Just a R&R on Allergies

allergies

Humour me – I need to do a R&R (Rant and Rave) on patient’s allergies.

I am sick of people with ridiculous allergies.

My anaesthetist once told me, that if a person put down more than three drug allergies, then he/she is most likely crazy. I have had patients who ran out of space on their pre-consultation questionnaire for their allergies that they started to list them on the back of the form. I understand that there may genuinely be people who have multiple allergies, but these people are extremely rare. Their allergies are often proven with forma allergy-testing.

I have had patients who have listed every class of antibiotics under their allergies, so I have had to tell them that I couldn’t operate on them, because if they got an infection, I won’t be able to treat it.

Then there are the patients who put down ‘allergic to general anaesthetics’ when they check into hospital for their operation. Really? Would you prefer a sledgehammer instead? You can’t be allergic to general anaesthetics – to put someone to sleep it requires a finely-balanced cocktail of different intravenous drugs and inhalable gases. Sure, there are known idiopathic reactions to specific anaesthetic drugs, but these are rare – often the specific agent can be identified and the patients are informed in detail. The generalisation of being allergic to general anaesthetics just shows patient’s complete ignorance to their true allergies. Nausea and vomiting or a mild rash after a GA is common – it doesn’t mean you are allergic to it.

Patients who are allergic to multiple pain killers are a complete headache to surgeons. When patients put down that they are allergic to all narcotics except Pethidine, they shouldn’t be surprised that medical and nursing staff treats them like Pethidine addicts. Pethidine is a narcotic, it’s hard to fathom that someone could be allergic to all narcotics but not Pethidine. Most often, people who get a high on Pethidine prefer Pethidine injections to any other narcotic as their pain relief. There are also patient who claim they are allergic to simple analgesia like paracetamol/acetaminophen, or anti-inflammatories, but can only take narcotics. That to me, also sounds pretty suss.

Then there are patients who think they are hilarious. When I ask them what they are allergic to, the response is, ‘doctors’, or ‘pain’, or ‘hospitals’. If only I had a penny for each time I get the funny patient, I’d be a millionaire by now. What about patients who write ‘hay fever’ or ‘eczema’ in the box next to ‘Drug Allergies’. Really?! Do they know of any doctors who prescribe ‘hay fever’?

Food allergies, however, are important to disclose, as some people who are allergic to seafood or crustaceans can also be allergic to iodine. One of the intravenous anaesthetic (propofol) also has egg protein in it, so can cause severe allergic reactions in those who are allergic to egg. As for being allergic to cat? Well, we don’t normally prescribe cat, and the well known cat-gut sutures are actually made out of sheep gut.

People need to understand the difference between side effects and allergy. Nausea, indigestion or even itch sometimes, is not an allergy; it is just a common side effect. These side effects can be avoided if advice or treatment is sought. Being sensitive to something is not an allergy. Patients love telling me they are allergic to all tapes.  When tested, they are usually not allergic to any, because the ‘red rash’ they describe are just irritation from the sweat which has accumulated under the tape on their sensitive skin. Some people are also quite ‘sensitive’ to medications, and although understandable, is still not a true allergy. All that is needed is a dose or timing adjustment or even treatment to prevent these sensitivities.

Sometimes I have to admit, it can be the doctor’s fault that patients think they are allergic to numerous things. When a patient reports a side effect, the doctor is often quick to blame the drug and put it down in the allergies column, instead of explaining to the patient that it is not a true allergy, and find out if the drugs were taken correctly.

Why is it so annoying to a doctor when patients put down allergies which are not true allergies? Because once you have written it down as an allergy, medicolegally, we find it very hard to give that particular drug to you, even if you need it desperately. So if you put down that you are allergic to an antibiotic when all you get is a bit of nausea, we have to give you a second-line antibiotic choice to treat your infection because we don’t want to be sued for drug reactions. If, instead of putting it down as an allergy, you tell us that you get a bit of nausea with the antibiotic, we will dose it so that you can take it with food and maybe some antacids to treat the side effect, but you will now get the best antibiotic for your infection.

So next time you write down your allergies, think twice before you start listing them.

What about the patient who told me that she was allergic to light?

I told her that it was ok. I can operate in the dark.

 

8 thoughts on “Just a R&R on Allergies

  1. I am going to go ahead and say that the person listing the allergies is usually not a doctor. It might be a medically trained person (perhaps I nurse, I’m not laying blame, just perhaps) but I don’t know any doctors who do the charting about allergies.

    Also, how about being allergic to epinephrine with a side effect of “makes my heart race.”
    So, if your heart stops beating, I shouldn’t give you epi because you are allergic, or should I just ignore that and save your life?

    • Yes, I have had patients who tell me that local anaesthetic make their hearts race so they are allergic to it. I try to explain to them that it’s the adrenaline – otherwise they will have to swap LA for some whiskey and a bark to bite on!!!

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