My 23-year-old daughter has life-threatening allergies to antibiotics — penicillin, Ceclor, and others. I am very worried about this in the long term. She also has severe allergies to bee and wasp stings, and more “typical” allergic responses to cats, dust, etc. My question is: Can the drug allergies be approached in any way? Can they be overcome, as food and environmental allergies can be, with shots?
Immediate life-threatening reactions to antibiotics, foods, insect stings, or other allergens are called anaphylactic reactions. They are also called immediate type hypersensitivity reactions because they tend to occur rapidly after the exposure to the allergen. (An allergen can be any foreign substance that evokes an allergic reaction.) The most common allergens capable of provoking anaphylaxis are the penicillins and related cephalosporin antibiotics, of which Ceclor is an example, foods such as shellfish and nuts, and bee stings.
Individuals who manifest many allergies, such as the daughter of today’s writer, are said to be atopic, and this tendency runs in families. Members of atopic families often have high levels of a particular class of immune globulins called IgE in their blood. Members of such families are prone to allergic rhinitis (hay fever), asthma, urticaria (hives), and eczema, and to anaphylactic reactions. However, anaphylaxis can also occur in people who are not from an atopic family and have no other allergies.
Anaphylactic reactions can manifest themselves in several different ways. Skin reactions such as hives, with swelling of the lips, tongue, and throat, may occur. This swelling may progress to severe breathing difficulty. Vascular collapse — that is, shock — may occur, with or without the skin manifestations or breathing difficulty. There may also be GI tract symptoms such as nausea, vomiting, diarrhea, or crampy pain.
Since these symptoms appear literally within minutes after the person is exposed to the allergen, immediate medical treatment is crucial. Someone having a severe anaphylactic reaction can die within a few minutes of respiratory difficulty and shock. Treatment with an immediate injection of adrenalin can be lifesaving, and many people who have had such reactions carry a syringe preloaded with adrenalin to administer to themselves. Shock and respiratory difficulty may require more advanced treatment, such as a tracheostomy — making a hole in the throat to allow the person to breathe.
Having severe reactions to different antibiotics can be a serious problem, as today’s writer mentions, because doctors may be limited in their ability to treat severe infections in such people. It is sometimes possible to desensitize a person who is severely allergic to penicillin or another antibiotic by administering increasing doses of the antibiotic first by injection under the skin, then by intramuscular injection, and then intravenous injection. However, this is a very risky procedure that can only be done in a hospital setting with an IV running and the equipment to do a tracheostomy and render life support immediately available. In other words, one would only try to desensitize someone if she were suffering from a severe infection that required the use of a particular antibiotic. I am not aware of any doctors trying to desensitize someone to antibiotics in advance, simply to reduce her allergy.
Desensitization, however, can be done for people allergic to bee stings, using tiny doses of purified venom. Such a process should only be attempted by an expert, since the attempt at desensitization itself may provoke an anaphylactic reaction. Indeed, even testing for penicillin allergy by doing a simple skin test has been known to provoke anaphylaxis. Such testing is therefore not common in this country, and most doctors will prefer to simply avoid using an antibiotic to which a person is known to be allergic.
The daughter of today’s writer should certainly be under the care of an allergist, and should discuss the possibility of being desensitized to bee and wasp venom with him or her. The allergist can also prescribe one of the small portable preloaded syringes of adrenalin, which she should probably carry at all times when she is outdoors or in a location where she might get stung. Her other allergies to cats, dust, etc. can be treated by standard means, which might include desensitization if her allergist agrees.