Sodium based anti-biotics and side effects

[Skwinty]

I had the misfortune, about 20 years ago, of contracting necrotising fascitus. I underwent 3 surgeries in 2 days and recovered after about 3 months.
the anti-biotics were sodium based, a small amount of white substance in a vial, which was dissolved and injected into my drip.
For the duration of the drug being administered, my urine smelled like perm lotion and ever since then, I am unable to have any prolonged contact with any form of metal.
I cannot wear a metal watch, jewellry etc without the immiediate contact area erupting into blisters. Even the rivet button on my Levis have this effect regardless of 2 layers of clothing between my skin and the button.

Am I correct in attributing this too the sodium based anti-biotic and what could I do to alleviate this condition.:confused:

[Rolfe]

Sodium is the commonest cation salt incorporated with anionic preparations. Such sodium is of no more consequence than the sodium in the salt you sprinkle on your chips.

Your symptoms sound exactly like those of nickel allergy. This is extremely common, and I developed it myself when I was in my 40s. Most cheap jewellery, watch straps, belt buckles and so on have nickel in them. The condition is commoner in females because of their habit of wearing cheap bling, and most women can recognise it. Also that pure silver or gold can be worn without a problem. The easy solution is to paint anything nickel that might come in contact with your skin with clear nail varnish.

Association with the antibiotic treatment is probably pure coincidence - or, if not coincidence, the trigger is more likely to be related to the illness than to the treatment.

Rolfe.

[fls]

I had the misfortune, about 20 years ago, of contracting necrotising fascitus. I underwent 3 surgeries in 2 days and recovered after about 3 months.
the anti-biotics were sodium based, a small amount of white substance in a vial, which was dissolved and injected into my drip.
For the duration of the drug being administered, my urine smelled like perm lotion and ever since then, I am unable to have any prolonged contact with any form of metal.
I cannot wear a metal watch, jewellry etc without the immiediate contact area erupting into blisters. Even the rivet button on my Levis have this effect regardless of 2 layers of clothing between my skin and the button.

Am I correct in attributing this too the sodium based anti-biotic and what could I do to alleviate this condition.:confused:

It sounds like you have a contact allergy to nickel (quite common). I don't see how the antibiotics would have anything to do with this. The immediate reaction with blisters is a bit worrisome as it may be an acute urticarial reaction that can progress to anaphylaxis (although this would be unusual). Latex allergies are a more common example of this kind of reaction.

The key, really, is avoidance. If you can't get rid of all metal (like pulling off the metal buttons on your jeans and putting on plastic buttons), then put on a barrier that moisture can't get through, like a non-porous tape or nail polish. And mention it to your doctor. :)

Linda

ETA: What Rolfe said. :)

[Skwinty]

Thanks for the replies.
I associated this reaction to the anti-biotics as I never experienced this prior to the condition requiring the medication. I have asked my doctor about this over the years and have not had a helpful response.
The metals are not isolated to those containing nickel as the same thing happens when I wear 18 carat gold.

I have altered my clothing to get rid of metal buttons etc , but now have the problem with my crash helmet buckle. I guess I will just have to find one with no metal fasteners.

As far as the anti-biotics were concerned, they were according to the doctors the strongest available at the time (late 80's), and very expensive.
If my memory serves me correctly, they were used to treat staphyllococcus. I was also subject to large volumes of Betadyne (Iodine based?)solution which was used to irrigate the incisions in my abdomen.

I would really like to find out what has caused this problem for my own curiousity rather than to blame the medical treatment.

[ElMondoHummus]

Shouldn't some antihistamines help alleviate the symptoms, since an allergy does in fact mean that there's a histamine reaction?

ETA: Blah! I hit "submit" too soon. The Mayo Clinic suggests that a doctor could do exactly that (http://www.mayoclinic.com/health/nickel-allergy/DS00826/DSECTION=treatments-and-drugs):


Medications


Your doctor may prescribe one of the following medications to reduce irritation and improve the condition of a rash from a nickel allergy reaction:

Corticosteroid cream, such as clobetasol propionate (Temovate, Cormax, others) and betamethasone dipropionate (Diprolene)
Oral corticosteroid, such as prednisone, if the reaction is severe or a rash covers a large area
Oral antihistamine, such as fexofenadine (Allegra) and cetirizine (Zyrtec), for relief of itching


ETA: Double blah! Sorry for the messed up coding; I just cut & pasted, and only saw the output after I hit "Save". Thus corrected.

[Hydrogen Cyanide]

I am also allergic to nickel. It can be very annoying, especially if one has a hobby like sewing (pins and needles are coated in nickel, I have to look for special supplies).

My nickel allergy became a serious problem after having my wedding set redone, the gold was hardened with more nickel than my previous set (and I had lost to diamond from the engagement ring, and only had a tiny wedding band). That caused my rash to flare up.

