Here’s a text only version of my ER Safety Sheet for people trying to access from mobile phones while in the ER:
Severe allergic reactions to corn and corn products, especially corn-derived sugars, starches, and alcohols. (see References at end of document)
Rinse all tubes to remove corn starch before inserting.
SALINE IV ONLY
NO: lactated ringers.
NO: dextrose solutions.
YES: diphenhydramine hydrochloride injection – Check inactive ingredients against list below.
YES: ranitidine hydrochloride injection- Check inactive ingredients against list below.
YES: Rocephin injection WITHOUT dextrose.
- YES: SOLU-MEDROL- methylprednisolone sodium succinate injection, powder, for solution” *preservative free*. No lactose, no benzyl alcohol.
YES: Xopenex or other albuterol-only nebulizer.
NO: ethanol propellants or inactive ingredients from the list at end of document.
Check inactive ingredients of all injections and oral medications and cross-reference with ingredient list at end of document. ESPECIALLY avoid:
modified food starch
Check inactive ingredients/anticoagulants. Many are corn-derived. Please discuss with patient or an advocate if possible before using blood products. If a transfusion is absolutely necessary and the patient does not have other documentation refusing blood products, take necessary measures to prepare for allergic reactions when the products are used.
Wound treatment and disinfecting
Disinfectants: Use only saline or betadine solution that contains only water, povidone iodine, and sodium hydroxide. Betadine solution from Purdue products is one safe product. Isopropyl alcohol may also be used where appropriate. No products containing citric acid, glycerin, Pareth alcohols, or ethanol!
Sutures: NO DISSOLVABLE SUTURES. Use only non-dissolvable nylon or polypropylene sutures. Rinse to remove corn starch.
Local anesthetic: Use only carbocaine or preservative-free lidocaine. No inactive ingredients other than water and sodium chloride!
Wound dressing: Use cotton gauze and kerlix or coban tape. No adhesive bandages or steri-strips.
NO hand sanitizer. Medical staff must wash hands and wear powder-free nitrile gloves when touching patient.
NO paper gowns or bedding. Cloth gowns and bedding only. No disposable paper pads, gowns, or bed covers. If possible, please allow patient to wear own clothes and allow family to provide linens.
NO powdered rubber instruments. Use metal or glass only.
NO disposable thermometers or covers. Only use glass or metal thermometers. If thermometers have been disinfected with alcohol rinse in water first.
Do not touch disposable products to face eyes or mouth. Paper, cotton, wood, or disposable plastic should NOT be touched to mucus
Possibility of allergic reactions to corn-derived sugars:
“Probable anaphylactic reaction to corn-derived dextrose solution.”
Dextrose intravenous solution package insert stating contraindication for those with corn allergies
Additional package insert stating contraindication for corn allergies.
Possibility of allergic reactions to corn starch:
Annals of Allergy: “Anaphylaxis due to cornstarch surgical glove powder.”
Possiblity of allergic reactions to corn-based alcohol: International Archives of Allergy & Immunology: “Corn Allergens: IgE Antibody Reactivity and Cross–Reactivity with Rice, Soy, and Peanut” (Abstract states that corn proteins are soluble in alcohol.)
Allergen Ingredients To Be Avoided
- Acetic acid
- Alpha tocopherol
- Artificial flavorings
- Artificial sweeteners
- Ascorbic acid
- Aspartame (Artificial sweetener)
- Baking powder
- Barley malt* (generally OK, but can be contaminated)
- Bleached flour*
- Blended sugar (sugaridextrose)
- Brown sugar* (generally OK if no caramel color)
- Calcium citrate
- Calcium fumarate
- Calcium gluconate
- Calcium lactate
- Calcium magnesium acetate (CMA)
- Calcium stearate
- Calcium stearoyl lactylate
- Caramel and caramel color
- Carbonmethylcellulose sodium
- Cellulose microcrystalline
- Cellulose, methyl
- Cellulose, powdered
- Cetearyl glucoside
- Choline chloride
- Citric acid*
- Citrus cloud emulsion (CCS)
- Coco glycerides (cocoglycerides)
- Confectioners sugar
- Corn alcohol, corn gluten
- Corn extract
- Corn flour
- Corn oil, corn oil margarine
- Corn starch
- Corn sweetener, corn sugar
- Corn syrup, corn syrup solids
- Corn, popcorn, cornmeal
- Cornstarch, cornflour
- Crosscarmellose sodium
- Crystalline dextrose
- Crystalline fructose
- DATUM (a dough conditioner)
- Decyl glucoside
- Decyl polyglucose
