Rare Allergic Drug Reactions | DORIS MANFORD BPharm, PharmD | RxEconsult

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Rare Allergic Drug Reactions Category: Allergies by - July 23, 2013 | Views: 33292 | Likes: 1 | Comment: 1  

Allergic reactions are the body’s natural way of responding to an invader. The invader could be food, drug, a chemical or a component of a substance. An allergic reaction could be as minor as a simple rash or could be as serious as death. The best way to deal with an allergy is to prevent it from happening.

The most common allergic drug reactions include penicillin, cephalosporin, and sulfur allergies. However, there are some serious but uncommon cross sensitivity drug allergic reactions. Here are some of them.

Atrovent Inhalation Aerosol and Peanut Allergies

Soy Lecithin is the propellant in Atrovent inhalation aerosol. This propellant is made from soybeans and patients who are allergic to nuts or soy have a cross reactivity to the propellant in Atrovent. The active ingredient ipratropium is also known to cause some serious allergic reactions such as difficulty breathing and unexplained swelling of the tongue unrelated to nut allergy. Other formulations that do not contain the propellant can be used for patients with nut allergy

Alternative Option: Atrovent Inhalation Solution

Propofol (Diprivan) and Soybean or Egg Allergy

Propofol is a sedative-hypnotic usually used for induction of anesthesia. It is marketed as oil in water emulsion using soybean oil (10%), and egg lecithin (1.2%) as the emulsifying agent. Patients with soy bean allergy may develop an allergic reaction within minutes of receiving propofol.  Patients with egg allergy may experience a cross sensitivity reaction to lecithin.

Alternative Option: Other anesthetics

Drug Allergic Reactions

Inactivated Influenza Vaccines and Egg Allergy

Some of the currently available influenza vaccines are prepared by means of inoculation of virus into chicken eggs. Advisory Commission on Immunization Practices (ACIP) has reviewed the use of influenza vaccines for persons with a history of egg allergy recently. For the 2011–12 influenza season, ACIP recommended that persons with egg allergy who present with only hives can receive the vaccine and should be monitored for at least 30 minutes. Patients with more serious allergic reactions to eggs, such as hypotension and respiratory distress, should consult a physician with expertise in management of allergic conditions.

Alternative Option: Flucelvax

Warfarin and Dye Allergy (D & C yellow No 6 and 10 Aluminum Lake)

Warfarin tablets, except for the 10 mg dose, contain a dye and patients with dye allergies should be counseled appropriately. Patients with allergic reactions to dye may have a cross sensitivity reaction with warfarin.

Alternative Options: Warfarin 10 mg is dye free; other anticoagulants if appropriate (e.g., Pradaxa, Eliquis, Arixtra, Xarelto)

Flucelvax and Latex

Flucelvax is an inactivated vaccine indicated for active immunization for the prevention of influenza disease caused by influenza virus subtypes A and type B contained in the vaccine. Flucelvax is a suspension for injection supplied in a 0.5 mL single-dose pre-filled Luer Lock syringe. The tip caps of the pre-filled syringes may contain natural rubber latex which may cause allergic reactions in latex-sensitive individuals. Other pre-filled flu vaccines that may also have a cross reactivity to latex include Agriflu, Fluarix, Fluvirin, and Fluzone.

Alternative Options: Afluria

Glucosamine Sulfate and Shellfish

Glucosamine sulfate is a dietary supplement derived from chitin. It stimulates proper joint function, and helps with bone diseases such as arthritis.  Some glucosamine sulfate supplements are made from the shells of seafood such as  crabs, lobster or shrimp. Patients with shellfish allergy may have an allergic response glucosamine. There is controversy whether shellfish allergy is due to the actual meat and not the shell. Some sources also refer to this cross reactivity as a precaution and not a contraindication. In all cases, providers should exercises clinical judgment on a case-by-case basis.

Alternative Options: Prescription arthritis medications

Carbapenems and Penicillin allergy

Carbapenems are parenteral antibiotics used in a hospital setting. It include drugs such as meropenem, ertapenem and doripenem. They have a structural similarity with penicillin. They both have a beta lactam ring and act on bacterial cell wall. Studies have shown more than 50% cross sensitivity to carbapenems in patients with penicillin allergy.

Alternative Options: Depending on the microorganism fluoroquinolones (ciprofloxacin, levofloxacin) may be used.  

Progesterone and Peanut

Progesterone is a hormone used for the prevention of uterine hyperplasia; an adjunct in female infertility treatment; and abnormal uterine bleeding. Oral dosage forms of progesterone contain peanut oil and should not be taken by patients with peanut allergy. Brands such as Prometrium, Crinone, Prochieve have a contraindication for peanut allergy.

Alternative Option: Medroxyprogesterone may be considered if appropriate.

Aztreonam and Beta lactam Allergy

Aztreonam is increasing gaining popularity as the safer alternative when it comes to Penicillin allergy cross sensitivity. Aztreonam however is a beta lactam and certain patients may be allergic to the beta-lactam ring.  The product package insert has a warning of potential cross sensitivity reaction with beta lactam allergy, even though this reaction is very rare. Thus depending on the specific allergy that a patient has, aztreonam may not be safer alternative for patients with penicillin allergy.

Alternative Options: Other drugs with activity against gram-negative bacteria include fluoroquinolones (levofloxacin, ciprofloxacin) and aminoglycosides (tobramycin, gentamicin). 

Aspirin and Yellow No 5 dye (Tartrazine)

Tartrazine or yellow #5 is a common additive in many foods. About one-third of patients who are allergic to this dye have a cross sensitivity reaction to aspirin and other Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Patients who have tartrazine allergy should be monitored carefully for cross sensitivity reactions.

Alternative Options: Acetaminophen for mild pain or fever; Plavix for stroke or heart attack prevention

Preventing Cross Reactivity

Allergic reactions can be an emergency medical condition. Patients should call 911 immediately. Patients who have previous episodes of serious allergic reactions should always have Epipen and be counseled appropriately on how to use it. Patients with allergies should let all healthcare providers know about their allergies and wear medical alert bracelets. The best way to prevent allergic reactions is to avoid triggers. 


Byung-Chul et al, 2012. A Case of Propofol-Induced Oropharyngeal Angioedema and Bronchospasm Allergy Asthma Immunol Res. 2012 January; 4(1): 46–48. Retrieved from www.pubmed.com on July 16, 2013.

CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011;60:1128–32.

Flucelvax product information.

Institute for Safe Medication Practices (ISMP). Medication Safety Alert- Acute Care Atrovent Inhalation Aerosol and peanut allergy. From the October 21, 1998 issue retrieved from www.ismp.org.

 www.micromedex.com accessed on July 15, 2013.


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