It is something that slowly comes on, and you may have encountered some tool, or something else (like chrome trim on a boat, which caused a rash on my foot). Nickel is unfortunately used everywhere.

[Madalch]

The metals are not isolated to those containing nickel as the same thing happens when I wear 18 carat gold.

What makes you think there's no nickel in 18 carat gold? Try 24 carat gold.

[fuelair]

Can't add much except to say Clobetisol is good working stuff for me!! (first imem in ElH's post 5 above!)

[Capsid]

Shouldn't some antihistamines help alleviate the symptoms, since an allergy does in fact mean that there's a histamine reaction?
No the skin reaction to nickel is contact dermatitis (a type IV delayed hypersensitivity) involving T cells and cytokines in the skin. The histamine reaction is IgE antibody mediated and involves basophils.

[ElMondoHummus]

No the skin reaction to nickel is contact dermatitis (a type IV delayed hypersensitivity) involving T cells and cytokines in the skin. The histamine reaction is IgE antibody mediated and involves basophils.

Ah, okay. Got it. I'm screwing up and mistakenly thinking that any sort of allergic reaction is a histamine one (and as an aside, shows that I don't remember a damn thing from my college career :o). Mea culpa.

The Mayo Clinic indicates that certain drugs - fexofenadine and cetirizine (Allegra and Zyrtec) - can help relieve the itching. That means that there are a few palliative treatments. I also wonder if there's any simple immunotherapies that might help as well. You know, like allergy shots in desensitizing the human body's immune reaction.

[Rolfe]

I developed my nickel allergy shortly after surgery too, funnily enough. The first manifestation was as swelling and itch associated with my glasses. I initially thought that swelling of my face consequent on the surgery was causing the legs of the glasses to rub and irritate my skin. Then I realised that the itch was continuing even if I spent most of the day without my glasses on. Finally, the penny dropped.

Next day:
The boss: What on earth are you doing?
Me: Nail varnishing my glasses, what does it look like?
The boss: :confused:

I also had to nail varnish the clips on my earrings, but that more or less did it. Interesting about the recent surgery though. I wonder if there is actually any connection?

That was about 12 years ago. Then in November I suddenly came out in a very severe urticarial rash, dermatographic reaction, the lot. Fortunately I had a friend staying with me who has a specialist qualification in dermatology. She told me I needed oral antihistamines and wrote down the names of the things to buy. Not had a recurrence since, or at least not as severe as that, but then I take the antihistamine if I feel an itch starting. Don't know if it was related to the nickel allergy or not.

It's odd the number of things that seem to have nickel in them. I don't react to 9-carat gold though. I don't think I really have it in a severe form.

Rolfe.

PS. I have a friend who genuinely seems to have a silver allergy. I thought it must just be the usual nickel one, and she was overestimating the quality of the jewellery she was reacting to. But I've actually seen her react to silver earrings.

[luchog]

The metals are not isolated to those containing nickel as the same thing happens when I wear 18 carat gold.

18 Carat gold is an alloy which contains nickel to increase the hardness and durability. Even 24 carat gold can contain trace amounts of nickel, enough to set off a severe allergy with prolonged contact.

Other than that, you should be fine with other metals, as long as they're not alloyed with nickel. Titanium is safe if it's a medical grade (other alloys often have nickel), as is hypoallergenic surgical steel and niobium.

[luchog]

PS. I have a friend who genuinely seems to have a silver allergy. I thought it must just be the usual nickel one, and she was overestimating the quality of the jewellery she was reacting to. But I've actually seen her react to silver earrings.
Even a lot of supposedly "pure" metal jewelry can contain trace amounts of nickel.

[Rolfe]

Even a lot of supposedly "pure" metal jewelry can contain trace amounts of nickel.


Mmm, yes. But I'm not sure that she actually reacts to the junk. I'll ask her.

I do think we've diagnosed Skwinty though. What he describes is classic, though he does seem to have it in a very severe form. Clear nail varnish is your friend.

I'm just astonished that his doctor didn't figure it out. It's not exactly rare. And for 20 years???? :nope:

Rolfe.

[Ivor the Engineer]

<snip>

PS. I have a friend who genuinely seems to have a silver allergy. I thought it must just be the usual nickel one, and she was overestimating the quality of the jewellery she was reacting to. But I've actually seen her react to silver earrings.

Was she expecting gold?

:D

[Rolfe]

:D

I've just had my new phone delivered, a replacement for one that upped and died. I'm reading the setup instructions. Quite near the start....

Warning: The Navi key [4] in this device may contain nickel. It is not designed for prolonged contact with the skin. Continuous exposure to nickel on the skin may lead to a nickel allergy.


