Category: Health

Treating Allergic Reactions: Corn-free Benadryl

The go-to drug for treating a severe allergic reaction is diphenhydramine, the active ingredient in Benadryl.  Unfortunately, there is no corn-free version of this drug available off the shelf. Benadryl dye-free liquigels contain sorbitol from corn. Benadryl children’s liquid formula contains glycerin and sucrose from corn. Many generic store-brand versions of Benadryl, such as Wal-dryl, contain corn starch.  All of these are derivatives that would send me to the hospital, especially if I were already reacting when I took them.

The only way to get truly corn-free Benadryl at this time is to get it made specially for you by a compounding pharmacy. This isn’t a post on how to do that, but there is a very nice blog post on getting medications compounded on the News For Corn Avoiders blog. Here are my additional notes on compounding medications and here is some advice on finding a compounding pharmacy.

Another possibility, though it requires a prescription, would be to get a prescription for an injectable version of Benadryl, and then drink it.This is an off-label usage but I am told it works just fine and will be relatively corn free. (It is in water though so if you react to some waters it may not be 100% safe for you.) Always check ingredients. There are probably several versions of the injectable Benadryl and all of them may not be corn free.

When I got my first Benadryl prescription compounded, I spent 30 minutes on the phone with the pharmacist deciding on ingredients used in my prescription. The pharmacist assured me that the microcrystalline cellulose they used for a filler in capsules was corn free. It was not. I got $50 worth of pills I reacted to worse than the corny off the shelf meds, and they wouldn’t take them back or give me my money back. I had very very recently gotten much more sensitive to corn products at that time, and was reacting constantly so feeling very sick and muddled while trying to hold down a full time job, and just did not have the mental energy to get it done right. I just gave up on getting medications compounded.

But I had to have something for reactions. Fortunately, I was still able to take one version of over the counter Benadryl and have it do more good than harm. While I am not *the most* sensitive corn allergic person in the world, I am pretty sensitive, and my reactions are pretty dramatic. However there are some derivatives I react to less than others.

This stuff has *lots* of corn ingredients, but for me the derivatives are ones that don’t cause huge reactions:

Alka-Seltzer Plus Allergy. Active ingredient: diphenhydramine hcl 25mg. Inactive ingredients:  croscarmellose sodium, D&C red #27 aluminum lake, dibasic calcium phosphate dihydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, talc, titanium dioxide.

I also found this”sleep aid” which is actually benadryl- the inactive ingredient, diphenhydramine, and the dosage, 25mg, is the same ingredient and dosage as benadryl.

Walgreens Sleep II Nightime Sleep Aid. Active ingredient: diphenhydramine hcl 25mg. Inactive Ingredients: Croscarmellose Sodium, Dicalcium Phosphate, FD&C Blue #1 Aluminum Lake, Magnesium Stearate, Microcrystalline Cellulose, Silicon Dioxide, Stearic Acid


Both of these products still have  a number of ingredients that could be (and often are) from corn. I’ve bolded them. They are definitely *not* corn free. It is the same drug as Benadryl, just a different brand. When I was VERY desperate, I was able to take them for reactions and they helped more than they harmed. I would definitely feel some reaction right when I took them, but once they kicked in the antihistamine effect would overtake the reaction. 

Getting compounded Benadryl made a world of difference though- it works faster and leaves me feeling much less hung over. A good portion of the effectiveness of the drug was previously being spent on counteracting the corn in the pills themselves.

But if you are ever in a very bad spot, you may find that there are some versions of the drug off the shelf that you can tolerate enough to help you out when you are reacting severely.

Note that which version will work best for you will depend heavily on what derivatives bug you. The liquigels contain sorbitol, so are a bad choice for me as sorbitol in toothpaste sent me to the ER once. Granted the quantity in the liquigels is probably small but I just skipped it because of the toothpaste reaction. Others may do better with that tiny amount of sorbitol versus the inactive ingredients in the product pictured above. Please choose carefully, use good sense, and consult your physician.

