the show. ~Miz

Mike W., MD -

Reply below

Mike W., MD -

Thx for the thoughts Matt, I have wondered the same thing through the years (typically with my own URIs - ha ha) - "if we can send men to the moon, then why can't we cure the common cold?"

Mike W., MD -

Response by Bryan Hayes, PharmD: This is a great comment, and probably mostly true. I don't have specific references either way, because antihistamines haven't really been studied or proven to do anything in this scenario. Because the symptoms of a common cold often overlap with allergic rhinitis (or other allergy-related responses to allergens), it is often difficult to differentiate one from the other. So, while I think marketing is a big component of it, there may be times when an antihistamine could relieve some of the symptoms.

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Assistant Professor of EM, Harvard Medical School
Attending Pharmacist, EM & Toxicology, MGH
Twitter: @PharmERToxGuy
PharmERToxGuy.com

Mike W., MD -

Bryan Hayes comments above

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Fibrillate into the Future! Full episode audio for MD edition 208:08 min - 98 MB - M4AHippo Urgent Care RAP - March 2018 Written Summary 487 KB - PDF

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