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Conditions and Diseases > Allergies Forum > Drug allergies and anaphylactoid reactions
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Q: Drug allergies and anaphylactoid reactions
asked by: DoctorQuestion on November 21st, 2008
After surgery, I suffered an allergic reaction. hives, swelling, turned red, throat started to close up. i received 50mg benadryl IV and 10mg decodron(i think) IV. The reaction subsided. My problem is this; I'm not sure what I am allergic to. The only things different I received was 2gm Ancef in the PACU and Fentanyl. I'm guessing it was the Ancef, as I haven't ever really heard of reactions to Fent, except for topical dermatitis around the places people put duragesic patches. I guess I just need my suspicions to be confirmed. I have taken penicillin over the years without any problems, but I do know that allergies can develop over time. So should I consider myself to be allergic to cephalosporins from now on, and avoid penicillins and what have you??


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Dr. Goce Aleksovski , MD
replied on November 25th, 2008
Allergies Answer A4962
Current medical status: had surgery to repair this on 11/11/08
Current medical treatment: motrin, i stopped taking oxycontin about 3 days ago. my follow up visit is next tuesday.


Given your description of hives, swelling, turning red and throat starting to close up, it seems that you might have experienced a medication-provoked anaphylactoid reaction. Without further proof, it is hard to speculate which of the 2 drugs provoked the allergic reaction (whether parenteral fentanyl with only few case reports of allergic reactions, as a less probable provoker, or cefazolin, Ancef®, common to provoke such reactions in people prone to cross-reactive allergies to penicillins and cephalosporins, as a more probable provoker).

In order to find out which drug exactly you are allergic to, you might consult with an allergologist or dermatologist to do risk-free serum ELISA tests to look for blood antibodies against penicillins, cephalosporins and fentanyl, 4 weeks after the day of the anaphylactoid reaction. If these doctors-specialists approve of the next, the second step are the risky skin prick tests with extremely low concentrations of these drugs. Finally, if approved (because of the possible risks), tests with progressively increasing concentrations of the 3 drugs might be performed, with your informed consent, of course. This is the procedure to find out which drug exactly, sensitized you to react in an allergic way.

If not proven by these tests, it might be wise to strictly avoid both penicillins and cephalosporins as well as fentanyl (at least parenterally).





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