So we are switching to a new computer system at work. Not everything will carry over and we have to do some manual entry of certain things. Allergies is one of the items that falls onto that list. We are able to print out that info from the old system so we can put in onto the new, so the information has all been verified at some point by nursing staff or physicians. Which also means at one point it was all ENTERED by someone with a license or someone who is supposed to have enough medical knowledge to do such things.
Some of the "allergies" (complete with reaction, since it's a required field):
Nitroglycerin---"it makes my ears ring"
Tetnaus shot---"my arm hurts after I get one"
E-mycin---"diarrhea"
iron supplements---"makes my BM dark"
and my favorite:
Epinephrine---"makes my heart race"
Seriously?! I can shrug and say "meh" to many things, but truly?! WHY do trained professionals DO this? Go ahead and put some of these things down and attribute the poops after an ABX to a side effect, but not an ALLERGY. Yes, side effects, intolerances and allergies are all options to choose from.
I am not even entering the epinephrine "allergies", nope, not doing it.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
Please go see an allergist for testing. I work for an allergist and he does this. He does PCN challenges, "caine" challenges, food allergy testing plus all the routine plant/pollen/dog/cats etc.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
Prior to anaphylactic reaction to contrast, I found out I was "allergic" to benadryl. I was given it IV in the ED and developed urticaria at the site. So, I wear medic alert tag. Terrified I might be in crash/crush injury and they would order contrast and treat anaphylacsis with benadryl. MD believed it might be the preservative in the benadryl, but advised against taking it again.
Well they make a "dye free" benadryl due to allergy to the dye (red food color #?5). I have also had patients allergic to the gelatin that GelCaps are made from, so they ask me to be sure to prescribe Tabs not capules if available. I do work with an allergy/asthma/immunology doc so am learning tons.
My Mom was "allergic" to all antibiotics. She WAS allergic to penicillin but the others, no. My Mom was the kind of person who immediately looked a drug up in her drug book to see what the side effects were. I don't think she ever finished a prescription.
When she developed dementia is was a different story. Early on she hoarded all the anti anxiety meds the urgent care prescribed and one night took over 200 of them. She didn't die but she was in a coma for over 24 hours and it seemed to accelerate the progression of her dementia.
Well they make a "dye free" benadryl due to allergy to the dye (red food color #?5). I have also had patients allergic to the gelatin that GelCaps are made from, so they ask me to be sure to prescribe Tabs not capules if available. I do work with an allergy/asthma/immunology doc so am learning tons.
This makes sense. A patient of mine developed hives and wheezing from generic p.o. benadryl.
I have also seen a pt develop rash and wheals from acetaminophen tabs.
Recently I had a pt develop swollen lips and become bronchospastic immediately after receiving Haldol IV.
I would not have believed that any of these allergic reactions were possible but I do now.
This makes sense. A patient of mine developed hives and wheezing from generic p.o. benadryl.
I have also seen a pt develop rash and wheals from acetaminophen tabs.
Recently I had a pt develop swollen lips and become bronchospastic immediately after receiving Haldol IV.
I would not have believed that any of these allergic reactions were possible but I do now.
I can't think if any medication off the top of my head that consists only of the active ingredient, they all contain various binders, stabilizers, preservatives, and other assorted additives. Someone can be allergic to the active ingredient but also to an additive, which is why some people might be allergic to one brand of a medication but not another since different manufacturers often use different additives even though the active ingredient is the same.
Last I checked (today), there are no biological markers (i.e., no "test") for gluten sensitivity. Diagnosis is made by eliminating Celiac Disease, IBS, or wheat allergy as the cause of symptoms, and then by an elimination diet. Did that change?
Again, completely untrue. Research is your friend.
I do know what I'm talking about. I don't doubt your symptoms, and of eliminating gluten has helped- glad to hear it. But the evidence just isn't on your side on the non-celiac, gluten intolerance thing. Sorry.
"In a placebo-controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs."
I'm not saying you're a trend follower, but for many people- it is a trendy diet.
Currently, tests are available to detect the genes that control the immune system's reaction to gluten. These genes are called human leukocyte antigens or HLA. There are several types of HLA genes within each person. It is a particular type called HLA-DQ that is most useful in the assessment of the probability that a person may be gluten sensitive. The reason gene testing assesses probability rather than disease itself is because some people have the genes for gluten sensitivity but have no detectable evidence of the immune reaction to gluten or have no symptoms. In such people, gluten sensitivity is still possible but the probability (or in other words the chances or the odds) is lower than in a person who may be having symptoms attributable to gluten or that has antibodies detected. HLA testing is most useful when there is diagnostic confusion about whether or not a person is gluten sensitive. Such confusion often stems from one of the following: atypical intestinal biopsy results, the presence of associated diseases (such as microscopic colitis) that may mask the expected improvement of symptoms when gluten is withdrawn from the diet, negative tests for gluten antibodies in the midst of suggestive symptoms or signs of gluten sensitivity or celiac sprue (see the paragraph below to understand the difference), or when there are no symptoms at all and the person or the doctor can hardly believe that gluten sensitivity is really present. Other situations that HLA testing is useful is when a person is already on a gluten-free diet, and for testing family members (particularly children) for the odds that they have or will develop gluten sensitivity.
