Did Montelukast save my life?

Back in March I had the virus (COVID-19) but not in the same way as other people. I spent a scary night aching all over like the flu. My partner and I both had dry coughs and what is left of my sense of smell was eliminated. Later as I recovered I notice that much of my food tasted strange and sweet things were obnoxious. There was no fever.

There was rudimentary diagnosis from the NHS 111 service - and so we self-isolated - but this was never recorded anywhere. We think we got it from someone on the London Underground.

At the time loss of smell and taste was not recognised as a symptom and it was thought the disease behaved much like flu. Now doctors and scientists think differently.

When it happened I had taken Montelukast several times in the previous days as I had been to a number of functions and meals. And spring was starting up.

Could Montelukast have saved my life? It is now known that one of the ways the disease causes its damage is through an over-reaction of the immune system, of the white blood cells. Montelukast suppresses part of the immune system, the leukotrienes, a kind of white blood cells.

This study, http://www.englemed.co.uk/20/20aug101_covid19_eosinophils_link.php, found that eosinophils, the precursor of leukotrienes, are the main source of immune system over-reaction in COVID-19 infection.

So did Montelukast save my life? That night I went to bed wondering whether I would wake up in intensive care. As I say the symptoms were unusual - no fever and the aching all over - but they were unpleasant and frightening.

I have also read that people with asthma have proved surprisingly resilient against the virus - they have not faced the high death rate experienced by others who were believed to be at risk. Steroids, which also form the basis of asthma treatment, have now been proven to be an effective treatment against the virus. Could Montelukast be a useful preventative treatment for some of us?

Six months later I count myself as among those who have not fully recovered from infection. I have experienced a strange congested feeling ever since. In the spring and summer I put it down to hay fever and took more Montelukast. However I don't like taking it in the winter as since it is an immune suppressant and I get concerned it could make me vulnerable to flu. I have just had a screening blood test ordered by the GP and the one measure that is out of sorts is my white blood cell level - it is low. I might have taken Montelukast a few days beforehand. I cannot remember as it never occurred to me it might be a problem. It could be a legacy of COVID-19 infection. I wonder if the GP will know?

Indeed earlier this year I went down with flu in spite of having the flu vaccine (so it is very unlikely that my episode in March was another bout of flu). I was let down, I think, by my unstable immune system. The choice of whether to take Montelukast during the winter is now even harder.

RAS

Bolognese sauce

 We've just got a juicer - or rather the other half has. It's supposed to aid weight loss as you are meant to chew up all sorts of vegetable matter in it to make juice.

It's certainly high-powered and cleverly designed. It has twin blades and seems to be able to chew up anything into a gritty sort of juice. Unfortunately some of the fresh vegetables you can juice leave a rather bitter taste. That may well aid weight loss as it's a real appetite killer.

So it occurred to me I could use it to make a proper Bolognese sauce to go with my pasta. That is a sauce that  feels like it's been made with tomatoes.

If you remember the story of my pasta sauce, I started by trying to make it like Bolognese. I chopped a range of vegetables - mainly red cabbage and leek - as finely as possible, sometimes adding Golden Delicious apple or banana for a sweet and sour effect.

To do this you have to fry the vegetables before the fish or separately from the mince.

So I've ended up with a delicious pasta sauce containing a variety of vegetable, fruit and fish together with soy sauce. It is delicious but some complain it's a little salty. And it's not Bolognese as the vegetables and fruit are stir fried and not pulped.

So for my first effort with the juicer I didn't use a base oil. I juiced red cabbage, leek, shallot and white cabbage and banana, put it in the pan and added soy sauce and tuna. It was disgusting and there was too much of it. The juicing of vegetables leaves a very bitter and unpalatable taste.

I tried again and this time I fried some sardines first and added the soy sauce first. Then I added the vegetable juice. That tasted a lot better and looked like Bolognese sauce also.

It's still nothing like a substitute sauce yet and I could not serve it to guests and pretend it was Bolognese. Next time I will try apple instead of banana.

That's if there is a next time as this really is not as tasty as what I was doing before with stir fry.

RAS

Sake

 Somebody introduced a bottle of Sake into the house as a Christmas present - that's what's often called Japanese rice-wine.

It's never appeared on any lists so I thought I would check out the ingredients. It's fermented rice - so basically rice except that a special yeast is used for fermentation.

There's nothing wrong with rice - no salicylate in it, nothing green, red or orange. What could possibly go wrong?

Here was a chance to widen my range of alcoholic beverages, I thought. Currently it's just whisky, gin and vodka that's "allowed" and of the three I only drink whisky as it's the only one with any kind of taste. I'm never sure about it because it does pick up chemicals when it's stored in wooden barrels - hickory barrels in the case of Bourbon I believe.

