Allergic to Everything
For some reason, patients with numerous allergies to medications seem to be predominantly female. Are women really more likely to have allergic reactions to medications than men, or are they simply more likely to receive a greater variety of medications over time and thus discover that they are allergic to them? Or are women just more likely to complain about subtle adverse reactions than men? Is guano somehow involved?
I've seen plenty of elderly ladies with bewilderingly comprehensive allergy lists, but I always give them the benefit of the doubt. They have lived for all these decades despite their limitations, so they must be doing something right. Anyway, these matriarchs usually have one or two different antibiotic classes they are willing to accept, so I'm happy (relieved, honestly) to throw some Keflex and a prayer at their UTI and bid them farewell.
But what of the 20 year old who claims to be allergic to "every antibiotic known to man?" And who can actually recite many of these drugs from memory, despite the fact that she seems totally healthy and takes no medications? What if she someday develops pyelonephritis, pneumonia, or PID? I guess we'll cross that bridge when we get there. For the nonspecific febrile illness, all I can offer is Motrin and a pat on the back.
And a good luck wish to the next doc who sees her.
I've seen plenty of elderly ladies with bewilderingly comprehensive allergy lists, but I always give them the benefit of the doubt. They have lived for all these decades despite their limitations, so they must be doing something right. Anyway, these matriarchs usually have one or two different antibiotic classes they are willing to accept, so I'm happy (relieved, honestly) to throw some Keflex and a prayer at their UTI and bid them farewell.
But what of the 20 year old who claims to be allergic to "every antibiotic known to man?" And who can actually recite many of these drugs from memory, despite the fact that she seems totally healthy and takes no medications? What if she someday develops pyelonephritis, pneumonia, or PID? I guess we'll cross that bridge when we get there. For the nonspecific febrile illness, all I can offer is Motrin and a pat on the back.
And a good luck wish to the next doc who sees her.
Labels: dodged bullet, full moon
posted by scalpel at 8:03 AM
27 Comments:
Its a psych problem, the patient takes pride in being allergic. Wants to feel different or special is my guess. Request an official allergy skin scratch test?
It's a memory thing. My husband can barely remember that he has a very serious allergy to shrimp. OK, that's probably wishful thinking on his part.
I am alwyas amused when people who look seemingly normal list "haldol" as an allergy.
And you know this how??
RE:anonymous and Haldol
I am always amused by people who claim of brain chemical imbalances, when there is no lab test for them.
There's always the people who are allergic to Benadryl cause it makes them tired, epi cause it gives them tachycardia, or versed cause it makes them "whoozy."
I sometimes tell people I'm allergic to NSAIDs. I'm not. I'm highly intolerant to them and have vomited intensely anytime I've ever tried anything past 1 ibuprofen, but there's no histamine involved.
Ha, ha, I'm allergic to Motrin.
The itching, swelling and wheezing are just imaginary, though, because I'm a girl.
I have a friend who has had several episodes of scarlet fever.
During the first episode she was taking an OTC cold remedy and attributed the rash to it and thought she was allergic. During another episode she went to her internist who gave her Augmentin. Yep, got a rash, thought to be allergic. Rx'd another abx - Biaxin, rash continued.
So she now feels that she is allergic to Dimetapp, Augmentin (and thus all penicillins), Biaxin (and perhaps all macrolides).
Even after determining that the rash was from scarlet fever, she refuses to try to take any of the abx again.
I guess some firmly held beliefs can have a partial basis in reality.
CardioNP
This comment has been removed by a blog administrator.
Let's stay on topic.
And please don't post huge articles from a month ago in their entirety.
I've had normal people with an array of allergies...pain meds, antibiotics, anesthetics and it turns out they were allergic to "something" during a surgery, so they were told to list everything hanging at the time or that had been recently administered as an "allergy".
The young females with multiple allergies seem to be those with psychiatric-tinged "chronic" "illnesses", so I think Mark's 1st comment is likely a big part of it. There are definitely people who enjoy being a patient and who enjoy listing all their allergies, which further prove how sick they are....
