Skin allergy and the shingles vaccine

DEAR DR. ROACH: I have been tested for skin allergies twice in the past 30-plus years. I am a 71-year-old female in good health.

One of the things I tested positive for both times was neomycin (the worst reaction I had was a rash on my foot when using a cream containing neomycin). This is an ingredient in the shingles shot. I’ve been told by my doctor and the pharmacist that I cannot have the shingles shot.

What would happen if I did get the shot? Is it worse than getting the shingles? Are they working on a shingles shot that doesn’t contain neomycin? What else can I do to avoid getting shingles?

Thanks for considering my question. I’ve been wondering about this for 10 years.

ANSWER: The shingles vaccine, like several vaccines, should not be given to people with a history of severe reaction to neomycin (the Centers for Disease Control and Prevention uses the term “lifethreatening” allergic reaction).

While neomycin is a common cause of contact dermatitis (the most likely explanation for the rash on your foot), it generally is not considered to be a contraindication to immunization with neomycin-containing vaccines; the amount of neomycin in the vaccine is very small.

As always, what I say in the column can’t override what your doctor tells you. He or she may know more than I do about your particular situation.

But I have researched this question and found two sources that have said there has never been a reported systemic contact dermatitis reaction to vaccines containing neomycin.

There is no other effective way of preventing shingles that I know.

DEAR DR. ROACH: I read a recent article saying that many cases of schizophrenia might be misdiagnosed as anti-NMDA encephalitis. Wouldn’t this be a good thing for people to know about?

ANSWER: Anti-NMDA encephalitis was first described in 1997. The disease often starts with fever or headache, followed by symptoms that can look a lot like schizophrenia: anxiety, bizarre behaviour, disorganized thinking and delusions. However, it is more sudden in onset than most cases of schizophrenia.

Also, there are some other clues to the correct diagnosis in most people: seizures, abnormal muscle movements and changes in blood pressure or pulse.

The diagnosis should be considered when observing abnormalities in an MRI scan, lumbar puncture (spinal tap) and EEG (brain wave) tests. It is confirmed by finding the specific antibody.

Because of the concern about potential misdiagnosis, a recent study looked at 50 people newly diagnosed with schizophrenia: None of them had the antibody specific for this condition, suggesting that misdiagnosis may not be as frequent as feared.

However, it is worthwhile to know about it, because prompt treatment can completely (or nearly so) reverse the condition.

DEAR DR. ROACH: I have painful adhesions due to the removal of an exploded appendix.

You addressed the issue of adhesions in a previous article, where you stated, “Unfortunately, the only methods I know to prevent adhesions pertain to surgical technique.”

What is the “surgical technique” that you mention? My surgeon did not know what you might be referring to. Thank you.

ANSWER: I’m sorry that I wasn’t more clear, but the details of the techniques wouldn’t make a lot of sense to a casual reader.

I don’t have any surprises for your surgeon, either: gentle tissue handling, laparoscopic techniques when feasible, physical barriers, such as hyaluronic acid sheets or possibly polyethylene glycol adhesion spray barrier.

I am not a surgeon and so offer my advice only as a way of letting readers know that surgeons are working on ways to reduce these complications.

The problem with a ruptured appendix is that the damage is done before the surgeon operates.

The material that comes out of the appendix sets up the potential for adhesions in the future, no matter how careful or skilled the surgeon, which is why we work so hard to prevent rupture.

DR. ROACH WRITES: A recent column on explosive bowel movements led to, well, a large number of letters.

Despite the fact that the letter writer said she had had a thorough medical evaluation, many readers were concerned that a diagnosis was missed. By far, most advice-givers recommend testing for celiac disease.

However, people identified many other causes of gastrointestinal distress, including nondigestible fats and lactose in dairy products.

One person noted that her issue finally was diagnosed as pancreatic insufficiency.

Several people said their condition was successfully treated with medication to bind bile, such as cholestyramine.

I was touched that so many people wrote in, asking me to contact the letter writer in hopes that their idea could bring some relief.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.