What do patient's drug allergies tell you about them?

[firedoc5]

Speaking strictly as a BLS provider, I am aware that if an individual is taking "Medicine 'A'", taking a "Medicine 'B'" can be contraindicated, so allergies may not be in play at all. Rather than telling us they have contraindications, sometimes the patients will phrase it to us as an allergy, like the often joked about patient on Phenobarbital who tells us he's taking "peanut butter balls".

Very good point, Rich. Also when "Medicine A" is a prescription med and "Medicine B" is an OTC med that they had just picked up off the shelf and didn't read the info, it can be concluded by the patient that they are "allergic" to it. When in matter of fact that if they took either one and not the other they'll be fine with it. I don't know how many times I've seen it. That's why I've always stress to Basics the importance of knowing a patient's allergies and meds, including any or all OTC meds.

[Richard B the EMT]

That's why I've always stress to Basics the importance of knowing a patient's allergies and meds, including any or all OTC meds.

That is a point I should have made, but at least now it has been made.

Everyone, remember that point!

[ladybear]

I also find it important to determine the type of reaction that the patient had to the medication. I find that a lot of people will tell you that they are allergic to "x" drug and upon determining the reaction they had to that medication - it wasn't an allergic reaction. In these cases the patient labels it an allergic reaction when it was only a common side effect.

I try to give everybody the benefit of the doubt, but if you have a pain complaint and tell me that your allergic to Tylenol, Ibuprofen, Aspirin, Naproxen, Toradol, (insert drug here that doesn't produce a "high") - you've just convinced me that your after pain meds and won't be receiving anything from me.

Oh I just love this type of reaction from the ones who treat. I caught a fellow nurse doing it to a patient the other night. The patient has a "Tylenol" allergy. He actually tried to give her Vicodin. She refused because it has "acetaminophen" in it. I asked her what her reaction was to the Tylenol and she said her throat swells shut. Yup.. she would be a bad candidate for a lot of drugs.

The last time I ended up having surgery, while I was in the ER trying to figure out what was wrong, I talked to the ER doc about pain management. I am lucky because he knows me. I discussed all the reactions I have to specific meds, such as morphine, Vicodin, etc... and he made sure that they were listed as allergies, because the reactions are true allergic reactions.

I asked if Toradol was an option, but the doc said no. They tried Fentanyl on me and it didn't do squat except make it so I was dizzy.. so I told them to leave it alone.. I would deal. The US tech got pissed off that I was in so much pain, but I just told him to do the damn test and get it done and over with. :sad1:

I was thrilled when two weeks after my surgery I got cleared to take Ibuprofin because I sure wasn't feeling so good with the Darvocet they had prescribed for at home. :sign11:

What was interesting about the whole experience is the different reactions that the various nurses verbalized when they were talking to me and about me regarding my allergies.

Those that know me know I'm as far from a "drug seeker" as possible. Those that don't figured that my extensive list proved that I was. What they don't think about is that when one has had multiple injuries and/or surgeries one has been exposed to most narcotics. Maybe there's a reason that we've found out the hard way that we can't tolerate them. Personally I like to breath, therefore I will list those that cause hives and swelling as allergies.

Please remember that some of those drugs metabolize down into byproducts that can cause the same reactions, therefore someone who has an allergy to A may have been told by their doctor to never try B due to risk of reactions. Sulfa drug allergies are significant for this. Celebrex doesn't cause any highs, but in folks who are allergic to sulfonamides this drug could be deadly.

:violent2:

[air.stump]

When a patient of mine tells me that they have a drug allergy, I ususally ask what it did to them the last time they took it. It is more a matter of curiosity than anything. During all this questioning, I have heard a few surprising things. One of my favorites is, "My mom is deathly allergic to it so I must be." I didn't challenge this statement, I just nodded my head. When I hear a long list of allergies, I just question more. It has been my experience that the longer the list, the greater the chance that a history of Migraines will be found.

An older ER doc told me that most people aren't allergic to codeine. He said that the drug breaks down into something that causes a reaction and that the codeine is too small for the body to recognize it? Anyone else heard of this before?

[mrsbull]

When I hear a long list of allergies, I just question more. It has been my experience that the longer the list, the greater the chance that a history of Migraines will be found.

Just curious what does the length of the list have to do with migraines?

[air.stump]

IMHO most people with migraines go to great lengths to control their pain. If the list is long and contains antiemitics, beta blockers, NSAIDS, and narcs, etc.... then, my thoughts are that they have tried many different things to live with this aliment.

I'm not picking on people with migraines, it's just what I've seen and experienced. I also ask about triggers and their history in dealing with the headaches.

[sirduke]

I love the ones who are allergic to torodol, yet take an asprin for their heart everyday.

I have frequent kidney stones, and am deathly allergic to codiene, so invaribly when I stagger into the ER begging for Torodol, they look at me like I've lost my mind.

One doctors reaction was to ask, "You know you can't get high on that don't you?"

Talwin NX works pretty good for me as well, no high, no hives, no difficulty breathing, just pain relief.

Did have a patient tell me she was deathly allergic to normal saline, but that's another story.

[firedoc5]

I love the ones who are allergic to torodol, yet take an asprin for their heart everyday.

I have frequent kidney stones, and am deathly allergic to codiene, so invaribly when I stagger into the ER begging for Torodol, they look at me like I've lost my mind.

One doctors reaction was to ask, "You know you can't get high on that don't you?"

Talwin NX works pretty good for me as well, no high, no hives, no difficulty breathing, just pain relief.

Did have a patient tell me she was deathly allergic to normal saline, but that's another story.

I can feel for you with the kidney stones. I stopped counting at 12. But I definitely can't take Torodol. IM I get red streaks and the injection site swells and becomes red and I get real sick. PO just tears my stomach up and abdomen cramps. But I agree that there are too many people that claim they are "allergic" to it because they can't get high on it. It becomes a problem with those who can't take it. So when I am offered it I tell them about it, but I don't ask for anything in particular. If I did it would make it sound like I'm drug seeking. That's the difference between those who are and those who are not actually allergic to it.

And I can't take aspirin either.

I'm tempted to list my allergies here and describe the reactions I get, but I don't know if anyone would be particularly interested.

[sirduke]

It is funny to see the doc's reactions when you request Torodol, really freaks them out.

[iMac]

Contrast agents for xray, CT scan, and angiography contain iodine, and this is the issue with this allergy and is usually how people find out that they are allergic to it. MRI contrast is gadollinium, and does not contain iodine, and is therefore safe for these patients. For this and other reasons, noncontrast CT is gaining wide use, even for intra-abdominal pathology. MRI is a reasonable alternative, though not typically available during off-hours.

On the OP's note, if a patient has more than 5 drug allergies, they have a high likelihood of having borderline personality disorder. There is a study out there to prove it, only I'm too lazy right now to look it up.

'zilla

I actually find that really interesting. From my experience and the select few that would call, I know for a fact that those given "allergies" were not allergies, just attention seeking-hypochoncriacs.

I appreciate that post. I would love to see the article if you ever decided or get around to posting it. Will pass it around.