Question
Can someone with a sulfa drug allergy swim in sulphur hot springs?
Answer
Allergic reactions to sulfa (sulfonamide) medications are not uncommon. However, I know of no relationship between the sulfur mineral and sulfonamide medications or sulfites. Furthermore there is no knows relationship between having reactions to sulfites, frequently added to foods and beverages as a preservative, e.g. wine, and sulfonamide medication allergies. I do not see any reason why soaking in the sulfur hot springs would have any adverse effect, although I have not been able to find any published articles on this topic.
Question
How long does it usually take for hives to disappear after a reaction to a drug? With the use of Benadryl?
Answer
With a drug reaction, hives can persist for several days, even with Benadryl. The severity and duration of drug reactions varies between individuals and the inciting drug. Sometimes prednisone is required to treat the reaction depending on the severity. It would be prudent for any individual experiencing a suspected drug reaction to see a qualified allergist for evaluation and acute and chronic treatment.
Question
I had an egg allergy when I was a kid, around 5-6 years old. Now I’m 33 and no longer seem to have any reaction to eggs. I would like to get a flu shot, but I’ve been told I need to be sure I don’t have an egg allergy. I eat eggs every morning and don’t notice any reaction, so I don’t think I’m allergic anymore. Can I just get the flu shot? What do you suggest?
Answer
If you are tolerating eggs daily without symptoms, you are no longer allergic to eggs. If you do not have any skin, stomach, swallowing, throat, or breathing symptoms related to eating eggs; then you do not have to worry about egg allergy. You should get the influenza vaccine annually, and you do not need any special precautions or monitoring.
Question
I was prescribed Amoxicillin Clavulanate, along with Medrol, for a bacterial sinus infection. I took the Amox-Clav for 6 days before I noticed hives appearing on my body. I am now covered with welts and hives, and also have swelling. My body has been reacting for almost three days now, and I haven’t seen any relief yet. I was given a corticosteroid shot two days ago, and I have been taking Benadryl every 4 hours. How long can I expect the hives, swelling, and itching to continue? It seems to come in waves, and it doesn’t take much to aggravate it.
Answer
Based on your symptoms, it sounds as though you may be experiencing a condition called a drug exanthem. You should discuss your symptoms and potential strategies for diagnosing and managing symptoms with your allergist.
Exanthems often occur several days into a course of an antibiotic. Skin symptoms can last for days to even a few weeks (or, rarely, even longer). Treatment includes high-dose antihistamines. It may require up to 4 times the usual dose of antihistamines used for allergic rhinitis to treat a reaction like the one you are describing.
Long-term use of systemic steroids can have significant side effects, and should be avoided. In general, oral steroids are preferred over shots.
Your allergist will likely recommend a non-sedating antihistamine (rather than the Benadryl, which will make you very sleepy). If that doesn’t work, a more potent antihistamine such as doxepin may be necessary.
Your allergist may recommend testing for penicillin allergy before you take an antibiotic related to amoxicillin or penicillin in the future.
Question
Does desensitization mean that you are no longer allergic to a drug? I had a rash for three months after starting Cozaar, but by the time I got into a dermatologist it was gone. My cardiologist wants me to stay on it.
Answer
If a patient has an adverse reaction to a medication, their immune system may be primed to have a similar reaction every time the patient is exposed to the same medication in the future. If the patient’s physician believes that this particular medication is essential for the patient, desensitization is sometimes recommended. Desensitization involves taking escalating doses of the medication in slowly increasing amounts until reaching the prescribed dose. For medications that are taken daily, desensitization only needs to be performed once. As long as the medication is taken daily, the body maintains a state of desensitization. If more than 2 days pass between doses, the body may not “remember” the desensitized state, and desensitization needs to be performed again.
With regard to your rash in association with Cozaar, you should follow up with your physicians. If you have continued to take this medication with no rash, it is possible that the rash and the medication were not related. If you have adverse symptoms with a necessary medication in the future, you should discuss evaluation and strategies with your allergist.
Question
I thought the flu vaccine changed every year, but my nurse looked at this year’s flu vaccine and found it has H1N1 in it. Isn’t that the same as swine flu?
