Weird allergic reaction to sawdust put on Prednisolone - any experience of side effects?

[arewenearlythereyet]

Just upfront, I’m not looking for medical advice, just any experience of side effects to look out for taking Prednisolone

Had a strange allergic reaction on Saturday...stupidly was just showing my son the electric sander not realising that it was still full of sawdust...well poof and a got a mild dose of sawdust. Now I take antihistamine daily anyway so was quite surprised by the reaction to this.

Immediately had a severe reaction ...couldn’t breathe etc...wheezing coughing luckily had an old ventolin at hand and this eased the constriction ...well this morning 5 days later still wheezing and struggling to breathe and cough getting worse and all the other unnecessary subjects.

Went to the docs and he’s given me prednisolone 30mg daily for a week. Not particulalry impressed since he didn’t know I had been diagnosed with asthma and didn’t seem to check the other drugs I was taking etc. I asked about side effects and he said...all drugs have side effects so it’s always a risk. Take them or stop them it’s your choice.

I notice a lot of side effects on the packet ...just wondering whether anybody had any bad reactions? I’m just a bit nervous about what I may have to deal with and there was no point talking to the doctor about ME etc.

If this contravenes a rule I’m happy for this post to be taken down by the mod team I just know a lot of people seem to have experienced taking steroids.

 

[Hutan]

Quite a lot of sawdusts can cause reactions, even in people who aren't particularly allergic. Rimu, a native timber here in New Zealand is notorious.

My sister (who doesn't have ME) reacted to rimu dust with wheezing and a rash. She had a short course of prednisone (no idea of the dose). She improved quickly and she didn't have any noticeable side effects.

I've had short courses of prednisone (prior to ME) and have never had any problems. How ME might complicate things, I don't know, but I seem to recall reports from some people with ME feeling that prednisone actually helped their ME symptoms (although obviously it's not a good drug to take for more than a short time if there is any alternative).

I hope you are feeling better soon. Struggling for breath is exhausting.

 

[arewenearlythereyet]

Quite a lot of sawdusts can cause reactions, even in people who aren't particularly allergic. Rimu, a native timber here in New Zealand is notorious.

My sister (who doesn't have ME) reacted to rimu dust with wheezing and a rash. She had a short course of prednisone (no idea of the dose). She improved quickly and she didn't have any noticeable side effects.

I've had short courses of prednisone (prior to ME) and have never had any problems. How ME might complicate things, I don't know, but I seem to recall reports from some people with ME feeling that prednisone actually helped their ME symptoms (although obviously it's not a good drug to take for more than a short time if there is any alternative).

I hope you are feeling better soon. Struggling for breath is exhausting.

Thanks @Hutan ...the cough is particularly draining too. The wood was plain old pine, so nothing too exotic... I saw that a lot of North American woods also give problems with allergy as sawdust ....what’s weird is that it was me that sanded it around 8 weeks ago with a dust mask with no sign of an allergy.

Anyway hopefully no reaction to the steroids

 

[MSEsperanza]

Just upfront, I’m not looking for medical advice, just any experience of side effects to look out for taking Prednisolone
.

Did your doctor instruct you how to take the Prednisolone?

This is no advice, and as you know, side effects can occur to everyone differently, and also each ME is different. And in case you experience severe side-effects or such of which you are unsure whether they are serious or not, you will not hesitate to seek apt medical advice?

So this is my experience with middle dosed predni (when I already had ME):

I had no drastic side effects from Predni up to 40mg / daily, when I took it early in the morning (around 6 a.m.) together with some stomach-friendly food. Sometimes this was too early for me to get up, so I made sure each evening that I had the drugs, sufficient water, and some food standing on the bedside table.

Also, I refrained from coffee (AFAIK predni can accelerate the heartbeat, at least did it in my case, and also will cause increased stomach acid. Perhaps your doctor prescribed you antiacids along with predni - then make sure to take both medications as instructed, not at the same time in any case.) .

When I took it after 6.30 a.m., I sometimes had insomnia the following night.

 

[Jonathan Edwards]

Went to the docs and he’s given me prednisolone 30mg daily for a week. Not particulalry impressed since he didn’t know I had been diagnosed with asthma and didn’t seem to check the other drugs I was taking etc. I asked about side effects and he said...all drugs have side effects so it’s always a risk. Take them or stop them it’s your choice.

