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Tuesday 12 May 2015

Minimizing Summertime Autism Flare-ups in 2015




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.






6 comments:

  1. Hi Peter, I am so thankful for your blog, and all of the science you go into and the discussions it facilitates. I am 31 years old and autism (aspergers) has really held me back in life, personally and professionally.

    Recently after reading your blog I've noticed how dramatically my autism irritability, and stubbornness correlate to allergies and histamine, as you and many others have discovered.

    I wanted to point out that the Fluticasone propionate contains propionic acid, you may want to steer autistic children and readers away from that particular medication, maybe something without the propionate would be just as effective. Let me know if you or anyone else has an alternative.

    Michael

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    1. Michael, large amounts of propionic acid in your bloodstream would not be good for autism. One spray of Dymista contains 50 micro grams of fluticasone propionate. Not much of that will enter your bloodstream. You produce much larger amounts of propionic acid via fermentation in your gut. I would not worry about the propionate in steroid sprays and inhalers.

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    2. Good to hear from you, I'll personally be trying alternatives and avoiding calcium propionate.

      Lately have been consuming green bananas to boost butyric acid, they seem to be a good source of XOS prebiotic for Bifidobacteria and others as well. Been avoiding dairy and making my own probiotic yogurts too. I've read Forskolin, NAC, and Carnitine can protect brain from propionate so I've been doing that.

      The calcium channel blocker really really helps my mast-cell issues, goodby runny nose hives and asthma, unfortunately literature says not to combine it with Forskolin, so I haven't tried them together.

      Megadosing on antioxidant polyphenol foods helping reduce my stubbornness and cognitive, opinionated rigidity as well.

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  2. Hi Peter--

    My kid's been on bumetanide for just over a year now and I think it's helped with her emotional stability--thank you for your blog, which has been an important resource for us. I'm also enjoying the book.

    Lately she's lost some progress and I'm trying to understand whether pollen is a factor. Do I understand right, from the paper I've linked to below, that quercetin actually makes NKCC1 more potent? They say it "stimulates" the enzyme without increasing its expression. That makes me think it would be a mixed blessing for my kid, and we should try some other measure, maybe pterostilbene. (Her doctor just put her on fluticasone propionate for allergies and it might be helping both with sneezing and mental health. But I'm not sure it's enough.)

    https://pubmed.ncbi.nlm.nih.gov/21865857/

    Thanks for any clues!

    --Mat

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    1. Mat your paper is saying that quercetin does the opposite of bumetanide in that it increases chloride in cells. What it does not mention is that the anti-inflammatory effect of quercetin is actually going to work in bumetanide’s benefit.

      Allergy driven regression is very common. Mast cell stabilizers and avoiding the allergen usually work well. In the case of bumetanide you can always increase the dose.

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    2. Thank you. Yeah, that's how it sounded; maybe I was hoping I'd misunderstood. In any case we're seeing some improvement already and have options to explore.

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