WhiteCoat

My Newest Medical Problem

I was extra busy during a recent shift, then I got annoyed about something and began keeping track of it.

The fun part of having a blog is that I can turn something that annoys me into a post.

I have now learned that a dreaded medical problem afflicts me. No wonder I’m not feeling well.

When I ask patients about their medical allergies, more often than not patients suffer from at least one. During a recent shift, I had 17 people who told me that they had medication allergies. When someone has an allergy, I always ask what the allergic reaction is. The responses I received included the following:

  • Seven people had allergies to various medications (most often penicillin) because their parents told them they had a reaction as a child. They didn’t know what the reaction was, but they have never taken the medication since.
  • Four people had nausea and vomiting with medications that typically cause nausea and vomiting as one of their side effects.
  • Three people tended to develop a rash.
  • One person said that allergies to medications “run in his family” and therefore his doctor told them that he was probably allergic to the medications as well.
  • One woman stated that her allergy to codeine caused her to get “higher than a kite.”
  • One guy said that if he takes penicillin, he “dies.” As an aside, I tend to hear this allergic reaction on a regular basis and wonder how the people are still alive to know about the allergy.

Well, I never stop learning and am glad to know that I should now avoid the following things as my allergic reactions to them will make me feel sicker:

Root Beer – it makes me burp
Tequila – it makes me higher than a kite and then makes me vomit the next morning. Actually, it gives me dizziness when I try to stand up from the bar, too.
Chili’s Baby Back Ribs – they always seem to give me the runs
Poison Ivy – it gives me a rash
Mosquitoes – they make it itch wherever they bite me
The Sun – it gives me terrible skin burns if I spend too much time in it
Telephones – they cause a ringing in my ears
Water – it makes me pee
Cyanide – if I take it, I die

Can I get disability for this?

UPDATE JULY 10, 2009
In the comments section, Jennifer raises an excellent point. How should patients describe adverse effects from medications if they aren’t allergic reactions?
We need to draw a line between “allergies” and “adverse side effects”.
As a rule of thumb, if you are experiencing one of the symptoms listed in the handout given to you by the pharmacist, then chances are that it is an adverse side effect and not an allergy. If you lost your medication handout, you can go to my “Useful Links” page at the upper right and click on the link for “Dailymed” – that site contains the package inserts for most medications marketed in the US.
The reason for the distinction is important. If a physician gives a medication to a patient after the patient has expressed an allergy to that medication and there is a bad outcome, the bad outcome will likely be attributed to an “allergic reaction” to the medication. However, if a patient experiences a side effect from a medication, the medication can still be given without the air of giving a patient something they “shouldn’t be receiving.”
Relaying that information to your physician might involve saying “I get constipated with ‘X’ medication, can we try a different one?”
Listing a medication as an “allergy” will often preclude you from getting that medication or any similar medications. For example, an allergy to penicillin will also keep you from getting amoxicillin, ampicillin, nafcillin, and any other medication that ends in “cillin.” If instead, you say that penicillin gives you diarrhea, you doctor may be able to work with you to find a solution that avoids the side effect – maybe probiotics or yogurt while taking the medication.

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80 Responses to “My Newest Medical Problem”

  1. Kateri says:

    That is totally hilarious! Especially the one where the the allergic reaction is “death”.

  2. DreamingTree says:

    My recent favorite: “when my mother is given dilaudid, she wants to die.” That was enough for me. Her mother was close enough to death’s door – I wasn’t going to push her through it. :-/

  3. Tina says:

    Very funny ! My mother carries a note with her/from herself alerting everyone she is allergic to latex. She really isn’t but is convinced she is. Sort of laugh when she starts to tell the attending physician in ER about it. I am so tempted to grab a set of latex gloves and slip them on while she explains. Such is life.
    Love your blog !

  4. Kim says:

    I thought the stereotypical poison ivy reaction was an allergy. Last I knew I was part of the (relatively large, IIRC) minority that doesn’t have it.

    Otherwise: LOL.

  5. brett says:

    A patient just told me they were allergic to sodium chloride.

  6. Jennifer says:

    I’m curious if there were any valid allergies among the seventeen people you saw? My non-medical guess would be only the folks who reported a rash?

    I was recently told by a physician that my two “medication allergies” were within the normal realm of expected results, despite the warnings from my primary doctor. So if they aren’t allergies, how else should one characterize that they never, ever want to take a medication because of the unpleasantness that occurs? I understand that sometimes medications cause unpleasant reactions that are just part of how they work-that’s not what I’m talking about.

    For example, Ambien can cause aggressiveness. That’s not an allergy, right? But something that you would desire to avoid as a patient if you had previous experience with that side effect? I wouldn’t want to be given Ambien as a sleep aid, knowing my reaction, while hospitalized. How should a patient express that?

    • DreamingTree says:

      Describe your reaction, Jennifer — as you did in your comment. We want to hear that when you are admitted, because we don’t want to get punched after trying to help you sleep. ;-) Seriously, while it may not be an “allergy,” it’s an undesirable response to the medication, so that’s good to know. Just like my lady who wants to die if she takes dilaudid — rather avoid that, thank you very much. :-)

    • WhiteCoat says:

      Very good question. Thanks for asking. Answered in the post.