I appreciate your desire not to seek medical advice and I hesitate to respond but in this situation I think I should make some comments.

The overriding risk with prednisolone at this dosage is gastrointestinal bleeding. Above about 20mg daily the risk is significant, although chiefly in older people. Bleeding can be enough to be dangerous. These days prednisolone is often given together with a prophylactic acid inhibitor for the stomach although I do not know how effective that is.

There is also a small risk of severe mood swing - largely depressive when stopping the dose - particularly if suddenly.

I very rarely prescribed this sort of dosage, except for temporal arteritis, where there is an urgent need to prevent possible loss of vision. Other acute immune reactions would be reasonable indications and I believe that acute asthma can be treated with this sort of dose. My concern is that GPs often do not know what they are doing. In recent years I more often saw patients who had been given this sort of dose for rheumatoid arthritis, which is inappropriate.

There is a general rule with steroid treatment of acute immune reactions that you want to give as little for as short a period as you can get away with. Temporal arteritis is an exception because the treatment is preventive. Even there is is probably suitable to reduce dose as soon as headache has settled. It is also always best to start steroids sharply and tail off gradually, to avoid rebound.

In the situation you describe if I were the patient I would try 10mg first and more only if not settling, and cut back the dose as soon as things started to improve.

I realise this sounds very like advice but your account of your GPs approach raises a serious concern that they have no idea about the practicalities of steroid usage. That may be wrong but better safe than sorry.

 

[arewenearlythereyet]

Did your doctor instruct you how to take the Prednisolone?

This is no advice, and as you know, side effects can occur to everyone differently, and also each ME is different. And in case you experience severe side-effects or such of which you are unsure whether they are serious or not, you will not hesitate to seek apt medical advice?

So this is my experience with middle dosed predni (when I already had ME):

I had no drastic side effects from Predni up to 40mg / daily, when I took it early in the morning (around 6 a.m.) together with some stomach-friendly food. Sometimes this was too early for me to get up, so I made sure each evening that I had the drugs, sufficient water, and some food standing on the bedside table.

Also, I refrained from coffee (AFAIK predni can accelerate the heartbeat, at least did it in my case, and also will cause increased stomach acid. Perhaps your doctor prescribed you antiacids along with predni - then make sure to take both medications as instructed, not at the same time in any case.) .

When I took it after 6.30 a.m., I sometimes had insomnia the following night.

No the GP was particularly unhelpful, but the pharmacist told me to take on a full stomach. Think the GP was a locum judging by his name on the door was a post it.

I rather stupidly took them straight away at lunch time after some food so had the insomnia thing last night. Also had raised heart rate and nausea/ heart burn. So far nothing worse than that

With the cough/wheezing not abating though I’m still waiting for it’s intended effect. Glad to hear it didn’t affect you too much

 

[Hutan]

I may well be contravening the 'no medical advice' rule here and creating problems for my fellow moderators.
FWIW This is an article from Medscape, dated July 2018.

Hypersensitivity Pneumonitis Treatment & Management

Treatment regimens for hypersensitivity pneumonitis vary according to the prescriber. A conceivable initial empiric treatment dose is prednisone 0.5-1 mg/kg/day for 1-2 weeks in acute hypersensitivity pneumonitis or 4-8 weeks for subacute/chronic hypersensitivity pneumonitis followed by a gradual taper to off or maintenance dose of approximately 10 mg/day. Continued therapy should be guided by clinical response, pulmonary function, and radiographic improvement. Maintenance doses are not always required, particularly if the patient is removed from exposure.

Note given later posts - this may not be relevant. A followup appointment with another doctor does sound like a good idea.

 

[arewenearlythereyet]

I appreciate your desire not to seek medical advice and I hesitate to respond but in this situation I think I should make some comments.

The overriding risk with prednisolone at this dosage is gastrointestinal bleeding. Above about 20mg daily the risk is significant, although chiefly in older people. Bleeding can be enough to be dangerous. These days prednisolone is often given together with a prophylactic acid inhibitor for the stomach although I do not know how effective that is.

There is also a small risk of severe mood swing - largely depressive when stopping the dose - particularly if suddenly.

