Atrovent Not Safe for PA

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I'm posting this on this forum at Chris' suggestion.

During the Christmas break, Kevin had to be rushed to the ER twice in 24 hours for asthma and croup, simultaneously. The second time we went, the MDs wanted to give him Atrovent. Thanks to this site, I knew that Atrovent was not safe for peanut allergic individuals and told them so. They were absolutely shocked. I don't think they quite believed me, so they went to look it up and just said "Wow, you are right" when they returned.

Another crisis averted thanks to PA.com!

Amy

On Dec 29, 2002

This same thing has happened with my pa son twice now. I too am soooo thankful that I knew to question them first. They too were totally shocked- they had no idea!

Valerie

On Dec 30, 2002

I showed the Atrovent literature to my son's pulmonary doctor a few years ago. He was floored that I knew this and he did not. He Xeroxed the literature and put it in my son's chart. My husband is also a physician and he did not know this. It takes a mother....... Peggy

On Dec 30, 2002

So sorry to hear about Kevin - how is he doing now? Last year our son had be hospitalized for croup that turned into bad asthma -- it was really hard on us (coming only a couple months after his anaphylactic reaction to PNbutter at 14 months.) -- Though he had a pretty good time at the hospital -- when he wasn't being poked an prodded by doctors, he enjoyed playing with all the toys (they actually admitted him rather than making us sit through the whole ER thing). Great catch on the Atravent! I'm thinking about adding that to our son's profile on MedicAlert -- NO ATRAVENT (and isn't there another one too? "Combivent" or something like that -- I'll have to check that out -- our pediatric pulminologist actually DID know about this restriction -- but he has a son with PA -- of course!)

On Dec 30, 2002

Hi Ali,

Hope your Christmas was wonderful!

Kevin is just fine now, thanks. And yes, he has been hospitalized for croup as well (not to mention numerous ER trips). Such a drag - when will he outgrow this? I have this vision of me having to drive him around at night when he's 40! It was much easier when he was in a stroller. [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img]

Amy

On Jan 2, 2003

Amy, we've been dealing with serious bouts of croup since Wade was a baby, he's now almost 5 and we still end up at the ER with regularity. You mentioned that you end up dealing simultaniously with croup and asthma. My son is also asthmatic and whenever we have to go to the ER and I explain that yes it is croup but his asthma flares at the same time so he needs asthma meds as well. They always look at me like I'm from Mars and ignore the information which means Wade gets treated for croup, discharged and we end up having to come back to the ER because he has an asthma attack.

I've brought this topic up before and was wondering if anyone else has a child with croup who does not EVER respond to either cold air or the steamy bathroom. We always end up in the ER. I do know that there are two kinds of croup, viral and allergic. I was thinking that Wade must have allergic croup given that his last hospitalization was in June but everything I have read about is says it is supposed to be less severe than viral croup. Any thoughts?

Something that completely iritates me is that frequently the ER staff do not take you seriously, I can think of one occasion in particular where Wade was in serious respiratory distress and it was only when I insisted that they take his Oxygen sat level that they jumped into action. I got into big trouble from the admitting ER doctor because I had not called an ambulance. It' s a hard call anytime. Glad to hear your little one is better. Here DD woke up with a fever and croupy cough, since she and Wade share a room, it's only a matter of time. Yippee!

Take care,

Katiee

On Jan 2, 2003

Hi Katiee,

You know how Eskimos have something like 32 words for snow? Well, we could have the same for croup! It has been a constant since Kevin was 4 1/2 months old.

If anything other than a shot of Decadron will clear it up, is occasionally the cool night air. Since he's too big to push around in a stroller now, I keep saline inhalation solution in the fridge and nebulize him with it. Oral Decadron is helpful too, and works faster than Pediapred. Often we still end up in the ER, but sometimes it eases him up enough to at least get us there. This last bout was really surprising, since it hasn't been that bad in a long time. I'm just grateful he didn't have to be admitted; a few years ago he spent 2 days in ICU and it's taken him years to recover from that!