That's how common and well-recognised this is. I suspect some crossed wires between Squinty and his doctor.

In my case, I've never really worn cheap jewellery on a day-to-day basis. What happened to me was that the inner structure of my glasses was nickel-based, but covered in a thin layer of inert gilt. With time, the protective layer wore away on the insides of the legs, exposing the nickel, which was then constantly touching the skin of my temples.

I've always thought the association with the recent surgery was a coincidence. It would be interesting to do a survey on that though, in the light of Squinty's experience. There may be an additional trigger factor.

Squinty, just get a bottle of clear nail varnish and attend to all your nickel bits already. You may have to re-apply from time to time.

Rolfe.

[casebro]

Stainless steel surgical instruments have LOTS of nickel in them. I'd guess exposure to that much nickel probing around in your guts brings on the allergy. You body don't like having probing going on anyhow.

Plus, I wonder of there are minute residues of nickel left behind? Like from the normal wear and dulling of instruments, or banging them against each other in handling? Or pivot joints in forceps and pliers type tools?

Any possible prophylactic treatment? An epinephrine or cortisone or antihistamine injection before surgery? Or anti-allergy Nickel shots?

[Skwinty]

Thanks for the input .

I only have the issue now with my helmet and will paint the metal bits with nail varnish.

As for crossed lines with the doctor, well I don't go to the doctor very often, unless of course I am bleeding profusely or bones are sticking out.

This is due to the misdiagnosis of the necrotising fasciitus by the GP in the first place. When the condition was eventually diagnosed correctly I went straight into surgery. The prof who diagnosed me said that if I had been without medical attention for another day, I would have passed on.

Oh well, I suppose any barrel of apples has a few rotten ones.

[godless dave]

I became aware I had a nickel allergy when I was 18 years old, because that's when I got my ear pierced. But it has gotten worse over time. I can't wear belts with metal buckles at all anymore - actually that's a bad example, as my belly didn't come into contact with my belt buckles when I was younger. Better example: inexpensive metal eyeglass frames cause a reaction, and that never happened when I was younger.

From your description of the antibiotics, I'd be willing to bet you get more sodium from a large order of French fries than you got from those antibiotics. I also think "sodium-based" is inaccurate, as the sodium is not the part of the drug that kills the bacteria.

[Rolfe]

I was wondering if any of the doctors on the forum might have commented on Casebro's speculation about the surgical instruments. I don't know enough to comment. It wouldn't even have occurred to me without the coincidence of Squinty's nickel allergy also coming on in relation to surgery. I would imagine it would be quite easy to test the hypothesis, by organising an unbiassed survey of nickel allergy sufferers to determine if a higher proportion than expected had had surgery shortly before the first manifestation of the allergy.

My feeling would be, however, that if that were the case, the surgery would not be the cause of the allergy, but merely the trigger that precipitated something that was going to happen anyway. As the Nokia manual rightly says, the real cause is prolonged or continuous exposure to nickel. In my case, just as Godless Dave says, it was cheap spectacle frames that really did it. The next pair I got after that were plastic, and the pair I have now are labelled "pure titanium". I just have to remember to take appropriate precautions (the nail varnish again) if I decide to wear junk jewellery.

Rolfe.

[casebro]

Did you read today's news about the potential Beryllium poisoning at Los Alamos? Seems it's a genetic thing, only 2% can get the disease, and there is a test for sensitivity. Couldn't there also be a test for the susceptibility to nickel? Do tha test on prospective surgical patients?

And, Rolfe, so far as triggering vs chronic exposure, a flake of plating worn off of an instrument would give ensuing chronic exposure. Hm, or a flake off of a cheap pierce stud? Or, is there nickel in tattoo dyes?

Now I'm wondering about metal poisoning in general. How many chronic fatigue cases could be caused by, say, copper leaching out of water lines? Gulf War syndrome caused by the pigment used in camouflage paint? Hmmmm... my mind boggles... metal poisoning symptom, perhaps? ;)

[Professor Yaffle]

I also have a nickel allergy. I have no idea whether it might have been triggered by surgery. I first noticed I had it, aged 14, after I had my ears pierced, and pretty much any earrings would make my ears inflamed. Has also been triggered by some watch sraps with nickel fastenings. I had some surgery aged 12 (to remove my eye teeth which were trapped under the hard palate of my mouth), but I have no idea if this is what triggered it.

[Skwinty]

From your description of the antibiotics, I'd be willing to bet you get more sodium from a large order of French fries than you got from those antibiotics. I also think "sodium-based" is inaccurate, as the sodium is not the part of the drug that kills the bacteria.

I don't recall the name of the anti-biotic, just remember the prof saying something about Sodium. The stuff looked like a small white crystal, and reacted vigorously with the saline solution which was injected into the vial.

