More welcome relief from modern medicines

This week we conclude our series on miracle medicines with a look at Biologic Response Modifiers, antidepressants and antihistamines.

Medical marvels: Biologic Response Modifiers

There are several proteins released by the body that have effects on other cells. These proteins are called cytokines. Some cytokines can cause cell growth and promote inflammation.

As one can imagine, if too much cytokine gets released, the balance is tilted and unwanted inflammatory reactions can occur. Because of relatively recent medical and scientific research and understanding, we have found a way to control or modify the biologic conditions that are driven by cytokines.

Scientists have artificially, via genetic engineering, developed specific proteins (some antibodies, some cytokine receptors, some hybrids of other antibodies or proteins) that bind to free-floating cytokines in the blood and effectively “mop them up” before they have a chance to land on target cells and cause any unwanted inflammatory reactions.

These engineered proteins are injected into patients and do their work in the bloodstream. They are called “biologic response modifiers.” Common names of some of these medications are Enbrel (Etanercept), Humira (Adalimumab) and Remicade (Infliximab).

Some of the conditions these medications treat include but are not limited to: rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, inflammatory bowel disease, juvenile arthritis and ankylosing spondylitis. New disease treatment indications for biologic response modifiers are coming out almost monthly. Biologic Response Modifiers really are at the very forefront of advanced medical treatments.

Pushing the depress button on depression: Prozac

Antidepressants are the most commonly prescribed medicines in the world. Making a better antidepressant commands the attention of the worldwide medical community. That is exactly what Prozac did.

A low level of a chemical (neurotransmitter) in the brain was associated with depression. That neurotransmitter is serotonin. The search was on to find a medicine that increased serotonin levels in the brain, thus treating depression.

In the 1970s a medicine called Fluoxetine was found to block the absorption of serotonin, effectively increasing the amount available in the brain. The trade name of Fluoxetine is Prozac. Fluoxetine was the very first of what is known as “selective serotonin reuptake inhibitors” (SSRIs) and gained FDA approval in 1988. In the first year of availability, over 2½ million prescriptions were issued.

Prozac is not without controversy; it can interfere with sleep, decrease sex drive, cause suicidal thoughts in teens, and the degree of its overall effectiveness has come into question as well as the consideration of it being overused. Nevertheless, Prozac has changed the way we treat depression.

Snuffing out the sneeze: antihistamines

Histamine is a substance released by specific cells in the body in response to irritation. Oftentimes the irritation is from pollen, foreign substances, or even foods that the body perceives as “unfriendly.” The body tries to get rid of the unwanted substance by producing histamines, which bind to cells in the body that cause tissue swelling and produce the classic symptoms of itching, sneezing, watery eyes and itchy skin.

Histamine release from food sensitivity may also cause stomach upset, cramping and diarrhea. The classic allergic reaction is triggered by H1 histamine receptors. H2 (histamine2) receptors can regulate acid production in the stomach. H3 receptors may play a role in dementia, including Alzheimer’s disease.

I will limit this discussion to just the classic H1 receptor antihistamines. By 1932, researchers had confirmed that histamines were the causative agents in these types of allergic reactions with runny nose, itchy eyes and sneezing. That began the search for an “anti-histamine” to give relief to allergy sufferers.

The first commercially available antihistamine became available in 1944. The original antihistamines also caused drowsiness, an unwanted side effect for those who need to be alert for their jobs or school.

A second generation of antihistamines is the most popular available now, and they very rarely cause drowsiness. Claritin is an example of such a non-sedating antihistamine. Antihistamines are also used to treat motion sickness, cold symptoms and insomnia. Thanks to antihistamines, millions of allergy sufferers can gain much-welcomed relief.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.