Sulfa Allergies & Morphine

ResTech

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I wanted to post this because I am surprised at how many providers, both novice and experienced of all levels, have the misconception over sulfa allergy and morphine.

Sulfa allergy relates to medications know as sulfonamides which are largely a group of antibiotics (Bactrim). Furosimide (Lasix) is also in this class as well. Morphine Sulfate is NOT a sulfonamide so if a patient say's they have a sulfa allergy, they CAN have Morphine.

I was with a preceptor one time and we had a fall patient having some pain who said she had a sulfa allergy. My preceptor then went on to tell the patient that the only med we had for pain was morphine of which the patient couldn't have due to her sulfa allergy. As a student I didnt want to correct my preceptor.
 

medic417

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Actually you are not entirely correct. Some people are allergic to anything that contains the "sul" in its name. So you need to discuss this with the patient and not rush to give something that can cause harm to many patients.
 

JB42

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Actually you are not entirely correct. Some people are allergic to anything that contains the "sul" in its name. So you need to discuss this with the patient and not rush to give something that can cause harm to many patients.

medic417, is it still a "Sulfa" allergy then, or is it something different? Not second guessing you, just trying to understand more about it. If it is still considered a sulfa allergy, what is the cause for the difference in allergy? Again, curiosity.
 
OP
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Some people are allergic to anything that contains the "sul" in its name

By chance they could be.... the same as they could be allergic to any drug with the letter "A" in it. But the point is there is no relation between sulfonamides and morphine sulfate as they are completely different chemically. They only sound similar. It's the same comparison as water and gasoline... both liquids but both totally different in their effects.

Sulfates are naturally occurring and we take them in daily in water and foods as they are largely salts.

Don't automatically withhold morphine just because your patient may have an allergy to sulfonamides. That's the point.
 
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medic417

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medic417, is it still a "Sulfa" allergy then, or is it something different? Not second guessing you, just trying to understand more about it. If it is still considered a sulfa allergy, what is the cause for the difference in allergy? Again, curiosity.

W/o doing the research for you, yes at least per the patient. In other words the patient will usually just say sulfa allergy, or just have the sulfa allergy medical bracelet/necklace. To presume it only refers to the antibiotics as the OP suggests is a road you do not want to be on.

I suggest an in depth research of this subject by anyone that thinks as the OP does. Yes the majority still only react to the antibiotics, but a large number still can and do react to anything with "sul" in its name. Many cannot even chew most regular gum or eat most store bought breads as they are so sensitive. If they react to such small concentrations as that you will risk killing them with the amount in our drug solutions.
 

silver

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Actually you are not entirely correct. Some people are allergic to anything that contains the "sul" in its name. So you need to discuss this with the patient and not rush to give something that can cause harm to many patients.

thats impossible. Sulfur is the 8th most common element found in the human body. It is essential to human life and is found in many amino acids.

However the sulfa category is huge. But there are many other "Sul" drugs given not in that category and aren't related.

Besides the sulfonamide allergy, people do have hypersensitivity to sulfites which gets metabolized to sulfur dioxide. It is now being classified by some as an allergy.
Some asthmatics also are sensitive to sulfur dioxide, but its not because of the "sul," but because of the interaction of sulfur and two oxygens.
 
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OP
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ResTech

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In other words the patient will usually just say sulfa allergy, or just have the sulfa allergy medical bracelet/necklace. To presume it only refers to the antibiotics as the OP suggests is a road you do not want to be on.

Who said anything about "presuming". The point was clear that sulfonamides ARE NOT related to morphine sulfate, albuterol sulfate, atropine sulfate, etc, etc. And not to ASSUME that they are the same thing... this is the road you do not want to go down as you could withhold a beneficial medication by not knowing the difference.

This post was made with the assumption that providers can do the elementary task of ascertaining an allergy history.
 

medic417

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By chance they could be.... the same as they could be allergic to any drug with the letter "A" in it. But the point is there is no relation between sulfonamides and morphine sulfate as they are completely different chemically. They only sound similar. It's the same comparison as water and gasoline... both liquids but both totally different in their effects.

Sulfates are naturally occurring and we take them in daily in water and foods as they are largely salts.

Don't automatically withhold morphine just because your patient may have an allergy to sulfonamides. That's the point.

And that is why some people have water filters that remove them and have to be very careful of the food they buy. Many cannot even eat certain fruits and vegetables.

But to avoid problems it is better to provide another pain relief med. If your service only has morphine it is time to join the 21st century.
 
OP
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Medic 417... your being ridiculous... nothing posted was incorrect. Are you disagreeing that sulfonamides and sulfates are totally different?
 

medic417

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Who said anything about "presuming". The point was clear that sulfonamides ARE NOT related to morphine sulfate, albuterol sulfate, atropine sulfate, etc, etc. And not to ASSUME that they are the same thing... this is the road you do not want to go down as you could withhold a beneficial medication by not knowing the difference.

