Opioids Codeine and hives

[IAmNotACat]

First I'll say that I'm not allergic to codeine. But I do have a chronic urticaria reaction called cholinergic urticaria - it's basically a transient allergic-type reaction that means I get very painful/itchy tiny hives when my body temperature goes up - this can be through emotion but also exercise, warm rooms, hot showers, blankets in bed, etc. It's usually worst during winter because of the temperature changes between outside and inside. Sweat seems to be involved somehow, I tend to have delayed sweating, but if I force myself to deal with the reaction, eventually I will sweat and then feel better. I assume that's why it's not very prominent for me in summer, when I'm sweating regularly.

I really like codeine though, and hope it's not a tradeoff between this reaction and the codeine. I try to remain as opiate naive as possible, usually a dose of 90-100mg of codeine is nice enough for me, I'll take it first thing in the morning before eating and once my tolerance gets to about 150mg I stop for awhile because I know I could easily wind up with an opiate problem if I'm not careful. I've had problems with benzos and alcohol in the past.

I'm not sure if the codeine is making the urticaria worse. It's particularly bad right now, almost as worse as it's ever been, but it is winter. It doesn't seem to lessen when I stop the codeine but maybe I don't stop for long enough. I don't really get itchy from the codeine itself. I use CWE to get out either acetaminophen or aspirin. I don't try to get the caffeine out but it doesn't usually bother me too much.

I guess this long rambly first post is just to see if anyone else deals with weird allergies and whether codeine/acetominophen/aspirin affects it. Will a CWE even let through enough acetaminophen or aspirin to make a difference? I usually filter it through a shirt, which gets it pretty clear, and then filter it again through a coffee filter.

Edited to add: I know this is no substitute for medical advice. I'm just curious - my doc says there's not really anything that can be done for cholinergic urticaria anyway.

 

[Slow_Mobius]

It's the codeine. Codeine is notorious for it's histamine response. I would also avoid hydrocodone. If you're prescribed the codeine, you should ask your doctor about switching to a different opioid.

 

[IAmNotACat]

Thanks. That's disappointing - I don't usually get "the itch" when I'm taking it. It's not prescribed, I'm using CWE on the OTC stuff currently. I know it's notoriously addictive as well but for some reason I can control myself with codeine, avoid physical dependence and take breaks when my tolerance starts to go up, which is saving me from a rather ugly alcohol addiction.

 

[Speed King]

You should take a break from this. At the minimum, try to taper your dose down. Also, at a low dose (25mg or less) I might medicinally use diphenhydramine to see if that off sets the the histamine reaction.

 

[IAmNotACat]

Yeah, I've been taking a break for a few days. I don't take codeine every day, and I didn't think 90-150 mgs was a very high dose?

The cholinergic urticaria doesn't respond to antihistamines, I've tried them all. Hydroxyzine helped a little, but only at high doses and my doc doesn't want to do that. Occasionally I'll take a tiny dose of diphenhydramine with the codeine but I don't get itchy when I take the codeine, so usually I just avoid the antihistamines since they don't seem to help.

I guess I'm just trying to figure out if quitting the codeine completely is worth it. I'm just afraid I'll go back to alcohol, which I don't want to do.

 

[d1nach]

I am a bit confused because I get chlorinergic urticaria from nicotine and it does response to diphenhydramine because chlorinergic system has two primary receptors and nicotinic and muscarinic receptors. Nicotine high doses gives me red itchy sensitive flush skin via full agonism at the muscarinic acetylcholinergic receptors.

Diphenhydramine dose dependently reverses the flushing and skin irritation from blocking histamine and muscarinic acetylcholinergic recetors

I believe you are confusing chlorinergic with histamine urticara. Codeine causes mast cells to release histamine which causes itchy red sensitive skin

Diphenhydramine blocks histamine receptors.

Also I use lotion rub lotion and mineral oil and or petroleum jelly all over my body it helps keep the skin protected

 

[Jekyl Anhydride]

If you are fairly certain that there is no correlation between the codeine and the urticaria, IE your not tearing yourself apart within several hours of dosing then maybe it is a better option than EtOH. Just proceed with caution if pushing past the 120 mg limit you have set for your self. Just because many people get itchy on codeine does not guarantee it's a causative factor in your condition, at least at the levels your at now which are fairly modest.

 

[tacodude]

Doses for codeine start at 30 mg so you're taking 3x the amount. Not a crazy high dose, but yes a high dose none the less.

 

[MDPV_Psychosis]

For what it's worth (probably not much) here is my experience:

I have a similar condition. When I suddenly get hot from either sudden external temperature change or physical excersize, I will sometimes get extremely itchy. The itchiness happens before or instead of sweating. It mostly happens on my legs but can spread across my entire body when really bad. The itchiness feels like millions of tiny pin pricks and can be incredibly intense and annoying.

I do not developed any rash though so I don't how relevant my condition is to yours (though I believe they may be related/similar?).

I have been able to abuse opiods, including codeine, over the years without any impact to this condition. Sure, I get itchy as fuck from a high dose of codeine like most everbody but it's not the same kind of itchiness in my case. The itchiness caused by the codeine is almost pleasurable to scratch whereas the itchiness from heat feels totally different and drives me insane. And I have never noticed an increase in flare ups during opiods use either.