HIV and Hay Fever
I always get allergies during the summer but they have got worse since I got HIV, any idea why?
Allergies are caused by the Immune system over-reacting to things in your surroundings like pollen, dust, insects, certain foods or medicines. Allergies can happen at any time during HIV infection, and some people who never had hay fever or were already allergic to commonly used medicines like penicillin, find that an allergy develops once they have HIV. It may seem odd allergies get worse when you have a weakened immune system, but allergy occurs when the normal controls of the immune system are not working properly. However, other people with HIV have reported a reduction in the severity of allergies like hay fever if their CD4 counts go down to low levels, and a return of the symptoms once their immune system recovers with treatment.
I've recently started anti-HIV drugs. Does that mean the allergies are going to go away?
For the reasons above we can't predict whether allergies like hay fever will improve or worsen if you take effective HIV treatment. In any case, it is important to distinguish between these seasonal allergies and allergic reactions to the HIV drugs themselves. Mild, transient allergic reactions such as rashes on starting certain HIV drugs are relatively common. However, a small number of people develop more serious allergic reactions to HIV drugs, especially nevirapine (Viramune) and abacavir (Ziagen, also in Trizivir). These can be dangerous and, very rarely, life-threatening.
Tell me about them. How do I tell if it's just my normal allergy or a problem with medications?
Allergies like hay fever generally cause symptoms like itchy eyes, sneezing and an itch rash in the form of hives or eczema. Rash can also be a sign of an allergic reaction to medication but looks very different. About 16% of people taking nevirapine develop a rash. This is to do with the way the body processes the medicine. It takes the form of red blotches, itchy lumps or speckles on the skin. This rash usually appears after one to four weeks of treatment. In most cases the rash goes away after two to four weeks on the drug, and thereafter, most people experience very few or no side effects. However, about 7% of people taking nevirapine develop a more serious rash which occasionally requires hospitalization. This rash usually goes away if the drug is stopped. If you develop a rash when taking nevirapine, you should consult your doctor immediately. A small number of people taking abacavir develop a severe allergic reaction to it, normally in the first few weeks of taking it, but can occur at any time. Fever, shortness of breath, stomach problems like nausea and diarrhea are normally present and occasionally a rash. It is essential that you see your doctor immediately if you think you have this allergic reaction, but do not stop taking the drug until advised to. If you stop taking abacavir because you are allergic to it you must never take it again, as this can be fatal. Some drugs used to treat infections like PCP and tuberculosis can also cause rashes, and you should tell your doctor if these develop. And many people develop an itchy red rash due to allergies to penicillin or other antibiotics.
OK, I'm sure I've got normal hay fever. Can I take antihistamines if I'm taking HAART?
Antihistamines can interact with some anti-HIV drugs. Some prescription antihistamines should never be used with anti-HIV drugs, and some should only be used with caution. So, if you are getting your GP to prescribe treatments for spring/summer allergies you should let them know about your HIV medications and indeed all medications. It's also wise to tell the pharmacist if you are taking antihistamines you can buy over the counter. The two most widely used antihistamines should never be taken with HIV drugs are Triludan (terfenadine) an Hismanol (astemizole). Check before you buy any others such as Zirtek or Clarityn to make sure it's safe to take with your medication(s). You should also tell your pharmacist if you are taking any natural herbal remedies for any health reason.
This information was obtained from the Website of Positive Nation, Issue 129 February 2007.