Answer
Your nurse is right! The terminology is a little confusing, so here’s a refresher: H1N1 is a subtype of Influenza A that has caused roughly half of all human flu infections we’ve seen in the past several years.
H1N1 viruses are identified by two surface proteins: Hemagglutinin (H) and Neuramidase (N). The strains H1, 2 and 3, and N1 and 2 are found in people – a lot more strains are found in birds and pigs, and can be spread to humans. If a sufficient genetic shift occurs in an animal virus strain, it can then be transmitted person to person.
Scientists closely monitor the strains infecting humans as well as animals, since crossover to humans may signal the next pandemic influenza.
Yes, the human influenza strains do shift from year to year, but it is very rare that all three strains in an influenza vaccine change in a single year. Therefore, you will see repeating strains if you watch the vaccines’ contents.
People need a yearly influenza vaccine for two reasons: the vaccines usually contain new strains each year, and immunity to influenza decreases over time. The yearly vaccine helps keep your immunity strong and ensures that you have resistance to the strains scientists have identified as important for the year.
Question
My 4 year-old son recently had anaphylaxis after the following vaccinations were given at the same time: chickenpox, DTP, polio, and MMR. Immediately after these immunizations in our pediatrician's office, he complained of his throat hurting, was sneezing, drooling, threw up and had red, itchy skin and trouble breathing. He was taken by ambulance to the ER, and treated with shots including epinephrine. In the past, he has had drooling and vomiting after eating a piece of protein chocolate bar and when taking his gummy vitamins, and complained of his throat hurting after eating marshmallows. My son doesn't have any hay fever, and we don't have a family history of allergies. Do you have any idea what could be causing these reactions?
Answer
Based on the information you’ve provided, your child’s reactions may be related to gelatin, which is added as a stabilizer to some vaccines and is found in both the MMR (measles-mumps-rubella) and chickenpox (varicella) vaccines. Yellow fever vaccine and rabies vaccine also contain gelatin, but are not part of the routine childhood vaccination schedule.
The foods you list also frequently contain gelatin.
Neomycin, an antibiotic, is another ingredient in some vaccines which can be related to allergic reactions; it can also result in a reaction if used with topical application (as in “triple antibiotic” antibacterial skin creams, sold over-the-counter).
Your allergist can evaluate the possibility of a gelatin (or other) allergy and perform testing on your child to confirm. Given the circumstances, any further vaccinations should be held – and foods containing gelatin avoided – until the exact cause of reactions has been determined.
Question
I am a 66 year-old man who was recently discharged from the hospital after a prolonged and resistant bout of pneumonia. After seeing an allergy/immunology doctor for an evaluation of a possible immune deficiency problem, I had some lab studies done. A certain test called gamma globulin came back in the low normal range, but some of the other tests were not quite normal. The allergist recommended that I have a Pneumovax (pneumococcal vaccine) and a tetanus/diptheria/pertussis vaccination and then have some repeat blood tests. Is it really necessary to have both of these vaccines? How do they help to identify if I have an immune problem?
Answer
Someone with an immune deficiency is very likely to have low normal or even normal gamma globulin levels but still have an inability to make antibodies to specific organisms such as pneumococcus (a bacteria which can cause pneumonia).
The blood work you had taken likely showed your allergist that you lacked proper antibodies to specifically fight pneumococcal diseases and that you lacked protection against tetanus and/or diphtheria. The absence of these antibodies does not in itself mean that you have an immune problem. You may have lost the immunity from the diphtheria/tetanus/pertussis that you had as a child, and may simply not have been exposed to many of the pneumococcal organisms that were tested in the blood.
However, you do need protection against all these organisms – that’s a standard recommendation for all adults over 65! Receiving the vaccines your physician has recommended will likely give you that protection. Repeating the blood tests 4 weeks afer the vaccinations will help your allergist know if your immune system is functioning properly. You really need both vaccinations for protection and to gain necessary information about your immune system. If your body shows an inadequate response to these vaccines, further immune studies and treatment, possibly long-term, may be required.
These vaccines can be administered at the same time. I would suggest that you follow your allergist’s advice and obtain the vaccines and then the blood tests 4 weeks later.
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