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.
I assume all allergies are real until proven otherwise. Yes, I have had the patients who are "allergic" to every pain killer known to man except dilaudid. I know differently but that is for the doctor to work out with the patient and I just educate him that between doses, all I can offer is a heating pad or an ice pack because of these "allergies".
I came to work one night to find the floor full of all sorts of emergency staff. A patient had a severe anaphylatic reaction to an alcohol wipe. I have also seen a patient develop severe rashes on any part of their skin that touched our linens...her family ended up bringing in her home sheets and a nightgown washed in whatever special soap she had found that worked. She was even severely allergic to aloe. She also would swell up anywhere she got a sq heparin shot.
I just assume the allergic reactions are real...and look to see what the patient says happens. If the answer is diarrhea to an antibiotic and I needed to pass an antibiotic, then I'd go educate them. I'd also watch to see what the patient's version of "diarrhea" was.
It used to be thought that the reason someone could be allergic to shellfish, but not other types of meats was that shellfish had higher levels of iodine, which is where the shellfish/iodone allergy myth came from. This connection was initially disproven in the 1950's when it was discovered antigens differed in different types of meats, although it still persists today.
You are correct that if it was actually possible to be allergic to iodine then you'd be dead because it's unavoidable. It's added to a number of common foods, notably salt, and if you were able to actually avoid iodine you'd have a goiter on your neck.
It's also not really possible to have an allergy to topical iodine, povidone can cause irritation or allergic reactions when used topically but contains no iodine itself, it just get confused as an iodine allergy when used as a substrate for iodine.
Contrast dye allergies are also not due to iodine and is due to various causes, frequently the osmolarity of the solution and often the preservatives as well.
Thanks to the iodine posters. I've learned something new today. :)
Unless wipe contained something of latex in the inner layer of package, I just cannot see how it is possible. Ethanol is is one of the molecules which cannot activate immune responce directly, even by hapten formation.
had a patient that was allergic to the generic synthroid, but not the name brand. apparently it was the dye in the generic that bothered her. the name brand was white.
I'm tempted to think in some cases the answer is less obvious, but the outcome is the same. for example, maybe the alcohol causes a glove, the nurse is wearing when wiping before an injection, to release other solvents, or degenerate a latex glove, onto a patient with only very mild sensitivity to dry latex...
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 think you're confusing the presence of IgG antibodies with symptomatic sensitivity or allergy. It's not unusual to have circulating antibodies to a number of things you are regularly exposed to, that does not however suggest a relationship between those antibodies and adverse symptoms.
From the American Academy of Allergy Asthma and Immumology:
Position paper
Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report*
Serological tests for immunoglobulin G4 (IgG4) against foods are persistently promoted for the diagnosis of food-induced hypersensitivity. Since many patients believe that their symptoms are related to food ingestion without diagnostic confirmation of a causal relationship, tests for food-specific IgG4 represent a growing market. Testing for blood IgG4 against different foods is performed with large-scale screening for hundreds of food items by enzyme- linked immunosorbent assay-type and radioallergosorbent-type assays in young children, adolescents and adults. However, many serum samples show positive IgG4 results without corresponding clinical symptoms. These findings, combined with the lack of convincing evidence for histamine-releasing properties of IgG4 in humans, and lack of any controlled studies on the diagnostic value of IgG4 testing in food allergy, do not provide any basis for the hypothesis that food-specific IgG4 should be attributed with an effector role in food hyper- sensitivity. In contrast to the disputed beliefs, IgG4 against foods indicates that the organism has been repeatedly exposed to food components, recognized as foreign proteins by the immune system. Its presence should not be considered as a factor which induces hypersensitivity, but rather as an indicator for immu- nological tolerance, linked to the activity of regulatory T cells. In conclusion, food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be per- formed in case of food-related complaints.
On some of the message boards I participate in, there's a lot of members that have survived cardiac arrests- often related to very benign things. I had no idea cardiac arrests had such good survival rates that so many people survived dying.
blackribbon
208 Posts
I assume all allergies are real until proven otherwise. Yes, I have had the patients who are "allergic" to every pain killer known to man except dilaudid. I know differently but that is for the doctor to work out with the patient and I just educate him that between doses, all I can offer is a heating pad or an ice pack because of these "allergies".
I came to work one night to find the floor full of all sorts of emergency staff. A patient had a severe anaphylatic reaction to an alcohol wipe. I have also seen a patient develop severe rashes on any part of their skin that touched our linens...her family ended up bringing in her home sheets and a nightgown washed in whatever special soap she had found that worked. She was even severely allergic to aloe. She also would swell up anywhere she got a sq heparin shot.
I just assume the allergic reactions are real...and look to see what the patient says happens. If the answer is diarrhea to an antibiotic and I needed to pass an antibiotic, then I'd go educate them. I'd also watch to see what the patient's version of "diarrhea" was.