  7. Nurse K says:

    My favorite allergies are still symptoms that the drug was likely prescribed to treat. Compazine–nausea and vomiting, Pepcid–GI distress, etc.

    • Teresa says:

      Pepto Bismal makes me vomit if I take it for an upset stomach. I’m not sure why you think these are funny, but have another laugh on me. I suppose if you were vomiting when taking something to alleviate nausea I would think it’s funny, too!

      • Nurse K says:

        If you are nauseated and put anything in your stomach from Jello to water to Compazine to Pepto-Bismol, there’s a good chance it’s coming up! I’m sure you’re not allergic to water or “all kinds of food” either. Besides, vomiting isn’t an allergy no matter what.

        I puke up birth control pills (x 5 different brands), so I should list “all BCPs”, reaction: “pregnancy and emesis”.

      • Teresa says:

        Besides, vomiting isn’t an allergy no matter what.

        If you say so.

        An uncommon effect of drug allergy is a life-threatening reaction called anaphylaxis. This reaction usually occurs minutes after exposure to the drug but may occur within a few hours. Signs and symptoms include:

        Nausea

        Vomiting

        Mayo better brush up. They’re calling a little skin rash an allergic reaction. Must not be any actual doctors and nurses over there.

      • Teresa says:

        Yet more idiots out there

        Gastrointestinal symptoms of food allergy include vomiting….

        Who do these allergists think they are? Really.

  8. Don says:

    Jennifer makes a good point,

    There really is no question asked to patients about medications that you have bad reactions to that are not allergies.

  9. ndenunz says:

    How about the people who state they are allergic to prednisone or epinephrine? They always crack me up.

  10. Pattie, RN says:

    I am SEVERELY allergic to french fries, as they cause semi-permanent swelling of my buttocks and thighs.

  11. C. says:

    My father is convinced he is allergic to EVERYTHING so when he went for allergy testing and the MD told him what he was actually allergic to, the MD was then a crock. He’s one of those described and it drives me nuts. My whole life I was told I was allergic to penicillin but never believed I was. So when asked I say i was told I was allergic but I dont believe it.

  12. Finn Haddie says:

    When I’m asked if I have any allergies, I usually answer either “No” or, if pain meds are likely to be an issue, “No but I find the side effects of percodan and vicodin intolerable. Codeine works well for me without causing any nausea.”

    It’s my understanding also that poison ivy reactions are an (extremely common) allergy, one that I don’t have.

    • WhiteCoat says:

      There is still debate on whether contact dermatitis is classified as an “allergic” dermatitis or an “irritant” dermatitis. Good point. Bad example on my part.

  13. paul says:

    i’m allergic to epinephrine. it makes me go into anaphylactic shock.

  14. paul says:

    i recently treated a lady who claimed to be allergic to “all antibiotics.” thank god she didn’t come in for pneumonia- i would have gotten “dinged” for sure!

  15. Pod A says:

    Normal saline, “medical oxygen” and hospital linens. Whatever.

    You know what I really hate? People who are allergic to latex that work in the medical field. Drives me insane.

  16. hannah says:

    The “horse serum” one always cracks me up because the people that know they’re allergic to it are always a million years old.

    But a rash IS an allergic reaction, right? Even if the vast majority aren’t fatal. Traz gives me a head-to-toe rash; so I’m allergic to it & that’s what I tell the doctor. (Obviously, that’s just a sleeping pill. If I NEEDED x antibiotic that I knew would give me a rash – would that be taken into consideration? Or does one relatively mild allergic reaction to a med predispose you to a more severe reaction from the same med?)

  17. ~M~ says:

    I see this topic in medical blogs a lot. I’m wondering when it IS appropriate to label a drug reaction an allergy. I understand the difference between anaphylaxis and other adverse effects…I think. I mean, I know that an allergy is an immune response, so nausea and vomiting probably wouldn’t count.

    My daughter developed an erythema multiforme rash literally all over her body after taking amoxicillin for pneumonia. Her face was so swollen, it scared me. Her pediatrician thought the rash might have been due to mycoplasma pneumonia, but the test for that was negative, so he discontinued the amoxicillin, and the rash went away. I know the rash might have gone away no matter what, and I know that the blood test used to diagnose mycoplasma pneumonia is neither particularly sensitive nor specific.

    So, my question is when medical professionals ask if my daughter has any drug allergies, what do I say?

    I have a Ph.D. in medical psychology. I am not a physician, but I do have a lot more medical knowledge than the general public. If I can’t figure this out (even taking into account my neurotic tendency to overanalyze things), I am not surprised that medical professionals don’t get good answers to this question. I’m wondering if there’s a better way to ask it. (E.g., “Have you ever taken a drug that made you have trouble breathing?” or something like that.)You’d still get dumb answers, but maybe not quite as many…??