This post was made with the assumption that providers can do the elementary task of ascertaining an allergy history.

No you said they can have morphine with a sulfa allergy. Many would take you at your word sadly and fail to dig into the patients history. Then wonder why the patient quit breathing.

By now you should know that most are not educated well enough to do a proper HX.

If you have other options why risk a reaction.
 

medic417

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they are sensitive to sulfites then.

They are sensitive to sulfa, sulfate, sulfites, etc etc. I am very familiar with the fact that some react very severly to anything with "sul" as I am one of the ones that it happens to.
 
OP
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I posted to provide clarification on a common misconception and your keeping that misconception alive and providing confusion. Its not difficult. Again for the fifth time, SULFONAMIDES ARE TOTALLY CHEMICALLY DIFFERENT THAN SULFATES. YOU CAN BE ALLERGIC TO BACTRIM OR SEPTRA AND STILL RECEIVE MORPHINE WITHOUT CONTRAINDICATION.

It's all over Google and I specifically recall my pharm instructor standing in front of class specifically going over this.

They are sensitive to sulfa, sulfate, sulfites, etc etc

They are chemically different and from the research I have done, there is no cross reactivity. Basicly its the same as being allergic to tylenol and Zantac. Its just by chance... not because the drugs are related... thats the point.
 
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medic417

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Medic 417... your being ridiculous... nothing posted was incorrect. Are you disagreeing that sulfonamides and sulfates are totally different?

They are different yes, but it is surprising how often a severe reaction to one equals a severe reaction to the other. To just say give them morphine when they say they are allergic to one w/o discussing in depth is asking for a bad outcome. Had you said in most patients it is still safe to give that would have been correct. But a large number react to all "sul" yet most only say sulfa unless drawn out.

I bring this out so people remember to do a complete HX.
 

medic417

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I posted to provide clarification on a common misconception and your keeping that misconception alive and providing confusion. Its not difficult. Again for the fifth time, SULFONAMIDES ARE TOTALLY CHEMICALLY DIFFERENT THAN SULFATES. YOU CAN BE ALLERGIC TO BACTRIM OR SEPTRA AND STILL RECEIVE MORPHINE WITHOUT CONTRAINDICATION.

It's all over Google and I specifically recall my pharm instructor standing in front of class specifically going over this.



They are chemically different and from the research I have done, there is no cross reactivity. Basicly its the same as being allergic to tylenol and Zantac. Its just by chance... not because the drugs are related... thats the point.

But to presume w/o doing a complete HX can bite you in the butt. Do not presume when they say sulfa that it is just antibiotics. Ask.
 

fma08

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They are sensitive to sulfa, sulfate, sulfites, etc etc. I am very familiar with the fact that some react very severly to anything with "sul" as I am one of the ones that it happens to.

How are your proteins still together?
 

rescue99

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They are different yes, but it is surprising how often a severe reaction to one equals a severe reaction to the other. To just say give them morphine when they say they are allergic to one w/o discussing in depth is asking for a bad outcome. Had you said in most patients it is still safe to give that would have been correct. But a large number react to all "sul" yet most only say sulfa unless drawn out.

I bring this out so people remember to do a complete HX.

Medic 417 may well be right on this subject. It is hit and miss as to which patients will react and it isn't a coincidence IMO. According to a board certified allergist, he claims multiple sulfa sensitivities/allergies isn't uncommon. Medication reactions are especially common among those with a HX of hypothyroidism. Perhaps there is a connection?

Example:
I am severely allergic to antibiotics containing sulfa but, not others that I know of. I am allergic to all fresh fruits and vegetables to a degree (some worse than others) and suffered an acute onset V-Tach within seconds of MS IVP.

Advise: Be ready for any adverse reaction to any medication. :)
 

medic_texas

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I get the feeling medic417 is arguing this point because... he can. You keep twisting the topic and throwing in things just to keep your argument alive.

The OP has a good and valid point from a situation that they encountered. Their paramedic preceptor was WRONG. When someone says "I'm allergic to Sulfa drugs" and the medics response is "well you can't have morphine".

WRONG!

True - not all sulfa medications are antibiotics.

Also, good job not mentioning anything to your preceptor and especially in front of the patient. An issue like that should be brought up subtle and later on, if necessary. I'm glad people are researching this and not going off the "infinite wisdom" that some of the keyboard warriors have.

My question is, what Sulfa medications do you carry on the ambulance?
 
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cm4short

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Medic 417... your being ridiculous... nothing posted was incorrect. Are you disagreeing that sulfonamides and sulfates are totally different?

I researched this topic using multiple sources. SULFATES ans SULFONAMIDES are completely different. Allergies to sulfa are directly related to antibiotics. Do the research. It only take a few minutes on google.
 

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