Hi larramie,
After extensively researching your question, I feel I am able to
answer your question, without waiting for your clarification. Please
request an Answer Clarification, before rating, if this is not the
answer you were hoping for.
I?ll start with your last question, first. Amphotericin B is not a
treatment for asthma, per se. You may be referring to the fact that
people with nasal fungal infections can suffer from asthma, a reaction
to the fungus. Amphotericin B treats fungus such as Aspergillis,
Mucor and Trichophyton, (the most common species of fungus to infect
the nasal passages) that may trigger asthma in some people. The Mayo
Clinic has pioneered quite a bit of research in the nasal fungus
infection field, and I can see why you are trying to obtain
Amphotericin B from Mayo. (More about locating Amphotericin B later)
The studies from the Mayo Clinic found that nasal lavage/wash with
Amphotericin B is much more effective than oral amphotericin B, with
virtually none of the side effects.
According to this MedicDirectUK site, fungal sinusitis (and fungal
rhinosinusitis) is rare, and more prevalent in warmer countries.
Describing the link between asthma and fungal sinusitis, MedicDirect
says ?Simple non-invasive fungal rhinosinusitis is unlikely to lead to
complications. Where an allergic response to the fungus occurs it may
be associated with asthma like symptoms or a worsening of pre existing
asthma. It may also be associated with destructive lung lesions which
cause fungus filled cavities to develop within the substance of the
lungs.?
http://www.medicdirect.co.uk/clinics/default.ihtml?step=4&pid=1733
Nasal polyps and asthma is not an uncommon pair of medical conditions.
?Fungal infections are more common in individuals with compromised
immune systems, including people with immunosuppressive disease or on
immunosuppressive therapy. Oral corticosteroids are a type of
immunosuppressive therapy and commonly used in the management of
Severe Persistent Asthmatics. Allergic type reactions to fungal
infections are also possible. Chronic sinusitis is more often
associated with long term inflammation due to allergic reactions. The
allergic triggers are the same triggers common to asthma.?
http://www.kfshrc.edu.sa/annals/166/96-140.html
About treating the fungal infection the site continues ?the allergic
symptoms can usually be controlled with topical steroid sprays or
drops, and oral antihistamines. In resistant cases intravenous
antifungal treatments such as Amphotericin may be necessary and may be
used in conjunction with irrigation with antifungal sinus washouts,
eg, nystatin or gentian violet. Where the infecting fungus is one of
the Actinomyces genus penicillin may be very effective.?
?Nasal polyps are small finger-like, fluid-filled blisters, often
associated with asthma and serious reactions to aspirin. Researchers
at the Mayo Clinic found fungi in 96 percent of people with chronic
sinusitis?
http://www.drmirkin.com/morehealth/G220.htm
?Scientists showed that some 96% of chronic sinusitis sufferers had
nasal fungus in their system.?
http://www.nosefiltersinfo.com/nasal-fungus.html
You can be tested for nasal fungal infection. Cultures, blood tests
and x-rays are ways of determine if you have a nasal fungal infection,
as well as the species of fungus.
http://www.aspergillus.man.ac.uk/patients/articles/diagnosis.shtml
http://www.positivehealth.com/permit/Articles/Asthma/mansfield25.htm
Allergic Fungal Sinusitis
Once fungus invades the nasal passages, it seems to invite a vicious
cycle?an inflammatory immune response ensues, causing tissue swelling.
This swelling causes stasis in normally flowing mucosa. The swelling
and static fluids creates a breeding ground for fungal elements. The
resulting increased fungal growth can stimulate an allergic response,
and even asthma, in susceptible individuals. This starts the
cycle?stagnant mucus allows growth of fungus, growth of fungus creates
allergy, allergic response causes swelling, which causes more stasis,
and on and on.
http://www.emedicine.com/ent/topic510.htm
?Allergic rhinitis is prevalent in this group and is considered to be
the trigger mechanism behind allergic fungal sinusitis. Patients are
immunocompetent and often have asthma, eosinophilia, and elevated
total fungus-specific immunoglobulin E (IgE) concentrations.
Surgery reveals greenish black or brown material (ie, allergic mucin),
which has the consistency of peanut butter mixed with sand and glue.
Allergic mucin and polyps may form a partially calcified expansile
mass that obstructs sinus drainage. Growth of the mass may cause
pressure-induced erosion of bone, rupture of sinus walls, and
occasional leakage of the sinus contents into the orbit or brain?
http://www.emedicine.com/ent/topic639.htm
======================
Locating Amphotericin
======================
If the Mayo Clinic won?t fill an out-of-country prescription, there
really is no alternative other than locating another source. The US
has strict laws and regulations regarding prescriptions.
Amphotericin-B is manufactured in the UK, and I am quite sure a nasal
wash/lavage solution can be found or compounded within the UK. You may
need to speak to a local chemist/pharmacist who can tell you whether
it is available ready to use, or if the chemist can compound the
solution for you. You would, of course, need a doctor?s prescription.
http://www.medicdirect.co.uk/clinics/default.ihtml?step=4&pid=1733
Amphotericin-B powder, in the form needed for compounding is available
from Amresco.