    • WhiteCoat says:

      I was trying to pick the obvious cases in my post, but you bring up another good point.
      If your daughter had EM from amoxil, then technically it isn’t an allergy, but do make sure to tell her doctors that she developed EM and can’t take amoxil.

      • Teresa says:

        So what you are saying is that the general public is stupid if they don’t know the difference between EM rash and an allergy? If the medical personnel would simply make that clear in a tutorial when it happens, sheesh, maybe you wouldn’t have such stupid patients. “Mrs. Smith, your daughter had an EM rash, not an allergy. And I want to emphasize here, THIS IS NOT AN ALLERGY, so please don’t ever say that she is allergic to this drug. Oh, but you do need to tell the doctor, even if he forgets to ask, that she had an EM rash. Just don’t call it an allergy whatever you do, for garden seed.”

        I get it now.

        /sarcasm

  18. Katherine says:

    I read on a blog once that what most people think of as allergies are instead just heightened sensitivity to some things i.e. if it only causes a bit of irritation but doesn’t cause massive swelling or anaphylactic shock, then it is only a sensitivity.

    That said, my mother once went into anaphylactic shock after taking an antihystamine (hope I spelled that right) which is pretty ridiculous to think back on now.

    • Teresa says:

      A lot of patients don’t have medical degrees. Perhaps that explains their different view of the question of drug allergies than doctors have. It’s always interesting to me that doctors and nurses seem impatient with the ignorance of people who come to them for treatment. “You actually went to see a doctor because you have a sore throat? You idiot!” I’m not sure how you think the patient is supposed to know which things actually require medical attention, especially when doctors and nurses refuse to give any guidelines over the phone. “Come on in, and if you’re aren’t seriously ill, then we can make fun of you on the blog tomorrow.”

      And I totally agree with you that going into anaphylactic shock after taking an antihistamine is ridiculous.

      • Adam says:

        “I’m not sure how you think the patient is supposed to know which things actually require medical attention, especially when doctors and nurses refuse to give any guidelines over the phone. “Come on in, and if you’re aren’t seriously ill, then we can make fun of you on the blog tomorrow.””

        Awesome point.

        You should have also mentioned something about getting annoyed when patients look stuff up on the internet. Whatever way you look at it, patients will be viewed as idiots by a lot of medical folks.

        Car mechanics should make blogs about idiot medical folks that don’t know about engines. Computer tech folks already write blogs about idiot users that don’t know how operating systems and networks work. The list goes on.

      • DreamingTree says:

        Have you ever complained about something you’ve experienced at work? Adam: I’m sure you can find those type of blogs if you do a search. We each have our specialty, and I’d be the first to admit that I’m clueless in many, many areas. My mechanic could write some funny blogs filled with my stupidity. And you know what, I’d read it for what it’s worth — entertainment & catharsis.

        This kind of reminds me of the Seinfeld episode when Jerry decided to heckle someone at their job. Good stuff! :-)

      • WhiteCoat says:

        Teresa’s comment just illustrates the point I was trying to make.
        People are smart enough to realize that belching isn’t an allergy from root beer and that diarrhea isn’t an allergy to baby back ribs, but let those same people ingest a pill that the “arrogant” medical providers gave them and have the exact same symptoms and suddenly all common sense goes out the window.
        Just because I get the runs from eating ribs doesn’t mean my kids or my second cousin will have the same reaction.

      • Teresa says:

        Oh, yes. I’m just one of the many ignorant patients out there. Not having completed medical school, well, wait, let’s be honest, I haven’t taken a single course, I should still know the difference between an allergy, an adverse reaction, and a side effect listed in the brochure in 3 point font. So sue me. ;)

        Glad I could be an illustration for you

  19. Gene says:

    My husband tells everyone that he is allergic to Sulfa because his MOTHER is allergic to it. He’s never had it. I keep telling him that HE is not allergic, but he won’t listen. Scientists… ugh…

  20. Christine says:

    Last night: “I’m allergic to any non-enteric coated pills, they upset my stomach.”

  21. Amy says:

    I had a patient tell me she had 3 medication allergies but couldn’t remember the name of the meds she was allergic to. I asked her the reaction and she said her tongue swelled – which worried me enough that I felt I shouldn’t medicate her until I knew what drug it was. She told me her pharmacy would know, so I asked which one and where it was. She proceeded to explain to me that it was the one 6 towns away “across from the Mobil station.” DUH! OBVIOUSLY! When we finally established the chain, I called and asked. Nope, they had NO IDEA what she was allergic to. LOVELY.

    People who don’t know their allergies piss me off even more than people who make s— up re: allergies.

    • Teresa says:

      I know what I’m allergic to, but I’m certainly not going to tell you now that I’ve read the comments of medical people here to patients’ allergies!!!

  22. angela says:

    I am a nurse practitioner, married to a physician. My step-mother always told me I was allergic to PCN, and I never questioned her until I went into medicine. I asked her one day what happened when I took PCN. Her response: “Oh, I never let you have any. My mother was allergic to it, so I figured it might run in the family.”