I also remember the prof saying that this particular drug was the last line of defence. In those days there was lot's of talk about anti-biotics reaching the end of their usefulness due to mutations in bacteria, people not following their presciptions correctly etc.

I will try and locate the Professor who handled my case and ask him.

[Rolfe]

And, Rolfe, so far as triggering vs chronic exposure, a flake of plating worn off of an instrument would give ensuing chronic exposure. Hm, or a flake off of a cheap pierce stud? Or, is there nickel in tattoo dyes?


One, both Squinty and myself are describing onset of the allergy within a few days of the surgery. No scope for chronic exposure.

Two, if a "flake of plating" from an instrument ended up inside a patient, all hell would break loose and lawyers would be involved. I don't think surgical instruments are plated anyway. Interior contact, yes, that may be a factor. The odd molecule remaining behind, possibly. But this is getting ridiculous.

Rolfe.

[Hydrogen Cyanide]

I was wondering if any of the doctors on the forum might have commented on Casebro's speculation about the surgical instruments. I don't know enough to comment. ....

When I found out about my nickel allergy (which started off gradually with pierced ears, then a small wedding set, and then set off with a larger ring set with lesser quality gold) I tried to find out about it terms of my sewing hobby.

I first emailed a notions company about pins, and they replied that they did have pins that were stainless steel. Okay.

Then I wrote a sewing magazine (Threads (http://www.threadsmagazine.com/)), and it turned into a small page article in the next issue (years ago). I was told that the nickel used in the stainless steel in scissors are very much bound to the crystalline structure of the alloy, so stainless is not so bad. There are also gold and platinum plated hand sewing needles, but they are the wrong size (by the way, I have found a set of sewing needles from Japan that are stainless steel and do not cause a rash).

And this is important: The allergy to nickel is not just the nickel, but the combination with persperation. Apparently that pulls the nickel off the plating and the skin reacts to that compound.

I also have searched PubMed, and did get some information there. By using an early AltaVista search (Google) I found one site with lots of information, it was a piercing parlor in Australia!

I would guess that since nickel is so common that surgical stainless would be the type with very little nickel, and at least not plated. Which is perhaps why some ear-rings are sold labeled "surgical steel".

Someday I will reset my wedding set into non-nickel gold (I think they substitute platinium, or something similar that is expensive).

[Skwinty]

Ok, I have found the name of the sodium based antibiotic.
Cefazolin Sodium. http://www.ehs.lilly.com/msds/msds_cefazolin_sodium.pdf Not quite the same as table salt.

Unfortuneately, most of the published papers are for subscription only, but I did manage to find some information.

1. It is a severe allegen.
2. Can cause serious allergies.
3. Prescribed also for lead or heavy metal poisoning.
4. A large number of vials were recalled due to contamination.

Does this data lend any credence to my initial assumption.

[Rolfe]

You need to forget the sodium part, and focus on the Cefazolin. The sodium is merely the cation salt, and as such, it is exactly the same as the sodium in table salt. Table salt, however, is sodium chloride. The difference is the Cefazolin part, and that's the bit that's important. That's the actual drug.

I'll defer to the pharmacologists here, but as I understand it, this is a fairly ordinary first-generation cephalosporin. Twenty-plus years ago these were the spiffy new cutting-edge antibiotics, but now they're pretty common in routine use. The common one you'll find dished out for lots of routine infections is cephalexin, which is very similar.

I've found quite a lot of pages about the antibiotic online, none of them restricted. I can't see anything untoward apart from all the usual backside-covering fluff dished out with pretty much every medication these days. If you pay too much attention to all that stuff, you'll never take any medication at all! (And I know people like that.) Similarly to penicillins, allergies are the main side effect. However, this refers to an allergy to the antibiotic itself, not to anything else - and especially not to anything completely unrelated like nickel.

Do you have a penicillin allergy? Or an allergy to cephalosporins? This is what the cautionary paragraphs are all about. I've certainly never come across any reference to penicillin or cephalosporin allergy being linked to nickel allergy (and I do look out for such things, having the nickel allergy myself). On the face of it, it seems very unlikely, as nickel is a contact allergy and the antibiotic allergies are a somewhat different mechanism as I understand it.

Rolfe.

[Yuri Nalyssus]

I don't think surgical instruments are plated anyway.
Even vets have given up using plated instruments for surgery these days, too many bits flake off and they're a haven for bacteria. Surgical instruments now are mainly high grade stainless steel so the patient is exposed to the nickel in that but hopefully not great lumps of it.

Yuri

[Yuri Nalyssus]

Ok, I have found the name of the sodium based antibiotic.
Cefazolin Sodium. Not quite the same as table salt.
You mean you've never been offered cephazolin and vinegar at the chip shop?

