Is a Sulfite Allergy Dangerous?

sulfa drug allergy :: Article Creator

People's Pharmacy: Rinsing Well Is Key To Comfort With Acne Medicine

DEAR PEOPLE'S PHARMACY: I have suffered from acne and rosacea since I was a teenager. Back then, my dermatologist recommended benzoyl peroxide, but I found it too irritating.

Despite trying numerous other treatments, I suffered periodic outbreaks over the years. More recently, I went back to using benzoyl peroxide as a facial scrub. Reading the instructions carefully, I saw that it should be rinsed well. Now, I use the scrub in the shower, leave it on for a minute as my dermatologist recommended, and then rinse it off really well. At the end of the shower, I rinse again.

This way, my skin does not itch or get irritated, and my acne rosacea is much better. I wish I had read the instructions more carefully decades ago.

A. Benzoyl peroxide has been a mainstay of many popular acne treatments for decades. There is one concern, however. Recent research in the Journal of Investigative Dermatology (October 2024) reveals that 34% of the various products tested contained unacceptably high levels of benzene. This compound is a carcinogen that has previously been detected in products such as hand sanitizers, sunscreens and spray antiperspirants.

For a list of products with lower levels of benzene as well as alternatives for managing skin blemishes, you may wish to read our "eGuide to Acne Solutions." This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.Com.

Q. I have pain due to severe compressed discs in my lower back. My doctor prescribed duloxetine, which was very effective. After a short time, though, I felt fatigued, weak and listless, with low energy. Also, I was very sad. These are symptoms of depression.

After reading about duloxetine side effects, I told my doctor and stopped taking the drug. My mental state improved immediately.

Now that I know the probable side effects, can I start duloxetine again and monitor myself closely? Would the side effects eventually fade away as I continue the medication?

A. Duloxetine (Cymbalta) was originally approved to treat depression in 2004. Later, the Food and Drug Administration gave it the green light for nerve pain, fibromyalgia and musculoskeletal pain.

The official prescribing information warns that patients suffering from major depression "may experience worsening of their depression and/or the emergence of suicidal ideation and behavior." Other potential complications include fatigue, weakness and lack of energy.

It is hard to tell whether such adverse reactions would fade with time. You may want to ask your physician if there is another approach to ease your back pain.

Q. My son came home from college just before Thanksgiving with an ugly, oozing purple spot on his leg. Our doctor's office was closed so we went to an urgent care center. The doctor there diagnosed a MRSA infection and prescribed an antibiotic.

My son is allergic to sulfa drugs, and this has been in his medical records since he was a baby. I waited in the car while he ran into the pharmacy to pick up his prescription. When he got back in the car, I asked what was prescribed. It was sulfamethoxazole -- a sulfa drug!

Lesson learned: Don't assume that the doctor or pharmacy will be aware of a drug allergy. Always ask the doctor about the prescription before you leave the office!

A. Thanks for the reminder that we all need to be vigilant. Your son now knows to alert the prescriber and dispenser about drug allergies.

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In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.Com. Their newest book is "Top Screwups Doctors Make and How to Avoid Them."

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Decongestants To Treat Allergy Symptoms

Decongestants offer temporary relief from nasal congestion brought on by allergies. But they have their limitations.

Most people who have allergies are familiar with nasal congestion. This can include a stuffy nose, clogged sinuses, and mounting pressure in the head. Nasal congestion is not only uncomfortable. It can also affect sleep, productivity, and quality of life.

Antihistamines may help prevent allergy symptoms. But sometimes you may need to take additional medications. This is especially the case if you need to relieve sinus pressure and a congested nose. Decongestants are over-the-counter medications that help break this cycle of congestion and pressure.

Decongestants work by causing blood vessels to constrict. This helps relieve congestion caused by the dilation of blood vessels in the nasal passages.

Phenylephrine is a common form of these drugs. These over-the-counter drugs can bring temporary relief from congestion. However, they don't treat the underlying cause of allergies. They merely offer relief from one of the more problematic symptoms of common inhalant allergies.

Oral phenylephrine was ruled as ineffective in 2023 by the FDA. However, the nasal spray version is still deemed effective, but it cannot be taken for more than 3 days at a time.

Another nasal spray, oxymetazoline, is helpful, but should not be used more than twice in a 24 hour period, and also cannot be used for more than 3 days.

Another formerly common decongestant, phenylpropanolamine, was pulled from the market starting in 2000 due to its associated increased risk in hemorrhagic strokes.

Decongestants are relatively inexpensive and readily available. Still, they're more difficult to obtain than over-the-counter antihistamines.