- Dextrose (also found in IV solutions)
- Dextrose anything (such as monohydrate or anhydrous)
- d-Gluconic acid
- Distilled white vinegar
- Drying agent
- Erythorbic acid
- Ethocel 20
- Ethyl acetate
- Ethyl alcohol
- Ethyl lactate
- Ethyl maltol
- Food starch
- Fruit juice concentrate*
- Fumaric acid
- Germ/germ meal
- Gluconic acid
- Glucono delta-lactone
- Glucose syrup* (also found in IV solutions)
- Gluten feed/meal
- Golden syrup
- High fructose corn syrup
- Hydrolyzed corn
- Hydrolyzed corn protein
- Hydrolyzed vegetable protein
- Hydroxypropyl methylcellulose
- Hydroxypropyl methylcellulose pthalate (HPMCP)
- Invert syrup or sugar
- Iodized salt
- Lactic acid*
- Lauryl glucoside
- Linoleic acid
- Magnesium citrate
- Magnesium fumarate
- Magnesium stearate
- Malic acid
- Malonic acid
- Malt syrup from corn
- Malt, malt extract
- Methyl gluceth
- Methyl glucose
- Methyl glucoside
- Microcrystaline cellulose
- Modified cellulose gum
- Modified corn starch
- Modified food starch
- Molasses* (corn syrup may be present; know your product)
- Mono- and di- glycerides
- Monosodium glutamate
- Natural flavorings*
- Pareths – e.g. Pareth 25-9
- Polylactic acid (PLA)
- Polysorbates* (e.g. Polysorbate 80)
- Polyvinyl acetate
- Potassium citrate
- Potassium fumarate
- Potassium gluconate
- Powdered sugar
- Pregelatinized starch
- Propionic acid
- Propylene glycol*
- Propylene glycol monostearate*
- Salt (iodized salt)
- Semolina (unless from wheat)
- Sodium carboxymethylcelluloseSodium citrate
- Sodium erythorbate
- Sodium fumarate
- Sodium lactate
- Sodium starch glycolate
- Sodium stearoyl fumarate
- Sorbic acid
- Sorbitan* (anything)
- Sorghum* (not all is bad; the syrup and/or grain CAN be mixed with corn)
- Splenda (Artificial sweetener)
- Starch (any kind that’s not specified)
- Stearic acid
- Sucralose (Artificial sweetener)
- Sugar* (not identified as cane or beet)
- Tocopherol (vitamin E)
- Treacle (aka golden syrup)
- Triethyl citrate
- Unmodified starch
- Vanilla, natural flavoring
- Vanilla, pure or extract
- Vegetable anything that’s not specific*
- Vinegar, distilled white
- Vinyl acetate
- Vitamin C* and Vitamin E*
- Xanthan gum
- Zea mays
40 thoughts on “Corn Allergy Emergency Room Safety Doc, Text Only Version”
I agree, great resource!! Emergency care is so scary with a corn allergy, it helps to have a list like this to refer to.
I could not get this link to work though: http://www.ncbi.nlm.nih.gov/pubmed/1808842-
Thanks Susan! I had some mangled markup. Fixed now!
This information is vital to the famil of a corn allergy sufferer….
I have a question…
Are the ranitidine and rocephin both medications that you have had and done ok with? I’m just wondering why you put these particular ones on the list. Do you know if there are others that would be options as well?
Thanks for asking these questions. As I state on the disclaimer along the right hand side of the site, I’m not a medical professional and am just sharing the results of my research and the information I am using for myself. I always want people using critical thinking and doing their own research when making decisions about their health!
Injections of ranitidine (zantac, an H2 blocker) and diphenhydramine (benadryl) are the standard ER response to an allergic reaction. For details on why see the end of my post on treating allergic reactions. I have had both, and they at least helped more than they hurt. Hard to say if they also increased my reaction mildly before helping as by the time I had them I was already reacting badly enough to be in the ER. Both of those drugs are on the list because they, or equivalents, are more or less required to treat reactions. I also take these drugs in compounded capsule form to treat reactions at home, and I know that I do fine with the drugs themselves so long as they don’t come with corny fillers or preservatives.
The inactive ingredients for all the varieties of injectable ranitidine and diphenhydramine injection I was able to find on DailyMed look relatively corn free. The “check inactive ingredients” phrase is there in case they happen to have the one random injectable variety that is full of glucose or something.
There’s no common alternative to diphenhydramine (benadryl), but I *have* heard of famotidine (pepcid) being administered as the H2 blocker instead of ranitidine (zantac) before. However when I looked it up on DailyMed, the first injection I clicked on was chock full of corn. So probably ranitidine is a better bet.