    My step-grandmother was allergic…so it skipped generations and blood lines? :)

  23. DaveyNC says:

    When they ask me if I’m allergic to any medications, I just say, “Not that I’m aware of.”

    How do you treat someone who says they are allergic to “all anti-biotics”? What a ridiculous thing to say.

  24. throckmorton says:

    I had a patient today who was allergic to steroids and benedryl. She said that she had a bee sting and soon after she she got the steroids and benedryl her hives got better but she got a rash.

  25. Amy says:

    I had a CT scan last year. I was given Barium sulfate to drink before and I also had the intravenous contrast. Later that night I broke out in hives from head to toe. No trouble breathing or anything like that. What Im wondering is was it the barium or the contrast dye that caused the reaction. I have no other known allergies.

    • WhiteCoat says:

      I’ve never heard of barium causing any type of reaction. Most likely the dye.
      P.S. Did you know that barium is used to create fireworks?

      • Amy says:

        Matter of fact I did know that. It was on an episode of How Its Made on the science channel last week.

  26. EskieNurse says:

    My personal favorite is the patient who insisted their child was allergic to oxygen…I mean, honestly.

    I was told to put down Epinephrine as an allergy because I got severe chest pain with it- but I always say if I am having a reaction- give it to me anyway- I had no EKG changes.

  27. Teresa says:

    So Dr. Whitecoat, what I take from this is that I should not tell doctors that antihistamines worsen my lung congestion, is that right? Just let them give it to me? Will it make a difference to them once they see that I can’t clear my lungs any more with coughing alone after they give me an antihistamine?

    Three people tended to develop a rash.

    And what about the rash thing? If you get a rash over your whole body, is that not something a doctor should know? I’ve always heard that that was a systemic reaction that a doctor would want to know about. I’ve learned something new here today. I’ve never had a throat-swelling, life-threatening reaction to anything I’ve ever taken, so I’m thinking now that I don’t need to report any of these other reactions.

    Oh, and I get a rash from poison ivy, too, but I’ve never reported that to a doctor. The big giant blisters actually just go away on their own, given enough time. But I’ve never actually used poison ivy as a treatment for anything.

    • Teresa says:

      I noticed you didn’t bother to respond to this, Dr. Whitecoat, nor did any of the others with superior knowledge. It was an honest question. How am I supposed to respond to the question of “do you have an drug allergies” if I don’t know what they are looking for?

      What are they looking for?

      We need to draw a line between “allergies” and “adverse side effects”.

      I appreciate your comments on adverse side effects, but you never actually said what constitutes an actual allergy. Why is this such a big secret?

  28. brighid says:

    I’m puzzled. For those of us who were given penicillin as small children and told never to take it again, but don’t have any idea what the reaction actually was, what SHOULD we report when doctors ask us about allergies? If we don’t know the reaction, should we say nothing?

    I can describe the rashes I get with sulfa drugs and the stomach cramps and tight throat I get with e-mycin. Are those okay to mention? And although I’m not actually allergic to epinephrine, I’m unusually sensitive to even small amounts; I get migraines from dental anesthetics, and cold preparations containing pseudephedrine give me palpitations, cold sweats, racing heartbeat and terrible anxiety. Should I mention that? (I know my doctors don’t care; they continue to prescribe psuedephedrine even when I tell them.)

    What should we tell doctors when they ask us about medical allergies?

  29. Zorro says:

    Next patient you see, try asking them this, “Have you ever had a zorphism?” If they ask what that is, absolutely refuse to give them an answer.

    This is stupid. How is a patient supposed to know what your definition of “allergy” is? They are familiar with allergies in a whole different way.

    You can avoid all of this miscommunication, and the onus is on YOU to do so, by simply asking the question differently:

    Have you ever had difficulty breathing, had your throat or tongue swell, or have you required emergency medical treatment as a result of taking a drug, and if so, what treatment was required?

    Now the patient understands what you are looking for.

    Of course, if you did this, you wouldn’t actually be able to make fun of patients for their medical ignorance. Talk to them in terms they understand, and all the fun goes away.

    • WhiteCoat says:

      In an ideal world, your idea might work. I wish it were that easy.
      You’re right that the terminology might be confusing, and I think that some doctors are to blame for this. Once a bell is rung, it can’t be “unrung” though. Patients cling to the diagnosis of an “allergy” even when it can be proven that no allergy exists.
      And your suggestion still doesn’t deal with patients who have allergies to water, steroids, or the color white. We can’t bring those patients under public scrutiny for fear of offending them, though.
      Neither you nor Teresa has explained the dichotomy, though. Why is it that a sixth grader knows diarrhea is not an allergy after eating spicy Mexican food, but, even when the product inserts specifically state that diarrhea can be a “side effect” of a medication, many patients then develop the same “allergic” symptoms after putting a pill in their mouth?

      • ~M~ says:

        I think it may be simply because of the public perception of medicine (and this has nothing to do with anyone being stupid, so I hope I don’t offend with what I’m about to say). There are some psychoactive drugs that we really don’t understand in terms of why they are effective (lithium, for example). My undergraduate students are always shocked by this. They think medicine is all science and no art and that we would never use a drug unless we knew exactly how it works and why.

