ER Visit-then found out meds givin had nut warning!!

[anxious]

So my 3 yr old who get's bronchitis bad got it bad last night and so we took him to the ER. There i told his of his peanut/tree nut allergies. They then gave him Albuteral but didn't help. So then they gave him an 1 hr treatment of Albuteral with Atrovert. his breathing did fine but his heartbeat was racing and his face turned bright red-flushed. he could not sit still. The doc said that with the hr of the steriod that the racing heartbeat was normal and kept us for another hour. Then i go home to read about the Atrovert only to find out it has a peanut warning. I went numb. Thank God nothing happened to him, but shouldn't the doctors have known this!!!  he tends to get bronchitis a lot and unfortunately we end up in urgent care or ER several times a year. Im now praying it doesn't happen again and fearing if i can ever trust the meds he gets from doctors in the ER.

[anxious]

Atrovent is the name of the steriod.

[gufyduck]

For some reason I *think* the atrovent and peanut allergy issue is only for inhalers, not nebulizer solution.  If I remember correctly, it is something in the propellant of the inhaler that is peanut derived, not the medicine itself.  The nebulizer meds are propelled by air (or oxygen in the ER) so it wasn't an issue. 

Also, a racing heart is a very common and well known side effect of albuterol.

[Carefulmom]

Atrovent is not a steriod; it is a bronchodilator, like albuterol is.  Any idea why they gave him atrovent and not albuterol?

[Linden]

Hello, everybody, I am new here. 

I can't comment on the Atrovent but I have suspected for a while that the Albuterol nebulizer does produce color changes in my DS (now 23 mos).  I've seen flushing and paleness.  The color changes will go on throughout the day - not just right after the neb. It also gives him a racing heart and makes him a little shaky if he's been on it for a few days.  But he doesn't seem bothered by any of it. 

I am really sorry to hear of your night trip to the ER.  Those are really not fun at all. I hope your son's Bronchitis clears up and never comes back. 

[twinturbo]

Ipratropium and ipratropium/albuterol metered dose inhalers (Atrovent and Combivent); contain the phospholipid soya lecithin, a legume related to peanuts, as a suspending agent. Anaphylactic reactions have occurred in patients with allergies to peanuts or soybeans who have received Atrovent. Soya lecithin is only used in the Atrovent and Combivent inhalers; the nasal spray and nebulized solution do not contain phosphatidylcholine, phosphatidylethanolamine, and phosphotidylinositol.(the phospholipids extracted from soybean oil that formulate Soya Lechtin)

Is this what it's based on? If so, then it's overlapping soy lecithin to peanut because it's a related legume. I don't know fwiw, I'm asking.

[rebekahc]

Yes, twinturbo, that's what I've always heard.  For some reason the soy component in the Atrovent inhalers has caused reactions in some PA people.   

[Carefulmom]

Yes, twinturbo, that's what I've always heard.  For some reason the soy component in the Atrovent inhalers has caused reactions in some PA people.   

So it has caused reactions in pa people who are also allergic to soy or in pa people who are not allergic to soy? 

[rebekahc]

That's what I can't seem to find out.  I've searched and all the mention I can find is of people with confirmed PA - nothing said about soy allergy, but I presume that if they were known to be soy allergic their soy allergy would have been blamed for the reactions rather than their PA.

Most of the references I can find WRT Atrovent and peanut allergy date from 1998-2002.  It may be that when inhalers were redesigned a few years ago to eliminate CFCs, that they removed the soy component.  I found the pharmacist insert from Atrovent Inhalation Aerosol dated 2002 that lists soya lecithin as an ingredient.  All the "new" info I can find is for Atrovent HFA (post-CFC removal??) and there is no mention of soy in the ingredients (dated 2008) nor is peanut allergy listed in the contraindications section as it was on the 2002 insert.

[Janelle205]

I am only soy allergic, not PA, but I take an Atrovent inhaler pretty regularly and have never had any problems.  My newest box says nothing about soy in the inactive ingredients.  Note: My soy allergy is mild, and I can eat soy lecithin.

However, there is a recommendation that I could find online to avoid using a Combivent inhaler (albuterol and ipratorium bromide - the active ingredient in Atrovent) for people with PA and soy allergies.  However, I can't find any warnings regarding Combivent nebulizer solution.

[nutless]

Wow, that is really scary. I know it took me years to even think about pn being in medicine. Should this thread go in the specific food allergy section too? I would hate to see it buried and for someone to get sicker!!!

[rebekahc]

nutless, Atrovent Inhalation Aerosol is listed on the unusual or unexpected peanut list. 

I'm not sure we need to add anything more to the specific allergy section because I'm not convinced it's still a problem.  It looks as if they have replaced the Atrovent Inhalation Aerosol (inhaler) with Atrovent HFA (inhaler) which does not have a peanut warning and does not contain soy.  The Atrovent Inhalation Solution (nebulizer med) has always been safe.

ETA:  Looks like all CFC propellant inhalers were phased out at the end of 2008.  After December 31, 2008, only HFA inhalers were allowed by the FDA.  So, there shouldn't be any Atrovent Inhalation Aerosol (with soy lecithin) left on the market now almost three years later.

[Mfamom]

I concur that the problem was with inhalers. 
A couple years ago, they wanted to give my ds atrovent via nebulizer in the er when he had pneumonia, but I wouldn't let them.  I spoke with allergist and did some research and realized the problem was inhaler, not nebulizer solution. 

[CMdeux]

That's what I'm thinking, too, R.

It's still listed in DD's Medic-Alert file, just as it has been since 2002, but I doubt that it's relevant info at this point in time.

[maeve]

That's what I can't seem to find out.  I've searched and all the mention I can find is of people with confirmed PA - nothing said about soy allergy, but I presume that if they were known to be soy allergic their soy allergy would have been blamed for the reactions rather than their PA.

Most of the references I can find WRT Atrovent and peanut allergy date from 1998-2002.  It may be that when inhalers were redesigned a few years ago to eliminate CFCs, that they removed the soy component.  I found the pharmacist insert from Atrovent Inhalation Aerosol dated 2002 that lists soya lecithin as an ingredient.  All the "new" info I can find is for Atrovent HFA (post-CFC removal??) and there is no mention of soy in the ingredients (dated 2008) nor is peanut allergy listed in the contraindications section as it was on the 2002 insert.

They could be PA folks like my DD who tests postive (both SPT and RAST) to soy but who is not allergic to soy.  She eats it (though she's not had tofu or edamame).  She tests positive because she tests so highly for peanut.  Dr. Wood said that he's found in his practice that PA folks who test highly and also test positive for soy are not allergic if the difference in the RASTS between peanut and soy is greater than 50 (which it is in DD's case).  It's a cross-reactivity in the testing.