For those that are allergic to benadryl (this does happen), another option is hydroxyzine hcl (atarax) or hydroxyzine pamoate (vistaril). Atarax is more commonly prescribed for allergies, Vistaril is more commonly prescriped for anxiety. Both forms help both allergy and anxiety. They also are comparably as strong of antihistamines as benadryl. They do tend to sedate more then benadryl, but not everyone experiences this.  Hydroxyzine is prescription only. You would need to either get it compounded or identify a brand and manufacturer that does not contain corn, or does not contain *much* corn. You can use these instructions for finding the inactive ingredients of medications to try to identify something that might be safe.

ER Safety: Emergency Medical Treatment With a Corn Allergy

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Updated 2/21/2017

Emergency Medical Instructions – For Mobile

Emergency Medical Instructions – Letter size (designed for front and back)

Corn products are in many  medical supplies. In particular, dextrose and glycerin (both usually from corn) seem to be in a number of injected drugs, and those two have in the past caused me severe–even anaphylactic– reactions when they come in contact with a mucus membrane. The last time I allowed a glycerin-based gel to touch my lip, everywhere it touched swelled immediately, and my tongue swelled on that side of my face, all the way into my throat. It was terrifying.

Injections aren’t the only danger, either. Disinfectants, lubricants, preservatives, and disposable  paper products also contain enough corn to give me at least a small problem, if not a dangerous reaction. Even the sugar used to treat dehydration and restore electrolyte balance is corn-based.

Even those without such severe and immediate reactions can and have experienced significant discomfort as a result of corn in medical products. GI reactions, migraines, or rashes may not block off your airway, but they are definitely unpleasant and can still be dangerous.

The idea that someone could kill me while trying to save me keeps me up at night, so I’ve been asking a lot of questions trying to figure out how a medical responder can avoid killing me when trying to save me. I don’t have all of the answers, but I have a plan, and I hope it works.

  1. Wear some kind of medical alert bracelet. I have a MedicAlert brand bracelet, the largest size available, to fit as much as possible, which still isn’t enough. The text reads: TREAT WITH IV SALINE. ANAPHYLAXIS TO LACTATED RINGERS, GLUCOSE,DEXTROSE, SUCROSE, PCN.  (PCN is short for penicillin.) I have a membership so that I can use MedicAlert’s online medical history service but there are definitely other services out there that do similar, and plenty of other jewelry-only type vendors.
  2. Keep a thorough but succinct treatment plan in several places on your person. The document below is my best attempt at this. It is formatted to fit on a letter-sized sheet of paper, front and back. I also want to make small laminated cards to keep in my wallet and a version on an In Case of Emergency app on my mobile phone.
  3. Keep a more detailed medical history on your person and/or an online repository. There are also USB medical bracelets that you can buy and wear.
  4. Consider putting together a hospital bag ahead of time for inpatient stays that contain necessities.

I don’t know how well this will work, but I really hope it will at least keep me alive in a medical emergency.

And, of course, I am sharing what I have so far. The following is a publicly available Google Doc that you can copy to your own google doc and alter as you like. My doc includes notes on what you should change to customize for yourself. And of course it only covers a corn allergy, so if you have other allergies, such as penicillin, that need to be mentioned, it is only a starting point. Here it is:

Corn Allergy Emergency Medical Instructions – Letter size (designed for front and back)

Corn Allergy Emergency Medical Instructions – formatted for mobile

I’ll update here as I get more formats set up for wallet cards and mobile apps.  Different ICE apps have different features, but they all usually provide a widget so that the info can be accessed from the lock screen without unlocking the phone. This is important to me since I have all of my email and social networking accounts hooked up to my phone. While I’m not particularly concerned that an EMT would stop trying to safe me to try to hack into my stuff, I think that my phone could end up in ANYONE’s hands if I were incapacitated.

Note that the document is only meant to cover emergency room procedures- not routine medical care, nor longer term or inpatient procedures. I now have a post about longer hospital visits that is very much work-in-progress.

