Wednesday, June 07, 2006

Allergic Reactions to Antibiotics

The very first thing I want to say here is: I'm not a doctor, and I don't play one on TV, and I have absolutely no medical training, and would never DREAM of giving anyone medical advice.

Disclaimer done.

What I CAN do is describe some of what happens with me when I have an allergic reaction to an antibiotic, and repeat some of the medical info I THINK I've learned, which is quite likely to have inaccuracies. And I mean that very seriously.

And please remember, the following may sound scary - but the chances are very good these days that you won't be reacting for long enough to have the icky things happen. Modern medical folks take one look, know what's happening, and instantly give you a little adrenaline/Benadryl cocktail - steroids and antihistamines - so fast you'll scarcely remember what your allergic reaction felt like. For real. So be cautious - that's good - but don't let the risk stop you from treating an infection.

When you go into that allergic state of being, all sorts of different things can happen. The release of histamine that occurs sets off a powerful chain reaction of events. There are (supposedly) four basic types of allergic reaction, and reaction to drugs is one of those types, all by itself.

Itching is perhaps the most universal symptom. Red rashes and/or red bumps (hives), huge blue-ish white conical shaped things called angioedema, perfectly ordinary looking skin, eyes, nose, what-all - it ITCHES. So bad it can drive you insane. So bad, I often wake up with little bloody scratches on my face, from scratching myself bloody in my sleep.

Another time, during allergy testing - where they scratch allergens into your skin to see if you make a red bump, saying *yes I'm allergic to this one!* - I was given a test for histamine itself. As a control, I was told. My response was extreme, and I almost immediately reached under my t-shirt and scratched my back so hard I peeled off a foot-long strip of skin.

You may get a swollen area in your arm, or wherever, that's not a rash or hives, just a swollen area. It's usually red and itchy. This is particularly true if you have IV antibiotics. The swelling will be around the place the IV goes in your arm.

Your heart may race, and you may feel strange. Shaky and scared. Clammy sweats. Light-headed, foggy, distant, feverish. Sound may disappear or seem far away. You may have a strange combination of heightened awareness and a sort of mental separation from your surroundings, almost a dissociation.

Your airways often constrict, in different ways. Spasming (e.g., bronchospasm) - is a sharp, fast, clenching shut you may feel as a stabbing pain, especially when you try to breathe deep. Or, tissue just swells up as it fills with fluid. This is an asthma reaction, and you may hear yourself wheeze - the docs call it *music* when they listen to your lungs.

Your throat may also swell and/or spasm. It can happen so fast and so hard that even very good docs can't get a tube down your throat to keep you breathing. They'll have to do a tracheotomy, make a little cut in your neck to get the tube in that way.

You may produce mucous, and in your lungs, it'll rattle. You'll cough and may bring up clear fluid when you do. The mucous of an allergic reaction is clear. If it's from an infection instead, it's usually cloudy or colored.

Your airway can also be affected by your vocal cords misbehaving, twitching open and shut when you're not actually talking. Or worse - staying shut.

Your nose may run, copiously, and your eyes water and redden. A sensation of fluid moving around deep inside your ears may happen. Your voice may change and your throat may feel scratchy. As your nose and sinuses drain mucous, you may feel it in the back of your throat: *post-nasal drip.* It makes you want to clear your throat, or cough. It's also so nasty that you can get nauseous from it. One doc described it to me as a slow constant drip of battery acid. It can cause acid reflux disease, big time.

The most recent antibiotic allergy I had - which is probably most relevant in the context of current medical knowledge and protocol - was when a certain fool of a doctor gave me not one, but two doses of Levaquin in May, 2004.

His name, by me anyway, is Dr. Numbnuts. It's a play on his name. Naturally, after thinking it was an original joke, I found out the entire SoFL medical community calls him that. He's triple board certified - his associate MD's have told me how brilliant he is. I tell them some of what he did and say, All the brains in the world are useless if the fool's got no common sense. Let him do research if he's so smart. Keep him away from actual humans. He's tormenting defenseless sick people, and one day he will kill one.

The IV antibiotics for MRSA are ones you may hear are very restricted. They are very strong, and if the population develops resistance to them, we're sunk.

They're also quite toxic to humans.

So they try to give you enough to kill the germs, but not enough to kill YOU.

A good job includes this: A culture of the actual germ you're dealing with, and then a sensitivity test.

They take a sample of your germs. If you have, say, pneumonia, they get you to cough up lung crud. In that crud is lots of germs. They get a little petri dish - that's a glass dish with a glass lid they use in labs. They have special Germ Food in the petri dish, and smear your sample on it. That way, the germs prosper and multiply. Good. They want to get a lot of germs to run a sensitivity test.

That test means they put various antibiotics in with those germs they've raised. Using several separate dishes, one for each med, they see which antibiotic(s) kill that germ the best.

Then, they give you that antibiotic.

But first and foremost and almost always, with MRSA, you start off on Vancomycin as the little germ farm is breeding away.

Later, they'll add other antibiotics to make a *cocktail.*

That's when I got the Levaquin. It was after they admitted me, but before the sensitivity test was done.

They time these very carefully, and don't put them in your IV at the same time. They also use so much antibiotic it can take maybe an hour to get it in you.

Several hours after my morning Vancomycin they did a dose of Levaquin. As they often do with me, they infiltrated the vein too - so the IV needle went back out the other side of the vein, instead of landing inside the vein. I'm a *hard to stick* patient. Tiny little veins that don't cooperate.

That causes swelling and redness. They have to pull it out and start over.

So at first, the irritated fool nurse didn't want to listen when I said, Infiltrated yes, but ALSO allergic!

The differences were: it wasn't just a swelling, but a pretty hard one to the touch; much redder than usual; warm; and it ITCHED like crazy. Also, it continued to swell. An infiltration swelling is just from the juice going from the IV into your tissues. Once they remove the IV the swelling pretty much stops. An allergic swelling is the histamine telling your body fluids to leak copiously into that IV area - and it may keep swelling all up and down your arm.

The thing to remember is that when it's an IV, as opposed to a pill, it can be much worse because you're getting a big bunch of it very quickly. A pill has to be dissolved and absorbed, right?

So if you're getting IV antibiotics, and you're not sure if you're allergic to them, it's PERFECTLY reasonable to ask that a nurse or the equivalent SIT with you for a little while. To keep an eye on you, and see what happens. In fact, in many places, it's a requirement.

I'm sure I've left off some very common other symptoms. But I did want to post this tonight, so maybe you can look the other way, if I did.

And remember, again, these are some of the most extreme symptoms that can occur. Everybody's a little different, and so is every allergic reaction. So I'll repeat this again: Just have a little awareness and you'll be fine. To let the risk of allergy hold people back from taking antibiotics is a lot riskier than taking the meds.


pepektheassassin said...

My third son had an allergic reaction to the anasthetic when he was about two and had his tonsils out. He was seeing things jumping all over his bed and tried to catch them, was laughing at some spooky cartoon only he could see. He'd push me away with one hand, clutch at my neck with the other and cry, "Where's Mommy?" Man, was that ever a weeird experience!

k said...

Lord yes! I didn't mention anything about hallucinations because I haven't heard about them as allergic reactions very often.

But I had a killer one last summer after being bitten by what I believe was a brown recluse spider.

Your sone seems to have taken it in stride.

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Antibiotics for Allergies said...

Do antibiotics help with allergies?

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