# Why would Sudafed improve my symptoms?



## Guest (Oct 13, 2001)

I have been taking Sudafed for a week to treat a cold I've had. It has all but eradicated my IBS symptoms, to my surprise. I've been having diarrhea 3-4 days/wk. I'm also 5 mos. pregnant and not taking any IBS meds. My IBS was diagnosed years ago, but has gotten worse again in the past year, and worse still since I've been pregnant. Could this improvement indicate a food allergy of some kind? Or is it simply the constipating effect of the decongestant that is helping me?


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## Mike NoLomotil (Jun 6, 2000)

STARRIDERlease read what I wrote on this thread http://www.ibsassociation.org/ubb/Forum1/HTML/000068.html and then what I am about to say in simple terms will make sense. This is an antihistamine you are taking. D-predominant IBS victims in particular, whether they have comorbid actual food allergies or not (and with inhalant allergy your chances of comorbidity or at least cross-reactivity with certain foods and your inhalants are increased) the mast cells of the small bowel are involved (in fact are apparently primary) in provoking your episodes. If you release histamine in the lungs you get what you know is asthma, in the upper airways mucosa you get all the nasal and sinus symptoms so picture this same action taking place in the intestines. Clean-out time. This is why some forms of immunomodulation (things which blunt immune response) and antihistaminics (block specific histminic sites thus effects) help in IBS esp. d types.IF the effect is this noticeable to you my suggestion is you may have not only the odd small bowel immune repsonses I described in that thread as having been recently discovered, but you may have an actaul food allergy or food cross reactions from your inhalant allergies as well so you are getting a real load of histamine. So an anthistamine will help locally as well as systemically.I think the first time someone discovered that stuff that worked on asthma sometimes worked on d-types was Stefanini back in the 1980's, who found cromolyn sodium (an asthma prophylactic) to reduce d-symptoms.I suggest that perhaps you should get this book today and study this further, as it will help you manage it:ï¿½FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENTï¿½, Professor Jonathan Brostoff (M.D.. Allergy, Immunology and Environmental Medicine, Kingsï¿½ College, London) http://www.amazon.com/exec/obidos/ASIN/089...r=2-1/102-64875 08-3420903[/URL] Eat well. Think well. Be well.MNL____________________ www.leapallergy.com [This message has been edited by Jeffrey Roberts (edited 10-13-2001).]


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## Guest (Oct 14, 2001)

Thank you very much for your response; however, I am unable to access the link you sent. I get a "cannot connect to this link" message - could you please double-check it? I am most interested in further reading about this subject.


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## Jeffrey Roberts (Apr 15, 1987)

The link is fixed - please try again.


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## Guest (Oct 15, 2001)

One more question... It is my understanding that Sudafed (pseudoephedrene hydrochloride) is NOT an antihistamine, but a decongestant that works through constriction of blood vessels. How would this have the same effect on histamine reactions? BTW, I do not suffer from asthma. I have little trouble with inhalant allergies although do have allergies to a number of medications.


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## Mike NoLomotil (Jun 6, 2000)

Hi Rider.Disclaimer: Ignore my usual typos as I am in a real hurry today.







Ok let's speak in a Less general sense. Some folks do not follow if I get too technical about specifics and then read me out for being to dense of content. Obviously you can and do follow along and don't mind a little more specific content. Good that actaully makes it easier to talk as I do not have to figure out exactly where to draw the line..at least we cn move the bar up a little