Seriously though, the sodium part of the antibiotic is actually the same as the sodium part of table salt that you put on your chips. It's an element, you don't get different types of sodium; it's just that in the case of table salt the other half of the molecule is choride whereas with your antibiotic the other half of the molecule is cefazolin. You can't be allergic to sodium because then you'd be allergic to yourself, sodium is as basic to the living body as water.

Yuri

[Skwinty]

Do you have a penicillin allergy? Or an allergy to cephalosporins? This is what the cautionary paragraphs are all about. I've certainly never come across any reference to penicillin or cephalosporin allergy being linked to nickel allergy
Rolfe.

No, I am not allergic to penicillin.
If you google "Cefazolin Sodium and Nickel" you get in excess of 1800 hits.
Now, I dont understand the technical details of all these papers, but it seems that there is a link between the two and I would think that there must be some reaction between them.

Could this perhaps be a trigger?

http://learningfromevent.scot.nhs.uk/topic-link-results.aspx?&q=publicid:"ovidmedl|15202497"&pm=fql&expand=true&header=Full Record&pn1=4&htid=278&h=

[Skwinty]

You mean you've never been offered cephazolin and vinegar at the chip shop?

Seriously though, the sodium part of the antibiotic is actually the same as the sodium part of table salt that you put on your chips. It's an element, you don't get different types of sodium; it's just that in the case of table salt the other half of the molecule is choride whereas with your antibiotic the other half of the molecule is cefazolin. You can't be allergic to sodium because then you'd be allergic to yourself, sodium is as basic to the living body as water.

Yuri

Sure, I know that there is only Na sodium element and I never said I was allergic to Sodium. I am allergic to all kinds of metal's that contain nickel.
My question is, could the trigger have been the antibiotics?

Given the link between nickel and cefazolin.

sodium forms the basis of the drug http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?sid=7849285

Hence my heading "Sodium based antibiotics and side effects"

[Yuri Nalyssus]

Sure, I know that there is only Na sodium element and I never said I was allergic to Sodium. I am allergic to all kinds of metal's that contain nickel.
My question is, could the trigger have been the antibiotics?

Given the link between nickel and cefazolin.

sodium forms the basis of the drug http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?sid=7849285

Hence my heading "Sodium based antibiotics and side effects"
Sorry, it’s difficult to know what level to pitch some resonses at. I guess I was puzzled why you would suspect this antibiotic of precipitating your sensitivity when there are so many other more likely environmental possibilities around all the time. Your remark about table salt led me to think that you weren’t clear about what sodium was.

I haven’t been able to find any references for antibiotics triggering nickel sensitivity. When I followed the link you gave there was no mention of cephalosporins triggering sensetivity to metals, just a conference about the antibacterial properties of various forms of kefzol (cefazolin) including forms containing copper, zinc and nickel (in the same way that the form you were given contained sodium as the metallic ion). Only the title of the conference is available so that’s all I can tell from that link. Similarly the google search you suggested didn’t show any causal relationship, just lots of web-sites with those words on (I’m happy to be corrected here, 1800 web sites is a lot of skimming!). So, to answer the question, no, I think it is extremely unlikely that this antibiotic has percipitated your nickel sensetivity.

The surgical instruments used would have contained some nickel and exposure to blood during surgery may have caused some to have gone into solution in the same way that sweat does on the skin surface although apparently surgical grade stainless steel doesn’t give up its nickel easily. According to the nickel institute (http://www.nickelinstitute.org/index.cfm/ci_id/99.htm#22):

“The development of nickel ACD requires that an individual become immunologically sensitized to nickel. This is termed the induction phase or sensitization phase and takes from 1 to 3 weeks of intimate skin contact with a form of nickel that can provide sufficient amount of soluble nickel ions to the skin primarily via sweat.”

So the instruments weren't really in contact for long enough to have had much of an effect so, given the quality of the metals used sufficient exposure is unlikely at that time. There are just so many other ways in which we are all being exposed to much larger qualntities of nickel all the time (food, coins, jewellry, buckles etc) that surgical quality steel would be way down on the list of likely contenders.

There are some very helpful sites out there, such as:
Allergy and asthma foundation of America re contact dermatitis (http://www.aafa.org/display.cfm?id=9&sub=23&cont=329)
Hints & tips for nickel sentitivity sufferers (http://www.royalberkshire.nhs.uk/pdf/Nickel_sensitivity.pdf).

Yuri

[Hellbound]

Here's something to consider (and correct me if I'm way off here):

Major surgeries require an extensive recoveyr period...perhaps you might look at something during this recovery period as being where your contact with nickel came in?

I've worked int he medical field, but primarily emergency medicine, so I'm not sure what the details would be for post-op recovery, or what the various tools or implements might be. But maybe some of the monitors, probes, bedpans, bed rails, or other items that you may have had prolonged contact with contain nickel? Maybe a watch that was worn during recovery that had a metal band?