I very rarely prescribed this sort of dosage, except for temporal arteritis, where there is an urgent need to prevent possible loss of vision. Other acute immune reactions would be reasonable indications and I believe that acute asthma can be treated with this sort of dose. My concern is that GPs often do not know what they are doing. In recent years I more often saw patients who had been given this sort of dose for rheumatoid arthritis, which is inappropriate.

There is a general rule with steroid treatment of acute immune reactions that you want to give as little for as short a period as you can get away with. Temporal arteritis is an exception because the treatment is preventive. Even there is is probably suitable to reduce dose as soon as headache has settled. It is also always best to start steroids sharply and tail off gradually, to avoid rebound.

In the situation you describe if I were the patient I would try 10mg first and more only if not settling, and cut back the dose as soon as things started to improve.

I realise this sounds very like advice but your account of your GPs approach raises a serious concern that they have no idea about the practicalities of steroid usage. That may be wrong but better safe than sorry.

Thank you @Jonathan Edwards My experience with the GP did seem inconsistent with what my Dad recently experienced where he did take a high dose for suspected temporal arteritis (took something for his stomach and told to taper down after symptoms go away) and this was part of the reason for my post.

 

[Trish]

With the cough/wheezing not abating though I’m still waiting for it’s intended effect.

Given that @Jonathan Edwards' advice and your doctors differ, and the symptoms aren't abating, my inclination would be to suggest you go back to the doctor (preferably not the same locum) and ask for a second opinion and more thorough assessment of what is best for you to do.

 

[Jonathan Edwards]

I may well be contravening the 'no medical advice' rule here and creating problems for my fellow moderators.
FWIW This is an article from Medscape, dated July 2018.

Hypersensitivity Pneumonitis Treatment & Management

Treatment regimens for hypersensitivity pneumonitis vary according to the prescriber. A conceivable initial empiric treatment dose is prednisone 0.5-1 mg/kg/day for 1-2 weeks in acute hypersensitivity pneumonitis or 4-8 weeks for subacute/chronic hypersensitivity pneumonitis followed by a gradual taper to off or maintenance dose of approximately 10 mg/day. Continued therapy should be guided by clinical response, pulmonary function, and radiographic improvement. Maintenance doses are not always required, particularly if the patient is removed from exposure.

This would make sense for pneumonitis but pneumonitis is more than just an asthmatic or bronchitis reaction. This sort of approach would apply if a chest x-ray showed pulmonary infiltrates ('shadowing'). The dose equates to about 30-80mg.

The advice looks pretty shoddy in fact. I ma not sure what a 'conceivable empiric treatment' is supposed to mean. The use of the word 'should' later indicates that the text is intended as advice or recommendation. But what it should say is: do not try to treat this serious condition without full expertise - it should be dealt with by someone who had done the relevant investigations and has read all the literature and knows the evidence base. NOT A GP.

So much of medicine seems to be reduced to magazine recipes these days.

 

[Jonathan Edwards]

Given that @Jonathan Edwards' advice and your doctors differ, and the symptoms aren't abating, my inclination would be to suggest you go back to the doctor (preferably not the same locum) and ask for a second opinion and more thorough assessment of what is best for you to do.

Sounds reasonable. If the symptoms have not gone away the prednisolone dose is clearly not too high if it is relevant at all. I would want to make a decision like this on the basis of a chest x-ray and routine spirometry tests.

 

[James Morris-Lent]

As someone who grew up with asthma I am wondering why the option of adding an inhaled corticosteroid (to go with the salbutamol ) has not been considered.

 

[arewenearlythereyet]

Given that @Jonathan Edwards' advice and your doctors differ, and the symptoms aren't abating, my inclination would be to suggest you go back to the doctor (preferably not the same locum) and ask for a second opinion and more thorough assessment of what is best for you to do.

Yes I discussed this with Mrs Sloth this morning ... unfortunately they don’t give a choice at my surgery unless you wait 2 weeks but i will give it a go. I also need to avoid the one that doesn’t think ME exists other than in patients minds, it’s like being a patient ninja trying to get the basics isn’t it?

 

[arewenearlythereyet]

Just a quick update. I decided to take a lower dose (10mg) and after 4 days my symptoms have disappeared so I think this was indeed an allergic reaction. Apart from insomnia no change to my ME symptoms from taking the lower dose. I will mention my experience and increased incidence of allergic reactions to the doctor next time I visit, but I’m not in a hurry to run the gauntlet just yet (waste of time and energy etc).