OK everyone. I need to help inform you about what an “allergy” is – at least in terms of what we in the medical profession call an allergy.
What is NOT an allergy(to a medication):
Nausea
Vomiting
Diarrhoea
Reflux or Heartburn
Feeling “weird“, “loopy“, or “out of it”
Going “crazy”
Anxiety or Palpitations
Urinary Symptoms
These are all INTOLERANCES or SENSITIVITIES, not allergies, which means you CAN take them if they are really necessary – often a dosage change or taking the drug with food or not can minimise the side effects.
What is an allergy:
A Rash – usually reddish or blotchy -often accompanied by:
Hives
Wheezing
Sneezing and Watery, Itchy Eyes
Swelling of the Tongue, Lips, Face, or Throat
Cardiovascular Collapse. (anaphylaxis)
Note, there are only a few things(other than foods) that are common to be allergic to:Antibiotics – mostly Penicillin and Sulpha -based drugs like Bactrim.
Everything else is very rare. Yet somehow once you develop a chronic pain condition you mysteriously develop an “allergy” to every pain medication out there except for narcotics……
Please be aware of this terminology when you are asked by the triage nurse whether or not you have allergies. Thank you.
Hey Doc,
I want to thank-you for the very interesting posts that you write daily. I have only been reading and enjoying your blog for a very short period of time. I have also been telling all my co-workers about your posts and your writing prowess.
I am a 35 year old ER Technician in a Level II ED in the Phoenix metro area. I started in the medical field 4 years ago. I am now in school to become a RN. I love my second career and wished I started sooner. I was in sales, all my life, before entering the medical field and I have noticed, that this new field that I have entered is lacking a key element, customer service.
I noticed that what you post is pretty much universally correct in my own interactions. These same problems exist everywhere? Why can’t, for all the smart people in this industry, solve these issues, which affect everyone, and make it a better system, FOR EVERYONE.
One Solution – You can’t graduate high school without taking a basic life saving class. With this class you will also learn the ins and outs of emergency medicine, from EMS to the ED to being admitted. We also need to teach everything that would in tale a visit in a ED from labs, CT, US, and what to expect and how long everything takes.
Keep up the good work!
Thanks! And I think Basic Life Saving/CPR is taught in a lot of high schools – but it should be universal.
People list all this stuff and I don’t know if I should write it on the allergy band or not. I don’t want to sit there and argue with people all day and night that “hyperactivity” with prednisone isn’t an allergy nor is “cough” with lisinopril or whatever nor is “nausea” with cipro. We use computer charting, and some doctors aren’t smart enough to click on the actual allergy to see what the reaction was (nausea) when the chart flags an order as an allergy. They just won’t order whatever drug people list no matter what the allergy. So, I still really don’t know what to do about these non-allergies.
A very educational and practical post.
Thank you! Thank you! Thank you! This is my biggest pet peeve and a huge problem where I work, even with the medical staff. I spend so much time explaining the difference between an adverse drug reaction and an allergy..not to mention trying to get an allergy removed from the computer once it’s been entered. Sigh..
Nurse K, in our computer charting system, the triage RN SHOULD enter the type of reaction a patient says they have to any “allergy” – ie “sees into the future”. The doc then HAS to look at it since in order to update his or her note, that screen has to be accessed and reviewed. Otherwise, it won’t show up in the MD’s note and thus billing may not be captured. Med lists are dealt witht the same way – thus we have no excuse. I always correct patients when they say they have a non-allergy to drug so it does not end up permanently in the pharmacy’s record.
Do not give me Ativan or I will rip your face off!!!! :O :O :O
Hannah–maybe someone is trying to feed you ativan BECAUSE you are about to rip someone’s face off!
Surely Hannah was being ironic?
I’m curious about mineral allergies, since I never believed I had any allergies until an internist decided the peeling skin and clear ‘bubbles’ of fluid on my hands and fingers were a sort of allergy to chromium. I never mention this to doctors because I’m not actually sure if it’s an allergy or just some oddity of my personal chemistry.
Unfortunately even cutting out minerals in my multivitamin only moderately reduced that reaction, but, of course, chromium is present in half of everything and there’s simply no way to avoid exposure.
We have to deal with a lot of allergy vs. intolerance; the most common culprit is N&V associated with codeine.
The weirdest “allergy” I ever saw? A little old lady who said she was allergic to enemas. Hmmmm, I’m probably allergic to those too.
Well I am allergic to tree pollen but it’s not as if anybody is going to give me medicine with tree pollen in it. LOL! Yes doctor this medicine is giving me a runny nose, itchy watery eyes and I want to sneeze very badly. Now that would be a weird drug reaction!
Overall, I haven’t taken many different medications so I wouldn’t know in most cases if I was allergic to something or not until I was given it and had a bad reaction to it. So far, the few medications I have taken in my lifetime, I have had no allergic reaction to them at all. Touch wood.
Rameses, yes you can be allergic to minerals. Sometimes it develops over repeated exposures – I personally am allergic to the powder in sterile gloves – I get itching, blisters, and swelling if I wear them for more than about 20 minutes. However, TECHNICALLY I am probably just hypersensitive to it – and develop a contact dermatitis-type thing as opposed to a true “allergy”. Basically, if you think you are allergic to something, see an allergist and have them do a battery of skin and antigen/antibody testing and you will have your answers.
Uh, yes, ERPA, sounds like you have an ALLERGIC contact dermatitis, as opposed to an irritant CD.
Just as Rameses has an ALLERGIC contact dermatitis to chromium – BTW chormate salts are also used in leather tanning, so if you have foot rashes, itching, etc, think of that.