Just an idea, but it seems a higher possibility to me than that an antibiotic caused a reaction to something completely unrelated to its own structure.

[Rolfe]

No, I am not allergic to penicillin.
If you google "Cefazolin Sodium and Nickel" you get in excess of 1800 hits.
Now, I dont understand the technical details of all these papers, but it seems that there is a link between the two and I would think that there must be some reaction between them.

Could this perhaps be a trigger?

http://learningfromevent.scot.nhs.uk/topic-link-results.aspx?&q=publicid:"ovidmedl|15202497"&pm=fql&expand=true&header=Full (http://learningfromevent.scot.nhs.uk/topic-link-results.aspx?&q=publicid:"ovidmedl|15202497"&pm=fql&expand=true&header=Full) Record&pn1=4&htid=278&h=


Actually, if I google "Cefazolin Sodium and Nickel" I get no hits at all. No documents with that exact phrase. If I google the words with no quote marks I get 3,900 hits, but that's just pages with the three words on them, regardless of context. No indication at all of what the connection is between the three words. And absolutely no reason to believe "there must be some reaction between them".

The single paper you've selected is, as Yuri Nalyssus says, merely looking at the antibacterial properties of various cationic compounds in conjunction with cefazolin. Noting at all about allergies. And indeed, we already know you weren't given any unusual cefazolin compound, as you yourself noted that it was the ordinary sodium salt you received.

I have googled - cefazolin nickel allergy - (no inverted commas) and got just under 500 hits. (That's what you're really asking about. The sodium is irrelevant.) However, the ones I looked at were all simply papers which mentioned nickel allergy in one place, and cefazolin in another. I couldn't find any texts making an actual link (though I didn't look at every page). Just having the words appear on the same page doesn't imply anything, really.

I asked about penicilin allergy because the information sheets I found for cefazolin all highlighted the importance of asking the patient about any penicillin allergy before treating. None of them mention nickel allergy in that context though.


Sure, I know that there is only Na sodium element and I never said I was allergic to Sodium. I am allergic to all kinds of metal's that contain nickel.
My question is, could the trigger have been the antibiotics?

Given the link between nickel and cefazolin.

sodium forms the basis of the drug http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?sid=7849285

Hence my heading "Sodium based antibiotics and side effects"


Well, with respect, your OP and thread title emphasise the sodium. "Sodium based antibiotics". I suspect most anionic antibiotics will be presented in the sodium salt, as sodium is the natural extracellular fluid cation in the body. It was quite a while before you even mentioned what the antibiotic in question actually was. Cefazolin. Fine. The sodium is irrelevant.

Could the cefazolin have triggered the nickel allergy? Could the surgical drapes have triggered the nickel allergy? Could the anaesthetic have triggered the nickel allergy? Could the hospital food have triggered the nickel allergy? Could the surgical instruments have triggered the nickel allergy? Answer, I have no idea. I don't know why you're homing in on the antibiotic in particular - there must have been quite a lot happening if you were hospitalised with necrotising fasciitis, I think.

Now, funny things happen. Just compare this. A doctor friend of mine happened to remark to me at Christmas that bananas trigger or markedly exacerbate latex allergy. Now, I didn't know that before. I mentally filed it away, and checked that the gloves we use in the lab are not latex. However, right now, I've just googled - banana latex allergy - and got a whacking 52,200 hits. And on the very first page of these, even just looking at the short text strings Google reports, it's clear that all these pages are talking about an actual link.

Around half of all people with latex allergy have allergic reactions when eating particular foods including avocado, banana, chestnut, kiwifruit, ...


IgE antibodies reacting with both latex and fruit allergens (papaya, avocado, banana, chestnut, passion fruit, fig, melon, mango, kiwi, pineapple, peach, ...


18 Oct 2006 ... Others develop banana allergy because of the similarity between the allergens in banana and natural rubber latex (e.g. gloves, condoms, ...


And so on ad almost infinitum. Compare this with the returns I got for - cephazolin nickel allergy - very few pages in comparison, and the returns that are there do not actually discuss any connection between the terms.

So, while nobody here can say that it's impossible for there to be any connection such as you suggest, we can say that there seems to be no such connection reported. And on the face of it, since there is unlikely to be any antigen/allergen similarity between nickel and a fungus-product based antibiotic, no immediate reason to suspect one.

Again, given all that was happening to you at the time, why did you home in on the cefazolin as the likely culprit?

I have to say again that the one thing which has been shown to produce a nickel allergy is prolonged contact with nickel.

Rolfe.