Transcript of a talk given by Kenneth Fine, M.D. to the Greater Louisville Celiac Sprue Support Group, June 2003."Gluten sensitivity" is the process by which the immune system reacts to gluten contained in wheat, barley, rye, and oats. The reaction begins in the intestine because that is where the inciting antigen, gluten, is present (from food). When this immunologic reaction damages the finger-like surface projections, the villi, in the small intestine (a process called villous atrophy), it is called celiac disease (or sometimes celiac sprue or gluten-sensitive enteropathy). The clinical focus of gluten-induced disease has always been on the intestine because that is the only way the syndrome was recognized before screening tests were developed. The intestinal syndrome consists mainly of diarrhea, gas, bloating, nausea, vomiting, fat in the stool, nutrient malabsorption, and even constipation. Although the small intestine is always the portal of the immune response to dietary gluten, it is not always affected in a way that results in villous atrophy. Even though recent research has shown that celiac disease is much more common than previously suspected, affecting 1 in 100-200 Americans and Europeans, past and emerging evidence indicates that it accounts for only a small portion of the broader gluten sensitive clinical spectrum (often referred to as the "Tip of the Gluten Sensitive Iceberg"). With better understanding of how gluten triggers immune and autoimmune reactions in the body under the control of various genes, and advancing techniques of detecting these reactions, it is becoming apparent that the majority of the gluten sensitive population (the submerged mass of the icebergâ€) do not manifest villous atrophy in its classic, complete form and therefore do not have celiac disease.
There may be some sort of rare non-celiac from of gluten intolerance, but there actually is very good quantifiable evidence that "gluten allergy" does not exist at anywhere near the level people claim it does, it's a "fad" in other words. In tests where those who claim to have non-celiac gluten sensitivity (NCGS) were given a gluten placebo they claimed to suffer from gluten exposure symptoms, and when they were given gluten but were told they eating gluten-free products they denied having symptoms. There are no validated tests for NCGS, although that doesn't keep unscrupulous medical (and "medical") professionals from performing tests and implying they are of some significance in diagnosing NCGS.
Things like this wouldn't be funny (to some of us anyway) if there was no truth at all to them:
You're really going to make me do your research for you? Dismissing something because it doesn't match your objective isn't applying nursing process. In a situation like this, where results are unclear, it's best to keep an open mind and read a lot.
Abstract
BACKGROUND:
Non-celiac gluten sensitivity is a syndrome characterized by gastrointestinal and extra-intestinal symptoms occurring in a few hours/days after gluten and/or other wheat protein ingestion and rapidly improving after exclusion of potential dietary triggers. There are no established laboratory markers for non-celiac gluten sensitivity, although a high prevalence of first generation anti-gliadin antibodies of IgG class has been reported in this condition. This study was designed to characterize the effect of the gluten-free diet on anti-gliadin antibodies of IgG class in patients with non-celiac gluten sensitivity.
METHODS:
Anti-gliadin antibodies of both IgG and IgA classes were assayed by ELISA in 44 non-celiac gluten sensitivity and 40 celiac disease patients after 6 months of gluten-free diet.
RESULTS:
The majority of non-celiac gluten sensitivity patients (93.2%) showed the disappearance of anti-gliadin antibodies of IgG class after 6 months of gluten-free diet; in contrast, 16/40 (40%) of celiac patients displayed the persistence of these antibodies after gluten withdrawal. In non-celiac gluten sensitivity patients anti-gliadin antibodies IgG persistence after gluten withdrawal was significantly correlated with the low compliance to gluten-free diet and a mild clinical response.
CONCLUSIONS:
Anti-gliadin antibodies of the IgG class disappear in patients with non-celiac gluten sensitivity reflecting a strict compliance to the gluten-free diet and a good clinical response to gluten withdrawal.
Caio, G., Volta, U., Tovoli, F., & De Giorgio, R. (2014). Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC gastroenterology, 14(1), 26.
I saw an epi "allergy" recently as well. The reaction also stated that it caused her heart to race. (eye roll)
If you are sensitive to cardiovascular/central nervous system side effects of epinephrine (if you look up the list you will see how extensive it is) you will understand that experiencing these side effects, some of which can also indicate toxicity, is nothing to take lightly. You would want your reaction to be listed under "allergies" if there is no where else to list sensitivities because you would want your medical providers to be aware of these side effects, and to be very cautious in using epinephrine.
What I've discovered with the epi "allergy" is the fault of a dentist. Pt goes to the dentist, gets some lido with epi, and has a reaction. Dentist tells pt "you're allergic to epi and can never have it again" so pt believes that. When I tried to explain that the allergy is most likely to the lidocaine and epi is adrenaline that your body produces, I got argued with and told that I was flat wrong because Dr. Dentist said no epi. Did I mention I was an allergy nurse and we rx epipen/adrenaclick/auvi-q daily? Yeah, we know a thing or two about epi.
I try to clarify the difference between allergy and s/e
Some patients are sensitive to cardiovascular/central nervous system side effects of epinephrine and local anesthetics as used at the dentist. Even if not true allergies, it is still very important for these side effects to be listed. I wouldn't find it helpful for someone to try to educate me on the difference between true allergies and side effects of these medications; regardless of whether they are true allergies I want them to be listed with the effects I experience, and if the only section to list these reactions under is "allergies", then list them under allergies with a note of explanation. Also, there is a wide variation in dosages at which people can experience signs of toxicity. Why argue with the patient or try to re-educate them? Surely what is important is to accurately transcribe what the patient says their responses to the medications are; they are the person who experiences the reaction and they have the right to inform the staff of that reaction, and to state a preference to not receive that medication.
QuiltDog
134 Posts
I agree with you both on the Reglan. Had IV Reglan and did not enjoy the sensation at all. I list that as an intolerance when at a provider.