Drug Allergies

ACE Inhibitors Allergy

Overview of an ACE Inhibitor Allergy

ACE Inhibitors are used for treating hypertension, congestive heart failure, diabetes-related kidney failure, and aid in the prevention of strokes. Mainly people use them because they are proven to prevent an early death from hypertension, heart attacks and heart failure as well. An ACE Inhibitor is often combined with other medications in order to reach the optimal blood pressure.

  • An ACE inhibitor, or angiotensin-converting-enzyme, is a drug used to treat hypertension.
  • They are best identified by the last part of their name, -pril, such as captopril, enalapril, Lisinopril, etc.
  • Side effects include: dry cough, increased blood-potassium level, fatigue, dizziness, headaches, loss of taste.
  • Angioedema, as a result of ACE Inhibitor use, can be life-threatening when swelling occurs in the throat.
  • It may take weeks or months for side effects to occur. Angioedema can occur at any point during treatment.

Symptoms of an ACE Inhibitor Allergy

Symptoms of an allergic reaction to an ACE Inhibitor may be: low blood pressure, headache, rash, cough, diarrhea, weakness, dizziness, drowsiness and headache. More serious side effects can include: allergic reactions, white blood cell count decrease, kidney failure and angioedema. ACE inhibitors can also result in a persistent cough and can take about 2 weeks to go away after the ACE inhibitor is no longer being used. Switching types of ACE inhibitor will likely not solve the problem.

Causes of an ACE Inhibitor Allergy

The cause of the allergic reaction upon taking the ACE Inhibitor may be the bradykinin. Bradykinin is produced in the body and causes blood vessels to expand, which lowers the blood pressure. It may cause sudden swelling. The bradykinin may cause the body to react to proteins in food. The reaction of the proteins in the food is what leads to oral allergy syndrome, which can lead a patient into angioedema.

Risk Factors of an ACE Inhibitor Allergy

The use of ACE inhibitors is very common. Lisinopril is taken by millions of people, and actually makes it one of the top five most common prescriptions. The various ACE Inhibitors are very similar, but are excreted in different ways. For example, in a patient with reduced liver or kidney function, they may choose the one that is excreted through bile. The problem is that people who use ACE inhibitors are more at risk to experience oral allergy syndrome.

Oral allergy syndrome is also called pollen-food allergy syndrome, and happens when your body is not able to differentiate between pollen and food. If you have this, you will notice itching, tingling and swelling to the mouth, lips and throat. Most people do not realize they even have it. It is most common in teens and adults, and rarely in young children. Reactions to an oral allergy are short and mild – showing up right after eating and lasting for an hour. With each different allergy that you have comes with a list of possible foods that will trigger the oral allergy. Even though most allergic reactions happen within minutes of ingestion, there are often times when reactions are delayed and can also be severe.

Complications of an ACE Inhibitor Allergy

Angioedema is a life-threatening reaction that can occur from taking ACE inhibitors. The reaction usually consists of swelling in the face, lips, tongue, larynx, etc. There are two causes of angioedema, one of which is due to a histamine. The histamine would be the cause of the reaction in this case. The reaction can happen instantly, hours later or at any point through treatment. This can be treated with antihistamines, corticosteroids, and epinephrine. If this does not work, then you should end use of the ACE inhibitor and consult your physician.

Chronic cough as a result of taking ACE inhibitors is common. To decide if the two are correlated, it is best to discontinue use and see if symptoms resolve. It can take up to four weeks for the cough to go away.

Diagnosis of an ACE Inhibitor Allergy

An allergic reaction can happen on the first day of use, or even ten years later. There is no timeline on when reaction can occur. Upon the first set of symptoms, it is essential to end the use of the ACE Inhibitor and speak with your physician. To ensure a proper diagnosis, the physician must rule out other factors, such as an insect sting or food allergy. Once the physician knows that the ACE Inhibitor is the cause of the problem, the physician can give a proper diagnosis and can begin treatment and finding the best alternative medication.

Treatment of an ACE Inhibitor Allergy

The best treatment for an allergic reaction to an ACE Inhibitor is to stop the use of the medication. While some symptoms will last for weeks, the severe reactions should stop. Once you have stopped the use of the ACE Inhibitor, it is best to visit your physician to identify the best alternative for the medication. To treat the symptoms that have occurred as a result of the allergic reaction, the physician may use antihistamines. If you are allergic to one type of ACE Inhibitor, you are likely allergic to the rest of them.