[Yuri Nalyssus]

Ok, I have found the name of the sodium based antibiotic.
Cefazolin Sodium. http://www.ehs.lilly.com/msds/msds_cefazolin_sodium.pdf Not quite the same as table salt.

Unfortuneately, most of the published papers are for subscription only, but I did manage to find some information.

1. It is a severe allegen.
2. Can cause serious allergies.
3. Prescribed also for lead or heavy metal poisoning.
4. A large number of vials were recalled due to contamination.

Does this data lend any credence to my initial assumption.
Not really.

Points 1 & 2 (Allergens are simply things that cause allergies): In common with penicillins the beta-lactam ring in cephalosporins' structure can cause allergies (ignoring the value-laden "severe" and "serious") but that would be allergies to penicillins and cephalosporins, not nickel. You have to be exposed to nickel to get a nickel allergy - nothing else will do it. In fact it says in the data sheet you link to that it can cause allergies to penicillins and cephalosporins - not nickel or other substances.

Point 3: I don't know why you'd prescribe an antibiotic for heavy metal poisoning but even if you did that would have no bearing on whether it pre-disposed to a nickel hypersensitivity.

Point 4: Contaminated with what please? If it was nickel and you were injected with one of those vials you could be onto something. You need recall dates and batch numbers.

Yuri

[Yuri Nalyssus]

why did you home in on the cefazolin as the likely culprit?
That's the most interesting thing about this whole thread IMHO

For the duration of the drug being administered, my urine smelled like perm lotion and ever since then, I am unable to have any prolonged contact with any form of metal.
As far as the anti-biotics were concerned, they were according to the doctors the strongest available at the time (late 80's), and very expensive.
The stuff looked like a small white crystal, and reacted vigorously with the saline solution which was injected into the vial.
I also remember the prof saying that this particular drug was the last line of defence.
An expensive, powerful and weird looking antibiotic which caused weird changes in the body (urine smelling like perm lotion) is followed by an equally weird change in constitution, a nickel sensitivity.

Difficult then to accept reassurances from disinterested parties that there’s no causative link. More appealing to believe the magic.

Sometimes though stuff just happens, correlation doesn’t equal correlation. it doesn’t demean your experience, you’ve still got a problem, it’s just that it doesn’t have an easy explanation, like much in life.

Yuri

[Rolfe]

I never thought much about my own nickel allergy. I know it's common, and I just filed it as one of those things. I seem to have a much milder reaction than Squinty though.

Looking back, I think it was like this. My spectacle legs had worn, exposing the nickel. The nickel was in contact with my face for 16 hours a day. I was heading for the allergy, just because of that. Then I had the surgery, which left my temples swollen. That swelling increased the contact between the spectacle legs and my skin, and hey presto, within a couple of days, symptoms of contact allergy.

So perhaps the recent surgery was a related factor, but it was all pretty much coincidence.

I think Squinty needs to stop focussing on the antibiotic, which is a common and innocuous preparation, and think about what contact with nickel he had in the few weeks before the onset of the allergy. It might be something connected with the hospital stay.

Rolfe.

[skeptigirl]

I had the misfortune, about 20 years ago, of contracting necrotising fascitus. I underwent 3 surgeries in 2 days and recovered after about 3 months.
the anti-biotics were sodium based, a small amount of white substance in a vial, which was dissolved and injected into my drip.
For the duration of the drug being administered, my urine smelled like perm lotion and ever since then, I am unable to have any prolonged contact with any form of metal.
I cannot wear a metal watch, jewellry etc without the immiediate contact area erupting into blisters. Even the rivet button on my Levis have this effect regardless of 2 layers of clothing between my skin and the button.

Am I correct in attributing this too the sodium based anti-biotic and what could I do to alleviate this condition.:confused:Not the sodium but let's look closer.

Your body fluids on average contain .9% sodium. So sodium in an antibiotic is unlikely to trigger a metal allergy.

Cefazolin for injection (http://www.drugs.com/pro/cefazolin-injection.html) has no nickel in it and since allergies to nickel exist it would be listed as a warning to not use in patients with nickel allergy.

Allergies can exist without being triggered. An event occurs which is typically a 'first exposure' that sensitizes the immune system to respond the next time the substance is encountered and the person can be allergic from then on. You may have had an exposure to the metal you are now allergic to in or around the time you were in the hospital. But it is not the antibiotic which would have triggered this allergy.

[skeptigirl]

Ok, I have found the name of the sodium based antibiotic.
Cefazolin Sodium. http://www.ehs.lilly.com/msds/msds_cefazolin_sodium.pdf Not quite the same as table salt.

Unfortuneately, most of the published papers are for subscription only, but I did manage to find some information.

1. It is a severe allegen.
2. Can cause serious allergies.
3. Prescribed also for lead or heavy metal poisoning.
4. A large number of vials were recalled due to contamination.