BTW, we also have a tough call regarding calling an ambulance. We live so close to the hospital that we can usually be there before the ambulance would even arrive at my house. I know they get you through triage and registration faster, but I have to say that the one time I arrived with Kevin in my arms (blue, I might add) they sped me right in and went to work on him immediately.

Jeez Louise, just thinking about this all is making my heart race. Sorry I don't have better insight for you. Oh, wait - I do. A pulmonologist suggested in light of Kevin's allergies to try him on Intal for the winter months. Didn't do a darned thing, so ... Back to square one.

Amy

On Jan 6, 2003

I'm so sorry to hear about these instances of croup/asthma occurring for so many years -- but at least I'm reassured that we're not alone. One time when DS had a cough that was turning into bad asthma, we actually did get it under control ourselves by giving him a double dose of Xopenex by nebulizer (at the advice of the pediatrician who we were in touch with by phone) -- that "broke" the episode and we were able to get on top of it, giving a Xopenex treatment every few hours and then tapering off. It was SO much better than dealing with the hopsital -- but scary too... Katiee -- I know exactly how frustrated you must have been to have been scolded by a doctor after YOU insisted that they measure your son's oxygen. That kind of stuff really gets to me -- I had a lot of trouble after DS was born with nursing and other physical problems recovering from birth and was told a few times, in a not-nice way, what I "should" have done...I know it shouldn't get to me -- who really cares what they think as long as everyone's getting the treatment they need, right? But still, I always want to scream back at the doctors who do that that I'm doing everything I can and trying to make good judgments and scolding me isn't going to help anyone!

On Mar 16, 2003

Just wanted to tell you all what happened today regarding this... we were in the ambulance on the way to the ER after a very scary reaction and the EMT and I were discussing ds's school plan for allergy and asthma. I mentioned being surprised that the ER Doc's did not know that Atrovent and Combivent used peanut oil as a propellant. The EMT was shocked! She said, I did not know that. She insisted that I tell the teacher and secretary to make it [b]very clear[/b] to the EMT's if he should ever have a severe asthma attack at school and they need to be called to [b]not[/b] use the atrovent as it is normal procedure for the EMT's to use a combination of Atrovent and Albuterol on anyone having a severe asthma attack enroute to the hospital.

Just wanted to let you all know so that you can be aware of this. The EMT did say that she would be passing the info along to all the other EMT's.

HTH, Valerie

On Mar 16, 2003

CVRTBB/Valerie

I hope your DS is o.k.

Please post back that all is well.

Warm regards, Syd's Mom

On Mar 17, 2003

When the question about Atrovent first came to the board (or the first time I saw it), I remember checking our then family doctor's CPS. Then, when he came in, I tried to discuss it with him. I swear, the man looked at me as though I was an alien. [img]http://uumor.pair.com/nutalle2/peanutallergy/mad.gif[/img] The CPS is right there on his desk and yet I'm sure that he didn't check it except for when prescribing a new medication where the patient had some questions. And, I'd have to say that overall, he was a *good* family doctor. The look on his face suggested that I knew something I shouldn't really know and of course, he didn't have the answers about the asthma puffers that my children use (Ventolin and Flovent). Found out about them here. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Thanks for posting the information Valerie. I really appreciate it and the up-date. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

------------------

On Mar 17, 2003

Syd's Mom and Cindy, Thanks for the support [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Timmy is doing much better today, thanks. I just called the school to check on him as it is only 1 mile away and I just heard an ambulance go by [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] I will be going there shortly to teach so hopefully that will take the edge off of my worry [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Thanks again, Valerie

On Mar 17, 2003

Wow this is scary. I had not heard of this before. I'm wondering if I should add this to Andy's medic alert file since he has asthma symptoms during a reaction. Has anyone else added this?

Jen

On Mar 17, 2003

CVRTBB - Hoping things today are good this afternoon for your DS. Your both in our thoughts.

nvmom - I am adding Atrovent (I have to update DD's bracelet anyways to add cephlosporin allery, so I am putting Atrovent) and maybe even Combivent as I understand it is made by the same company as Atrovent and may also be another asthma drug to steer clear of if allergic to peanuts. I don't have absolute confirmation on the combivent, but I'd rather have both Atrovent & Combivent listed on the medicalert bracelet just in case. I've had to stop respirologists from administering Atrovent to DD twice in the last year as they didn't know it wasn't an acceptable asthma drug for PA people.

