When Is A Drug Allergy Not A Drug Allergy?

So what do you do when a person has a “10 out of 10″ migraine and hands you this list?

We all know about patients who exhibit drug seeking behavior. One Seattle Times article showed that in 2003, some patients racked up substantial Medicaid bills for chronic pain complaints. Most patients visited multiple EDs (one patient hit 59 different hospitals in one year) and the costs were well over $20,000 for costs and prescriptions for most of the patients (one patient racked up $175,000 in costs in 2003 by visiting the ED 106 times in 365 days at 28 different hospitals for CHF and chest pain-related complaints). I don’t intend for this to single out Medicaid patients, but unfortunately, the data for Medicaid patients and their care is readily available. I’m sure that there are just as many bad apples in the insured and uninsured patient crowds as well.

Many patients aren’t drug seeking, though. And those patients warn physicians about allergies that aren’t really allergies. Penicillin “allergies” are notorious. When I ask the patient what their allergic reaction is, they tell me “My mom just always told me I was allergic. I must have had a reaction when I was a little kid.” That’s it. So what do you do?

I have to blame some physicians for not explaining to the patients that nausea, flushing, diarrhea, and bad tastes in the mouth are NOT allergies. They are adverse reactions. If you want to get better, sometimes you have to live with the adverse reactions.

The problem with “allergies that aren’t allergies” is that sometimes the “allergies” can prevent you from giving a medication that the patient really needs. What do you do with a patient who has allergies to multiple antibiotics and who comes in with septic shock? If you give the patient something they are “allergic to” and there is a bad outcome, you get sued. If you don’t give them an indicated antibiotic for the type of infection because of an “allergy” and there is a bad outcome, you can get sued, also.

A patient once handed me a list that contained 150 things to which she had allergic reactions, including “anything fermented,” yellow #5, oat smut, Rizopus, cocklebur, and Russian Thistle. Information overload! Danger, Will Robinson! Danger!

I can just see cross examination now: Well, Dr. Whitecoat, while it appears that this patient died from a heart attack, our expert has concluded that the true cause of death was an allergic reaction. Didn’t you think it was necessary to check to see that aspirin you administered was manufactured in a factory that also processes oat smut? How do you win?

The strangest allergy ever told to me was a little old lady who said she had an allergy to “water” — all except city water from the town she lived in and water from a “spring in a little town in northern France.” She brought a gallon jug of water from her home faucet whenever she came to the hospital. She always told everyone that if she drank any other kind of water, she “could die.” She always got IV fluid with no adverse reactions. Maybe the bags were manufactured in France. Always told myself I’d write about her some day.

Well, world, here it is.