Pseudoephedrine

Pseudoephedrine (e.G., Sudafed) is another class of decongestants. It's offered in limited forms in certain states. It may be available through the pharmacist, but other states might require a prescription.

This ensures proper and legal use, and prevents drug interactions. Pseudoephedrine is a raw material used in the illegal manufacture of the dangerous street drug crystal methamphetamine.

Congress passed the Combat Methamphetamine Epidemic Act of 2005 to limit the damage to communities caused by abuse of this drug. President George W. Bush signed it into law in 2006. The law strictly regulates the sale of pseudoephedrine, pseudoephedrine-containing products, and phenylpropanolamine.

Many states have also enacted sales restrictions. Typically, you have to see a pharmacist and show your ID. Quantities are also limited per visit.

Decongestants are stimulants. Potential side effects include:

anxiety

insomnia

restlessness

dizziness

high blood pressure, or hypertension

In rare cases, pseudoephedrine use may be linked to an abnormally rapid pulse, or palpitations, also called an irregular heartbeat. Most people do not experience side effects when they use decongestants correctly.

You will need to avoid these medications or take them under close supervision if you have the following:

type 2 diabetes

hypertension

overactive thyroid gland, or hyperthyroidism

closed angle glaucoma

heart disease

prostate disease

Pregnant women should avoid pseudoephedrine.

Decongestants are often taken once every 4-6 hours, ideally for no more than one week at a time. Other forms are considered controlled-release. This means they are taken once every 12 hours, or once a day.

People who are taking any drug from a class known as monoamine oxidase inhibitors (MAOIs) should not take decongestants. Certain other drugs, such as the antibiotic linezolid (Zyvox), may also cause a serious drug interaction.

Consult with your doctor before taking a decongestant if you're currently taking any other medications. You shouldn't take more than one decongestant at a time. Although they might have separate active ingredients, you may still put yourself at risk for an interaction.

Most people take decongestants in a pill form. Nasal sprays feature a decongestant that is delivered directly into the nasal cavities. The American Academy of Family Physicians (AAFP) recommends that you don't use spray decongestants for longer than three days at a time.

Your body may grow dependent on them, and then the products will no longer be effective in alleviating congestion.

Nasal spray decongestants may provide temporary relief from congestion. However, they're especially prone to inducing tolerance for the drug. This tolerance may result in "rebound" congestion that leaves the user feeling worse than before treatment. Examples of these nasal sprays include:

oxymetazoline (Afrin)

phenylephrine (Neo-synephrine)

pseudoephedrine (Sudafed)

Studies have shown that the combination of an antihistamine drug and a decongestant is better at relieving the symptoms of allergic rhinitis due to seasonal inhalant allergies.

These drugs only offer symptomatic relief and should be used with some caution. But they can be important weapons in the ongoing battle against the misery of allergies.

Sometimes taking decongestants aren't enough to alleviate severe nasal allergy symptoms. If you're still having bothersome symptoms despite taking medications, it may be time to see a doctor.

The AAFP recommends seeing a doctor if your symptoms don't improve after two weeks. You should also call a doctor if you develop a fever or severe sinus pain. This could indicate sinusitis or a more severe condition.

An allergist can help you determine the exact causes of your congestion and recommend methods of more long-term relief. Prescription decongestants may be necessary for the most severe cases.

Drug Allergies

Allergic reactions occur as an immune response of our body to a foreign substance. When the allergic reaction is due to a drug, new or old, it is said to be a drug allergy. Adverse drug reactions can occur with any class of drugs, but more so in case of antibiotics followed by anti-tumor drugs.

Symptoms

Symptoms of drug allergy are the same for any type of allergy. Common ones are skin rash, hives, and itching of the skin or eyes. These are not very serious symptoms. These reactions are usually treated by substituting the current drug with another.

However, severe reactions after taking the medication include swelling or tightening of the airways, dizziness or lightheadedness, rapid pulse, or even loss of consciousness. Seek emergency treatment since these are anaphylactic symptoms that are potentially life threatening.

Causes & Risk Factors

Anyone and everyone can be allergic to one or the other drug. Generally children and middle aged people are more prone to drug allergy than others. Female gender is also a risk factor for allergic reactions to a drug. You may also have an allergic reaction if

you have a past allergic reaction to any drug

you are allergic to penicillin then you may be allergic to some other antibiotics as well

you have a weakened immune system as in AIDS /HIV

you have a history of other allergies

you have asthma, high blood pressure or heart disease.

Types

You can have an allergic reaction to any drug. But some are more common than others. Here's a list of the most common drug allergies.

