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What Were They Thinking?

Mr. Blackwell has his Hollywood “Worst Dressed List” of celebrities whose desire to make a bold personal statement exceeds their fashion sense, creating an outfit so outlandish that you wonder, “What Were They Thinking?”

Instead of Nobel prizes, we also have their counterpoint: Ig Nobel prizes. These dubious distinctions are awarded to people whose achievements “cannot or should not be reproduced”. In 2000, the Ig Nobel Computer Science prize was awarded to Chris Niswander of Tucson, Arizona, for his ingenious invention of PawSense, a computer software program to protect your computer from cats. Able to detect when a cat is walking across your computer keyboard, it blocks dangerous cat typing, and help train your cat that your keyboard is OFF LIMITS.

Don’t forget the Darwin Awards, those lists of unfortunate souls whose jaw-dropping exploits and not-quite-death-defying stunts were preceded by these famous last words, “Hold my beer, and WATCH THIS!” Tragically, they leave grieving friends, relatives, and the rest of us wondering, “What Were They Thinking?”

It’s time to recognize similar outstanding contributions in the field of medicines and supplements. When a new remedy leaves you scratching your head and asking yourself, “What Were They THINKING?”, you could nominate them for a WWTT Award.

There are 2 products that are being introduced to treat itching: one called Allegra® Cooling Relief and another called Allegra® Intensive Relief. They are non-prescription creams that can be applied to the skin 3-4 times a day to relieve itching.

Why would they be nominated for a WWTT Award?

Because neither of these products contain any Allegra®. You can buy non-prescription Allegra® as tablets in two formulas: regular which is taken twice a day, and a 24-hour, which is longer acting. Both of these contain the generic medication fexofenadine, which is the active ingredient found in the prescription version of Allegra®.

But Allegra® Cooling Relief and Allegra® Intensive Relief don’t have ANY fexofenadine in them. Instead, they have diphenhydramine.

One reason for nominating Allegra topical for a WWTT is that diphenhydramine is the generic name for Benadryl®, not Allegra®. We look at the name on the box and think, “Allegra®. Okay, I’ll try it. You would assume that the same ingredient that’s sold as tablets of Allegra is going to be in the skin cream. Wrong!

Several years ago, several anti-itch products that contained Benadryl® were introduced as being relief for itching. Several problems with them showed up.

Problem #1: Hallucinations occurred in children and adults using Benadryl cream for chicken pox blisters.

Problem #2: Side effects such as hallucinations, agitation, abnormal tongue movements, even seizures were reported in both children and adults who used the cream and then also took oral tablets or Benadryl® syrupfor relief of their itchy skin.

Problem #3: Side effects from Benadryl® given as a cream or gel also were reported when added to broken skin. When you apply a cream onto your skin, only a small amount is absorbed, and only into the immediate area. Applying a cream to broken skin is different. Like the Panama Canal cuts a path that goes from the Atlantic to the Pacific Ocean, when your skin has a cut, deep scrape or blisters, the medicine can move right into your blood stream.

Problem #4:
When it was first released the Benadryl® gel was packaged in a container that didn’t look quite like a tube of ointment or cream.  It also contained menthol, and several children were given it by mouth instead of on their skin, causing side effects from both menthol and diphenhydramine.

Whether you use Allegra® or Benadryl® cream, gel or lotion on your skin, the FDA has labeled them with the same cautions.

If you choose to use a cream, gel or ointment containing diphenhydramine on your skin please be careful to avoid using it in cases of chicken pox (varicella) or over large areas of your body, and never apply it to broken skin.

One more caution about using either Benadryl® or Allegra® cream, gel, or ointment for itching. Do not use the topical cream in addition to taking it by mouth as a tablet, capsule or liquid. You may be surprised to find out that Nytol® and Sominex® have formulas containing 50mg tablets of diphenhydramine.

If you talk to a pediatrician, they will tell you that diphenhydramine cream or gel is not very effective for itching. Benadryl® Syrup or its generic is far more likely to work. For chicken pox, use calamine lotion or cool compresses moistened with water. Moisturizers can help tame the intense experience of itching. If skin is not cut, scraped or scratched, either 0.5% or 1% hydrocortisone cream, lotion or ointment can be used safely, even in children.

Allegra® Cooling Relief and Allegra® Intensive Relief with diphenhydramine instead of fexofenadine: “ What WERE They Thinking?”

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  • ABOUT DR. LOUISE

    Dr. Achey graduated from Washington State University’s school of pharmacy in 1979, and completed her Doctor of Pharmacy from Idaho State University in 1994.

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