# Albuterol alternative for allergic reactions



## URI (Feb 20, 2013)

Hey guys
I was wondering if anyone had some insight on some good recommendations for alternatives for Albuterol. 

If a patient were allergic to Albuterol, what would be your first med choice? 

Currently, we stock Albuterol, Terbutaline, and Epi.   But I was wondering if Atrovent would be the way to go or Mag sulfate.    
I wanted to know what you guys thought before recommending we stock certain drugs.  Thanks.


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## Wheel (Feb 20, 2013)

URI said:


> Hey guys
> I was wondering if anyone had some insight on some good recommendations for alternatives for Albuterol.
> 
> If a patient were allergic to Albuterol, what would be your first med choice?
> ...



We have terbutaline and atrovent. I would probably go with atrovent first.


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## URI (Feb 20, 2013)

Can you tell me, would the pt. still have the allergic reaction of you gave the Terbutaline? I know it's also beta 2 stimulant, but I simply don't know enough about physiology to know for sure.


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## Rykielz (Feb 20, 2013)

URI said:


> Hey guys
> I was wondering if anyone had some insight on some good recommendations for alternatives for Albuterol.
> 
> If a patient were allergic to Albuterol, what would be your first med choice?
> ...



Atrovent is commonly given in conjunction with Albuterol, so I wouldn't necessarily call it an "alternative" but it would be beneficial and could resolve the issue. Magnesium Sulfate is the drug I've gone to after a few rounds of Albuterol didn't resolve the problem and I've never had it fail. Epinephrine can also be given, but I'd normally leave that as the last drug of choice as it has the most severe side effects and can't be titrated. The order I'd go in if Albuterol weren't an option are:

1) Atrovent
2) Magnesium Sulfate
3) Subcutaneous Epinephrine

As for Terbutaline, it's not in my protocols and I'm not familiar with it.


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## Shishkabob (Feb 20, 2013)

URI said:


> Can you tell me, would the pt. still have the allergic reaction of you gave the Terbutaline? I know it's also beta 2 stimulant, but I simply don't know enough about physiology to know for sure.



The use of Albuterol in an allergic reaction isn't to stop the body's reaction to an allergen, it's more to correct the bronchoconstriction / wheezing that develops.

Epi, benadryl, pepcid... those are the main ones that 'correct' the reaction.  Albuterol + Atrovent for the wheezing, Solu-Medrol for the inflammation.  


Terbutaline, being a B2-agonist, would as far as I know be a good replacement of Albuterol.  Xoponex, being a selective B2 agonist, would probably be another.  Atrovent is an anticholinergic, not a B2 agonist.


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## URI (Feb 20, 2013)

Magnesium Sulfate is the drug I've gone to after a few rounds of Albuterol didn't resolve the problem and I've never had it fail. 


Does Mag work the same way as Atrovent in that it is a antichlornergic?


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## Shishkabob (Feb 20, 2013)

Mag is a smooth muscle relaxer.


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## URI (Feb 20, 2013)

Thank you guys, I definitely appreciate it.


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## bigbaldguy (Feb 20, 2013)

Allergic reaction in albuteral is usually due to peanut allergy no?

"Patients allergic to soybean protein or other legumes, such as peanuts, may be allergic to the soya lecithin contained in the metered-dose inhaler 

Ipratropium—Patients sensitive to atropine or its derivatives may be sensitive to ipratropium. " 

http://www.drugs.com/mmx/ipratropium-bromide-and-albuterol-sulfate.html

What about nebulized epi?


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## systemet (Feb 21, 2013)

Depending on the severity of the symptoms,  you could give epi IM, or simply nebulise the epinephrine.  You can expect a little more tachycardia,  so there's some risk in the patient w/ CAD, but its probably outweighed by the potential benefit. 

Atrovent's adjunctive therapy and unlikely to fix any but the mildest symptoms when used alone. Magnesium IV works ok for some people,  does little for others -- and that's with continuous nebulised beta agonist, so I wouldn't rely on it by itself.


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## systemet (Feb 21, 2013)

bigbaldguy said:


> What about nebulized epi?



Sorry, saw that after posting. I think it's the best idea.


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## bigbaldguy (Feb 21, 2013)

systemet said:


> Sorry, saw that after posting. I think it's the best idea.



Whoowhoo I got one! "fist pumps"


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## johnmedic (Feb 23, 2013)

bigbaldguy said:


> Allergic reaction in albuteral is usually due to peanut allergy no?
> 
> "Patients allergic to soybean protein or other legumes, such as peanuts, may be allergic to the soya lecithin contained in the metered-dose inhaler
> 
> ...



Patients with allergies to peanuts are cautioned about Albuterol or Atrovent (Ipratropium) inhalers. The allergic risk is to the aerosols in MDI's & not the associated drugs, nebulized breathing treatments don't use soy-lethicin (sp?) so the drugs aren't contraindicated for peanut allergies.


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## johnrsemt (Feb 27, 2013)

Just an odd thought,  but if you were treating patient for allergic reaction;  hopefully with Benadryl, and Epi already;  wouldn't that overcome any allergic reactions to the Albuterol that they are allergic too, but you give them for the wheezing?


  and before anyone has a cow;  I am joking


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## Dwindlin (Feb 27, 2013)

johnrsemt said:


> Just an odd thought,  but if you were treating patient for allergic reaction;  hopefully with Benadryl, and Epi already;  wouldn't that overcome any allergic reactions to the Albuterol that they are allergic too, but you give them for the wheezing?
> 
> 
> and before anyone has a cow;  I am joking



We do this frequently in the hospital.  Especially for IV Dye allergies.


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