Dealing with Skeptics

Something that comes up often in any medical situation is skepticism that corn can be the root cause of all the reactions to various chemical derivatives. Rather than argue this in an emergency situation, the following tactics have worked in the past:

  • Claim chemical sensitivity: Say that you react to “preservatives,” “dyes,” and “additives.” People are for some reason more likely to believe that one can have a non-specific sensitivity to these things than that one can be reacting to the corn source of them.
  • Claim multiple sensitivities: For some reason people are more willing to believe that you are separately allergic to citric acid, potassium benzoate, polyethylene glycol, glycerine, and a dozen other ingredients than that you are only allergic to them when they are derived from corn.
  • Use the term “sensitivitiy” or “adverse reaction” rather than “allergy” unless you have a positive IgE test result to show. “Allergy” means something specific in the medical world, so if your adverse reactions are not proven to have IgE as a mediator, it’s only going to hurt your case to insist that you have an allergy. Adverse reactions can still be severe, so make sure that you stress that you have had severe adverse reactions to corn derivatives, preservatives, and excipients in medications.
  • Remain calm and be as logical as possible. If you seem emotional, you will not be taken seriously. I realize that the fear and the coursing adrenaline in emergent situations make this difficult. Try to breathe. If they are insisting that there is no choice other than a product or medication you fear you will react to, ask if they can try a small amount or do a skin test to make sure it’s safe. Also ask what their protocol is for severe reactions or anaphylaxis. This is both so that you understand what will be done if you react, and to remind them that anaphylaxis is a possibility.

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Corn Free Antibiotics

There is no such thing as a 100% corn free antibiotic. BUT, if you have an infection and need a safe-ish antibiotic right now, here are some possible options:

Rocephin (Ceftriaxone) Injection

Many corn allergic folks have had success with a rocephin injection. I have never personally done this, but here is the package insert. It looks like it can be prepared in water or in ethanol. Ethanol is corn alcohol, so request that the solution be in water, and double-check the package insert in the office to be sure that the inactive ingredients look safe. (Cross reference with the corn allergens list.)

Additionally the rocephin injection is often combined with a numbing agent, lidocaine, which can be skipped. Preservative free lidocaine (Xylocaine is one brand) can be corn free but you will need to check package inserts, not all clinics have the corn free version in stock.

There may also be other injections that could be safe. Check using these resources: how to find inactive ingredients of medications.

Update 2015: I personally have gotten this injection… There are a few different brands but basically I got a Ceftriaxone injection that was a powder with only the active ingredient. My doc mixed it only with distilled water. It hurt a LOT. I am a grown up with a fairly high pain tolerance, and I was crying a little.  I did have a mild/moderate reaction from it that passed within 3 hours, and I believe it was a corn reaction from the growth medium, but I don’t really know. I recommend pre-treating with any safe antihistamines you have before getting the injection.

Zithromax Brand

The Zithromax brand, 600 & 250mg,  are very corn lite.  Not corn free, but I’d take them in a pinch. The generics all seem to have corn starch, so brand name only.

Cephalexin

There are many corn-lite formulations of cephalexin.

Here’s a list of all the formulations of cephalexin and their inactive ingredients. Depending on sensitivity, you may be able to get away with taking one that just has as few ingredients as possible and no corn starch.

If you need pills and can’t tolerate potentially corny derivatives, you will need to have your antibiotics compounded. Here’s some good advice on how to do that. 

Note that much like probiotics, antibiotics are not 100% corn free just due to what they are. They are a product of microbes and are almost always grown on a medium containing corn sugar.

So with that in mind, I would avoid antibiotics as much as possible, opting for natural remedies as much as you possibly can. But sometimes you have no other choice, and when that’s the case, be aware that even if you get the “cleanest” antibiotic you can get your hands on, you will still be getting some corn, and prepare yourself accordingly.

Finding Inactive Ingredients of Medications

There are a few different ways to find inactive ingredients of a medication. My absolute favorite by far only works for pills, but I always check it first. It’s a brand new search engine from the NIH called Pillbox. In fact, it’s so new it’s still in beta stages.

This search engine is intended for identifying “mystery” pills, but I’ve been using it to get a quick list of every manufacturer of a particular drug and the inactive ingredients.

