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To the Editor: The review by Sampathkumar et al1 on shingles and postherpetic neuralgia raised 1 question and 1 concern. The authors mentioned the risk of contagion via contact and by the airborne route, but the reference provided discussed only varicella, rather than specifying shingles or the route of transmission. I understand direct contact as a mode, but is there good evidence for airborne transmission of shingles? My concern about the recommendation for combinations of low doses of medications for treating the pain associated with shingles or postherpetic neuralgia is that tramadol, one of the agents suggested, has a risk of serotonin syndrome when combined with several of the other agents, such as serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants. These drug combinations still may be useful, but it is worth reminding readers to be careful when administering them.