Medication Allergies - Know the answers to these questions

Just started giving your child a new medication and (s)he has developed hives, difficulty breathing, fever, swelling of the lips or eyes, an itchy rash, or anaphylaxis? Chances are your child has been exposed to this medication (or an ingredient of this medication) in the past. Note that sometimes it is the inactive ingredient (for example, the dye, preservative, filler of the tablet) that is the culprit. Medication allergies are rarely fatal, but they can be scary and do warrant immediate attention, especially if your child appears to be struggling to breathe. If your child has a history of severe allergies and has an Epi-Pen, use it as directed and call 911. If it is a mild reaction, a dose of diphenhydramine (Benadryl) is all that is necessary to relieve the symptoms. Be sure to contact your child's pediatrician or allergist beforehand.

To help confirm that the reaction was a true drug allergy, a detailed history is crucial. Be prepared to answer these questions: When did the reaction occur? What drugs were you giving your child? How soon after taking the drugs did your child have the reaction? What kind of reaction did your child have? How severe was the reaction, and how long did it last? If your child had a rash, did it blister, peel, or cause ulcers in the mouth, vagina, or rectum? Has your child since taken that drug or one like it without a reaction?

Sometimes a side effect (or intolerance to the medication) is mistakenly labeled as an "allergic reaction." For example, having an upset stomach, diarrhea, or rash to a penicillin are common side effects and they resolve on their own, even when the medicine is continued. Attributing these to an allergic reaction could pose problems in the future, especially if the best course of therapy involves a penicillin. Optimal therapy may end up being delayed as your child is being desensitized to the medication. So, talk to your child's doctor and pharmacist to clarify whether what your child is experiencing is a side effect or an allergic reaction. Also, if your child is allergic to shellfish, soy, eggs, cross-sensitivity to certain medications and vaccines is possible. Be sure to alert your doctor and pharmacist about these food allergies so that they can be updated on your child's medication profile.

Food allergies and medications

I'm taking my 3 year-old daughter to an allergist today to be tested for shrimp, fish, nuts, and peanuts. She has had fish without a problem, but since there is a strong family history of food allergies to peanuts, beans, fish, and nuts it will be more of a precaution. Her first skin test at 12 months was for beans, fish, shrimp (her eye became swollen after eating a Japanese shrimp chip), and milk (a rash around her mouth developed each time she consumed dairy products). She apparently outgrew her milk allergy when she was tested again at 2 years of age, and actually loves to eat cheese when it was reintroduced to her. Yes, we have an EpiPen Jr. If you do not remember how to give your child a dose, now is a good time to watch the video or ask your pharmacist to show you again. It is crucial to be prepared if your child has known allergies to food or medications; carry the pen and to know how to use it. If your child is old enough, (s)he should be taught, too. Don't forget to teach people who are always with your child to use it (e.g. teacher in school, if there isn't a nurse, older siblings, etc.). Make sure the pen hasn't expired, yet.

Be aware that medications may contain inactive ingredients that should be avoided if your child has allergies to certain foods, like lactose, peanuts, and shellfish. For example, a child with asthma and a known peanut/soybean/soy lecithin allergy should not be given the old CFC-containing Atrovent (ipratropium bromide) metered dose inhaler (MDI) or Combivent (ipratropium bromide and albuterol sulfate) MDI. Some children have had worsened asthma attacks, if not anaphylaxis, after being given the old Atrovent inhalers. Note that the other forms (e.g. brand or generic nebulized solution or the new Atrovent HFA MDI) of these medications do not contain soy lecithin and are fine to use. Other medications to look out for are described in this article. Great information on food allergies in general can be found at the Food Allergy & Anaphylaxis Network, including how to look for the culprit ingredient disguised with a different name.

Ask the pharmacist, read the label, or call the drug company to make sure any new medications are safe if your child has severe food allergies. Update your pharmacy and doctors today about your child's food allergies so that they can document them and help keep your child safe from allergic reactions to medications.