NBS Biologicals Ltd
14 Tower Square
Huntingdon
Cambs PE29 7DT
England
Tel +44 1480 433875
Fax +44 1480 459868
http://www.nbsbio.co.uk/amres01a.htm#A
Contact Information
http://www.nbsbio.co.uk/contact.htm
Since Amphotericin B in other forms is definitely available in the UK,
the druggist/chemist will probably be able to compound a nasal spray
for you, with your doctor?s prescription, of course. It?s possible
that you may be able to order it here
Tel: + 44 (0)1782 617 463
Fax: +44 (0)1782 636098
E-mail: info@solgar.co.uk
Directors
Keith Woolley
Michele Woolley
Address
Boots Herbal Stores
5 Castle Walk
Newcastle
Staffordshire
ST5 1AN UK
http://www.solgar.co.uk/healthnotes/healthnotes.asp?ContentID=1316005
Contact Information:
http://www.solgar.co.uk/pages/servicedesk.htm
On page 28 you can see that Amphotericin B is in the Gwent Healthcare
formulary, listed as an OROPHARYNGEAL ANTI-INFECTIVE DRUG. (Gwent
Healthcare covers care for over 600,000 people in Wales)
http://www.wales.nhs.uk/sites/documents/79/FORMULARY%20Third%20Edition%20kg.pdf
Not an endorsement, but another tip that Amphotericin-B is available
from within the UK: This nasal irrigator, with a container designed
for adding antibacterial or anti-fungal medicines. If you are buying
this for a medical condition, in the UK, you may be exempt from VAT.
http://www.ishop.co.uk/ishop/1013/shopscr37.html
Amphotericin B is manufactured by Bristol-Meyers Squibb and Wyeth in
the UK as well.
http://www.netdoctor.co.uk/medicines/subindex.asp?id=22
This Florida, US, pharmacy does sell Amphotericin B nasal spray, but
does not ship to the UK.(I?m posting this because they will accept
your doctor?s prescription. If you knew someone in the US who could
ship it to you, this may work)
Amphotericin-B Sig: Spray 5 times into each nostril twice daily Disp
Qty:#1 x 60ml Antifungal agent
http://www.sinucare.com/quikscript.pdf
=================================
Dosage and Duration of Treatment:
=================================
The correct Amphotericin B dosage and treatment regimen will need to
be prescribed for you by a doctor, familiar with treating nasal fungus
infections. The information presented here is for informational
purposes only, and is not intended to diagnose or treat.
The dosages listed in the following paragraphs were dosages used in
studies, and may not reflect current standards.
Found on Page 2 of the Adobe .pdf document, of a study of 51 patients
at the Mayo Clinic, Rochester, MN by Jens U. Ponikau, MD,a David A.
Sherris, MD,a Hirohito Kita, MD,b and Eugene B. Kern, Mda J ALLERGY
CLIN IMMUNOL DECEMBER 2002 :
?Patients were treated for at least 3 months with intranasal administration
of an antifungal agent. Amphotericin B was chosen as an antifungal
agent because it is available in a water-soluble formulation and
because it is poorly absorbed through a mucus membrane, thus
minimizing systemic bioavailability. The intravenous preparation of
amphotericin B was dissolved in sterile water at 100 ug/mL. A bulb
syringe was used for drug delivery to overcome the potential delivery
difficulty of intranasal drugs to the nose and paranasal sinuses. As
shown in Fig 1, patients applied 20 mL of the antifungal solution in
each nostril twice daily with a bulb syringe by gently pointing the
tip toward the middle meatus region. Thus each patient used 80 mL/d of
a 100 ug/mL solution, and the total daily drug dose was 8 mg. The
patients were also instructed to bend their head laterally to the side
being irrigated to treat the maxillary sinus.? On Page 3 is an
illustration of the bulb syringe used in the study.
At the conclusion of the study, about 75% of participating patients
reported improvements in nasal obstruction and discharge. None of the
participants reported any symptoms worsening, but 25% reported no
improvement at all. A different 25% noticed an improvement in
symptoms, but not the condition was not completely resolved.
http://www.biology.lsu.edu/webfac/rlaine/MayoAmpho%20B%20pilot%20trial.pdf
In another study by Ricchetti A, Landis BN, Maffioli A, Giger R, Zeng
C, Lacroix JS. Rhinology Unit, Department of Otorhinolaryngology -
Head and Neck Surgery, Geneva University Hospital, Switzerland., it
was found that allergic rhinosinusitis could lead to nasal polyps. In
order to evaluate how nasal washes worked, patients performed a twice
daily nasal lavage, in each nostril, using 20 ml of a 1:1,000
solution of amphotericin B, for four weeks. After four weeks, nasal
polyps completely disappeared in 39% of the patients.
http://www.sinucare.com/publish/printer_26.shtml
?Nebulised amphotericin (non-liposomal) may be used in difficult cases
at a dose of 5-10 mg twice daily after physiotherapy (check for
bronchoconstriction and use bronchodilator pre-dose). The liposomal
(very expensive) form would be considered only for those in whom
bronchoconstriction is a severe problem.?
http://www.rbh.nthames.nhs.uk/ChildrenCF/respiratoryCare.htm
All about Amphotericin B, in general. This site does not discuss nasal
sprays or washes.
http://www.aspergillus.man.ac.uk/languages/indexhome_lang.htm?english.htm~main
More about aspergillosis:
http://www.aspergillus.man.ac.uk/languages/indexhome_lang.htm?english.htm~main
I hope my answer has provided you with the information you needed.
Please request an Answer Clarification, before rating, if this answer
is unclear. This will allow me to assist you further, if possible.
Sincerely,
crabcakes
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