Allergy to epi

Published

What do you say to pts who say they're allergic to epinephrine? Typically it's a story of a bad experience at a dental appointment and the dentist tells them they're allergic to epi and can't ever have it again, but when I point out it's more likely an allergy to the lidocaine and not the epi, they get quiet. I'll remind them that it's supposed to make your heart race and epi is adrenaline, like the panicky feeling when a car cuts you off too closely in traffic, only times 1000. Yesterday I had a pt say they were sensitive to epi due to mitral valve prolapse and it gets the heart rate up too high. That makes sense to me, but all the other ones just don't.

Up Vote Up Vote ×
Specializes in Home Care.

Some people don't understand the difference between "sensitive" and "allergic".

I'm sensitive to the epi and prefer not to have it

Up Vote Up Vote ×

But in an emergency it's the drug of choice. 98% of pts who say they can't have epi say it's because their heart was racing and their dentist said not to have it again. When I tell them the rapid heart rate is a side effect and how it's regulating everything, they get quiet. I do epi-pen teaching to our food allergy pts and when I explain everything they realize it's not going to kill them, but NOT using it could.

Up Vote Up Vote ×
Specializes in HH, Peds, Rehab, Clinical.

I tell them "you DO know that your body is producing epinephrine right now, as we speak, right?" Usually quiets them right down

I worked in dentistry for 26 years b/4 turning to nursing. Never ONCE saw anyone "allergice" to the lidocaine, mepivicaine, etc. It was always the racing heart that they didn't like that comes from the epi, NEVER a true allergy. We just used epi-free. Which doesn't last nearly as long so they many times had to have additional injections of anesthetic

Up Vote Up Vote ×
Specializes in Home Care.

I'm allergic to wasp stings. I wouldn't hesitate to use my epi-pen. But at the dentist I go epi free.

Up Vote Up Vote ×
Specializes in NICU, Trauma, Oncology.

(Not a nurse) many of the patients in the clinic I do research for cannot have epi bc it is contraindicated in pts with carcinoid/NET. It can elicit life threatening carcinoid crisis. However, these patients are the exception not the rule.

Up Vote Up Vote ×
Specializes in HH, Peds, Rehab, Clinical.
Dental MythBuster #10: I'm allergic to Epinephrine | Allergy Just an FYI article, written in layman's terms, but by a medical professional. Explains it pretty well
Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.

I had a friend that couldn't use an epipen. It wasn't the epinephrine she was allergic to but a severe sulfate/sulfite allergy. Couldn't have certain wines or morphine sulphate either. She carried a vial of epi that had no sulfate preservative. & syringe. This was years ago so I don't know if Dey changed preservatives since. Very unique but verified allergy.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

There are preparations of epinephrine that contain sulfates. There has also been some documented evidence that the latex in the plunger may cause a reaction.

http://www.dentistrytoday.com/pain-management/anesthesia/265

https://www.allergyuk.org/sulphites-and-airway-symptoms/sulphites-and-airway-symptoms

Up Vote Up Vote ×
Specializes in NICU, Trauma, Oncology.

When I worked in a dental clinic I had a patient tell me she was allergic to Benadryl bc it made her sleepy ...

Up Vote Up Vote ×
Specializes in Ambulatory Surgery, Ophthalmology, Tele.
When I worked in a dental clinic I had a patient tell me she was allergic to Benadryl bc it made her sleepy ...

This.....and the epi, and allergic to lantus because "It made my sugar drop", benedryl "made me sleepy", albuterol inhaler "made me feel shaky", strong plastic tape "rips my skin off", Ibuprofen/asa "hurt my stomach". Oh I love it when they say they are allergic to asa but they take it daily. :facepalm:

Sorry, had to vent a bit. I hear all of these daily. Tape, I understand: many elderly patients have super thin skin so we use paper tape instead of the strong plastic tape.

I don't like to take benedryl because I get a dry mouth and cotton throat but the time my throat was closing up when I discovered I was allergic to dogs, benedryl was my best friend. :yes:

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.

For any med, I ask what type of reaction they had to it. Lots of times epi made their heart race, benadryl made them sleepy, or morphine made them nauseated. Then I take the opportunity to contrast side effects with true allergies.

Now with one of my own kids I am firm, I list penicillins as an allergy for her. Many providers have told me about penicillin rashes, and while that's true some of the welts she got from amoxicillin were fluid-filled blisters. I am too paranoid about SJS/TEN to chance it. :( Now if it had given her the runs or a candida rash... :)

Up Vote Up Vote ×
+ Join the Discussion