        I dislike the phrase “side effects” because it facilitates this misperception. (I prefer “aversive effects”.) Drugs are chemicals, and they have effects. We like some of those effects, and we don’t like others. It’s not as if a drug’s primary purpose in the universe is to cure disease and its “side effects” are peripheral functions that only occur when it doesn’t work correctly.

        I wonder if the current mindset is a function of:

        1) generations of paternalistic medicine (“Don’t ask questions. Just do what I say, and I’ll fix you.” I realize this is not usually the case anymore.)

        and/or

        2) the efforts of pharmaceutical companies to market drugs as sure fixes for any and all problems

        The effects of the practitioner-patient relationship is one of my areas of interest, and I wonder how communication might be involved in this issue. I’m not suggesting that the emergency department is necessarily the place to re-educate the public, though. Just thinking out loud, really.

  30. Jessica says:

    My absolute favorite (I’m an anesthesia resident): the patient of mine who had an allergy to succinylcholine. “It made me stop breathing.”

  31. DefendUSA says:

    This was funny!!
    I will say though, that genetics do seem to play a role in families.
    My mother and I are both allergic to sulfa. We get hives.

    My mother cannot take codeine and neither can I. It makes me very hyperactive. My son received Tussy with codeine (he was 2 or 3) for a cough. after finally falling asleep at 9, he got up at 0100 and brought his toys to my room to play! This was completely out of character for him. It happened the next night, too. We stopped it and he stayed asleep.

  32. Joeymom says:

    I was told when my baby got a rash from amoxicillin not to give it to him again, because the reaction can get increasingly severe, he could go into full anaphylactic shock. Should I not inform the doctor? And since he will never have it again, if he forgets that the reaction was a rash because he certainly didn’t remember having it and I’m not going to test the theory, should he just risk the anaphylactic shock?

    • Teresa says:

      Well, Joeymom, it would seem that it might be OK to mention it to the doctor, as long as you don’t call it an actual allergy.

      When he’s an adult, though, he certainly shouldn’t be telling doctors that “my mom says I can’t take that.”

  33. CA says:

    A question for all the readers out there (as Whitecoat does not dispense medical advice on/over his blog):

    The family history says that my eldest brother (I’m the youngest of 3)had a “reaction” to penicillin when he was a wee tot, and I have always been warned away from it and told to declare it as a drug allergy. I tried to find out the specifics, but nobody remembers anything other than he had a “reaction.”

    So my question is: Is there a SAFE way for me to find out whether I am allergic to penicillin?

    Could an Allergist test me and make a determination?

    The only method that comes to my mind: if I have need of an antibiotic and penicillin is appropriate, I could take the medication in my PCP’s office or waiting room, and if I should go into anaphylactic shock or swell up like a balloon, my MD could take care of the problem.

    But, would I need to be at my MD’s office more than one day as one form of anaphylactic shock is cause “upon a second exposure to a specific antigen (penicillin) after previous sensitization.”?

  34. HospiceDoc says:

    My two favorites that occurred in one patient:
    Water
    The color white

    I kid you not. She wouldn’t touch white medications, we had to find sheets for her hospital bed that weren’t white, a gown that wasn’t white, food services had to be advised of no white food…it was insane.

  35. Teresa says:

    To say the least, I’m disapointed in you today, Dr. Whitecoat. You won’t define allergy for those of us who don’t know, but you continue to mock us.

    • WhiteCoat says:

      Come on. You’re one of my favorite readers. I’m not sure where the animosity is coming from.
      If you want to call side effects allergies, go for it.
      Even the article you linked in one of your previous posts said “Possible drug side effects are listed on the label of any medication you take.”
      My last episode of diverticulitis I was taking Flagyl and my mouth tasted like I was constantly sucking on construction paper. Bad taste was listed as one of the side effects. I had to choose which was more adversive – bad taste or surgery. I bought some peppermints and lived with the taste. That’s the point I’m trying to make. “Allergies” often preclude you from getting medications, “side effects” people can choose to deal with.
      Your article doesn’t say that allergies run in families. Nor does it advocate avoiding medications because another person might have thought a funny reaction developed 50 years ago. Is anyone who hears a patient say that he/she is allergic to the color white supposed to take that patient seriously?
      If you or anyone else out there wants to strap a medic alert ID that looks like Valkyrie’s Shield to your body, go for it.
      I actually had another post about a patient who couldn’t get proper treatment due to all her medical “allergies”, but now I’m not sure that I want to go kicking that hornet’s nest again.

    • Teresa says:

      Come on. You’re one of my favorite readers.

      And you are one of my favorite bloggers; top three, easy. Smooch.

      Now the the lovefest it out of the way…

      not sure where the animosity is coming from.

      Well, perhaps it is coming from the fact that none of the medical people writing on this thread were willing to give a definition of a drug allergy, but most of them were quite willing to make fun of patients for not know whether what they are experiencing is a drug allergy or not.

