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Many patients experience adverse reactions to medications. Only a small percent of these reactions, however, are true allergic reactions. An allergic reaction means the patient’s immune system is programmed to recognize a certain medication and produce a specific reaction whenever it encounters that drug. The most potentially severe allergic reaction to a drug is anaphylaxis. This happens when the patient, unknowingly, has a large amount of an allergy protein (called IgE antibody) in his or her body specific for a drug, such as penicillin. Common Medications Can Have Major Side Effects It is essential to know exactly what medications you are taking, how to take them and what the potential side effects can be. This advice is especially true for older adults with allergies or asthma. Asthma Medications There are times when a medication can be very beneficial for one ailment, but has the potential to cause concern for another condition. Such is the case with inhaled corticosteroids (ICS), one of the most effective classes of medications used to treat asthma. On one hand, ICS are the most effective class of drugs in the treatment of asthma. On the other hand, corticosteroids can contribute to the development of osteoporosis, a condition leading to brittle bones, especially in older women. In most cases, physicians believe the benefits of ICS far outweigh the potential downsides. First, uncontrolled asthma puts you at a high risk for complications requiring hospitalization. Also, if your asthma is uncontrolled, chances are you aren’t sleeping well and exercising is difficult. Reduced levels of activity can also cause osteoporosis. An allergist/immunologist, often referred to as an allergist, has extensive training in the management of asthma and in minimizing the side effects of medications such as inhaled corticosteroids. Your physician can weigh the risks of osteoporosis with the risks of asthma, and may prescribe medications to counteract osteoporosis or order bone density testing. Your physician may also suggest things you can do to reduce your risk of osteoporosis. Regular exercise and dietary supplementation with healthcare practitioner prescribed calcium and vitamin D are good ways to reduce the risk. Allergy Medications Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis and urticaria (hives) are common problems and often require the use of antihistamines. This medication is divided into two classes: first generation antihistamines and second generation antihistamines. First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common in people being treated with certain antidepressant medications. The second generation antihistamines tend to cause fewer side effects. Triggering Asthma Beta-blockers are drugs typically used to treat problems such as high blood pressure, heart disease and migraine headache. They may also be used in an eye drop form for treating glaucoma. Beta-blockers are classified in one of two groups: non-specific and specific. Non-specific beta-blockers, such as propranlol, are known to trigger asthma symptoms. Yet beta-blockers can be very important preventative care medications. Your physician may conduct a trial using a “specific” beta-blocker. Remember that even beta-blockers in eye drops can make asthma worse, so be sure to tell your ophthalmologist if you have asthma. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) include some common over-the-counter pain relievers, such as ibuprofen and naproxen. Approximately 10% to 20% of people with asthma may notice that one or more of these drugs trigger their asthma. These asthma attacks may be severe and even fatal, so patients with known aspirin sensitivity must be very careful to avoid these drugs. Pain relief medications that usually don’t cause increased asthma in aspirin-sensitive patients include low-to-moderate dose acetaminophen, propoxyphene and prescribed narcotics (such as codeine). ACE inhibitors, which may be used for hypertension or heart disease, include lisinopril and enalapril. Although they usually don’t cause asthma, approximately 10% of patients who receive one of these drugs develop a cough. This cough may be confused with asthma in some patients and possibly trigger increased wheezing in others. The bottom line in avoiding medication-induced asthma is to talk with your physician about what medications are best for you.

For most people, an insect sting means a little pain and discomfort. But some people may have trouble breathing or itch and have hives all over their body after being stung. These people are allergic to insect stings. This means that their immune system overreacts to the insect’s venom. Most allergic insect sting reactions are caused by five kinds of insects:   Yellow jackets   Honeybees   Paper wasps   Hornets   Fire ants For people who are very allergic to an insect’s venom, a sting may cause a dangerous allergic reaction called anaphylaxis (an-a-fi-LAK-sis). Signs of anaphylaxis include:   Itching and hives over a large part of the body   Swollen throat or tongue   Trouble breathing   Dizziness   Stomach cramps   Nausea or upset stomach   Diarrhea If you are allergic to insect stings, you can reduce your risk of having an allergic reaction by staying indoors during insect season and always carrying autoinjectable epinephrine. You can also talk to your allergist/immunologist about receiving immunotherapy, which can protect you the next time you are stung by an insect.