Summary of an ACE Inhibitor Allergy

ACE Inhibitors are a commonly used medication to help control blood pressure and other heart problems. There are a few side effects that may occur when taking an ACE Inhibitor, such as coughing, rash, diarrhea, etc. Some side effects may be minor, but can also be life threatening. The body produces a chemical called bradykinin which also lowers blood pressure, and when ingesting fruit, can sometimes lead to an allergic reaction to food. This is known as oral allergy syndrome and this can occur at any point during treatment. Side effects become life threatening when an oral allergy occurs and swelling begins to happen in the mouth and tongue. Breathing becomes difficult and it is essential to act fast. When symptoms first happen, it is crucial to get in touch with your physician to properly diagnose your symptoms, and ensure the side effects did not occur from another allergy, such as an insect sting. Once the diagnosis is complete, it is best to avoid all types of ACE Inhibitors and find another treatment route.

Aspirin (Salicylate) Allergy

Overview of an Aspirin (Salicylate) Allergy

Aspirin is used to treat pain, reduce fever, and ease inflammation. In some cases, under physician supervision, it is also used to prevent heart attacks, strokes, and treat chest pain. An aspirin allergy is especially seen in patients with severe asthma. These patients typically will have an allergic reaction to other NSAIDs.

  • Allergic reactions to aspirin are common and can oftentimes mean that you also have an allergy to other nonsteroidal anti-inflammatory drugs (NSAIDs) – such as Advil, Aleve, Motrin, etc.
  • Side effects include: hives, itchy skin, runny nose, red eyes, swelling of lips, tongue or face, coughing, wheezing, shortness of breath, or anaphylaxis.
  • Keep an eye out for aspirin! It may be found in cosmetics, shampoos, soaps, cleansers, and even other remedies for the cold, flu, cough or stomach problems.
  • Side effects usually occur within one hour of taking the tablet.

Symptoms of an Aspirin (Salicylate) Allergy

Symptoms can range from mild to severe. These reactions can typically occur within minutes or hours of taking the medication. The symptoms include: hives, itchy skin, runny nose, red eyes, swelling of lips, tongue, or face, coughing, wheezing, shortness of breath, or anaphylaxis. While typically symptoms remain minimal, there are extreme instances where swelling of the tongue and face will occur.

An aspirin allergy can be divided into three categories, as defined by their reactions. The first is Aspirin-exacerbated respiratory disease which can cause symptoms such as rhinitis or asthma attacks. Aspirin-exacerbated urticarial/ angioedema can cause symptoms such as swelling and hives. Aspirin-exacerbated urticarial with or without angioedema can cause life-threatening symptoms, such as anaphylaxis.

Causes of an Aspirin (Salicylate) Allergy

You are more likely to have an allergic reaction to aspirin if you have asthma, chronic sinusitis, chronic hives, or nasal polyps. When a reaction occurs, it will worsen these pre-existing conditions. The cause of the allergic reaction is from the overproduction of leukotrienes and this buildup of leukotrienes is what causes the allergic reaction to the aspirin. This allergy is seen most commonly in people with asthma, inflammatory bowel disease and food allergies.

Risk Factors of an Aspirin (Salicylate) Allergy

The biggest risk is in those with asthma. People with asthma are more likely to experience an aspirin allergy, and will typically experience an asthma attack or reduced breathing capacity. In many cases, the patient will need to go to the emergency room because the reaction can be severe and even fatal.

Complications of an Aspirin (Salicylate) Allergy

Some people with asthma have never experienced an aspirin allergy, but they can occur at any point during taking the aspirin. It will not necessarily happen on the first dose. Samter’s triad is when a person with asthma also has an aspirin allergy and nasal polyps. In patients with asthma and nasal polyps, their aspirin allergy chances are doubled from those without.

Prevention of an Aspirin (Salicylate) Allergy

Once you have a reaction to an NSAID, it is not guaranteed that you are allergic to the others. However, it is best to avoid them all until consulting with your physician. It is crucial to check labels of other medications, as aspirin may oftentimes be found in various medications, cosmetics, soaps, etc. Some medications that may also contain aspirin are: cold medications, flu medications, topical creams that treat arthritis or teething gels. Speak with your pharmacist or physician to find the best alternatives for you.