Warm regards, [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

On Mar 17, 2003

I have been thinking about this since I took my PA daughter to the ER for her asthma and asked them not to use atrovent.

When I spoke to the manufacturer, they specifically stated that the problem was the propellant and with then new non CFC propellant the problem with atrovent for peanut allergies would go away.

Now, in the ER, we are using atrovent nebules. My question is whether they have any propellant or not? I will need to follow up with the manufacturer again. In the meantime I will try to raise the thread where I posted the response I got from the manufacturer.

take care

deb

On Mar 18, 2003

I am new here so I havent heard of the atrovent problem. My PA son is also asthmatic but what a shock this thread was. My son has croup all the time and no one really knows why. Then it seems he always ends up with pneumonia within a few days. He has been in the er so many times with it Ive lost count. Once with diff. breathing, put on oxygen, etc. Very scary to walk in your childs room and see them struggling to breathe. So has the atrovent problem been taken care of or is that one more thing I need to worry about? I think Im going to just put him in a bubble.

On Apr 13, 2003

How scary! We were in the ER with my son this past week for asthma and the doctor said "Normally I would prescribe Atrovent, but since your son is allergic to peanuts he can't have that." I was impressed that he knew that and told him so.

On Jun 6, 2003

Can someone please clarify this thread for me - is Atrovent and Combivent both a NO NO!! Is this an absolute positive? Do you put this on your medical bracelet for your PA child? Are there any other medicines that I should know about?

On Jun 6, 2003

Danielle - I never received any confirmation about combivent, but here is the exact quote about [b] Atrovent[/b] from the Physicians Desk Reference website (exact link page also attached).

quote "Why should this drug not be prescribed? If you are sensitive to or have ever had an allergic reaction to Atrovent or any of its ingredients, or to soybeans, soy lecithin, or peanuts, you should not take this medication.

You should also avoid Atrovent if you are allergic to drugs based on atropine. Make sure your doctor is aware of any drug reactions you have experienced."

[url="http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/atr1037.shtml"]http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/atr1037.shtml[/url]

The PDR (physicians desk reference) was enough for us to make sure it is never to be used on our DD at the hospital during treatments and we added it to her medical alert.

Note - it has been stated on this PA.com website that some forms of Atrovent are safe and some aren't but I honestly can't remember which version is safe or unsafe so we simply put it as a product that our DD must always avoid.

On Feb 15, 2004

I can clarify some of these questiona about Atrovent. I am a Pulmonologist (Lung disease specialist). Atrovent in the metered dose inhaler and Combivent both have peanut oil in them in a highly refined form. The risk is theoretical at worst, since it is so refined and in all likelihood is free of peanut protiens. In any event, Atrovent is a great drug for people with emphysema, but I rarely if ever prescribe it for peope with asthma, as there are much better drugs available.

As far as "safe" forms of Atrovent, the nebulized solution (the one that gets put into a nebulizer, as opposed to a "puffer"), has no peanut oil in it to my knowlege, as it does not require a propelleant to get inhaled. I hope this clarifies some of this issue. Here is a quote from a newletter I read regularly...

"Soya lecithin is only used in the Atrovent and Combivent inhalers; the nasal spray and nebulized solution do not contain peanut products. (Source:

On Feb 22, 2005

Bumping up.

Katiee

On Jul 24, 2005

Atrovent solution for the nebulizer is safe! So is the nasal spray. Its the inhalers that aren't although I've heard since they changed the propellant that the inhalers are ok.

I'm severely allergic to pnuts and have chronic lung problems. I use Atrovent nebulizer solution with no issues and checked on it before I started using it and could find no contradiction to using Atroven nebulizer solution

[url="http://www.findarticles.com/p/articles/mi_m3225/is_1_60/ai_55391828"]http://www.findarticles.com/p/articles/mi_m3225/is_1_60/ai_55391828[/url]

Thats a link to an article published in the American Family Physician journal that states according to the institute for safe medicine practices that atrovent for the nebulizer and atrovent nose spray are okay for peanut allergic people

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