.Pseudoephedrine is what is called a "sympathomimetic" drug....which means it "mimics" the effects of stimulation by sympathetic nerves. There are various types of sympathetic "receptors" which have different effects on different body structures. Some sympathomimetics can cause smooth muscle to contract in one structure and the opposite effect on another similar structure in another body location..like constrict blood vessels in the peripheral circulation but relax smooth muscle in the bronchial wall. Pseudoephedrine is called "pseudo" ephedrine because it can be viewed as a "synthetic" variation of ephedrine...sound familiar?....ephedra...Ma huang...dieting....speed.?Most pseudoephedrine is sold these days in combination with an antihistamine and other junk. There are many many OTC formulations you can find in your medical guides and the PDR. You can purchase Sudafed brand or generic alone as well, but most sales are in the form of combinant antiallergy preps (think like Claritin, Allegra, Tylenol Sinus ad nauseum).This way you get the combined effects of the antihistamine of choice and the adrenergic effects of pseudoephedrine. In the case of PE, it activates a type of receptor which causes peripheral blood vessels including those in the mucosal linings of the respiratory tract and intestinal tract to constrict. This reduces the overall fluid volume of the mucosa thus "decongestion".This action can offset the effect of histamine and other vasoactive mediators like leukotrienes (C4 and D4 for example which can be dumped by eosinophils)that are released in the small bowel during an aberrant immune response as seen in the loss of oral tolerance demonstrated in IBS.So indeed adrenergics are not "antihistamines" by mode of action, they are amines which can Offset (have the opposite effect) as histamine and other vasocative mediators. As they are usually taken in combination with an antihistamine (and and antitussive and a mucokinetic even in many preparations) I just cut to the simplest analogy. But waht does it have to do with affecting IBS symptoms, you query?Local and systemic vasoconstrictors by themselves reduce the permeability of the small blood vessels in the mucosa of the small bowel just as well as they do in the mucosa elsewhere. In the case of the types of reactions that occur in d-type IBS, this can have several "beneficial" effects.Anything which "tightens" the smooth muscle of the capillary walls makes them less permeable...in both directions...so the question becomes is it the chicken or egg which will come first which produces the benficial effects. For example, Investigators doing in vivo studies in confirmed food sensitive non-IgE allergic IBS patients, have seen that the mucosal immune response seems to first start with the small bowel mast cells and the lymphocytes which circulate in and out of the vascular bed and lymphatics, and which are hanging around in the wall of the small bowel, and like to aggregate near the nerve endings. Bad place to hang out as if the lose cell wall integrity they dump lymphokines right where they are not wanted unless you are trying to provke a protective-response by the small bowel immune system (lymphokines are cytokines made by lymphocytes...of which there are multiple types of both...the lymphokines and the lymphocytes).Anyway, the release of the various proinflammatory mediators results in a cascade-reaction which as a consequence increases vascular permeability, makes the smooth muscle contract more easily, and stimulates the gut motor nerves and sensory nerves. If you increase the capillary permeability, more immunocytes can leave the blood vessels and enter the bowel "wall" and their reaction is additive. There are chemicals released which not only facilitate their recruitment to the area but open upthe blood vessels to make it easier for them to migrate there.Also, even though some small food particles are always normally transported through the network of cells between the lumen of the small bowel to the lumen of the capillary so the circulating immune system can check out the food and make sure it is not a bacteria (forming immune complexes with IgA which are neutral, and just assimilated by macrophages), it appears that SOMETHING causes mistaken-identity by the cellular immune system in IBS (d and cyclics in particular) and thus triggers granulocyte reactions which then can lead to platelet reactions, and then even serotonin gets in on the act as the plateltes recruited are loaded with serotonin. Anyway, All their mediators get dumped into the bloodstream and have local as well as widespread effects depending upon which reaction profile takes place. There are at least (8) different mechanisms which can be involved to varying degrees depending upon the person and the provocation applied.It appears that the net effcet of this vascular dilation, caused when the mucosa starts to respond inappropriately, that much larger immune complexes may be formed by the passage of larger quantities and particle sizes of unprocessed foods, and that some chemotoxins in some foods which would normally not be assimilated in large enough quantities to have a noticeable effect on immunocytes can also pass through into the bloodstream. It becomes a viscous cycle as the large immune complexes can be "read" as pathogens. Oops. [Note for the immunotekkies...I am way oversimplifying so one need not point that out...just trying to get to the end of some intelligable explanation of how constricting the small blood vessles of the small bowel can be benficial].I think maybe at this point you can envision what the benefit would be of ingesting something which could constrict the blood vessels locally in the small bowel which have been dilated by vasoactive mediators released in these reactions...starting with histamine. Anything which will reduce the blood vessel permeablity in the small bowel will attenuate to a degree the aberrant reaction and the consequences of same by reducing the vessel permeability in both directions, both to immunocytes and chemical mediators coming out, and to transport of potential provoking substances which can be moving IN to the bloodstream from the lumen.This does not mean that these drugs have been found to be terribly effective with most patients with IBS-d or cyclic IBS. It can make a noticeable difference if the reactivity is relatively mild. But once degranulation gets to be, for lack of a better word, "massive" (of mast cells and granulocytes) some of the chemicals released which act on the structures in question are way way way more powerful than histamine and their effects are very very difficult to reverse even with some of the most 'powerful' antidiarrheals you will see dicussed. So pseudoephedrine would be like those little airplanes in King Kong shooting .30 caliber machine guns at him...nil.What works alot better than trying to put the horses back in the barn after they are out and are trampling everything under hoof, is to keep them inside the damn barn in the first place.So far this can only be done effecively with identification of that which provokes the reaction and then avoiding it (foods or chemicals in foods) or immunomodulating substances (substances which stabilize the various immunocytes redcuing their tendency to unload mediators in response to the wrong stimuli). There are limited choices.I hope that is a little more specific without going too far.Eat well. Think well, be well.MNL_________________ www.leapallergy.com


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