People with food allergies have an allergic reaction when they come in contact with certain foods. This happens because their immune system overreacts to the proteins in that food. Eight kinds of food cause most food allergies:      Cow’s milk     Eggs     Peanuts     Wheat     Soy     Fish     Shellfish     Tree nuts  Signs of a food allergy include:     A rash, or red, itchy skin     Stuffy or itchy nose, sneezing, or itchy and teary eyes     Vomiting, stomach cramps or diarrhea     Angioedema or swelling  Some people with food allergies can have a serious reaction called anaphylaxis. Signs of this kind of reaction include:     Hoarseness, throat tightness or a lump in the throat     Wheezing, chest tightness or trouble breathing     Tingling in the hands or feet, lips or scalp

Allergy is defined as a “harmful, increased susceptibility to a specific substance,” also known as hypersensitivity, while immunity is characterized as a “protective, enhanced resistance.” The American Academy of Allergy, Asthma & Immunology has an array of resources about allergic disease to help you understand how your allergies affect you, your friends and family. Skin Allergies Red, bumpy, scaly, itchy or swollen skin – any of these signs may mean you have a skin allergy. The most common allergic skin conditions are: Eczema Hives and angioedema Allergic contact dermatitis Symptoms of a skin allergy include: A strange rash Red, scaly or itchy skin A swelling of the deeper layers of the skin, such as the eyelids, mouth or genitals Dry, flaking skin Inflamed or blistered skin Skin allergies are painful and unpleasant, but there are things you can do to treat and prevent an allergic skin reaction. Some people are allergic to latex, a substance often found in rubber gloves and balloons. Signs of latex allergy may resemble those of contact dermatitis. But sometimes latex allergy causes a serious reaction called anaphylaxis. This life-threatening condition requires immediate medical treatment. If you think you are having this kind of reaction, call 911 immediately. Skin allergies can take several forms and have a variety of causes. To find out what is causing your skin condition, talk to an allergist/immunologist – a doctor with special training to manage allergies and asthma. An allergist can also help you develop a treatment plan. Eczema and Atopic Dermatitis Eczema, or atopic dermatitis, is a common allergic reaction often affecting the face, elbows and knees. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of other allergic conditions – such as asthma or hay fever. In infants, eczema usually appears as tiny bumps on the cheeks. Older children and adults often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp. Itching is the hallmark symptom and can sometimes be very intense. Eczema can appear very dry, with flaking skin, or can have lesions that ooze – often a sign of a bacterial infection caused by scratching. Identifying the cause of the itch is essential in relieving the dermatitis. Common triggers include allergens, overheating or sweating, emotional stress, eating certain foods and contact with irritants such as wool, pets, soaps or other agents. Urticaria (hives) Urticaria, also called hives, are red, itchy, swollen areas of the skin that can range in size and appear anywhere on the body. The blotches can migrate on body, appearing in different areas throughout the course of the reaction. Usually, the cause of urticaria is readily identifiable—often a viral infection, or allergic reaction to drugs, food or latex. These hives usually go away spontaneously or by avoiding the allergic trigger. However, in some cases, medical intervention is needed to increase comfort or prevent recurrence. Treatment with oral antihistamines is frequently successful, but in severe cases, steroids may be needed. Some people have chronic urticaria that occurs almost daily for months or, in some cases, years. For these individuals, scratching, pressure or stress may aggravate hives. An allergist/immunologist can diagnosis the problem and prescribe treatments for this bothersome condition. Angioedema Angioedema is a swelling of the deeper layers of the skin and often occurs with hives. Angioedema itself is not red or itchy and most often occurs in the body’s soft tissue, such as the eyelids, mouth or genitals. Angioedema is called “acute” if the condition lasts only a short time (minutes to days) and does not recur. This is commonly caused by an allergic reaction to medications or foods. Chronic recurrent angioedema occurs when the condition returns over a long period of time. Chronic recurrent angioedema most often does not have an identifiable cause. Contact Dermatitis Contact dermatitis refers to a broad range of reactions resulting from the direct contact of an allergen or irritant with the surface of the skin. A reaction usually appears after one to three days. This type of reaction can develop at any time in life. The skin becomes red, itchy and inflamed, and will frequently blister. Poison ivy is the most common cause, but other plants, metals (such as nickel), cosmetics and medications can also cause a reaction. Allergic contact dermatitis can be treated by scrubbing the skin with soap and water after exposure to the allergen and using prescribed antihistamine and cortisone medications, depending on severity. Avoidance of the irritant is the most effective prevention.