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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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.

447

u/TheOtherPhilFry Feb 02 '25

Nobody is allergic to lightning.

196

u/heytheremoustache ED Attending Feb 02 '25

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

109

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.

17

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.

41

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.

7

u/Heavy-Waltz-6939 Feb 02 '25

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