Your cough medicine could cause anaphylaxis

Recent shocking news that an ingredient in many high street over the counter cough medicines might be linked to anaphylaxis is worrying news for anyone who struggles with congestion, coughs and colds.

This applies to all cough medicines that contain Pholcodine. Anyone who has used these cough syrups within the last year could be a risk.

The Medicines and Healthcare products Regulatory Agency said it was withdrawing pholcodine-containing medicines from the UK market as a “precautionary measure”, owing to the risk of anaphylaxis during general anaesthesia.

Read ‘Cough medicine with anaphylaxis risk to be removed from UK market, announces MHRA’.

This follows similar action carried out by the European Medicines Agency, which recommended the withdrawal of pholcodine-containing medicines from the EU market in December 2022.

This isn’t about food allergies

Don’t worry if you just have anaphylaxis to foods etc, these medications won’t be dangerous unless you have an anaesthetic. However they are being recalled because sometimes operations are not planned, and having a year window from when a person sook cough medicine is a long time. If you have taken one of these cough medicines just make sure you make people aware of you need to have anaesthetic for any reason.

Research into Pholcodine and the risk of anaphylaxis

This isn’t new either. Studies as far back as 2014 show this was a risk factor, and that as well as Pholcodine, an added risk factor was having a higher BMI.

Read the following if you want to find out more:

• From 2014 – Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis.
• May 2021 – Relationship of perioperative anaphylaxis to neuromuscular blocking agents, obesity, and pholcodine consumption: a case-control study.

Pholcodine was withdrawn from the Norwegian market after the risk of anaphylaxis was exposed.

Which cough relief products are affected?

Check your medicine cabinets for the following over the counter cough syrups:

• Day and Night Nurse (GSK)
• Covonia (Thornton and Ross
• Many own brand cough relief products sold by major multiples, including Boots, Superdrug and Well Pharmacy

This is only affecting medications containing Pholcodine.

How does Pholcodine cause anaphylaxis?

The medicine works directly in the brain, depressing the cough reflex by reducing the nerve signals that are sent to the muscles involved in coughing.

Taking pholcodine up to 12 months before general anaesthesia may increase the risk of having an NMBA-related anaphylactic reaction. NMBAs are Neuromuscular blocking agents used in anaesthetics to aid surgical procedures.

You aren’t in any risk at all unless you are given anaesthetic after taking these medicines within the space of a year, so don’t panic!

What ingredients are in most cough medicines?

Most over the counter cough syrups and medicines are mostly sucrose and a load of other flavourings and chemicals. Sucrose is also usually the first ingredient, meaning it makes up the largest part of the ingredients mix.

For example the ingredients for Covonia: Sucrose, glycerol 1.36g. capsicum oleoresin 500,000 ws, citric acid (E330), caramel (E150), maltitol liquid (contains sorbitol E420), blackcurrant & menthol flavour (containing E1520 propylene glycol), anise flavour L7802 (containing E1520 propylene glycol), hydroxyethyl cellulose, sodium benzoate (E211) and purified water. Do not use the medicine if you have an allergy to any of the ingredients listed.

Can you get sugar free cough sweets and medicines?

It’s not easy, most cough medicines are mostly sugar. I’ve not found anything yet, because if it’s sugar free it’s usually got some synthetic sugar in it. Why not just get some fresh lemons, root ginger and honey. Make yourself a hot lemon, grind in a teaspoon of raw ginger and add some honey for taste if you must. It works a treat. And if you really struggle at night, one thing I’ve found helps and obviously only for adults – a quick small tot of whisky has often really helped warm my throat and help me get off to sleep.

What are more natural cough medicines or remedies?

Check the labels before buying and I strongly advise you to find more natural solutions.

• A Vogel Bronchoforce – herbal medicine. Ingredients: 376mg of tincture from fresh ivy herb (Hedera helix L.), 329mg of tincture from fresh aerial parts of thyme (Thymus vulgaris L.), 234 mg of tincture from liquorice root (Glycyrrhiza glabra L.), Bronchoforce also contains Star Anise oil and Eucalyptus oil.
• Echinacea – from a good quality reputable source will help boost your immune system. You can also get vitamin C and echinacea herbal teas to soothe the throat.
• Vitamin C – Get plenty of vitamin C rich fruit and veggies into your diet
• Spoonful of honey – will work just as well as any spoonful of cough syrup
• Steam bath – with eucalyptus oil. Hold your head over a steaming bowl of hot water for a instant relief of phlegm and congestion.
• Saline throat sprays – can also work really well to clean out the nasal area and reduce phlehgm.
• Xylitol sprays – also proven to help remove phlegm.
• Hot lemon, honey and ginger tea – It’s been my go to for years. Works better than any expensive cough syrup.

So you don’t need to buy expensive sugar filled cough syrups and throat sweets. Cough sweets can also have a high sugar based and I’m on the look out for a more natural solution. However for something with fewer ingredients, check out Jackemans peppermint soothing menthol lozenges – just sugar, glucose syrup, menthol crystals and peppermint oil. Still a lot of sugar, but better than some of the ones on the market.

What do you take when you have a nasty cough?

I’d love to hear your own cough and cold remedies. What do you take? What works best for you?

You may also be interested in reading:

• ‘No more allergies and asthma’ book review
• Anaphylaxis – The Essential Guide by Ruth Holroyd
• 20 life saving anaphylaxis tips

Photo by cottonbro studio on Pexels.