Bring on the Misery: Allergy Season Hits Tennessee
Bring on the Misery: Allergy Season Hits Tennessee | Allergies, Asthma, Pseudoephedrine, Methamphetamine, Meth, NPLEx, Nexafed, Acura Pharmaceuticals, Nasal Steroid, Nasal Antihistamine, Antileukotrienes, Immunotherapy, Dr. John Fahrenholz, Vanderbilt ASAP Program
Wheezin’, Sneezin’ and Meth … deranged law firm or the primary sources of frustration among allergy and asthma sufferers in Tennessee? If you guessed the latter, you would be correct.

Tennessee holds the dubious distinction of being one of the worst areas in the nation for those plagued by allergies and being among the worst offenders when it comes to the production of methamphetamine. In combination, the two ‘honors’ make for a pretty miserable spring season across the state.


The Meth Factor

Despite new laws to better regulate and track the sale of precursor pharmacy products used in methamphetamine production, the cottage industry is alive and well in Tennessee. In 2011, in an effort to better track sales and limit the quantities of pseudoephedrine an individual could purchase, the Tennessee General Assembly passed the NPLEx legislation (National Precursor Log Exchange), a real-time, electronic tracking system.

According to a State of Tennessee Comptroller Report released in January, the NPLEx system hasn’t produced the hoped-for results of curbing meth manufacturing. Instead, activity in small labs is still extremely prevalent.

Law enforcement officials attribute the high number of meth lab incidents to the ability of manufacturers to work around the precursor legislation. However, the report authors also cautioned against drawing firm conclusions based on the relatively short history of Tennessee’s precursor law. Those who work for the company that runs the tracking system have been quick to point out that NPLEx does what it’s supposed to do … make it easier to find meth producers, which is different from stopping meth production.

Some states, such as Mississippi, have instituted stricter laws that have moved to a prescription-only policy for previously over-the-counter (OTC) precursor medications and have seen decreases in meth lab incidents. However, those decreases have to be balanced against the cost to the majority of residents whose use of precursor products is for legitimate purposes.

The Tennessee report also emphasized that decreasing the supply of methamphetamine produced locally doesn’t necessarily result in a reduction of meth use. The report pointed out a large quantity of methamphetamine available in much of the United States is supplied by Mexican criminal organizations and is produced in foreign and domestic “super labs.”


A Potential Weapon to Fight Allergies & Meth

At the end of last year, Illinois-based Acura Pharmaceuticals, Inc. announced a potential weapon against meth use with the launch of Nexafed® (pseudoephedrine hydrochloride), a next generation 30mg immediate-release product with a unique technology that disrupts the conversion of the precursor product into methamphetamine.

Brad Rivet, vice president of marketing for Acura, said the company developed novel Impede® technology, which uses a combination of safe, inactive ingredients to disrupt the extraction and conversion of pseudoephedrine into meth. He stressed the technology doesn’t impact the efficacy of Nexafed in relieving nasal congestion. “Patient relief is first and foremost with us,” he said, adding the company conducted bioequivalence studies and found Nexafed to be right in line with the leading national OTC remedy on the market today.

“The legitimate user will see no difference in efficacy, and should see no difference in cost, compared to Sudafed® brand 30mg pseudoephedrine HCI tablets,” he said. “Taken as directed, the tablets immediately dissolve and work into the bloodstream.”

However, for those trying to convert the product to meth, there is a significant difference with Nexafed. In two of the three common methods of manufacturing methamphetamine, the producer must first extract the pseudoephedrine. In laboratory tests conducted by an independent research organization, no pseudoephedrine could be extracted and isolated from Nexafed using a range of solvents. “We totally block that extraction process,” said Rivet. In the third method, known as the direct conversion or ‘one-pot’ technique, the Impede technology reduced the yield by about half as compared to other pseudoephedrine products, he noted.

He added, “This will be extremely frustrating to meth cooks, who will prefer to search for older generation pseudoephedrine products for their precursors.” Rivet continued, “For every package of Nexafed sold, there is potentially one less package of the older pseudoephedrine products that don’t have this technology finding its way into meth production.”

This isn’t the company’s first foray into addressing the potential for pharmaceutical abuse. Rivet noted, “Acura developed Aversion® technology, which addresses opioid abuse, for a product that is being commercialized by Pfizer so Acura does have some history of developing deterrent technology in abuse medications.” In the case of Nexafed, he continued, Acura developed, commercialized and launched the product on its own. The product now has been picked up by many regional wholesalers, as well as the nation’s three largest wholesalers, and is currently available in pharmacies in Tennessee. “We’ve got national coverage so any pharmacist in the country can buy this from their preferred wholesalers,” Rivet said.


The Allergist’s Options

The state’s prolonged pollen seasons factor into the reason why so many cities in Tennessee wind up being designated ‘allergy capitals.’

“We go from no pollen to very high pollen counts very quickly,” said John Fahrenholz, MD, assistant professor of medicine at Vanderbilt University Medical Center and a board-certified allergist with Vanderbilt’s Asthma, Sinus & Allergy Program (ASAP). He also noted we roll from the peak of tree pollen season into grass pollens and then onto ragweed. And of course, he added, this doesn’t even count the indoor allergens that affect many patients.

However, he said, there are good options available to dramatically improve the quality of life through the proper management of allergies. “We talk about avoidance of those allergens, which is somewhat easier to do with indoor allergens than outdoor allergens,” Fahrenholz said. While it’s impractical to stay indoors forever, of course, he said those with the most severe allergies might have to consider limiting outdoor activity. “Pollen levels are often highest in the morning so taking that walk or jog might be better in the afternoon.” When driving or inside, he said common sense measures like closing windows and using air conditioning also could help.

“We’ve certainly seen medication improvements in terms of newer antihistamines that are longer lasting and produce fewer side effects, such as drowsiness,” he continued, adding that many are now available over the counter in generic formulations.

“On average, the class of medications that works the best and is most effective for people is a steroid nasal spray,” Fahrenholz said.

In addition, he said nasal antihistamine sprays could help with symptom relief. Unlike nasal decongestant sprays, such as Afrin®, nasal antihistamines are not currently available in an OTC format. That isn’t the only difference between the two, however. “Nasal decongestants cannot be used regularly for long periods because people will develop rebound nasal congestion over time which worsens symptoms, but the prescription sprays improve symptoms over time,” he said. Fahrenholz explained the prescription spray is “basically an anti-inflammatory and helps turn off the inflammation caused by the allergic response.”

He added there is now a product that combines the two types of sprays — steroid and antihistamine — into a single nasal spray. Antileukotrienes, he noted, are also effective in select patients alone or in combination with other allergy medications. Although there haven’t been any new options mechanistically for a number of years, Fahrenholz said the next generation of antihistamines are currently in clinical trials, which could offer another layer of protection in symptom improvement.

Despite the effectiveness of current medications, he pointed out all of these options just treat symptoms. To treat the underlying disease, immunotherapy must be evaluated and considered. “By treating with immunotherapy, we are making the patient less allergic to their specific allergen,” Fahrenholz said. “It’s highly effective in appropriately selected patients.”