      Perhaps it is coming from the fact that when I looked for a medical definition of drug allergy I got the runaround:


      Definition

      Drug allergies are a group of symptoms caused by allergic reaction to a drug (medication).

      Perhaps it is coming from the fact that the government (see link above) says that “[m]ost drug allergies cause minor skin rashes and hives,” yet you mocked patients who said they had rashes as symptoms of a drug allergy.

      Perhaps it comes from the fact that one of the drugs listed on the link you referred to says that:

      Allergic:
      Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, allergic myocarditis, erythema multiforme, exfoliative dermatitis, angioedema, drug fever, chills, Henoch- Schönlein purpura, serum sickness-like syndrome, generalized allergic reactions, generalized skin eruptions, photosensitivity, conjunctival and scleral injection, pruritus, urticaria, and rash

      and you said that both EM and rash are not allergic reactions but something else.

      Perhaps it comes from the fact that I looked up an antihistamine on two different sources, and one suggested that thickening of bronchial secretions was a respiratory side affect, while the other told me “get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing.” Is it a side affect or an allergic reaction? I’m really not sure. (And no, I did not start singing looks like I’m heading to the ED. In fact, I did not even seek attention from a primary care provider. I just stopped taking the drug, and magically, my lungs cleared up in a couple of miserable days.)

      I could provide several other inconsistencies in stuff you guys wrote here, but you should have the idea by now, and more won’t help.

      I don’t identify with patients who think they are allergic to the color white. I can only suppose that they have some sort of mental illness.

      However, a patient who gets a rash or gets a serious symptom in reaction to taking a drug might legitimately think you would want to know that.

      Just out of curiosity, I went back and looked at the notes I made to give doctors when they ask about this crap, asking about the medications and supplements I take, my medical conditions, and “drug allergies,” which are the 3 questions they always ask. For the last, I had it described as “drug reactions,” but even so, when they ask about allergies, I generally give that information. I have even asked them “define allergy.” Oddly enough, they are interested in more than just genuine drug allergies. I believe that is the kind of information most medical people expect from the patient when they inquire about drug allergies.

      So let me just leave you with a couple of questions.

      How is a patient supposed to know whether or not they have a drug allergy? Do you realize what happens when we have a reaction to a drug that might be serious? We are told to stop taking it, and generally, we may be told “you should never take that drug again,” but we are not necessarily told “you are allergic to that drug.” We’re left to deduce that on our own, without any medical education.

      If patient like me answers your question “do you have any drug allergies” with just a plain “no,” would you follow that up with questions about other serious and undesirable side affects? If not, then why is it so funny to you that patients try to relay that information to you without being asked? Do you not wish to know? Can you not understand that as a patient I have to filter what I tell you, because I can’t tell you everything, but I sometimes err on the side of telling you more than I think you might want, assuming that you can ignore what you don’t need? If I knew enough to know exactly which pieces of information you need, perhaps I would know enough not to need you.

      Keeping people in ignorance is the ultimate way to insure a steady supply of hilarity at their expense.

      I feel fortunate that my PCP doesn’t make fun of me when I say something ignorant; he takes the time to explain what it is that I don’t understand. He believes that an educated patient is a healthier patient.

      • Teresa says:

        “affect” should be “effect”

        Sigh.

      • WhiteCoat says:

        I’m not going to reiterate what I’ve already stated in previous comments, but will make these few statements.
        I try to educate my patients – even in the rushed emergency department. Few of them want to hear me disagree with conditions they have embedded in their persona. In fact, not too long ago a patient complained about me to the hospital administration because I told her that her diarrhea was not an allergic reaction to medication and she believed otherwise. Most people think that I’m questioning the intelligence of their primary care physician or think I don’t know what I’m talking about when I try to help them, so for the most part I stop trying.
        I think that physicians are to blame for many “false alerts” with allergic reactions. Those false alerts could stem from a lack of knowledge, fear of liability, desire to please the patient, or a combination of all of the above. Unfortunately none of those motivators is likely to change in specific physicians.
        There is a spectrum of reactions – real and imagined – to any medication. On one end of the spectrum are allergic reactions such as wheezing/throat closing/trouble breathing/rashes, ect., and serious reactions to medications. No one takes issue with those. No one is “making fun of people” who have or who claim to have those symptoms. Nowhere have you read anything close to “Hey Joe, it was hilarious – my patient took penicillin, she started wheezing, and she flopped on the floor holding her neck. You should have seen the look on her face!”
        In the middle of the spectrum are annoying side effects from the medications which are not allergic reactions and are listed on the product insert. Some of the more common medication side effects claimed as allergies I take issue with. Antibiotics commonly cause diarrhea. No, isolated diarrhea is not an allergy. Flagyl causes a bad taste in your mouth. Isolated bad taste is not an allergy. If you’re saying that you think doctors should sit down and recite every potential side effect from every medication they prescribe, you’re being unrealistic. Patients have to take some initiative to at least read product inserts.
        Further down the spectrum are people who experience intended effects of medications, yet for some reason term those reactions as “allergies” – Benadryl makes me sleepy, succinylcholine paralyzes me, codeine knocks me out. Again, reading the product insert would be a good first step.
        At the other end of the spectrum are people who have reactions to things such as water, the color white, and air. These are akin to a child saying that a cloud bit him on the arm. Humorous because most people know that such a thing can’t happen. It’s obvious that you don’t find humor in the oddity of those type of complaints, so we’ll leave it at that.
        Mottsapplesauce is correct. Talk to your doctor. Just realize that not every doctor knows everything about every medical topic.
        Even me.