Penicillin and related antibiotics such as cephalosporins, sulfonamides (sulpha drugs), and aminoglycosides are the most common cause of drug allergies. However, the different classes of antibiotics vary in respect of their mechanism of actions and adverse effects.

Anticonvulsants such as carbamazepine, lithium salts, divalproex sodium, oxcarbazepine, and others used for seizures and other mental illnesses can cause allergic reactions.

Insulin, especially animal sources of insulin, is a common example of drug allergic reactions.

Radiocontrast agents or X-ray contrast dyes containing iodinecan also cause allergic reactions. Sometimes, they can cause anaphylactic reactions that can be life threatening. The incidence of reactions appears to be lower with non-ionic agents as compared with ionic agents. Oral corticosteroids and H1-antihistamines are generally used to treat such allergies.

Sulpha drugs, another common cause of drug allergy, can be both antibiotic as well as non-antibiotic. You can have an allergic reaction to either or both these categories. Sulfonamides antibiotics are often associated with more severe drug reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) characterized by fever and extensive necrosis (premature cell death). People with HIV are at an increased risk of sulphonamide allergy. Non-antibiotic sulpha drugs such as acetazolamide, frusemide, hydrochlorothiazide, chlopropramide, sulfasalazine, dapsone, etc, are thought to be less likely to cause severe allergic reactions.

Aspirin and nonsteroidal anti-inflammatory drugs, too can cause allergy in some people. 'If you have an aspirin allergy or sensitivity, you may also have a reaction to nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others)', says Mayo Clinic asthma and allergy specialist James T C Li. The allergy can range from mild to severe and the reaction can occur within a few hours of taking the medication.

Vaccines have been found to cause allergic reactions in some people. Serum sickness is a delayed type of drug allergy that occurs a week or more after you are exposed to a medication or vaccine.

Diagnosis

It is very difficult to identify a drug allergy. And that is because there are very few good laboratory tests that can be helpful in diagnosing them. What happens is, generally the original form of medication does not cause the allergic reaction. It is the modified form of the drug or the metabolite of the drug that the immune system responds to. However, the skin test for penicillin is very effective because all of the important metabolites of penicillin have been identified. So much so, the test can correctly identify not only who is allergic to penicillin but also who is not allergic. There are a few tests to diagnose drug allergy and these include –

Blood test – Allergy to some antibiotics, muscle relaxants and insulin can be diagnosed through blood test.

Skin test – Skin test may be required for certain antibiotics. A small amount of the drug is injected into the skin. If you're allergic to the drug being tested, you will develop a reaction.

Drug provocation test – This test is resorted to when the other two tests are inconclusive. In this test, you will be given gradually increasing doses of the offending drug. If there is a reaction, sensitivity to the drug is indicated; if not, then it could be considered a safe treatment option.

Since lab tests or skin tests are not always helpful, allergists have to depend on a detailed and accurate history of all your current and past medication to identify which drug is responsible.

'First of all, the most important test of a drug allergy is not a laboratory test or a skin test at all, but a careful history of what happened when the allergic reaction occurred previously. That tells an allergist, more than any testing that is done, whether or not the drug reaction was due to an allergic mechanism, allergic cause, and also gives some estimate of whether or not that type of allergy is likely to persist over time. So a good careful history is the most important tool that we have to determine who is allergic to a particular drug', says N. Franklin Adkinson, M.D., Prof., Div. Of Allergy and Clinical Immunology, Johns Hopkins University. 'For many other drugs, including other antibiotics, we don't have a validated skin test, and we have to rely on that crucial historical information to tell us, to give us an assessment of how likely it is that a drug allergy exists'.

Tips

Whenever and every time you visit a doctor, discuss with them your current medications and supplements, and describe all prior adverse reactions to medications. Share this information with your pharamacist too. Sometimes if the prescribed medicine is not available, they tend to give a substitute medicine.

For new medications, ask questions regarding possible drug-drug reactions and read the drug inserts included in the medication.

Do not take short acting antihistamines (like Benadryl or diphenyhydramine) for 2 days prior to your skin test, and longer acting antihistamines (like cetirizine, fexofenadene [Allergra], loratadine [Claritin, Alavert], or desloaratadine [Clarinex]) for 3-4 days, because they might interfere with the test. However, if you need to take antihistamines, do so, but re-schedule your skin test appointment.

Always keep with you an identifying-card that mentions your drug allergies or chronic conditions.

Notify your doctor immediately if you notice adverse reaction to any drug you are taking. Your doctor will make the decision for further action, viz. Stopping the drug, etc.

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