r/emergencymedicine • u/Asleep-Palpitation43 Nurse Practiciner • Feb 02 '25

Advice Allergy Olympics

Is it wrong that if I see a patient has more than 10 allergies I IMMEDIATELY assume she's (bc it's always a she) a psych case?

In 24 years I've never been wrong.

You'll never read this in a textbook but add it to your practice today and thank me lateršŸ‘

495 Upvotes

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108

u/Nurseytypechick RN Feb 02 '25

Coworker joked for every 5 allergies you get a psych dx. I looked over and said "hey!" Real sad like because I have 5 documented allergies and PTSD... lol.

It's not gender exclusive though.

The real question is, is it overinterpretation of allergic symptoms by anxious folks, or is there some correlation between anxiety/mental illness and system hyperreactivity. For the non shitpost aspect.

125

u/USCDiver5152 ED Attending Feb 02 '25

Itā€™s the fact that the EMR doesnā€™t distinguish allergy from intolerance/side effects.

74

u/the_taco_belle Feb 02 '25

Am a paramedic. Woman told me with a straight face she didnā€™t give her husband his EpiPen because heā€™s allergic to the epi. When asked what the reaction was: ā€œit makes him dizzy and feel like his heart is racing!ā€

Right. I bet heā€™d prefer that over death.

8

u/harveyjarvis69 RN Feb 02 '25

I had that listed as an allergy and it made my jaw dropā€¦epi makes your heart race??? THAT IS THE POINT

3

u/dhwrockclimber EMT Feb 02 '25

Yeah and lasix makes him pee!

68

u/MarfanoidDroid ED Attending Feb 02 '25

Allergy: metoprolol

Reaction: bradycardia

30

u/axp95 Feb 02 '25

Allergy: codeine

Rxn: ā€œmakes him highā€

Literally in the emr lol

2

u/melatonia Feb 02 '25

Sometimes recovered addicts will list opioids as an allergy.

1

u/axp95 Feb 02 '25

That was the only allergy listed lol

8

u/broadcity90210 Feb 02 '25

My personal favorite.

Allergy: Black Pepper

Reaction: ā€œSneezingā€

21

u/purebreadbagel RN Feb 02 '25

They really do need to fix that. I will list whatever the hell someone wants and thinks will make them feel better under ā€œintolerance/side effectā€ if they fix it so it doesnā€™t clog up the allergy list.

Sure, penicillin makes you nauseous, gotcha but I really do need to know if you have an anaphylactic reaction to wheat or something and it tends to get lost among 30 listed side effects.

39

u/hybrogenperoxide Feb 02 '25

Ding ding ding. My chart has compazine listed as an allergy- Iā€™m not allergic, just really, really hate akathisia as a side effect. It also has dissolvable sutures listed, which I am actually allergic to and nobody takes seriously, so my dehisced umbilical incision required a month of 2x weekly wound clinicšŸ« .

18

u/als_pals Feb 02 '25

Oh god akathisia is the worst thing Iā€™ve ever experienced. NEVER AGAIN

21

u/hybrogenperoxide Feb 02 '25

I got compazine twice (both times for intractable migraines) before I figured out the issue. The second time, I requested no benadryl because it makes me feel bad. Oh my god was it so much worse without the benadryl. The best way to describe it is that my soul, the core of my being, was restless fucking leg syndrome. I remember just laying there thinking that I could handle it because it was going to have to end at some point and I just needed to wait it out.

13

u/als_pals Feb 02 '25

Same!! I had gotten it many times without issue so it took me a few times to figure out what was going on. I felt the absolute NEED to rip out my iv and run out of the er! Trying to just focus on my breathing was agonizing

6

u/cleopatra_andromeda ED Tech Feb 02 '25

yes! that's the exact feeling i get! needing to rip my iv out and run out, even if i'm too sick to do just about anything. it's the worst feeling ever, and almost all of the antiemetics cause it šŸ˜­

1

u/Flautist1302 Feb 03 '25

Oooh I had the restlessness and agitation from Gabapentin, and it was awful. I felt like a fruitloop describing it to my doctor. "I just felt really restless and trapped, and like I wanted to rip my chest open to break out" !