So I tried a small glass of sake. Wikipedia advises that it is not really a wine and is a little stronger. Tastewise, it's like a dry sherry. Terrific, I thought. We could keep a bottle of Sake in the sherry cupboard (if we had a sherry cupboard, that is). The taste is not massively appetising - it's no substitute for red wine or a good Chardonnay. That's so far as I can  remember as I have - with a few exceptions - only ever sniffed any wine for the last eight years.

That was yesterday. Today I'm not so sure. It seemed to have quite a kick. Maybe get some in for next Christmas.

RAS

World Urticaria Day

 Today has been World Urticaria Day. There's a lot of world days, weeks and months out there - but this one is welcome. It used to be called "hives", which makes it sound like something that people were familiar with. Now people don't talk about it very much - so it needed a bit of publicity.

My worst experience was when I suffered the kind that you get from fleas. But if you're anything like me you won't have great skin.

More details of the day here:
http://www.englemed.co.uk/14/14oct013_world_urticaria_day.php


RAS

Coleslaw indigestion

 I've eaten coleslaw for quite some time and have eaten supermarket coleslaw provided it doesn't advertise itself as containing onions.

After all it is basically cabbage and carrot and both are ok so far as I'm concerned. It can be made with mayonnaise and cream. Mayonnaise is a bit iffy, as it is usually vinegar and egg. Egg is fine of course, if not better than fine. Vinegar is not - but I assume the quantities are so low it can't cause harm.

So it's better home-made with the ingredients controlled. Some commercial coleslaw contains onion, which I never eat unless its shallott. Theoretically onion should not cause too much harm because the lists all say its low in salicylate - but not entirely free of it.

About a week ago we had a meal of supermarket coleslaw and supermarket cooked chicken, which was meant to be plain chicken.

That night I had such severe indigestion I nearly dialled 111. That's the National Health Service non-emergency out of hours number. I was advised to call it by one of those questionnaires you fill in for NHS Choices, the questionnaire it flashes up if you say you have pains in your chest. Yes, you can imagine they take no chances.

Yes this was real indigestion, under the rib cage, not in the bowels, crippling pain, rising up the right side of the rib cage. No question of it being a heart attack but I'd worry about problems like stomach ulcer.

Anyway it lasted no longer than 12 hours. I went for  a swim the next day and that seemed to burn it off.

Today we had the same coleslaw with our meal. It is branded as being cabbage and carrot coleslaw. I don't see why they should add onion as I would have thought it would simply make it more expensive to prepare. And, yes, now I have stomach pains coming and going, just as I write. Not as severe as last time, I hope, but the night is young.

It's not even obvious why indigestion of this kind should be caused by  salicylate - except that we know that salicylate causes a reaction in whatever tissue it comes into contact with. Could that cause ulcer?

And I come back to the issue that it may not even be salicylate. A doctor friend of mine once suggested that other syndromes, specifically sulphite (sulfite), might cause similar reactions. I'm not even fully convinced that there isn't some gluten intolerance. Remember I originally thought it was a wheat allergy and abstained from wheat products for six months until tests proved it was not.

Ah well, I'm going to have to break the news I can't eat coleslaw.

* I've now checked the small print ingredients and it does contain onion together with white wine vinegar.

RAS

Season's Greetings!

 And if you're celebrating Christmas I hope you get turkey stuffed with leek and shallot and basted in soy sauce, served with rich red cabbage and peas. For pudding may you have Christmas pud made from chopped Golden Delicious and peeled pear. Failing that, may someone who loves you rustle up a trifle made from chocolate log roll, custard and whisky whipped into a rich, pure cream. All this followed by a platter of Brie, Camembert and other cheeses untainted by herbs or fruit. And may your Christmas presents, if you are of age, include the best whisky, including a savoury Jura or Jack Daniels to enrich your lunch. If you are under age, I wish you a great many chocolate bars, none of them with nuts or fruit and not so dark chocolate you feel the caffeine content. Happy Christmas!

RAS

Peppers and tomatoes

 I've got a feeling this piece of research into Parkinson's and tomatoes and peppers may miss the point.
 
Let me declare an interest - a close relative has just died from Parkinson's; and then a second interest, a very personal one. There has been evidence in the past linking Parkinson's to a history of allergic conditions. I'm a little worried.

The researchers here set out to show that tomatoes and peppers help to "protect" against Parkinson's. Their thesis is that these two fruits contain nicotine - which is thought to protect against Parkinson's. So they find that people who get Parkinson's don't eat many tomatoes and peppers.