Rocephin is an antibiotic, and I haven’t personally had oral OR injected antibiotics in years, thank goodness. When I cleaned my diet up 7 years ago I suddenly stopped getting chronic respiratory and sinus infections. Imagine that. Anyway, Rocephin in particular is on the list due to a number of moms on the Facebook Corn Allergy Group stating that they’ve used it successfully with their kiddos. There are probably many other antibiotic alternatives that could be fine as well. But if you are in a situation where you need a shot RIGHT NOW, that is a name to suggest.
Something important to note about the Rocephin injection is that it is very painful, and is usually combined with a topical numbing injection such as lidocaine. Lidocaine *can* be corny, or not, just depending on what the hospital stocks. You just have to check the package insert every time.
Thanks! I have had diphenhydramine injections in the ambulance and the ER. Like you said, it’s hard for me to say how truly safe they were due to the fact that I was already reacting but they did seem to help.
It’s good to know when certain things work for other people but i also try to do as much research as I can. I always feel like we have to be just as knowledgeable, if not more so, than the medical professionals in order to really be able to advocate for ourselves. So the more info I can gather, the better!
An emergency plan is something that is long overdue for me.
I appreciate all the the work you have done here. It has given me a really good place to start. Thanks again!
No problem. I’m happy that you are doing this kind of thinking instead of just taking my word for it!
Not sure if you’ve seen my main “ER safety” post, but I have a google doc linked from it that you can save a copy of and use as a template to make your own personalized ER doc. My personalized one has my penicillin and sulfa allergy, and has a lot of the “contact” reaction warnings removed because I don’t react to contact as much and don’t want to clutter the page with uneccesary information.
Do you have any additional information on Lactated Ringer’s solution? I was recently in the hospital and was administered this without any noticeable reaction. My sensitivity is much less than others on the Delphi Avoiding Corn Forum, though. I can tolerate medications with corn derivatives, though with a previous surgery I noted feeling awful from head to toe as I was given a Dextrose IV solution. I thought I had done pretty well until I read this resource. Many thanks for posting this.
Sure. 🙂 Lactated Ringer’s is much less corny than dextrose, so it’s no surprise that you did okay. I might even do okay but my reactions are anaphylactic so I’m not interested in chancing it. 🙂 The corn problem is the sodium lactate that gives it the name “lactated” ringer’s. The lactic acid is probably from corn fermentation just as citric acid is, and there’d be no particular way to find that out in an ER type situation. So I just said leave it out. Non-lactated Ringer’s should be okay.
Giving you wikipedia links here but they are easily substantiated via more “academic” sources.
Thanks for all the work you’ve done to help our community and to educate us, and outsiders!
Thanks, girl. Copying and pasting now…hoping to not need any of this information.
Thank you for this document. Now on phone and paper copy in wallet.
Thank you so much for this whole
site! I’ve never concerned myself with a corn allergy until my daughter, now 2, came along. Avoiding corn has been the toughest challenge in my life. This helps!
High Corn allergy girl! Your blog is a lifesaver. I am interested in the article about the possibility of allergic reactions to Corn derived alcohol. The link does not work. Can you give me some guidance as to how I can find it?
Thanks Cathy! I updated the link above, and here it is again: http://www.karger.com/Article/Abstract/24107
Note that this leads to a portal that wants you to pay for the article.
What does the asterisk after some infredianrs mean?
It means the ingredient CAN be derived from corn but is often not. TBH the list itself is not 100% accurate, just a better place to start than nowhere at all, and the asterisks are probably wildly out of date. The source of the list is here, and Jenny did a lot of work putting it together, but hasn’t been able to keep up with it: http://cornallergens.com/
It’s still the best resource we have for a list of ingredients to avoid.
I am extremely corn allergic, and work in the medical laboratory.
I have found that I have to be very careful to check ingredients in ultrasound gels before having an ultrasound done.
Please note that application of ultrasound gels containg corn result in IMMEDIATE anaphylaxis as soon as the ultrasound gel is applied to the skin.
I have had good results by checking the brand and manufacturer of ultrasound gels available at the location where the ultrasound will be performed, then using that information to verify the ingredients of the ultrasound gel with the manufacturer. Make sure the persom you speak with knows that you are allergic to corn, as they may not be able to provide a list of ingredients in their product(s). Of course, this requires planning ahead and checking things out in advance.
Surgi-lube in the past has been safe, check ingredients again if you will be using this product in case ingredients have changed. This product might be an alternative that can be used when advance planning is impossible.
Regarding blood products for transfusion: All donated blood is collected into ACD anticoagulant (Acid Citrate Dextrose). Some red blood cells are frozen in a glycerol solution, with the glycerol removed before transfusion.
