Allergies

In past posts I have mentioned being allergic or intolerant to various medications. I wanted to explain a bit about what that means and what the difference is between an allergy and an intolerance.

The definition of an Allergy:

a damaging immune response by the body to a substance, especially pollen, fur, a particular food, or dust, or medication, to which it has become hypersensitive.

The definition of an Intolerance:

abnormal sensitivity or allergy to a food, drug, etc.

Since that may not be clear, an allergy is an immune response and is usually measured by anaphylaxis, rash/hives, difficulty breathing, or swelling. There are many ways allergies can present, but there is a focus on the most prevalent.
An intolerance is an unusual adverse reaction that deems the patient unable to eat or take a specific substance.
For example, an intolerance to Advil could be a severe stomach bleed. It may not be considered an allergy, but if a patient is susceptible to this reaction several times over then they are advised not to take that medication.

An allergy is considered more severe and/or life-threatening, while an intolerance can be milder. With that said, an allergic reaction is not necessarily life-threatening and an intolerance can be life-threatening. It simply depends on the situation.
Good and confused now?
Great!

Sometimes, if a patient has an intolerance to medication or even an allergy to medication that is considered to be a mild reaction, if an infection or issue is especially severe, they may be asked to take it (with an antihistamine).

I have several allergies and intolerances.
They started within the first few months of being diagnosed with Ulcerative Colitis.

I was placed on Pentasa first. It is a 5ASA medication (related to Aspirin) and a common medication for inflammatory bowel diseases.
Within the first 3 doses I became severely ill and was hospitalized with severe pancreatitis.

The next was Salofalk - another 5ASA - same reaction.

Then we tried Immuran.
Hospitalized with severe Pancreatitis again.

6MP. Same story.

So we resorted to Prednisone on and off for several years along with Methotrexate.
Nothing could control the UC, which is why I wound up with an emergency surgery to remove my large bowel.

Over the years I have had some pretty major (and some strange) reactions, including the pancreatitis. With the Pentasa, the pancreatitis reaction was initially called an intolerance. Once I had several hospitalizations for pancreatitis as a reaction to various medications, it is now deemed an allergy.

Ampicillin - full body rash/hives
Gentimycin - full body rash/hives (one dose)
Erythromycin - full body rash/hives (one dose)
Biaxin - full body rash/hives
Cymbalta - pancreatitis

Remicade - severe swelling. This occurred before I was diagnosed with Hereditary Angioedema. Now that I have that diagnosis, we have found that biologics severely exacerbate my HAE and causes severe swelling. This particular reaction would be an intolerance, because it is not an immune response (Benadryl or epinephrine will not reduce this reaction or help). We have tried to use benadryl several times with biologics with no improvement on the swelling.

Simponi - instantaneous throat swell

Enbrel - body swelling

Humira - body swelling

Cosentyx - body and moderate-severe throat swelling

Cimzia - body and moderate-severe throat swelling

Toradol (related to Advil/Aleve etc...) - severe stomach bleed.
Oxycodone - severe stomach bleed. (These two in particular account for one of THE most frightening situations I have ever been in. Writhing in pain with 7 nurses in the room trying to get things under control and prevent me from dying).
Percocet - stomach bleed.

The Hereditary Angioedema confounds the issue of allergic reactions. A throat swell reaction could be either an allergy or an triggered HAE attack. The problem of not knowing is that a shot of epinephrine could actually make an HAE attack worsen. If an antihistamine is given and does not work, then it is a clear sign that it is an HAE attack... but when your throat is swelling up to the point where your breathing is affected, do you really want to wait to find out which is which?

I also have major reactions to both Caffeine and Chlorine, and a severe intolerance to Star Anise (and Jägermeister).

The reactions to both caffeine and chlorine is improved by taking an antihistamine. They both result in some hives in small doses and a throat swell in large doses. So I stay entirely away from caffeine (unless it is in one of my medications that I cannot avoid, in which case I chase it with an antihistamine). Chlorine is nearly impossible to avoid (unless I decide to bathe in lake water all year-round or in expensive filtered bottled water). I am also a water-baby and love to swim - AND swimming helps reduce my joint pain - so any time I want to go swimming I simply take an antihistamine and limit my swimming time to 20 minutes or less, and only go once every few months. 

With Star Anise and Jäger I have had instant vomiting reactions with blood. Even in accidental exposures and several times over.

With so many odd reactions, strange allergies, a disease that gets triggered by entire classes of medications, and various intolerances, no wonder it has been difficult finding medications that work!

Plus, even though I do carry an EpiPen for my allergies, I also know that using it could cause a severe throat swell due to HAE. Luckily I have never been in a position where I needed to use it... but it sits there in my purse as always.

Now with this new adverse reaction of migraines to prednisone/cortisone, I am pretty worried that another anti-inflammatory medication may be cause for concern.
With all of these allergies it also makes natural products even more elusive. We often do not know all of the ingredients, or may not recognize the familial ingredients. For instance, star anise is related to fennel. Aspirin is acetyl-salicylic-acid (ASA), which originates from Willow Bark - so anything with willow bark or salicylic acid (or any derivative) is a no-go. This means many natural remedies, many skin-care lines, and over-the-counter medication. Caffeine is also in many skin-care products and is found in various foods and natural products.

It is an interesting labyrinth navigating with so very many substances to watch for.