Letters to the Editor

(Aust Prescr 2002;25:27-8)

Letters, which may not necessarily be published in full, should be restricted to not more than 250 words. When relevant, comment on the letter is sought from the author. Due to production schedules, it is normally not possible to publish letters received in response to material appearing in a particular issue earlier than the second or third subsequent issue.

Over-the-counter medicines in children

Editor, - Some of us have had serious reservations about the advisability and efficacy of over-the-counter medications in children for some time (Aust Prescr 2001;24:149-51). As stated in the article, there are few reliable sources of information. I thought your readers may be interested in some others.

There is an article showing the striking absence of efficacy data for cough and cold medicines in children, and the many non-scientific factors contributing to the frequency of their use.1 I was interested to learn that healthy children, who have not had a respiratory tract infection within the past month, cough 1?34 times per day.2

Another article on antipyretic therapy states that neither the detrimental effects of fever nor the salutary effects of antipyretic therapy have been confirmed experimentally. Furthermore, carefully controlled efficacy studies have never quantified the degree to which antipyretic therapy enhances the comfort of patients with fever.3
Even the old dependable gripe water for the treatment of colic is a sham! It now seems that its soothing effect derives from its sweet taste, which can be duplicated with sugar solutions.4

Ben Basger
Pharmacist
North Bondi, NSW

R E F E R E N C E S

1. Gadomski A. Rational use of over-the-counter medications in young children. JAMA 1994;272:1063-4.
2. Chang AB, Robertson CF. Cough in children. Med J Aust 2000;172:122-5.
3. Plaisance KI, Mackowiak PA. Antipyretic therapy: physiologic rationale, diagnostic implications, and clinical consequences. Arch Intern Med 2000;160:449-56.
4. Blumenthal I. The gripe water story. J R Soc Med 2000;93:172-4.

Screening for thalassaemia

Editor, - The article 'Screening for thalassaemia' (Aust Prescr 2001;24:120-3) provided an excellent and concise overview of the thalassaemias and haemoglobinopathies in Australia.

A major point arises in relation to initial testing and how to identify a suspected carrier. While the thalassaemias and haemoglobinopathies are more prevalent in particular ethnic groups and geographical areas, the mutations causing these conditions can be found in virtually every country because of genetic drift and ethnic melding over the centuries.

Australia has a particularly heterogeneous population with an increasingly diverse pattern of these conditions. A positive family history is clearly an indication for testing, but this detects only a limited number of carriers. Clinical experience at our hospital shows that testing on the basis of name, place of birth or religion is unreliable for detecting carriers. Furthermore, reliance on red blood cell indices (MCH and MCV) as a screening process is inadequate. Haemoglobin electrophoresis is essential for the diagnosis of ß thalassaemia minor and the haemoglobin variants of clinical significance, the latter being seen with increasing frequency due to recent immigration from Asia, Africa and the Middle East.

Comprehensive testing is advisable to provide optimal detection of couples at risk of having children with severe thalassaemia, so that they can be offered genetic counselling and prenatal diagnosis if appropriate. This means that, at the very least, all antenatal patients should be tested by full blood examination and haemoglobin electrophoresis (or HPLC), plus ferritin in the presence of microcytosis, as early in pregnancy as possible. Ideally, testing should occur in primary care before conception. Partner testing can then be pursued in accordance with the recommendations in the article.

F. Rex Betheras
Specialist in Charge
Thalassaemia Clinic
Royal Women's Hospital
Melbourne, Vic.

Coeliac disease

Editor, - Recently you published articles on irritable bowel syndrome (Aust Prescr 2001;24:68-71) and oesophageal reflux (Aust Prescr 2001;24:110-2). Over the years, these diagnoses have been made by three gastroenterologists as a consequence of my epigastric reflux and colonic pains. A fourth endoscopy has now found evidence of coeliac disease in a duodenal biopsy. Since going on a gluten-free diet I am gaining weight. (Over the years, despite having a healthy appetite, I was close to being almost anorexic in appearance and my mental and physical energy was below average.) Now the pains have disappeared and I am feeling and reacting in a more appropriate way. (Even my tennis has improved!)

I write to tell your readers that coeliac disease is the 'great imitator'. It was late in life (I am 80) that it was discovered. As a student I suggested to a general practitioner that I had a malabsorption syndrome but this was discounted. (Lesson: listen to the patient.) A pathologist tells me that the physiology of the whole gastrointestinal tract is disturbed in coeliac disease. Pains, dysfunction, aphthous ulcers and bowel disturbances are the result. I now hear of increasing numbers of patients like myself being diagnosed late in life, after their symptoms had been diagnosed as something else. One wonders how many patients have had surgery and/or medications when the correct management should have been a small bowel biopsy1 followed by a gluten-free diet.

Bill Woods
Radiologist
Wahroonga, NSW

R E F E R E N C E

1. Selby W. Gluten enteropathy. Aust Prescr 2001;24:38-40.