I think the female aspect of it seems to be true for me, and I would suspect it has to do more with passive manipulation vs. active manipulation. I would guess that the sick female patient likes it when the doctor asks her which meds works for her or which antibiotics she can take so she can control or influence the MD's decisions rather than him just telling her what to take, if that makes any sense.
IME, men are more likely to tell you what is wrong with them and what they need from the MD.
*Sorry, veered from the topic.
Maybe women report more allergies because women are more likely to seek medical treatment overall, and therefore experience more medical intervention, etc...
As for the 20 year old---probably learned behavior from a parent. It got attention in the past, keep the thrill going.
Also, read this. This American Academy of Family Physicians author considers multiple drug allergies to be a "fashionable" variant of "somatic preoccupation".
Ever hear of a specialty called "Allergy- Immunology"? This is what we do for a living. While multiple drug allergies are relatively rare, a physician or any health care practitioner can not just dismiss them offhand, since as you know, this may have serious medical and medico-legal consequences.
I replied to a similar question on my blog: (http://allergyasthma.wordpress.com/2007/02/24/welcome-to-the-red-carpet-pediatric-grand-rounds-123/)
and am reposting my answer, hope it's helpful to you:
The approach I would recommend, which I suggest to anyone who is told by a patient that he/ she is “allergic” to something is:
1. Inquire what kind of reaction the patient had to the drug, how soon after exposure it happened, and how long ago it occurred.
2. If the reaction was itching, hives, rash, wheezing, swelling, throat closing, abdominal sx, or dizziness/ hypotension within 30 minutes to a few hours after exposure, then it is possible that the patient may have had an allergic reaction and I would not give him/ her that medication until further evaluation by an allergist.
Other delayed type hypersensitivity reactions such as serum sickness with hives and joint swelling, and cutaneous rashes can occur several days after exposure, but these are not life-threatening.
3. If the reaction is not as described above, or occurs a few days after exposure, it is most likely not an allergic reaction.
4. I would document the patient’s history of allergy, describe the reaction, and the physician’s evaluation of the complaint, regarding whether it is most likely a side effect/ adverse effect of the drug or a true allergy.
I agree that self report of allergy should be documented as this makes for a more complete history. However, it is up to the physician to assess whether the report is a “true” allergy or a side effect, and whether it requires further evaluation. The patient’s self report should be addressed, but it is the physician’s assessment which should be the basis of further treatment, if needed.
Thank-you Dr. De Asis. I have handed my test results to physicians from a well-respected allergist and gotten guff for it. Granted, people like me are rare - but guess what, if you press us, we actually know the difference between a chemical drug reaction and a histamine reaction because we have been forced into knowing it.
Trust me, I hate being allergic to half the world. It complicates everything. Please do not say it is psychosomatic if you have allergy test results from the patient in hand - or a person is wearing a medic alert. It is disingenuous and can lead to death.
You want to know what someone is like if presented with a real, dangerous allergen of theirs? You will see panic from remembering that reaction. From being helpless to help themselves and you will find yourself with a patient being non-compliant if you insist on prescribing something that the patient knows causes a reaction.
Benadryl is an OTC sleeping pill - even allergists tell you that :-). And, well epi is supposed to cause your heart to race - you know, that adrenalin thing. Sounds to me like a little education needs to happen in that patient population. And, please, do not claim to have an allergy when you don't. I understand the temptation, but you are endangering the lives of people who have allergies when you do that by desensitizing physicians to hearing the words, "I'm allergic."
Truthfully, women do have a higher incidence of all immune diseases from what I have read - and a much lower rate of proper treatment. It does not speak well of any physician to automatically assume a psych problem because it is a woman who is presenting. I know I suffered through a horribly sickly adolescence because no one thought my complaints were real. It wasn't until I got to 18 and insisted on getting a referral that I found out what it was like to be "normal." In other words, not to be constantly sick or in pain.
Oh, yeah, ingestible alcohol makes my head hurt and gives me dry heaves as I slowly pass out from ingesting just 0.001% of it. No allergy or chemical sensitivity there. That doesn't even get into the fillers in medicine when we try and say "I'm allergic to corn." which is in everything, it seems ... but I digress.
I know real multiple allergy is rare, but please, don't dismiss the patient presenting the information because she is a woman.
