TO PERSONALIZE THIS DOCUMENT, go to FILE > Make a Copy above.

ALLERGY WARNING  and Emergency Treatment Plan

Patient Name - Medic Alert Id# -------------- - DOB xx/xx/xxxx

Severe allergic reactions to corn products and corn derivatives, especially corn-derived sugars, starches, and alcohols. (see References on page 2)

Symptoms

Ingestion: [example, modify for your own needs] swelling of the tongue, lips, and throat occurs within 5 to 60 minutes

Contact with mucous membrane: [example] localized itching and swelling occurs within the range of 5 to 60 minutes.

Skin contact: [example]dermatitis can occur after prolonged contact.

Injection: [example]So far untested, but please exercise caution.

Intubation

Rinse all tubes to remove corn starch before inserting.

Injected Medications

• SALINE IV ONLY
• NO: prefilled saline flushes. Manual-fill preservative-free normal saline only.

• NO: lactated ringers.  Plain, non-lactated ringers may be used for large transfusions.
• NO: dextrose solutions.

• YES: diphenhydramine hydrochloride injection - Check inactive  ingredients against list below.

• YES: ranitidine hydrochloride injection- Check inactive  ingredients against list below.
• YES: Rocephin injection WITHOUT dextrose.
• YES: Solu-medrol- methylprednisolone sodium succinate injection, powder, for solution”  *preservative free*. No lactose, no benzyl alcohol.

Inhaled Medications

• YES: Xopenex or other albuterol-only nebulizer.
• NO: ethanol propellants or inactive ingredients from the list on page 2.

Oral Medications

Check inactive ingredients of all injections and oral medications and cross-reference with ingredient list on page 2. ESPECIALLY avoid:

• dextrose, sucrose, glucose
• sorbitol
• glycerin
• polysorbate
• ethanol/alcohol
• corn starch
• modified food starch
• pregelatinized starch
• citric acid
• xanthan gum
• maltodextrin

Blood Products

Check inactive ingredients/anticoagulants. Many are corn-derived. Please discuss with patient or an advocate if possible before using blood products.  If a transfusion is absolutely necessary and the patient does not have other documentation refusing blood products, take necessary measures to prepare for allergic reactions when the  products are used.

Wound treatment and disinfecting

• Disinfectants: Use only saline or betadine solution that contains only water, povidone iodine, and sodium hydroxide. Betadine solution from Purdue products is one safe product. Isopropyl alcohol may also be used where appropriate. No products containing citric acid, glycerin, Pareth alcohols, or ethanol!
• Sutures: No dissolvable sutures. Use only non-dissolvable nylon or polypropylene sutures. Rinse to remove corn starch.
• Local anesthetic: Use only carbocaine or preservative-free lidocaine. No inactive ingredients other than water and sodium chloride!
• Wound dressing: Use cotton gauze and kerlix or coban tape. No adhesive bandages or steri-strips.

General Care

• NO hand sanitizer. Medical staff must wash hands and wear powder-free nitrile gloves when touching patient.

• NO paper gowns or bedding. Cloth gowns and bedding only. No disposable paper pads, gowns, or bed covers. If possible, please allow patient to wear own clothes and allow family to provide bedding.

• NO powdered rubber instruments.  Use metal or glass only.
• NO disposable thermometers or covers. Only use glass or metal thermometers. If thermometers have been disinfected with alcohol rinse in water first.
• Do not touch disposable products to face eyes or mouth. Paper, cotton, wood, or disposable plastic should NOT be touched to mucus membranes.

References

Possibility of allergic reactions to corn-derived sugars:

https://www.ncbi.nlm.nih.gov/pubmed/1808842 - “Probable anaphylactic reaction to corn-derived dextrose solution.”

Dextrose intravenous solution package insert stating contraindication for those with corn allergies:

https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=74916

Additional package insert stating contraindication for corn allergies:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016679s104,016682s105,016692s095,019367s026lbl.pdf

Possibility of allergic reactions to corn starch:

http://europepmc.org/abstract/MED/1696439/-  Annals of Allergy: “Anaphylaxis due to cornstarch surgical glove powder.”

Possiblity of allergic reactions to corn-based alcohol: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=24107&Ausgabe=226017&ProduktNr=224161 - International Archives of Allergy & Immunology: “Corn Allergens: IgE Antibody Reactivity and Cross–Reactivity with Rice, Soy, and Peanut”  (Abstract states that corn proteins are soluble in alcohol.)

Allergen Ingredients To Be Avoided