Diagnosis of an Aspirin (Salicylate) Allergy

There is no skin testing or lab testing to determine the aspirin allergy. The only way to test for the allergy is to do a provocative challenge, which means that under physician supervision, small doses of aspirin are administered until the allergic reaction occurs or is ruled out. If a patient does not choose to go through this testing, the other option is for the physician to study the timing and reactions to a patient taking aspirin. If these line up, then the physician can diagnose this allergy without the provocative challenge.

Treatment of an Aspirin (Salicylate) Allergy

The best treatment is to avoid NSAIDs all together, upon diagnosis. If you are having severe symptoms, it is best to call 911 or go straight to the emergency room. These symptoms may be life threatening. After the symptoms are gone, it is crucial to avoid these drugs.

For less severe reactions, there are a few treatments that can be done at home. For a skin rash, it is best to use an over the counter hydrocortisone cream. For itchy, watery eyes, it is best to use allergy eye drops. If severe symptoms occur, it is best to go straight to the emergency room.

Another course of treatment would be to go through desensitization, which means that you will begin by taking small doses of aspirin and working your way up to large doses. The goal is to be able to take aspirin with no problem at all. These will be able to aid in asthma and sinus symptoms too. You will have to continue use every day.

A more severe treatment method would be to remove nasal polyps through surgery. This will typically be the recommendation from your physician if they are a real problem.

Summary of an Aspirin (Salicylate) Allergy

Aspirin is a pain killer that most use for headaches, reducing fever, and reducing inflammation. An allergic reaction to aspirin is very common in those with asthma, nasal polyps, or even other food allergies. The best way to diagnose an aspirin allergy is to watch for timing and symptoms, or go through a provocative challenge to see if the drug and reaction are correlated. Symptoms are not typically severe, until swelling occurs. Discontinue use of aspirin immediately. Symptoms such as itchy eyes can typically be treated at home with eye drops. If swelling occurs, the patient must call 911 or go directly to the emergency room as this can be life threatening. After a positive diagnosis, it is critical to avoid aspirin in any form. Aspirin can be found in various other medications as well as soaps or cosmetics. A form of treatment called desensitization may be beneficial. This allows for a physician to administer doses of aspirin until your system has adjusted. For further treatment, your physician may suggest removing nasal polyps.

Penicillin Allergy

Overview of a Penicillin Allergy

Penicillin is typically used for treating bacterial infections. During the first dose of penicillin, it is rare that an allergic reaction will occur. An allergic reaction is usually seen in patients on their second or more exposure to penicillin, and they typically also have a history of food or drug allergies, or a family history of drug allergies.

  • If you have previously experienced an allergic reaction to penicillin, then you may also be allergic to other types of penicillin or to some cephalosporin.
  • Side effects include: skin rash, gives, itching, fever, swelling, shortness of breath, wheezing, runny nose, itchy and/or watery eyes, and anaphylaxis.
  • Symptoms usually occur within an hour after taking the drug, but can sometimes occur hours, days or weeks later.
  • You are at an increased risk for an allergic reaction to penicillin if you have a history of allergies, a family history of drug allergy, increased exposure to penicillin (either high doses or repetitive use), or a certain illness.

Symptoms of a Penicillin Allergy

Some common symptoms include rash, hives, itching, fever, swelling, shortness of breath, wheezing, runny nose, itchy and watery eyes, or anaphylaxis. Symptoms will typically occur within one hour after taking the drug.

Other symptoms that may occur after days or weeks include, achy joints, swelling, rash, nausea, drowsiness, fever, blood in the urine, irregular heartbeat and confusion.

Causes of a Penicillin Allergy

An allergic reaction to penicillin occurs when your immune system believes the drug to be harmful. You will not experience the allergic reaction on the first exposure. The first exposure does not necessarily mean that you have to take the drug previously, and in some cases the amount of it in our food is enough to trigger the anti-body.

Risk Factors of a Penicillin Allergy

Anyone can be allergic to penicillin, but there a few factors that will increase your risk. If you have other known allergies, such as a food or drug allergy or hay fever, then you may be at an increased risk for a penicillin allergy. A family history of drug allergies may also increase your risk. Lastly, you are at an increased risk if you have had an increased exposure to penicillin (such as high doses, lengthy use or repetitive use).