Here’s a brief tour:

pillbox_0

Go to http://pillbox.nlm.nih.gov/ and click on Advanced Search (picture on the right).

pillbox_1

In “Drug Name,” enter the name of the drug you’re looking for. In this case, I’ve entered cephalexin, the generic name of Keflex. This will give me both the brand-name drug and all generic variants.  Click Search.

cephalexin_2The search results will give you a listing of all known manufacturers and dosages of the drug, with the inactive ingredients listed right on the page. You can click hide/show next to “Inactive Ingredients” to see the full listing.

If I can’t find what I’m looking for on this search engine, or need more details, my next go-to search engine is NIH’s DailyMed database, which is an archive of package inserts for all kinds of medication and medical supplies.

For each med listed on DailyMed, there should be an “ingredients and appearance” section on the bottom.

dailymed1

The inactive ingredients should be listed in this section.

dailymed2

 

Corn Allergy Safety At the Dentist

I just got back from my first corn-free dental cleaning, and no reactions! My last dental cleaning was a bit over 6 months ago, and two weeks after that visit, I had a Tom’s of Maine toothpaste that contained corn-derived sorbitol send me to the hospital. As you can imagine, I pushed back my upcoming appointments for fillings so that I could figure out how to get them without landing in the hospital. Fortunately the office manager at my Seattle-area dentist is just a wonderful human being, and was able to help me navigate this successfully. Our process was convoluted, but we eventually got to the right place for my specific needs. However, if I had to do this all over again, this is what I would have her do:

  1.  Get a list of all products that could be used during a dental cleaning, filling, or root canal. This includes gloves, cotton or gauze, paper bibs, and other “incidental” products, as well as products that are also directly used in your mouth, on your lips, or injected.
  2.  Get the package insert/MSDS for each. Make photocopies and just hand me the sheaf of them to go over.
  3.  Study up each of the products on my own, using google/the Corn Allergens list, and questions to the Facebook Corn Allergy and Intolerance group or the Delphi Avoiding Corn Forums to determine what should be safe.
  4.  Return with a list of approved items to use. And a gift to show my appreciation.
  5. Show up on the day of my appointment with an instruction sheet to remind them of what should and shouldn’t be used, and what to do if a reaction occurs.

Following is a list of the possible places to check for corn at the dentist. This list is written with the most sensitive in mind, including those who react to water treatment chemicals, so not all may apply to you:

  • The “bib” put around your neck could be dusted in corn starch. Bring your own cloth towel.
  • Water for rinsing or swishing. Water could be filtered through a corny filter or include corny softener salts. Additionally an additive is sometimes used to help plaque rinse away better, which could be corny. Bring your own safe water and rinse and swish with that.
  • Sonic cleaning devices which spray continuous water. Find out where the water comes from and if you are in doubt, ask for the “old school” polish and scraping tools to be used.
  • Chapstick or vaseline on  used during a procedure to keep lips from cracking. Bring your own safe.
  • Mouthwash. Skip or bring your own.
  • Dentifrice/tooth polish. Skip or bring your own. I use bentonite clay from living clay co for tooth polish.
  • Sanitizer used on tools will be corn derived. Wash and rinse them in safe soap and water. This includes the cup that holds the dentifrice during a cleaning- I kept having a mild reaction until we realized that and rinsed the prophy cup.
  • Floss- the wax can be corny. Bring your own.
  • Cups/containers for water and other supplies, including the cup that tooth polish is kept in. Bring your own containers or ask that the containers they use be rinsed first.
  • Gloves- can be dusted with corn starch. Make sure they use unpowdered.
  • Numbing injections- inactive ingredients can contain corn, usually dextrose. Check inactive ingredients.
  • Filling adhesive.
  • Dissolvable sutures are corny. Use the non-dissolvable and have them rinsed before use.
  • Xrays: Film or covering over the receiver if digital. If you tolerate any plastic bags such as ziploc brand, bring those along to cover anything being placed inside your mouth if possible.
  • Intravenous solution: Lactated ringers and dextrse are corny. Request saline only.
  • Topical numbing agents: Skip them entirely, they are pretty much all corny.

Numbing Injections

Carbocaine is the “standard” that most corn allergy folks have used, but there are other possibly safe injections. Septocaine and Zorcaine have been used by many but may cause issues for those with sulfa allergies. Preservative free lidocaine, both with and without epinephrine, has been used safely as well. In all cases, check the package insert and compare the ingredients against the corn allergens list before using.


