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👍

499 Upvotes

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554

u/tturedditor Feb 02 '25

Once had a lady in afib with RVR reported allergies to every rate control medication in our armamentarium. I told her to her face I didn't believe her and we were going to push diltiazem.

She of course did not have a reaction.

446

u/TheOtherPhilFry Feb 02 '25

Nobody is allergic to lightning.

71

u/Vprbite Paramedic Feb 02 '25

I'm a paramedic, and I'm stealing this. Thank you

24

u/TheOtherPhilFry Feb 02 '25

When I cardiovert my instruction to nursing is "bring the heat."

3

u/crash_over-ride Paramedic Feb 03 '25

I prefer "ride the lightning"

68

u/cookiecutie707 Feb 02 '25

EMS chiming in, on a very real PCR it once said: allergic to: XYZ county bedsheets/stretcher sheets 🤣

39

u/ButterscotchFit8175 Feb 02 '25

Could be allergic to the detergent that county uses.

20

u/cant_helium Feb 02 '25

You know you’re a frequent flyer when…..

1

u/roccmyworld Pharmacist Feb 04 '25

They all use hypoallergenic scent free stuff.

1

u/ButterscotchFit8175 Feb 05 '25

Well, that's all I had! 😃

5

u/Vprbite Paramedic Feb 02 '25

Good lord

194

u/heytheremoustache ED Attending Feb 02 '25

Seen that as a listed allergy. Along with "fresh fruits & veggies" in a 250 kg man.

110

u/Heavy-Waltz-6939 Feb 02 '25

Ok so I never believed this either until a coworker told me it was only fresh fruits and vegetables. If they had cooked either, they were totally ok. Apparently it was a protein that was denatured during cooking. She also proved it to me over the course of a few weeks by eating small bits of fruit and I watched a rash develop in real time. I used to think it was the same BS but there may be some truth to that one in some patients.

16

u/bamshabam0 Feb 02 '25

Yup! Officially called a Birch Allergy- being around a protein released by birch trees causes the patient to be sensitized to proteins in several fruits, vegetables, and nuts. Anything that denatures the protein (cooking, canning, ect) fixes the problem.

10

u/centz005 ED Attending Feb 03 '25

Didn't know. I'm allergic to fresh apples and pears, but if it's cooked I'm fine. Sometimes get an itchy throat with bananas or lychee, but otherwise I'm good with fresh fruit/veggies.

I still always feel like an ass when I bring that up at restaurants, though.

40

u/dbbo ED Attending Feb 02 '25

I don't think anyone doubts the potential for food protein induced allergy. The problem is the allergy section of the patient chart is intended for severe adverse reactions that might alter care decisions.

In reality, when people list every single thing that ever gave them a rash or an upset tummy, it just creates more warning boxes for me to click through before I can treat them.

8

u/Heavy-Waltz-6939 Feb 02 '25

Of course, agree with that, especially when they list side effects to medications that are commonly known

44

u/padurham Feb 02 '25

Unless it’s fried in bacon fat, my mouth breaks out in this terrible taste. It’s an affliction.

2

u/cant_helium Feb 02 '25

That took me entirely too long to get 😂🤦‍♀️ Which makes it the best comment

26

u/catilineluu Feb 02 '25

Oral allergy syndrome is a thing! So it’s possible

2

u/Different-Counter658 Feb 02 '25

I have oral allergy syndrome! Also really bad hay fever and dust allergies, so I’m sure it’s related. But honestly there’s certain fruits/veggies I’ll eat raw anyways because I like them 😭

0

u/2ears_1_mouth Resident Feb 02 '25

PKU?

53

u/InadmissibleHug RN Feb 02 '25

Give em the ol’ Pikachu

9

u/Simple_Log201 Nurse Practitioner Feb 02 '25

😂

7

u/drinkwithme07 Feb 02 '25

Edison medicine is always a correct answer.

2

u/BlackEagle0013 Feb 03 '25

God. I did love that Tesla song growing up.

9

u/halp-im-lost ED Attending Feb 02 '25

lol that was my thought. Low threshold to shock