As it happens my relative did not eat many tomatoes. Neither do I, nor many peppers - because I am allergic to them. My relative never had an allergy diagnosed - but he did not like tomatoes and I watched once when he ate one. Shortly after he reached for his hanky as his nose began running. Yes, I am concerned we may share genes.

This piece of research may be what's known as a failure of causation. It may well be that tomatoes and peppers do not "protect" against Parkinson's but help cause it - but because they cause it through allergic reactions, susceptible people actively avoid them, thereby eating less of the substance. Or it may be a bit of both.

What continues to be frustrating is the way a whole range of medical research simply fails to display joined up thinking. There are some people who recognise that allergic syndromes cause general inflammation - but they are few and far between. I know there are some in medicine who recognise that super-specialisation is the wrong way forward - it means that researchers and doctors simply fail to make connections. 

RAS

Euro-pollen map

 A Euro-pollen map from the University of Vienna could eventually be helpful if you are travelling the continent over the next few months. However you may need to use a translator as it is in German.

There is an app available at  www.polleninfo.org covering several countries.

Details at  http://www.meduniwien.ac.at/homepage/news-und-topstories/?tx_ttnews[tt_news]=3354&cHash=ab4e3683aa

RAS

World Allergy Week

 There's been no need to keep ice on the go in the fridge as our tap water has come through at freezing temperatures for the last two months.

Meanwhile here is news of World Allergy Week, starting tomorrow. It's all about food allergies so it will be interesting to see if anyone discusses salicylate.

Milwaukee, WI. The World Allergy Organization (WAO) will host its annual World Allergy Week from 8-14 April, 2013, together with its 93 national Member Societies, to address the topic of “Food Allergy – A Rising Global Health Problem,” and its growing burden on children.

Globally, 220-250 million people may suffer from food allergy [1], and the occurrence of food allergies continues to rise in both developed and developing countries, especially in children. This year WAO plans to highlight the need for greater awareness and understanding of food allergy as well as the exchange of ideas and collaboration in order to address a variety of safety and quality-of-life issues related to the care of patients with food sensitivity. Activities will include international teleconferences with experts presenting information about global food allergy concerns and answering questions immediately afterward.

According to Professor Ruby Pawankar, President of the World Allergy Organization, “There are problems that need to be addressed in many countries throughout the world such as the lack of awareness of food allergies, lack of standardized national anaphylaxis action plans for food allergy, limited or no access to adrenaline autoinjectors, and the lack of food labeling laws. Moreover, some countries have standardized action plans but no ready access to autoinjectors; others have autoinjectors but no standardized action plans. These circumstances can be improved with the distribution of information and resources for physicians, patients, parents, schools, health ministries, and throughout communities and by a call to action to
policy makers.”

“As in previous years, many of the national Member Societies of WAO will organize local events and programs around food allergy issues that specifically affect their communities,” said Professor Motohiro Ebisawa, WAO Board of Director and Chair of the Communications Council. WAO is providing information about food allergy online at www.worldallergyweek.org and will track activities of its Member Societies. “Everyone with an interest in food allergy can participate by contacting their national allergy societies and food allergy advocacy groups,” said Professor Ebisawa. A list of organizations is also available on the website.
______
[1] Fiocchi A, Sampson HA et al. “Food Allergy”, Section 2.5 in WAO White Book on Allergy, Editors: R Pawankar, GW Canonica, ST Holgate, RF
Lockey (Milwaukee, Wisconsin: World Allergy Organization, 2011), pp 47-53.

About the World Allergy Organization
The World Allergy Organization (WAO) is an international alliance of 93 regional and national allergy, asthma and immunology societies. Through
collaboration with its Member Societies WAO provides a wide range of educational and outreach programs, symposia and lectureships to allergists
and clinical immunologists around the world and conducts initiatives related to clinical practice, service provision, and physical training in order to
better understand and address the challenges facing allergy and immunology professionals worldwide. For more information, visit www.worldallergy.org.
 
RAS

Ice!

 Three, small, fillings at the dentist today - the first I've had for a long time.

That's not bad considering I haven't used toothpaste for six years. But three fillings in one day is too many and expensive also.

So I've resolved to do better.This will be my belated New Year resolution. I had a think about things and realised I'm not drinking as much water as before. I used to alternate it with my half-pints of decaf coffee and I've stopped doing it. I just drink decaf by the pint.

So even though I was eating a lot of cheap chocolate the water, which is fluoridated here, must have swilled my mouth out.

And here's how I'm going to make this happen. We are going to keep the freezer stocked with ice cubes, just like we do on holiday. This will have another great spin-off. For while instant decaf does nothing to keep me awake when I'm working, iced water surely will.

RAS