I once had a female boss (before I went to pharmacy school) who had chronic ear infections that defied treatment until it was discovered that she was allergic to one of the metals in her favorite pair of earrings.
And I once heard about a woman who had chronic skin rashes that also defied treatment, until her dermatologist discovered she had a copper-containing IUD. IUD replaced with one containing no copper: rash gone within hours.
The adage in my old ER regarding ‘allergies’ was:
the longer the list of ‘allergies’, the crazier the patient.
I know it sounds evil but it proved itself over and over again…
My favorite is the guy who once told me
“I am anaphylactically allergic to something that starts with a “B”…name some “B” drugs…”
“Do you have the name written down somewhere sir?”
“Yeah, on my fridge.”
Perfect.
I admitted a patient last night who answered my allergy question by telling me he was allergic to city tap water. I thought he was joking and smiled but oh no, he was serious and offended that I didn’t take it as seriously. Once he drank some and vomited so he is now convinced he’s allergic and brings his own water with him. I chose note to officially document this allergy.
and all this time I thought I was allergic to codeine when, in reality, it’s an “adverse reaction” (palpitations and black-out). Interesting that in the 15 or so years I’ve been telling doctors or ED nurses that, no one has corrected me. I am allergic to the adhesive on medical tape and band-aids, which makes hospital stays a pain in the ass (or where ever I happen to have a catheter).
Hey, I have a suggestion for a future post. How ’bout covering how much “history” you need when a patient comes into the ED/ER? I never know what info they really need and at what point they start thinking “shut up, already” when they ask for a history LOL.
Good idea June. I will post something along those lines….
So that’s what I am experiencing, an adverse reaction to codeine. Thank you, I was wondering why I was having palpitations. Mmmm, codeine; must switch back to oxycontin and stop breathing…hahaha…oh wait I can’t breathe, lol. Yes I am high on codeine right now sorry. I just want to say thank you again. I read your blog frequently. I enjoy.
How about the people who are allergic to sugar-free candy because it makes them have diarrhea?
YOU’RE NOT SUPPOSED TO EAT THE WHOLE PACKAGE IN ONE SITTING!
I know the difference between allergies and adverse reactions, but listing something as an allergy is a good way to be sure that it’s not given to you. For example, my husband was ghgiven a medication that caused him to hallucinate and put him in the hospital for a week. We prefer that he not be given that medication, so we list it as an allergy. (Since it’s a pain med there’s no problem with just using something else.)
And for those who say lots of allergies mean the person is crazy, I know the exception to the rule. My mom has a long list of allergies, several of which are medical.
I went to an allergist because I was constantly sick, and nobody could figure out why. They did the standard test for both city and country allergies for my part of the country, and I was allergic to most things, including penicillin, which I had taken many times without any adverse reactions. Because it came up as an allergy, it was put on my file, so I can’t have it any more, even though I’ve never had a bad reaction, whereas Morphine makes me stop remembering to breathe. I was still feeling pain, but I had a nurse standing over me telling me “breathe in, breathe out…” for about 20 minutes after every shot of morphine. It’s not an allergic reaction, but it is unsettling to think that the nurse may have had an emergency to attend to while I wasn’t breathing, so I have listed Morphine as an allergy, with the symptoms as “severe respiratory depresion” as opposed to anaphilactic shock.
I know its suspicious, but I am actually allergic to Percocet and its derivations. Trust me, I woke up after having my wisdom teeth out with hives all over my body. I always get the hairy eyeball when I ask for something else. I hate doctors suspicious nature sometimes. ^_^
Hey Eskimo, at least you are not allergic to NSAIDS.
Once I told a dentist that I’m allergic to spring. When I pulled out the list from my allergist, he finally understood.
I was in high school when an oral surgeon removed my wisdom teeth & I was given percodan. Don’t recall what happened, but the doctor told my mom to make sure I never took it again.
In college I was given vicodin for the first time – my neck turned red; I was in so much pain that I didn’t notice the rash. By the second day it was difficult to breathe. A few years later, new doc didn’t believe I was allergic, so wrote the Rx for hydrocodone – as if I’d be able to breathe if he used the generic instead of brand name. I figure myself lucky to have survived. It’s happened a few other times – doctor was told that I’m allergic, but prescribed it anyway. Now I just say “No thanks. I’d rather breathe.” When pain gets unbearable, 800mg ibuprofen three times a day plus 1000mg tylenol four times a day allows me to function.
I understand that doctors need to be careful about those who are drug seeking. But some of us really ARE allergic to a couple pain medicines. There should be a way to convey that information in a believable manner. When I say that I’m allergic to vicodin & percodan I’m not wanting something even stronger. I’m scared to death what would happen if I was to ever take another narcotic pain med. FWIW
Hi – enjoy your blog.
Ancient post I know – but I am curious.
What would you think of a patient who has pain, but also has aspirin sensitive asthma which does cross over to NSAIDS? Samter’s triad – life-threatening asthma. As I’m sure you know, asthma standards say you should not give NSAIDS to asthma patients anyway. So no ibuprofen, no toradol, etc.
btw – I am not the patient, I know the patient. He does not go to the ER for pain management, but we’ve been a few times for other problems. Always worry when we have to tell them no NSAIDS. They often look happier when we say don’t need any meds from you, just a glass of water, he has his own. But it sucks to have to worry.
Would you find that suspicious? Or is it a known enough thing with asthma patients?
Most allergies can be treated by corticosteroids and also some antihistamine blockers.-,~
Sure, but you still don’t deliberately give a patient a medication they are really allergic to. And corticosteroids are hardly without risk and side effects.
Aspirin sensitive asthma is slightly different from a true allergy, although pretty much just as serious.