Does this data lend any credence to my initial assumption.No.

1&2) Allergy yes, to cephalosporin and penicillin antibiotics, not allergies to anything and everything.

3) Where are you getting that it is prescribed for lead or heavy metal exposures?

4) Contamination would have likely been bacterial contamination. I'd need more info to be sure.

[skeptigirl]

Sure, I know that there is only Na sodium element and I never said I was allergic to Sodium. I am allergic to all kinds of metal's that contain nickel.
My question is, could the trigger have been the antibiotics?

Given the link between nickel and cefazolin.

sodium forms the basis of the drug http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?sid=7849285

Hence my heading "Sodium based antibiotics and side effects"You have taken the fact studies are being done looking for new antibiotics using metals (because some metals have antibiotic properties) and misunderstood the fact you get Google hits when you search for named antibiotics and metals being looked at for antibiotic properties. They come up together because of ongoing research, not because there is currently anything to do with nickel in cefazolin.


Here you were in a hospital for months, in contact with all sorts of things from the IV needles to cleaning agents and you seem to think the antibiotic was the only thing that was "new" to your body. :rolleyes:

[skeptigirl]

OK, I just looked and IV and other injection needles contain nickel. If I was going to bet on it and we could prove the connection, I'd say your IV needle was as likely a candidate as any to have sensitized you to react to nickel.

[Skwinty]

The effect of the antibiotic was immiediate and apparent.
The very strong smell of the urine.
The taste in the mouth.
The taste of your sweat.
The reaction to my watch and the needle, although I never felt a similarity between my watch arm and the needle arm.

The doctors , when I asked , said it was due to the sodium based antibiotics.

Now, I had other medical treatments with extended periods of intravenous drips and I never had the arm / watch reaction.

The connection seemed logical

[Yuri Nalyssus]

The effect of the antibiotic was immiediate and apparent.
The very strong smell of the urine.
The taste in the mouth.
The taste of your sweat.
The reaction to my watch and the needle, although I never felt a similarity between my watch arm and the needle arm.

The doctors , when I asked , said it was due to the sodium based antibiotics.

Now, I had other medical treatments with extended periods of intravenous drips and I never had the arm / watch reaction.

The connection seemed logical
You've made these points before and they've been addressed.

I can understand why you have made the connection - powerful antibiotic with bizarre effects followed by bizarre changes in your body; but it is not logical as at least 3 people have explained, in detail, already.

This is an important point in the debate. Do you accept the advice of people who know about allergies and antibiotics and the information to be had on the net, none of which seems to support your theory or do you continue in your beliefs? If you are not going to take this advice then all you have are beliefs, you're uncoupled from evidence and in the realms of magic thinking.

Yuri

[skeptigirl]

The effect of the antibiotic was immiediate and apparent.
The very strong smell of the urine.
The taste in the mouth.
The taste of your sweat.
The reaction to my watch and the needle, although I never felt a similarity between my watch arm and the needle arm.

The doctors , when I asked , said it was due to the sodium based antibiotics.

Now, I had other medical treatments with extended periods of intravenous drips and I never had the arm / watch reaction.

The connection seemed logicalIf some doctor told you your metal allergy was the result of cefazolin, either: they were wrong you misheard them they were agreeing with you to placate your concerns they have information not available to other health care providers

Is there some reason you asked for our opinion when you already had your mind made up?

[Rolfe]

The effect of the antibiotic was immiediate and apparent.
The very strong smell of the urine.
The taste in the mouth.
The taste of your sweat.
The reaction to my watch and the needle, although I never felt a similarity between my watch arm and the needle arm.

The doctors , when I asked , said it was due to the sodium based antibiotics.

Now, I had other medical treatments with extended periods of intravenous drips and I never had the arm / watch reaction.

The connection seemed logical


Skeptigirl, I'd go with misheard/misunderstood. It's such bizarre thing for any doctor to say that I think there must have been crossed wires. We know how easy it is for people to get the wrong end of the stick when encountering something unfamiliar - especially if they're very sick at the time. The whole focus on the sodium suggests a fundamenal misconception - It would have been as sensible to blame the sodium pentothal he might have been given as an anaesthetic, or even the sodium in the i/v drip he almost certainly received. I'm surprised the fact that the cefazolin was presented as the sodium salt even rated a mention.

I'm also wondering about that list of strange side-effects above. I'm not that familiar with cefazolin itself, but I'm very familiar with its close cousin cephalexin and other cephalosporin antibiotics, none of which do any of these things. I very sceptical that cefazolin does these things either.

Is there something else he might have been given at the time that would account for all that? What does perm lotion smell like anyway? Ammonia? Would this be related to the taste in the mouth and of the sweat? What could he have been given that might have caused all that?

Rolfe.