Pax,
MLO
I didn't invent the concept.
Didn't say you do, Scalpel. It is an unfortunate human trait that seems to get emphasized in medical treatment. Even women have been known to take female patients' concerns with less seriousness than they do their male patients.
Pax,
MLO
In the early 1990s I used to get hives after I'd been to the dentist, particularly when they did something with the rubber dam.
So I told the dentist I thought maybe the rubber dam was a problem. Oh no, they couldn't imagine anything they were doing was causing that -- maybe it was my makeup. I started asking them to wash their rubber gloves off at cleanings since that seemed to make things better.
The next year I go back to the dentist and everything is vinyl. I asked about it, oh, the dentist found out he was allergic to latex so we had to switch
When it was me who was itchy it wasn't anything they were doing or using -- when it was him with problems it was a different story!
qA corn allergy can cause you to be allergic to Benadryl, since every formulation of it contains corn.
Having a true allergy sucks, and those of us with a true allergy to corn must tell our ER docs what meds we should not take, because we don't expect anyone with out this allergy to be up on what ingredients contain corn. We wish we didn't have to know all this, but being a pain to a doc is better than having your throat swell shut.
I hate to go to the ER after I've used the epi-pen for a reaction, because allergies are often met with the 'it's a psych problem' attitude.
I am aware that 'food allergies' are a fashionable thing to self-diagnose. I would advise erring on the side of caution with your patients who report an allergy, since those of us who have them can be harmed by a doc who decides not to take us seriously.
Well after reading your post I don't know what to think about my predicament, maybe I am crazy enough to have brought it on myself, who knows. Before this year, I have had absolutely no drug allergies whatsoever, and I have taken a wide variety of antibiotics throughout my 21 years. However, in July, I took Levaquin for a sinus infection and got this nasty, red, blistering rash all over my lower chest, upper chest, neck, and sides that didn't clear up. Benedryl didn't help the rash, nor did Cortisone 10, which baffled me because that stuff makes anything stop itching. The doctor switched my medication to Amoxil,and the rash came back even stronger. They had me stop the Amoxil, and after 3 weeks of fighting this blasted rash, it finally went away. 1 month later I go to the oral surgeon to have my wisdom teeth out. He doesn't give me any "precautionary" medications, and I swell up pretty badly by the 3rd day with a hard lump in my "buckle cavity" as he called it, and he gave me Amoxicillin and a Medrol pack. I told him about my prior experience and he wrote me off as crazy. So, I take the Amoxicillin and my lump gets bigger. After day 2 of Amoxicillin, he keeps me on the oral steroids but changes the antiobiotic to Clindamycin. I was prescribed to take that for 10 days, and at first had no problems with it. However, as soon as that Medrol pack was completed, not 1 day after the same area - chest, upper torso, neck - blisters and turns red, itches like crazy. Despite it not working before, I take two Benedryl and lay down at first signs of it. Within 24 hours the redness went away and the entire area peeled. I would absolutely love it if you could tell me what in the world is my body doing to me. I have never had any experiences like this prior to this year, and I have no desire to be unique - I'd really like to go back to having 0 allergies and not look like a complete freak when I go to university.
I'm one of those women who is allergic to "every antibiotic known to man" (well, penicillins, bactrim, sulfas, erythromycin, and tetrocyclene). I've had nasty swellups, huge hives and respiratory distress from these drugs, so it's not just my imagination. Otherwise, I'm healthy and only take birth control on a regular basis, and have no other drug reactions (except that vicoden makes me pukey)
The reason that I know that I'm allergic to many of these was because they were prescribed in turn by a (very frustrated) dermatologist and I had recurring UTIs as a kid.
Now, I don't take any antibiotics unless I'm dying or have a massive open wound because I don't want to decrease the already limited pool of drugs my doctors have to work with.
I never realized how my list of allergies might sound to a doctor or a pharmacist, so I guess I'll need to watch out for that in the future.
But some of us 20-somethings with no other issues aren't all making it up or crazy or anything.
