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 later👍

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109

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.

124

u/USCDiver5152 ED Attending Feb 02 '25

It’s the fact that the EMR doesn’t distinguish allergy from intolerance/side effects.

39

u/hybrogenperoxide Feb 02 '25

Ding ding ding. My chart has compazine listed as an allergy- I’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 clinic🫠.

18

u/als_pals Feb 02 '25

Oh god akathisia is the worst thing I’ve ever experienced. NEVER AGAIN

20

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 😭

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 that’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