Hey Payg,

Great topic and thanks for the feedback.  For starters, what CHers need to understand is taking vitamin D3, Omega-3 fish oil and the vitamin D3 co-nutrients in the anti-inflammatory regimen is not 100% effective 100% of the time in preventing CH.  That said, this regimen is far better in terms of efficacy, safety, cost and health benefits than any of the Rx alternatives we've all taken to manage our CH.  However, like the Rx alternatives, the anti-inflammatory regimen is subject to breakthrough/burn through CH attacks.

Reasons why we have these breakthrough attacks follow:

One of the simple reasons for breakthrough CH is dehydration... not enough water...  Check the color of your urine...  If it's yellow more than 6 hours after taking vitamin B complex... you need to drink more water, like 2 liters of water a day...

Allergic reactions are likely the single biggest cause of breakthrough CH.  I know there are many CHers who claim they don't have allergies.  However from my experience, and from working with hundreds of CHers taking this regimen, there's sufficient evidence to say they do.  Allergic reactions can be subclinical, i.e., no obvious or outward symptoms, but that doesn't mean we're not having one. 

While these allergic reactions can be relatively minor, it's not unreasonable to expect them to have an effect on our CH patterns... even while we're taking the anti-inflammatory regimen.  The important thing to realize is these breakthrough CH can and will happen.  Accordingly, it's best to understand why, when and where it will happen and what to do when it does happen.

Our bodies are constantly fighting off allergens.  What allergens?  Pollen in the spring and summer, leaf mold spores in the fall and winter.  Mold spores will bloom any time there's water pooling, like in air conditioners and frost free refrigerators and freezers.  Dust mites and industrial pollutants can also be problematic... 

There are a few things you can do to minimize the affect of airborne allergens.  The first thing is reduce their concentrations...  Change the filters in your whole house ventilation systems monthly, spray a natural disinfectant, like white vinegar, 3% hydrogen peroxide or Simple Green on the heat exchanger coils and drip pans on air conditioners, refrigerators and freezers.  Don't forget showers and shower curtains. 

Keeping your nose clean doesn't hurt either.  I keep a bottle of Simple Saline nose spray handy at all times.  Rinsing the nasal passages with simple saline and a good blow removes allergens lining the nasal passages and that reduces the exposure to airborne allergens.

Travel is another event that's associated with breakthrough CH...  If you feel the CH beast stirring during travel or at a new location, it's likely a new allergen or an increase in the concentration of allergens that open the door for the CH beast. 

Additional clues to look for include the obvious allergic rhinitis...  stuffy nose, puffy face, itching sensations.  These are indications of an allergic reaction that's sucking up available serum vitamin D3 and its first metabolite 25(OH)D leaving too little to prevent our CH.

Allergic reactions occur when mast cells, neutrophils, basophils, and eosinophils loaded with granules containing histamine, prostaglandins, heparin, leukotrienes and other inflammatory peptides, are triggered by an allergen to degranulate (release their contents into the surrounding tissues). 

Although this degranulation process is part of the body's defense mechanism against allergens, it results in a flood of histamine and other proinflammatory agents. They cause inflammation, dilation and in some cases pain or itching throughout the body.  That's not a big deal for CHers until it occurs in the trigeminal ganglia where neurogenic inflammation hits hardest.  When this flood of histamine happens, neurons within the hypothalamus and trigeminal ganglia release CGRP and that triggers our CH.

Water retention can also be a clue we're having an allergic reaction... A simple test is to grab the muscle outside of your shinbone just above the ankle with a firm grip for five seconds then let up.  You should be able to feel indentations left by your fingers.  How long these indentations last can be a clue. Under normal conditions, these indentations should disappear in roughly 20 to 30 seconds.  If the indentations last for a minute or longer, you're retaining too much water.

What to do...  Like the old Boy Scout saying, "Be Prepared."  I always keep a supply of the anti-inflammatory regimen within reach while on travel including the Children's Benadryl (Diphenhydramine HCL) Liquid Allergy medicine.
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As soon as I get that "feeling" we all know, that the CH beast is lurking and ready to jump ugly, I take 5 mL (12.5 mg) of the liquid Benadryl, hold it in my mouth, swirling under the tongue and between my cheeks and gums for a couple minutes.  The Diphenhydramine enters the bloodsrteam through the mucus membranes in the mouth then crosses the blood brain barrier to block H1 histamine receptors on neurons throughout the brain and in particular, neurons within the hypothalamus and trigeminal ganglia.  This mediates the histamine reaction. 

