ASK THE DOCTOR: Side effects from codeine just that, not allergic reaction
By Dr. JIM MITTERANDO
For The Patriot Ledger

Q. I have an upcoming surgery and I am worried about taking pain medications. I have an allergy to codeine, which causes itching and vomiting. My doctor tells me this is not an allergy and that I can take pain medications. What do you recommend?

A. Many people think they’re allergic to opioid pain medications, such as codeine, hydrocodone, morphine and oxycodone, but they are not. People often mistake nausea, constipation and sedation for an allergy. These are side effects and not an allergy. These symptoms can often be prevented or treated with anti-nausea pills or stool softeners. I find codeine tends to cause more nausea than other pain medications. If you try another another pain medicine, such as hydorcodone, you probably will tolerate it well.

Itching, hives and flushing are common, especially with codeine, morphine and meperidine (Demerol). These symptoms would signal an allergic reaction with other kinds of medications like penicillin or foods like peanuts; but opioids release histamine in the skin causing this response. This side effect is often prevented or treated with antihistamines.

A true allergy to opiods causes trouble breathing, low blood pressure or swelling of the lips or tongue.

Opiod pain medicines are often needed after surgery if acetaminophen (Tylenol) or anti-inflammatories, such as ibuprofen (Advil, Motrin) or naproxe (Aleve ) do not relieve pain.

Q. I am a 34 year-old woman who keeps getting severe sore throats and swollen tonsils three times a winter since I have had children. When I was a pre-teen, I had frequent episodes of tonsillitis that I eventually outgrew and had no problems until recently. I know tonsillectomies are not usually recommended these days but what else can I do?

A. Tonsils - lymph nodes on either side of your throat - are a part of your body’s immune system. They help filter out bacteria and viruses that can cause infections.

Some people develop dysfunctional tonsils that seem to prolong an illness or make it more severe. If someone gets sick every month with severe prolonged sore throats, I would consider tonsillectomy. If you are getting these episodes three times a year, I would not recommend surgery. Tonsillectomy for an adult can be quite rough and with complications.

The good news: once your children get a little older, they will not be bringing home so many viruses and you will not get sick as often. Your history does not suggest an immunodeficiency.

Unfortunately, I do not have any solutions for you. Certainly, try to get more sleep since your immune system and energy can be quite depleted for several weeks after an illness and you may be more susceptible to another ‘‘bug’’ at that time. Good Luck.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2006 The Patriot Ledger
Transmitted Tuesday, February 28, 2006