Just for the record, I'm male, and extremely allergic to Benadryl. It's not a psychosomatic thing. Never assume that an allergy is not real. A good dose of Benadryl could probably kill me! I first started experiencing symptoms while talking Unisom to help me sleep. It started out as mild skin itching, and over time progressed into a very severe itching, weeping, chronic skin rash. It turns out that Unisom IS Benadryl, and now I know that Benadryl is the problem. Every time I take ingest anything containing diphenhydramine (Benadryl) now, I develop the most insane itchy skin rash around my nose, mouth, armpits, chest, etc. Any soft parts of my body. It lasts for days, and is absolutely agonizing! For weeks, or even months after an exposure, my skin will be hyper sensitive to a large variety of chemicals, including soaps, lotions, cosmetics, etc. It seems like anything that contacts my skin during a Benadryl reaction, will cause my skin will become very sensitive to it for quite some time.
Benadryl, over the years, has caused me suffering that I can't begin to describe. And I have found myself to be allergic to other OTC antihistamines as well, but to a lesser extent.
I've had people tell me that it's not possible do be allergic to antihistamines, and were it not for my own problem, I would be inclined to believe it. (How can an antihistamine create a histamine response?)
I can understand, though, how Health Professionals might be skeptical, considering all the nut-ball things they have probably heard over the years.
But please don't discount strange complaints about allergies. It really irks me when people think I'm just some nutcake when I tell them about my problem, believing that it's impossible.
In response to the person who posted about Levaquin. I had a very similar experience! After being prescribed Levaquin for an ear infection, I broke out in a horrible itching rash all over my body. Now I have allergic reactions to all sorts of things/medications that never caused problems before. I'm wondering if my immune system was permanently damaged by this incident. Prior to Levaquin, my only allergy was to Triclosan (used in antibacterial soaps). Now, it seems like I'm allergic to practically everything. I loath the day I ever heard about Levaquin!
did you know this page is a googlewhack of - tetrocyclene penicillins - if you type in these 2 word you will only get this page
In response to: "Anonymous said...
did you know this page is a googlewhack of - tetrocyclene penicillins - if you type in these 2 word you will only get this page"
However, if you spell tetracycline correctly and then type tetracycline penicillins, then you get lots of other things too. :o)
I'm allergic to latex so I have to avoid bandaids, ballons, latex gloves,etc. But not highly if I use a bandaid I get a little rash baloons make me sneeze a bit but it's not to bad I'm also allergic to ivory soap it makes me rash and my skin peels when I use it
I am a female who is allergic to all all antibiotics, and all opiates.
It really does happen. Every class of antibiotics now. When I take one I have never taken before, I am fine. Give it to me a second round, and I am allergic to it in a severe way. I have seizures, hives, anaphylactic shock, it goes on.
My doctor explained 15 percent of people with opiate allergies have no opiate receptor. This allergy runs in my family.
There is not one antibiotic I can take on this earth, and is a scary place to be in. I have to rely on natural things. I have severe gallbladder pain rite now due to a stone blocking the duct. They are trying to figure out what to to with me, no pain meds that I can take.
This is not in my head. A nurse at Mayo did not believe me and injected me anyway, and I broke out into hives, and could not breath, and they had to shove a tube down my throat. I now carry a paper in my purse from my allergist to give to any doctor who questions me .
My life is hell with chronic UTI, Kidney stones, torn legrum , slipped disk, and bad hips. I suffer it every day with no medications. If there is anyone in Arizona that can help me, PLEASE post on here. They already tried
to get me to take one antibiotic by admitting me into the hospital and giving short small doses every 10 min. Did now work, I had a bad reaction, and they had to stop.
I have no idea what causes these allergies and would really like to know. It is like my body recognizes the antibiotic as a foreign invader, and attacks it.
I'm sitting here reading how judgemental people can be of the things I actually have no comprehension of. Im a. 46 year old females who suffers from lupus . And it is possible to be allergic to all antibiotics . I have tried over a dozen in the last 15 years. and everytime I am in the hospital for about a 3 day stay after. the last incident was a doctor that did not think it possible and decided to give me a pediatric dose of z pack. so my 4 day st ay was full of benadryl solumedrol iv. no for all you people out there that think this is just a gain sympathy.. some people try to play for attention.. I call. Bull.. not all of us are crazy and need a shrink.
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