ALL blood products including red blood cells, platelets, fresh frozen plasma, and other components made from donated blood are of concern to the corn allergic patient.
Blood products obtained by pheresis, such as platelets, invlolve removing blood, separating out the desired component from your blood, and returning the remaining anticoagulated blood to your body. The pheresis procedure poses a risk to the corn allergic blood donor if the anticoagulant used contains corn.
Plasma expanders, used when blood transfusion is not possible, are made from corn and should be avoided.
Kidney dialysis may be problematic for the corn-allergic individual, depending on the anticoagulant used, and the ingredients in the dialysis solution used. Please check ahead of time just in case.
Please note that both BPA-free plastics and plastics made with a 3-D printer contain corn, making it harder to know if plastic medical/dental products are corn-free.
Glucose Tolerance Testing requires the patient to drink a glucose solution made from corn, and then have one or more blood draws at specified times after the glucose drink has been ingested. Gestational Diabetes is routinely screened by this method. In other situations, the Hemoglobin A1c test has become the preferred alternative.
If a corn allergic person will need to have the glucose solution for the test ordered, please contact the laboratory supervisor at the location where the test will be collected. Explain that you are corn allergic, and ask the lab supervisor to find an acceptable corn-free alternative so that the testing can be performed. This will need to be done in advance, so that the propet dosage of sugar from the selected source can be determined and obtained.
Lactose Tolerance testing can be done by a breath test, or after ingestion of lactose.
Checking with the laboratory supervisor before having this test collected is strongly encouraged.
Please note that paper cups and plates are generally coated with cornstarch; avoid these items if necessary.
I’ve been a Paramedic for 14 years and since my wife is allergic to corn [(her throat swells (called angioedema), but she never gets hives or even itches] I’ve spent extra time looking through the medications we carry on our ambulance. I am able to look at the package inserts that come with most of the medications. What I’ve found is that (at least on our ambulance) any liquid medications contained in a vial (usually given as some sort of injection) are corn free. Any medication we have in pill form [such as aspirin, nitroglycerin tablets, and Zofran ODT (orally disintegrating tablest)] are physically bound together by corn starch. I honestly wasn’t sure about Lactated Ringers until I read the information you posted; it makes sense. I had a gut feeling that it was unsafe for corn allergies. Obviously D50 (Dextrose 50% – used to treat low blood sugar levels) and D5W (IV fluid containing 5% Dextrose) are corn products and should never be used by people with a corn allergy.
D50 and Aspirin are the two big medications that I see the potential to be given to a corn allergic person in an emergency situation and most emergency medical providers are completely unaware of corn’s presence in any medication; you have to, but you have to be your own advocate. The Medic-Alert bracelets are helpful.
For personal use:
My wife has to have her Benadryl (diphenhydramine) compounded. Zantac (ranitidine) 150mg tablets are corn free and can be bought anywhere.
Medications we’ve found to be corn free
BC Headache powders contain both Aspirin and Acetaminophin and both are corn free in this packaging.
Tylenol, Advil, and Motrin LiquiJels are all corn free.
For people with diabetes whose blood sugar may drop, honey is a really good alternative to the prepackaged tubes of cake icing. Some of the packets of honey you put into hot tea are handy to keep in a first aid kit.
Lactated ringers are okay for some people with corn allergy, but I am always writing to the most sensitive audience. They aren’t okay for me, nor are the preservatives in the prefilled saline IV flushes.
I also can’t do the OTC zantac anymore and have to have my ranitidine compounded. At that point it’s not a direct corn ingredient but rather cross contamination in facilities- not things that manufacturers would ever be able to answer questions about if they were even willing. A strong and highly sensitive corn allergy begins to look like chemical sensitivity at a certain point because so many chemicals are so frequently made with corn ingredients.
I have seen some IV meds that have corn derivatives in them- it’s good to know that the ones stocked in your mobile gear are corn free.
In an emergency medical situation I have to be a bit fast and loose with how “corn free” I demand my meds be. It’s a balancing act of making sure I don’t tip myself into anaphylaxis and making sure I don’t die from some other cause. Which is also frustrating because in a medical crisis I’m not necessarily going to be at my best.
If you would like the rundown of how a severe emergency went for me from a patient perspective you can read about my hemolytic crisis and receiving blood transfusions here:
Be advised that now there are IV bags themselves that are made from biodegradable plastic that I believe is corn derived. I was on three times a week iv treatments and had facial swelling really bad when the normal bags were switched to these. Once I refused these bags and went back to the other ones the massive facial swelling didn’t return. They resemble more of a bottle shape than a flexible IV bag.