Complications of a Penicillin Allergy

While most symptoms are immediate and mild, there are a few complications that may occur when an allergic reaction to Penicillin occurs. Serum sickness is a complication that may occur, which can cause fever, joint pain, rash, swelling and nausea. Drug-induced anemia is where there is a severe reduction in red blood cells. This type of anemia causes fatigue, shortness of breath and irregular heartbeats. Drug reaction with eosinophilia and systemic symptoms, also known as DRESS, appears in the form of a rash, high white blood cell counts, swelling, etc. Another complication would be inflammation in the kidneys, which leads to fever, blood in the urine, swelling and confusion.

Prevention of a Penicillin Allergy

The best prevention is to avoid penicillin. Avoiding the drug can be done in a few ways, which include informing your physician, wear a bracelet and carry epinephrine. Your physician should be aware of the allergy and should be well documented. The physician will be able to identify if there are other drugs that contain penicillin and will avoid those. If you are visiting a new physician, ensure they have updated information. By wearing a medical alert bracelet, you are ensuring proper care during an emergency.

Diagnosis of a Penicillin Allergy

See a physician as soon as possible when the allergic reaction begins. There are side effects to taking this medication, and some can be tolerated. If there is a life threatening allergic reaction to penicillin, speaking with your physician is mandatory. Having a proper diagnosis is important because if not, you may be prescribed a less-effective or more expensive antibiotic.

At first, your physician will inquire about your symptoms, timing, and medical history. Then they may proceed to a skin test. During the skin test, your physician will administer penicillin into your skin with a tiny needle. If the bump turns red and begins to itch, there is a positive result.

Another type of test is the graded drug challenge. The physician will begin by administering a small dose of the drug and will work through five different doses. If there is no reaction to these doses, it can be concluded that there is no allergy suspected.

Treatment of a Penicillin Allergy

There are two divisions for treatment of the penicillin allergy. The first step is to treat the current allergic reaction symptoms. To treat, discontinuing the drug will be the first step. Antihistamines and corticosteroids will be given to treat the reaction.

After the symptoms are treated, the physician may recommend a treatment that will allow you to take a course of penicillin with no adverse effects. Drug desensitization is when the physician will administer a dose of penicillin every 15 to 30 minutes over the course of hours or days, where each dose is a little bigger than the last. During this time, it is important to take each dose to maintain tolerance through the whole test. This test will not be completed if the reaction has been life-threatening in the past.

Summary of a Penicillin Allergy

Penicillin is an antibiotic that is used to fight off infections. An allergic reaction to penicillin typically occurs in 10% of patients, and can only happen on the second exposure to penicillin. Symptoms may include: rash, hives, itching, fever, swelling, shortness of breath, wheezing, runny nose, itchy and watery eyes, or anaphylaxis. In rare cases are the symptoms life- threatening. You may be at high risk for an allergic reaction if you have other food or drug allergies, or have a family history of a penicillin allergy, Diagnosis can be done through skin testing or a penicillin challenge. The best way to treat an allergic reaction to penicillin is through first, treating the immediate symptoms. Discontinuing use of the drug is your first step. Then your physician may recommend an antihistamine and corticosteroids. Once the allergic reaction has subsided, your physician may recommend going through drug desensitization to build immunity to the drug.

Other Antibiotics Allergy

Overview of an Allergic Reaction to Other Antibiotics

While aspirin, penicillin and ACE inhibitors are the most common drugs that cause an allergic reaction, there are many others that may do the same. An allergic reaction to these medications may not occur on the first dose, but may appear later. The chance of having an allergic reaction to an antibiotic has increased, as the use of antibiotics has also increased.

  • You are at an increased risk for an antibiotic medication allergy if you: have allergies to other things (such as cats), have a family history of antibiotic allergies, use antibiotics frequently or have a long-term illness.
  • Side effects can range from mild to severe or even anaphylaxis symptoms.
  • Reactions can begin as soon as you take the medicine, or even days or weeks after.
  • Antibiotics that may cause an allergic reaction include: tetracycline, chloramphenicol, sulfa drugs, vancomycin, nitrofurantoin, ciprofloxacin, etc.

