I'm allergic to.....(laundry list)!

[AOx1]

I just had a patient who listed about a million allergies. Among them was "oxygen" lol! When asked about this "allergy" she reported "it dries my nose." Here lately, it seems every must have multiple "allergies" many of which are just side effects. It makes me worry that those with true allergies might not have them taken as seriously. For example, a frequent flier boy's mom listed a zillion allergies, and her son actually had an anaphylactic reaction to nuts. But I fear this gets lost in all the other "allergies" he has. Anyone else worry about this?

[iNurseUK, RN]

Wouldn't it just? The Registrar ( senior junior doctor if you get my drift) happened to be by the next bed.

He turned around and said "Madam, if you were allergic to salt I could certify you as legally dead"

[dianah, ASN]

I've often thought it might be helpful to list two categories per pt chart:

1. ALLERGIES: true: medications/foods to which one reacts with hives, "swelling," rash, itching, anaphylactoid reactions, etc

2. SENSITIVITIES (another word might be more descriptive/accurate): medications/foods to which one reacts with cough (d/t ACEIs, etc), GI upset, hypotension (from certain antihypertensives ), etc.

Just a thought.

[FranEMTnurse, CNA, LPN, EMT-I]

i stood outside her door and pretended to be talking to her nurse, but i was really talking at the pt.

"remember that other pt. you had with a low potassium? did they make it? i remember him saying he felt like his chest was going to implode!!!!! how long was he in the icu anyway? you mean he is still there? i hope he makes it."

she agreed to allow for the infusion.

:chair: yes, i know, i'm a horrible nurse. i know. not therapeutic communication at all.

i think it was a very smart move on your part.

[wooh, BSN, RN]

I still remember a patient when I was a PACU nurse that stated she was allergic to Morphine, ASA, and Nitroglycerin. When asked what type of reaction she had with these medications she stated: Morphine caused my blood pressure to drop (nice to know the vasodilation effects actually work), ASA upsets my stomach, and Nitroglycerin gives me a headache.....

I wonder if it was the same lady that had an allergy to epinephrine, as it made her heart race.

[bewitched]

Would vomiting and extreme nausea be considered an allergy or a sensitivity?

I've got that rx to Vicodin and Sulfa antibiotics, and I've been told that it's merely a sensitivity and that it *could* be prescribed to me again, it just "might not be comfortable" for a few days. To me, they are on the "do not take ever again" list. Both times I was so sick I was crying *as* I was throwing up.

[JSBoston]

I've had a pt allergic to cocaine and crest tooth paste before... also city water

[Fribblet]

Would vomiting and extreme nausea be considered an allergy or a sensitivity?

I've got that rx to Vicodin and Sulfa antibiotics, and I've been told that it's merely a sensitivity and that it *could* be prescribed to me again, it just "might not be comfortable" for a few days. To me, they are on the "do not take ever again" list. Both times I was so sick I was crying *as* I was throwing up.

Severe sensitivity, and one you should definitely let any prescribing practitioner know about. There may be a situation where you MUST have a sulfa ABX to treat your condition, and while it may be very uncomfortable, it's necessary. That said, most times, another ABX can be substituted. And, of course, there many other pain medications that can be substituted for Vicodin.

If you weren't heading towards an anaphylactic reaction, I wouldn't eliminate any potential beneficial drug. You never know when you might really need it.

[wooh, BSN, RN]

Would vomiting and extreme nausea be considered an allergy or a sensitivity?

I've got that rx to Vicodin and Sulfa antibiotics, and I've been told that it's merely a sensitivity and that it *could* be prescribed to me again, it just "might not be comfortable" for a few days. To me, they are on the "do not take ever again" list. Both times I was so sick I was crying *as* I was throwing up.

Sensitivity. If it was a choice between a sulfa antibiotic and an antiemetic, or spending 6 extra weeks in the hospital with a strong possibility of death, would you want it listed as an allergy and not have the choice?

[kids]

If it isn't an IgE mediated reaction then it isn't an allergy, and I take it off the patients allergy list. I list meds/food that the patient has had side-effects below the allergies with an explanation of what the reaction was, and note usually the patient requests not to be given these medications/foods.

Considering that allergic reactions can run the gamut from n/v/d to anaphylaxis, how do you determine what reaction is IgE mediated and what is a side effect from talking to a patient?

[sharkdiver]

No, I am not being bold. An allergy is an allergy and a side effect is a side effect. One allows me the comfort to pick another a drug in the same class with less of a side effect profile and the other usually requires me to pick another class of medications.

IMO people with multiple allergies need to have allergy testing done to find out what exactly they are allergic to. Maybe they are just allergic to a preservative, and possibly I can use a preservative free form of the medication instead. It makes their care a lot safer for them and helps providers choose the most appropriate meds without just using an educated guess.

I see your point, but it's not always black and white - sometimes it is a hypersensitivity or adverse reaction to an entire class of drugs. For example, I have a documented extreme hypersensitivity and severe adverse reaction to natural and semi-synthetic opiates. Per my PCP's recommendation, I wear a medic alert bracelet that says "Allergic to opiates" - he said it's easier than trying to explain "adverse reaction" and there's less chance they'll give me anything I might have a reaction to. Same with benzodiazepines - they have triggered a really nasty response (diaphoresis, increased BP & HR>200).

The bottom line is if a patient doesn't want any particular medication, all they have to do is say no. You can't force them.

[Pepper The Cat, BSN, RN]

During one of my clinicals I had a chance to shadow a nurse in the PACU. The nurse asked the patient if she had any drug allergies, she said that she was allergic to ACE-Is; the nursed asked what happened when she took them and the pt said "they make me cough." The nurse said immediately that was a typical reaction to an ACE-I, the pt's response was "Well I told my doctor and he said I shouldn't take it anymore." I don't know if there was a different reason for the pt to stop taking the med, but it was very eye opening to me as a student to see the need to educate pts on the meds they are taking and teach them the difference between an allergic reaction and a side-effect.

I agree, if every side effect is counted as an "allergy" then real allergies may be over looked.

My father stopped taking his Altace because "it made him cough". I live 250 miles away and he told me this over the phone. I freaked. I told him "You go and take one right now. NOW, NOW, NOW! I wouldn't get off the phone until he went and took one. Then I told him to go see his doctor and get his med changed. He told me; "the pharmacist told me the cough was from the Altace". Knowing my father, I asked "And WHAT ELSE did she tell you??" He then said "she told me to go see the doctor and get it changed. I decided to stop taking it because my blood pressure was OK" Yes Dad - that was because the medication was WORKING! (his BP was 220/110 when first diagnoses with hypetension). Next day he went to MD and got a new med. Mom thought I was funny until I pointed out that he could have had a stroke by stopping his med without MD approval.

[Pepper The Cat, BSN, RN]

I had a patient allegic to the "round tylenol" but not the "oval tylenol".

Still haven't figured that one out!