Here are my instructions for a dental cleaning. You will need to personalize to yourself, especially the second half, but it’s a good place to start. 

Here is the last instruction sheet I used for a filling.

Things that could be problematic but are notably NOT covered in my instructions: airborne contact with perfumes, fabric softeners, etc, and the bite contact sheet they use after a filling to see if your teeth are coming together right. I did not check the MSDS on that sheet, just let them use it.

How NOT to Treat Eye Infections

Spoiler alert: This is more of a narrative of my mishaps, and does not end in a solid conclusion about the correct way to handle eye infections with a corn allergy.

I don’t know why, but for some reason after going most of my young/young adult life without an eye infection, I have gotten bacterial pinkeye TWICE in the last three years! The first time the cause was obvious- a coworker had children with the infection, and I managed to catch it from her despite my best efforts at handwashing and avoidance.

This time? I don’t even know what happened. I wasn’t doing things considered bacterially risky such as hanging out with petri dishes small children or rubbing my eyes excessively. Probably I just touched the wrong grocery cart or doorknob and then had an itch, and my body has been pretty susceptible to infection lately due to a convergence of allergens. Now, it is totally possible to have non-bacterial conjuctivitis, however given the onset and symptoms, I felt pretty sure it was bacterial.

Continue reading “How NOT to Treat Eye Infections” →

Instructions for a Dental Filling

This is what I brought in to my dentist and it is tailored for my needs/level of sensitivity. You will need to modify it, but it’s a good place to start. 

Allergy Info for ______________

 

Products to use/not use:

– Please use only powder-free gloves.

– No topical anesthetic please, it contains a corn derivative.

– I need to provide my own cup and water for rinsing. 

– I have brought my own unwaxed floss and toothpaste. Please only use those.

– Please, no mouthwash/mouth rinse, only water!

– Please don’t apply anything to my lips using q-tips. I have my own “safe” lip balm that I can apply myself, no q-tip,  if needed.

– Injected anesthetic: Please use only Carbocaine.

Additional Information

– I have reacted before to highly processed corn derivatives such as sorbitol and citric acid, as well as to plastic and waxed paper cups. My first point of reaction is always my mouth and throat: tongue swelling, difficulty swallowing, sometimes lip swelling. In extreme cases I will have an asthma attack.  Since my mouth will be numbed, I may need your help to watch out for swelling if we’ve missed anything about the ingredients or products used. (Beth has been very thorough, I hope we will be fine.)

 

– I have taken 25mg of Benadryl to head off any possible reactions. I will likely be a bit sleepy but not completely out of commision.  My boyfriend will pick me up when the appointment is over.


– If there is a swelling reaction, I have an additional 25mg benadryl pill that I can take- prefer not to take it though, as it *will* put me to sleep. If my airway  begins close off, I will need to use my epi-pen and then go to the emergency room.

Dental Cleaning Instructions

This is what I brought in to my dentist and it is tailored for my needs/level of sensitivity. You will need to modify it, but it’s a good place to start. 

Dental Cleaning Instructions for ________________

Products Okay To Use:

  • powder-free nitrile gloves

  • white cosmetic (kaolin) clay (provided by patient)

  • cup for rinsing provided by patient

  • Desert Essence Tea Tree Dental Tape

Avoid:

  • No paper/disposable cups.

  • No q-tips

  • No mouth rinses/mouth wash.

  • When I rinse, I need to use my own water from home. 

  • Topical anesthetics, disinfectants, or any other products in the mouth or on lips that were not discussed ahead of time.

X rays: I react to the plastic sheath you use for the digital receiver. I need to use my own sandwich bags for this.

Safety

-My first point of reaction is always my mouth:  tongue swelling, difficulty swallowing, sometimes lip swelling. In extreme cases I will have an asthma attack.  I may need your help to watch out for swelling if we’ve missed anything about the ingredients or products used.

 

– If there is a swelling reaction, I have a benadryl pill that I can take.

 

– If my airway  begins close off, I will need to use my epi-pen and then go to the emergency room.