Symptoms of an Allergic Reaction to Other Antibiotics

Symptoms can range from mild to life-threatening. Mild symptoms of an allergic reaction to an antibiotic can include red, itchy, flaky or swollen skin or even hives. Severe symptoms may include skin blisters that peel, itching and swelling, and vision problems. More life-threatening symptoms such as trouble breathing, throat tightness, tingling, dizziness, or wheezing will require immediate treatment.

Causes of an Allergic Reaction to Other Antibiotics

An allergy to an antibiotic occurs when your body identifies the drug as a harmful substance. The reaction may not occur during the first dose of the antibiotic, but can occur during the second dose or later on. Even if it is your first dose of the drug, it still may cause an allergic reaction because some substances are also found in food. If your body builds an antibody against them, you may experience side effects.

Risk Factors of an Allergic Reaction to Other Antibiotics

You may be at higher risk for an allergic reaction to an antibiotic medication if you have other allergies, such as an allergy to cats, a family history of antibiotic allergies, frequent use of antibiotics, or a long-term illness that makes your immune system more sensitive. Your physician will ask questions about these before beginning the tests.

Complications of an Allergic Reaction to Other Antibiotics

Immediate care is needed in the case of anaphylaxis symptoms as a result of an allergy to the antibiotics. The symptoms of this are throat tightness, tingling, dizziness, trouble breathing, wheezing. Symptoms usually appear suddenly with little time to react. If this occurs, go to the emergency room or dial 911 immediately. If you have an epinephrine, administer one shot to the outer thigh muscle.
Prevention of an Allergic Reaction to Other Antibiotics

The best way to prevent an allergic reaction to the antibiotic is to not take the drug. It is important to check labels to ensure that they are not in any other products that you may be taking. Speak to your physician about the symptoms you are experiencing and ensure it is documented. In some cases, it may be beneficial for you to wear a bracelet that shows your allergies in case of emergency.

It is also important to create an action plan with your physician so that you know what to do in the case of an emergency. Making these decisions before an emergency will make handling the emergency much easier. Once the plan is created, pass out the plan to your family, friends and co-workers so they are also aware of what to do in case of emergency.

Diagnosis of an Allergic Reaction to Other Antibiotics

An antibiotic allergy can be diagnosed in a few ways. Your physician will begin by asking questions about your medical history, allergies and family medical history. There are three possible tests that can be given to diagnose the allergy. A blood test is simply where the physician draws blood to let them see how your body is working. A patch test is when a small dose of the antibiotic is placed on the skin and covered for two days. The physician will then see how your skin reacts. A skin prick test is done when a small dose of the antibiotic is put on your forearm and then pricked.

When diagnosing, it is important to understand whether what you are experiencing is simply a side effect from the drugs, or if it is truly an allergic reaction. Even in people that are not allergic to the drug, certain antibiotics may cause you to experience symptoms such as an upset stomach. Only during an allergic reaction will you experience hives, itchy skin, congestion, or any of the other true allergy symptoms.

Treatment of an Allergic Reaction to Other Antibiotics

An allergic reaction to an antibiotic can be treated in a few ways. An antihistamine may be given to lessen mild symptoms, such as itching. Steroids can aid in reducing inflammation. In extreme cases, epinephrine can be given to treat reactions such as anaphylaxis.

After the treatment of the symptoms of the reaction, your physician may recommend going through the desensitization process, which means that you will be given small doses of the antibiotic over a few hours. With each dose, the amount is increased until the full dose is given or the medicine no longer causes an allergic reaction.

Summary of an Allergic Reaction to Other Antibiotics

Allergic reactions to antibiotics are rising as a direct result of the use of antibiotics. They do not necessarily occur on the first use of the antibiotic, but may occur on the second dose. Antibiotics that may cause an allergic reaction include: tetracycline, chloramphenicol, sulfa drugs, vancomycin, nitrofurantoin, ciprofloxacin, etc. Diagnosing an allergy to an antibiotic can be done through skin testing, a blood test, or a patch test. The best way to treat an allergic reaction to an antibiotic is to discontinue use immediately and get in contact with your physician. Next, you will want to treat your side effects, such as using a steroid or antihistamine. Once the symptoms are taken care of, your physician may recommend participating in the desensitization process, which will increase the body’s tolerance to the drug. Prevention is also imperative as the fewer amounts of times the body is introduced to the antibiotic, the better. Ensure that your physician understands your allergy and alert every other physician that handles your care too. An allergy alert bracelet should be worn if medically necessary