After that I pop 50,000 IU of vitamin D3 liquid softgels between my back teeth and hold the contents under my tongue for 3 to 4 minutes.  The sublingual Diphenhydramine and vitamin D3 are usually sufficient to stop the pending CH in a matter of minutes.  In short, for me, they act as an abortive in 10 to 15 minutes. I continue taking all the vitamin D3 co-nutrients, but will hold off on taking additional vitamin D3 for a couple days to see what happens.  In most cases, I get 2 to 3 days without any indication the CH beast is trying to breakthrough.  That tells me the serum concentration of the parent vitamin D3 molecules are doing their thing as it's half-life is less than 24 hours.

It's also important to take the Omega-3 fish oil, magnesium and zinc as soon as possible.  The Omega-3 fatty acids inhibit an enzyme called cyclooxygenase (COX), which produces the prostaglandins that spark inflammation. Doubling or tripling the Omega-3 fish oil dose can help...  The magnesium, zinc and boron are essential in building the enzymes needed to hydroxylate vitamin D3 at the cellular level to its genetically active metabolite, 1,25(OH)2D3 that downregulates/inhibits the release of CGRP.

A second cause of breakthrough CH can be infections (viral, bacterial and fungal).  If you haven't watched it yet, grab a cup of coffee or your favorite beverage then click on the following link for the 42 minute video titled "Battlefield Cell."  It's a fascinating video in the Curiosity series.  It will give you an idea what the immune systems within the cells in our bodies are doing every minute of every day to keep us healthy.

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When an infection occurs they trigger our immune system into action and that consumes available vitamin D3 and 25(OH)D leaving too little to prevent our CH.

Our immune systems come in two varieties, the innate immune system and the adaptive immune system.  The innate immune system acts like a standing army to defend us against antigens and pathogens...  In most cases, a healthy innate immune system has a great IFF (Identification, Friend or Foe) so recognizes invading pathogens and attacks them. 

The adaptive immune system acts like our Special Forces or Seal Team Six.  It's equipped with immune cells that remember the last time any virus tried to attack us and has antibodies specifically tuned to detect these virus and trigger killer cells to attack them.  In either case, when our immune cells are activated, they consume vitamin D3 and 25(OH)D as fast as possible.  This leaves too little serum level vitamin D3 or 25(OH)D available to prevent our CH.

What I do...  If I suspect an infection, I take a 1000 mg (1 gram) tablet of vitamin C every two hours throughout the day.  This isn't much of a change for me as I usually take 2000 to 4000 mg/day vitamin D3 daily anyway to help guard against cardiovascular problems..  I also take an additional 20 mg zinc if I suspect an infection as it has antiviral, antimicrobial and antifungal properties.

What else can we do to help prevent breakthrough CH?  In a word, "diet."  I don't know about you... but as a good cook, I tend to eat too much...  There are several types of diets that will help prevent breakthrough CH.  They include the Ketogenic Diet, the Low Histamine Diet, the Low-Carb Paleo Diet, the Low-Carb Mediterranean Diet, the Zero Carb Diet, the Atkins Diet and the GOMBS diet.

When you boil these diets down, they all have a common theme: avoid sugar, starches, wheat gluten, most grains, grain oils, and drink plenty of water... at least two liters of water a day. 

Eat whole fresh fruits, veggies, nuts, (I like almonds), grass fed beef, free range chicken, and wild fish.  Good fats and oils include organic butter, lard, olive oil, avocado oil, extra virgin coconut oil, beef, hog and chicken fat.  Our brains are over 60% fat so we need good fats and oils to maintain a healthy brain and a healthy cholesterol level... 

If you haven't read the latest, there are several large studies out saying cholesterol does not cause cardiovascular disease and that we do not need statins... The whole statin-cholesterol myth has been spun by Big Pharma in order to sell statins... Several billions of dollars a year worth of statins we don't need... See the following link...

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Experts Warn Statin Drug Trend Puts Lives at Risk
August 09, 2017

The real problem is all the sugar in our diets.  Cardiovascular disease was virtually unknown prior to the early 1900s.  Since then, the per capita growth in the consumption of sugar mirrors the growth in the incidence of diabetes, obesity and cardiovascular disease... 

I've become a fan of Non-GMO and organic produce as many of the genetically modified grains and veggies contain glyphosate (Roundup).  Monsanto introduced genetically modified glyphosate-resistant Roundup Ready crops enabling farmers to kill weeds without killing their crops.  The down-side of this neat genetic engineering trick is the glyphosate residue in the crop may be building up in our tissues and in our case as CHers, adding yet another trigger...

In a nut shell, breakthrough CH can and will happen even if you've been pain free for months taking the anti-inflammatory regimen...  When they do happen, don't go into a tizzy and do not interrupt travel plans.  Remember... YOU ARE IN CONTROL! Be prepared and take action asap.  Drink more water, take a sublingual dose of Benadryl (Diphenhydramine HCL) and a 50,000 IU loading dose of Vitamin D3...  Keep a complete supply of the anti-inflammatory regimen nutrients handy.

Take care and please keep us posted.

V/R, Batch