  36. Bookwyrm says:

    This is the definition that most of us would use, we can’t help it if our Docs don’t speak the same language :)

    From Dictionary.com:

    al⋅ler⋅gy
      /ˈælərdʒi/ Show Spelled [al-er-jee] Show IPA
    Use allergy in a Sentence
    –noun, plural -gies.
    1.an abnormal reaction of the body to a previously encountered allergen introduced by inhalation, ingestion, injection, or skin contact, often manifested by itchy eyes, runny nose, wheezing, skin rash, or diarrhea.
    2.hypersensitivity to the reintroduction of an allergen. Compare anaphylaxis.
    3.Informal. a strong dislike or aversion, as toward a person or activity: He has an allergy to hard work.

  37. BK says:

    Neither you nor Teresa has explained the dichotomy, though. Why is it that a sixth grader knows diarrhea is not an allergy after eating spicy Mexican food, but, even when the product inserts specifically state that diarrhea can be a “side effect” of a medication, many patients then develop the same “allergic” symptoms after putting a pill in their mouth?

    this one is easy. many people are allergic to cats and dogs and EVERYTIME they are around them they get rhinorrhea, conjunctival irritation, etc. but how many people get diarrhea EVERYTIME they eat mexican food? i’d wager very few, and then it likely is a food allergy of some sort.

    and i put much of the blame on physicians (despite being a med student myself) very very few doctors take the time to explain all side effects of the medications they prescribe…they simply don’t want to spend the time. and certainly no one explains the pathophysiology behind side effects vs allergies to every patient for every potential side effect. but then we expect them to use proper medical jargon despite no formal teaching or even a proper explanation from ourselves.

    • WhiteCoat says:

      Your analogy fails, though because most “reactions” are deemed allergies after a single exposure. Once deemed an allergy, then no one gives the medications over and over again to see whether the same reaction occurs EVERYTIME they get the medication. How does one reliably determine an allergy based on one event?
      You’re right that there is a communication gap. Due to simple economics, many doctors can’t afford to spend inordinate amounts of time with every patient. You’ll see that once you start practicing. I could just as easily make the argument that the lack of communication is because patients don’t want to pay the doctor more to spend the extra time with them.

  38. Absolutely loved this post, WC. The message I received from all this is that it would benefit both patient & physician if patient’s were more pro-active with their own health concerns. Some patients don’t know how to do that though, despite the numerous resources out there. As you well know I don’t have a medical degree, but work in the healthcare industry. I know just enough terminology to make me dangerous. But I will say, that whenever I need medical care, I generally have no problems communicating with medical staff because I’ve learned much terminology the past 22 years, & they truly appreciate that (it’s a great ice-breaker, too). Whether patients learn any terminology is not my point; narrowing the communication gaps is. Both patient & physician need to strive for that, even though it doesn’t always seem possible.

  39. brighid says:

    Whitecoat, this is a serious question. For those of us who were given some antibiotic as small children and were told never to take it again, what should we be saying when doctors ask about allergies? My pediatrician and my parents are dead; I can’t ask them about the reaction. But the pediatrician who readily gave penicillin shots to my brother and sister wouldn’t give them to me, and from an early age my mother taught me to say that I was allergice to penicillin. What should I say instead?

    And when we get skin rashes, tight throats and other reactions that stop short of death — and doctors tell us we should not take those drugs again — is that information we should convey when another doctor asks us about medical allergies?

    I’m not being funny. I don’t want to waste a doctor’s time, but I don’t want to wind up dead, either. What information are doctors actually looking for when they ask about medical allergies? What’s an example of an actual allergy?

    • WhiteCoat says:

      Ideally, since most of the time the offending medication is a penicillin derivative (most other antibiotics weren’t around when older adults were small children), you ask your doctor to do a patch test to see whether you have a true penicillin allergy. My guess is that you don’t. Either that or just don’t take penicillin.
      Serious symptoms like tight throats and trouble breathing are not things to mess with and I absolutely agree that drugs causing those symptoms should never be taken. That’s not my beef.
      However, when people report that they are allergic to medicines because they get known side effects from the medication or have speculative reactions such as getting “googly-eyed,” they are doing themselves and their doctors a disservice.

  40. Pink says:

    Well, I certainly never thought about this issue in such detail. Another case in point: I had pinkeye. Took the drops the NP gave me. My eyes turned more red, became more swollen and I ended up with a terrible sinus infection. I went back. She told me I was allergic to the drops, prescribed another kind with some p.o. antibiotics and sent me on my way. I, obviously, got better but is that really an allergic reaction or a coincidence with a larger infective process brewing in the background? I had never had problems with the drops before this and I was in my early 30s at the time of the “allergic reaction.”