I also experienced it when a med interaction caused withdrawal symptoms. Had I been in my own house, I would've been on my bike to try to relieve it (before I realised the problem). But I was staying with others and didn't want to disturb them. I was pacing the room, but was struggling to stay upright. And then I was getting muscle spasms and cramps too. And then because I was so tired (no weird crap could just happen at 10am, if it could happen at midnight instead, right?!) every time my muscles would jerk, I'd then kinda kick out (not at anybody, just at the mattress, or space around me), in frustration. I was trying to calm down, and settle, and I'd get a few moments of relief, and have my breathing calm, before twitching and jerking and spasming again!

And within 15 minutes, I went from having no issue with the BP cuff, to it being excruciating, and triggering the cramps more!

1

u/Wild_Possibility2620 Feb 03 '25

This is the worst feeling ever! It's my whole body feeling like restless legs on steroids

1

u/hybrogenperoxide Feb 03 '25

Yes thatā€™s how I always describe it! I just remember being SO drowsy from the phenergan, but also like my whole body was a live wire. I felt like every inch of me needed to move, but I was so tired and loopy I kept trying to talk myself through it like this has to end, I just need to calm down. Awful stuff

25

u/Nurseytypechick RN Feb 02 '25

You can flag allergy/intolerance/contraindication and severity in Epic, but yeah, they all lump under allergy heading.

12

u/Jolly_North4121 Feb 02 '25

My favorite allergy in epic was metoprolol with the listed reaction as ā€œerectile dysfunctionā€. Apparently people donā€™t know the difference between allergy and side effect lol

21

u/Glowing_up Feb 02 '25

I have ptsd and would get itchy mouth/tongue for years eating things I'd eaten 100x. Now I'm doing much better I don't get these allergy responses. I do wonder if theres something to that. I also got that fruit/pollen crossover allergy thing, which is now also totally gone.

30

u/Nurseytypechick RN Feb 02 '25

Oral pollen syndrome is real interesting. I have that with honeydew melon in particular. I also can't do banana or kiwi with the latex allergy.

I do wonder if histamine response in someone whose nervous system is ramped up in fight/flight trigger is a part of it. I haven't done any actual digging, it just intrigues me as a possible component.

10

u/Footdust Feb 02 '25

I never made the connection until I read this, but my itchy mouth from eating certain foods and my random hives have disappeared since I left my jerk ex-husband and went through intense therapy for a variety of issues including PTSD. This is very interesting. You may be on to something. Also for some reason I feel like I should say I have no drug allergies, lol.

2

u/softwhisperz Feb 07 '25

I got an itchy mouth, and hives (both in my mouth and on my body) regularly and really badly while I was growing up with abusive parents. Havenā€™t had it much in my adult years. I think you guys are on to somethingā€¦

36

u/descendingdaphne RN Feb 02 '25

I have never seen a male patient with 10+ allergies, unless it was a special needs/total care patientā€¦under the care of his mother.

Iā€™m sure exceptions exist, but the rule prevails.

28

u/Nurseytypechick RN Feb 02 '25

I have. Multiple times. šŸ¤·ā€ā™€ļø

1

u/babypinkhowell Feb 04 '25

Iā€™ve only ever listed things as allergies because they gave me side effects that made me unable to function. I also have Lamictal, trileptal, and that whole family of anti-epileptics as an allergy because they give me drug induced lupus. Itā€™s happened twice, second time was because I saw a psych who didnā€™t listen to/believe me. Every time Iā€™m on one of those meds my immune system freaks the fuck out. Had an anaphylactic reaction to god knows what, we still havenā€™t figured it out. Drug induced lupus pretty much makes me allergic to living LMAO