Expert: Marc Rubin, RPh Asthma Educator - 10/19/2008

Question
My boyfriend has been ill with fatigue, low-grade fever ranging from 99 to 101, and a headache for 9 days now. He also has a raised rash on his forearm that I noticed three days ago that hasn't gone away. He has had asthma for 24 years, and it's allergic asthma. His doctor gave him a test for Lyme Disease and also ran a blood test for leukemia and mononucleosis, but that came back negative. We are still waiting for the Lyme Disease results. My question is, he has allergies to many antibiotics, including penicillin derivatives, Erythromycin, Tetracycline, etc. Safe to say, his choice for antibiotics is very limited because he may have allergic reactions, including full-blown asthma attacks because of it. My question is, if he does have Lyme Disease, what are his choices for treatment given his allergic history? I understand antibiotics are what they give for that, but I would hate to see him have a severe reaction to an antibiotic. He is taking Levaquin but that's just because his doctor really has no idea what is wrong with him. I did take him to the emergency room on Friday just to get a second opinion, and the doctor there said he thought it was viral, but didn't discount Lyme Disease either. Do you have any knowledge about his type of problem? Any suggestions if it does turn out to be Lyme Disease? Thank you.

Answer
Hi Carrie,

Recommended drug therapy, with his allergy presentation, would be 1) Ceftriaxone or Cefuroxime.

One consideration of allergy history with medications: it is not always the active ingredient, but the additives and binders that may be causing the problem. They include: Iodine products, lactose, gluten products, egg products,corn products, etc. If he hasn't, he should have allergy testing to determine if this is the source of his broad-based allergies.

Also, if he is truly penicillin allergic, even the compounds I gave you may develop cross allergic response.

Best bet: get a consult with an infectious disease specialist.

Hope this helps you and your boyfriend.

Sincerely,

Marc