Allergic Reactions to Medication After Long-Term Use

The father has been taking Depakote for a long time, and after stopping the medication and then resuming it, he has developed allergic symptoms?

Hello Doctor, my father is 66 years old and has a history of epilepsy and depression.
He used to take two tablets of Depakene 500mg daily to control his condition, and he did not experience any issues for two to three years.
Last month, my father fell at home and developed a subdural hematoma, which required surgery and hospitalization for about 20 days.
During his hospital stay, he did not take Depakene, and the doctor switched him to Keppra for seizure control.
However, after discharge, the doctor prescribed the same dosage of Depakene for my father and discontinued Keppra.

After taking Depakene for two days, my father developed redness and a rash on his arm.
Initially, it was itchy, but it is no longer itchy now.
It has been two days, and the rash has not improved but has not worsened either.
I would like to know if my father's rash symptoms indicate a drug allergy, considering he has taken Depakene for several years without any allergic reactions, and this is the first time he has experienced such a reaction.
Since my father is currently bedridden and unable to visit a hospital, I would like to ask if this could be a drug allergy or if it is due to a change in weather causing the skin rash.
I have 60mg of Allegra available; can I give it to my father to alleviate the allergic symptoms?

Dan Tou, 20~29 year old female. Ask Date: 2019/11/26

Dr. Hong Yuanbin reply Internal Medicine

Hello, regarding the skin rash, it is indeed necessary to observe it directly in order to determine the cause.
However, based on your description, a rash that is limited to the arms usually has a lower likelihood of being an allergy and is more likely to be localized eczema or an inflammatory reaction.
Nevertheless, if the symptoms persist, it is advisable to consult a dermatologist for safety.
Thank you for your inquiry.

Reply Date: 2019/11/26

More Info

Understanding allergic reactions to medication, especially after long-term use, is a complex issue that requires careful consideration of various factors. In your father's case, it appears that he has developed a rash after resuming the use of Depakote (valproate), a medication commonly prescribed for epilepsy and mood stabilization.
Firstly, it is important to note that allergic reactions can occur even after prolonged use of a medication without any prior issues. This phenomenon is known as "delayed hypersensitivity," where the immune system may become sensitized to a drug after repeated exposure, leading to an allergic reaction upon subsequent use. The fact that your father has taken Depakote for several years without any adverse effects does not rule out the possibility of developing an allergy later on.

The symptoms you describe—redness, swelling, and itching—are indeed consistent with an allergic reaction. However, they can also be attributed to other causes, such as changes in the environment, skin irritation, or even stress related to his recent health issues. Given that the rash has persisted for two days without worsening, it may suggest a mild allergic reaction, but it is crucial to monitor the situation closely.

Regarding the use of antihistamines like Allegra (fexofenadine) to alleviate the symptoms, it is generally safe to use antihistamines for mild allergic reactions. However, since your father is currently bedridden and may have other health considerations, it is advisable to consult with a healthcare professional before administering any medication. Antihistamines can help reduce itching and redness, but they may also have side effects, especially in older adults or those with certain medical conditions.

If your father’s rash does not improve or worsens, or if he develops additional symptoms such as difficulty breathing, swelling of the face or throat, or fever, it is imperative to seek medical attention immediately. These could be signs of a more severe allergic reaction known as anaphylaxis, which requires urgent treatment.

In summary, while it is possible that your father's rash is an allergic reaction to Depakote, other factors could also be at play. Monitoring the symptoms and consulting with a healthcare provider is essential for proper management. If you decide to use Allegra, please ensure it is appropriate for his specific health situation. Always prioritize safety and seek professional advice when dealing with medication-related concerns, especially in elderly patients with complex medical histories.

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