We take medications to make us feel better, but sometimes an adverse reaction, such as nausea and diarrhea, can result. While these types of side effects to drugs are common and usually not life-threatening, a true drug allergy occurs when your immune system overreacts to a medication, thinking it’s a threat to your body. What is often happening behind the scenes is that the first time you’re exposed to a drug; your body produces an antibody called IgE to counteract it. The next time you take the same drug, that antibody triggers the production of histamine.
Your body’s reaction to the histamine is usually what causes these common symptoms:
- A skin rash or hives
- Swelling of the tongue, throat, lips, or face
- Wheezing or difficulty breathing
Anaphylaxis, which happens very quickly after exposure to the drug, is the most serious reaction and can even lead to death if not treated. While many people associate anaphylactic shock with closure of the airways due to swelling, according to the National Institutes of Health, it actually affects tissues in all parts of the body and can cause:
- Abdominal pain
- Abnormal (high-pitched) breathing sounds
- Chest discomfort or tightness
- Difficulty breathing
- Difficulty swallowing
- Dizziness or light-headedness
- Hives, itchiness
- Nasal congestion
- Nausea or vomiting
- Skin redness
- Slurred speech
- Swelling of the face, eyes, or tongue
The most common categories of drug allergies are:
- Penicillin, a common antibiotic prescribed for bacterial infections
- Sulfa drugs, including antibiotics Bactrim and erythromycin-sulfisoxazole, and sulfonamide medications such as Imitrex for migraines, Celebrex, an anti-inflammatory, and some diabetes medications.
- Iodinated X-ray contrast dye
- Insulin, particularly those from animal sources
If you have an allergic reaction after receiving any medication, your doctor will usually consider that an allergy and instruct you to avoid the offending drug. To diagnose a penicillin allergy, your allergist might conduct a skin test, but skin and blood tests are not used to diagnose other types of drug allergies. A graded dose challenge, where a physician administers increasing amounts of the drug—first 1/100th of a dose, then 1/10th of a dose, building up to a full dose—also can be conducted in the office. If you’re able to tolerate a full dose without adverse symptoms, you don’t have a true allergy to that medication.
Treatment and alternatives
Once you’ve had an allergic reaction or been diagnosed with an allergy to a specific medication, your physician will instruct you to avoid that drug and can help identify safer alternatives should that type of medication be necessary for treatment. If the specific drug is necessary for your treatment, desensitization, which involves introducing very small, diluted amounts of the offending medication in gradually increasing amounts over a few hours or a day, can be done in a hospital setting.
If you have a severe reaction, particularly anaphylaxis, seek immediate medical care. Treatment may include an injection of epinephrine, antihistamines to address hives and swelling, bronchodilators to treat wheezing, and corticosteroids.
Make sure that any medication allergies are clearly communicated to your physician, dentist, pharmacist, and any hospital staff involved with any inpatient or outpatient care.
You also may want to consider wearing a medical alert bracelet or carrying a card in your wallet that identifies your allergies in case of emergency.
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