    • WhiteCoat says:

      If you truly had “pink eye” which is viral in nature, no drops will cure the symptoms. Antibiotic drops or oral antibiotics would have no effect.
      The logical fallacy “post hoc, ergo propter hoc” (after, therefore because of) may apply twice in your case. You used one drop and became worse, therefore the drops must have made you worse. Then you used a different drop and antibiotics and got better, therefore the other drop and antibiotic must have made you better. If your eye was extremely red and dripping pus, you had a bacterial infection and needed antibiotics. From what you described, it is likely that you would have gotten better if you did nothing — or if you ate rutabagas.
      My guess is that there was no allergic reaction.
      However, this is where labeling reactions as allergies creates a huge legal problem. If I tell you that you didn’t have an allergy, you take the medication again, and you have a bad outcome, now I’m fodder for the lawyers. So all the doctors just go on perpetuating the “allergy” myth so that they can’t be held liable for a bad outcome.

  41. PharmD2Be says:

    Not that this will help at this point, but we had to spend a week on “Allergic Reactions” in pharmacy school so that we would know the difference between a true allergy and a “Medication Intolerance.” It was my professor’s habit to make fun of those who claimed to have PCN allergies because “It made me throw up/Gave me diarrhea!” He did however point out that vomiting can be a sign of a true allergy… Just that it was more rare than an ADR.

    It has to do more with the immune response. There are IV classes of hypersensitivities, 2 types of which are of concern. Anaphylactoid reactions (OhEmGEE can’t breathe) and Urticaria (itchy hives!) They are both mediated by a type of immune cell that hangs around. That’s not to say that the other 3 classes of reactions aren’t bad, because they are… but usually the drug can be “re-challenged” if one of those were to occur.

    However, sometimes a drug will and can be administered even if the patient has a reaction… You just load them up on Benadryl and SoluMedrol because you have no choice (Someone allergic to contrast dye who needs a heart cath or the patient who reacted to his first dose of Amphotericin B, but has Cryptococcal meningitis. Not many options left there..)

  42. Adam says:

    When I eat bananas, I get chest pains and some difficulty breathing starting before I even finish eating it lasting for about 2-3 hours. Any clue what this is? (this is coming from someone who is clueless about medical stuff)

  43. LibraryGryffon says:

    The problem I’ve had with this is that very few hospital or doctor’s forms have a place for drug intolerances. And my reactions to sulfa and sulfates are such that, allergy or intolerance, I will not take them unless the only other option is death. (It took months for my guts to recover from three days on gent sulfate eye drops – I really don’t recommend severe abdominal cramping with diarrhea changing to mucus and then to blood over several hours. Taken orally, I vomit for hours after every dose, and albuterol sulfate by nebulizer just leaves me with severe nausea, even with compazine or similar drugs.)

    I explain this at triage, and I invariably end up with a red drug allergy bracelet. Nursing and medical staff tell me that it’s not an allergy, but it’s the only way to make sure they don’t give me any.

    So I usually just say it’s an allergy.

    And then get given sulfates anyway.

    Being “allergic to oxygen” does make me laugh, but also reminds me that I have real trouble being given oxygen in the hospital because of the smell of the tubing. It’s definitely not an allergy, I have had no obvious reaction of any kind the two times it’s happened, and it’s completely irrational, but I can NOT tolerate it. There’s one brand of plastic wrap which smells the same way, and I can’t eat anything that’s been wrapped in it for any length of time because it acquires the smell.

  44. [...] a satisfying post on WhiteCoat where he rants against patient-reported allergies. A sample: When I ask patients about [...]

  45. [...] a satisfying post on WhiteCoat where he rants against patient-reported allergies. A sample: When I ask patients about [...]

  46. Marry says:

    I know I am late but I had to comment. I come at this from the other side. I am one of those people allergic to “all antibiotics”. Well in actuality I am allergic to penicillin and all derivatives, doxycycline and all derivatives, erythromycin, clyndamycin, sulfonamides, Ceclor, and Levaquin. Most of these reactions involved trouble breathing although amoxicillin caused my skin to slough off. I now have severe reactions to new antibiotics on the first dose even when there is supposedly no cross reaction. All challenges have failed.

    I carry around a note from my allergist (head of the department at a well known hospital) stating my allergies. I still get told on a regular basis that my allergies are impossible. I now tell the ER they must call my allergist if they want to give me antibiotics as no one will believe me. The fifth time I get asked, “So (insert antibiotic here) causes nausea and diarrhea right?” I feel like screaming.

  47. ****** says:

    I remember my mother telling me I was allergic to sulfa. If I take it I’m totally wacked out….
    I start talking to people that are not really there……
    I have also developed a allergic reaction to those hard round peppermint candies…I used to eat them 20-30 times a day and now when I eat one I get an abdomin ache (all most feeling like I’m going to explode) and REALLY bad direah….

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