Drug Allergies - Why do they ask what type of reaction

[YouKnowWho]

I have allergies to sulpha drugs, ibuprofen, aspirin and probably naproxen sodium.

I had anaphylaxis to aspirin at a very young age to aspirin - vomiting, covered in hives and then eventually difficulty breathing which thankfully happened at the ER after my dad drove me there (prolly a 30 minute drive at best).   Years later, I was told not to take ibuprofen because of the aspirin allergy - Tylenol was my buddy so it didn't matter to me.

I had a dentist who insisted I was crazy and kept prescribing ibuprofen products which the pharmacy would kick back.  Yeah, not fun to make that trip back and forth to his office and have him berate me (he liked to berate me in the chair too - I swear that man was a dentist for the Reich). 

Believe me, I wish I could take ibuprofen because when Tylenol doesn't cut it that means I have to head to a dr and almost all of them think I am drug seeking 

A few years later, I pulled out my back (though looking back it could have been a gall bladder issue because we were moving and eating out a lot) and went to a walk in clinic.  He prescribed two pills - one of which was supposed to be a muscle relaxer combined with a new pharmacy that didn't ask about my drug allergies and I was given 800mg ibuprofen.  Dumb, dumb, DUMB.  I always read inserts, I always research meds.  I took him at face value.  So before I knew it, I was covered in hives and full body swelling that took two shots of steroids and a double run of steroids to clear up.  Even then, I would have residual hives that would pop up on the inside of my hives for two months - scratching your inner thighs while working for a religious institution is just wrong on so many fronts.

Years later when I was in-patient, I got the crud that was going around - I had a sinus infection, tonsilitis and laryngitis.  The NP prescribed a sulfa based drug because she insisted I needed something stronger even though I insisted the few times that I had this before that the z-pack took care of it (I am usually one who waits it out and had only taken antibiotics a handful of times in my 20's).  The result was head to toe hives.

But my question is this - why does every doctor that I see insist on knowing what the results of taking each of these meds.  I tell you that I am allergic and yes, I understand why you may think I am drug seeking but it ticks me off.  It's as if they want me to prove it to them.  I am not even looking for a stronger med like Oxycontin or such - just something that has a shade higher med than straight Tylenol before I destroy what is left of my liver.  My OB did explain when I was in the hospital with my gall bladder issue that if it came down to it, they may have to risk me having a reaction and dose with drugs to counteract a reaction to keep me on meds that were safer for the baby.  As a result, I put up with a whole lot more pain than I probably should have. 

Maybe I should share my story of a few years ago when I kept getting hives on my inner thighs and was struggling with a yeast infection that wouldn't go away.  Granted I am known for random hives and my inner thighs seem to be a trigger area.  Turns out DH was taking ibuprofen for another issue.  Dawned on me after a rather personal moment.  Now he asks if he is going to get lucky before he takes meds LOL

[rebekahc]

Part of it may be the drug seekers, but I think it's also because so many people say they're allergic to a drug who aren't.  If they ask what your reaction is they can tell if you're really allergic or just think you are - like if your "reaction" was really just a side effect.  I'm allergic to penicillin and they always ask me, too.  Pretty sure most drug seekers aren't looking for a z-pack LOL!

FWIW, DH is anaphylactic to both aspirin and ibuprofen and has no trouble with naproxen sodium - I think they lump all NSAIDS in the same category both in terms of mechanism and allergy, but I've heard of many aspirin/ibuprofen allergic people who tolerate naproxen.    It might be worth challenging it in your docs office to see.

DS has had anaphylaxis to ibuprofen (we've never attempted aspirin) and had facial swelling and hives from Tylenol.  When he had surgery at age 5 he had to recover without pain meds  because there wasn't anything they could give him - all the pediatric narcotic pain meds are mixed with either ibuprofen or acetaminophen.  The surgeon could have written a prescription for straight narcotics but he was concerned about dosing in such a tiny guy and didn't have the "triplicate" prescription forms he needed for a controlled substance.  He opted to send us home with phenergan to let him "sleep through the pain."  Luckily DS has a high pain tolerance.  I'm so glad now that he's old enough for the naproxen if he needs it. 

[CMdeux]

Yes, I think that the reason that they all ask is that there are different types of "reaction" to substances.

Like the difference between being celiac/lactose intolerant versus being IgE/anaphylactic to foods.

It isn't that bad individual metabolic quirks don't exist, or even that medications should be prescribed which cause them.

For example, I'm not technically "allergic" to any drugs-- at least not that I know of anyway...

but I very definitely DO NOT metabolize narcotics or pain medications normally.  As example A, there, let's refer to yesterday's dental anesthetic, which didn't get me anything close to COMPLETELY numb to pain... but lasted for a full eight hours anyway.  Most pain meds operating through the opiod recepter class-- in me personally, that is-- do not ever achieve "full" blockade, nor do I have normal 'clearance' times for them, and they often make me barf or hallucinate on top of that...    Not normal, I know.

I very definitely cannot take codeine or anything with codeine in it the way other people can for a migraine or for a cough... and this seems at least in part to be genetic.  A number of people in both sides of my family (mostly women) have had this problem with this class of drugs, but most to a lesser extent.

But that does NOT mean that I'm technically allergic to it in the way that I'm allergic to shellfish, wasp stings, latex, etc.  In technical terms, someone like YKW has a "drug allergy" and someone like me has an "idiosyncratic response" to the drug.

  In fact, I seem to be one of the relatively rare people who are both genuinely prone to mounting immediate-type hypersensitivity reactions (the kind which produce anaphylaxis) and to delayed hypersensitivity reactions (metal allergies, topical reactivity).  Apparently the two things are not synonymous and most people are firmly in one camp or the other.

So yes, physicians ask because someone like ME could be given a single dose of opiods (though probably not dosed continuously for fear of O.D.); but it limits HOW the drug can be used.

I often say "allergic" because I know that it means they will: a) ask for details, and/or b) avoid prescribing.   

[krasota]

Some people say "allergic" when they just feel icky on the med.  I'm *always* asked to clarify my reaction to diphenhydramine because they think I just don't want to be drowsy.  No, I dislike uncontrollable vomiting and really hate struggling to breathe as my airway closes.  And yes, there's quite a bit of irony there with a benadryl allergy, but it is what it is.

And I'm not allergic to some antibiotics, but they make me feel like hell.  Someone else might say they're allergic, but in reality that med might be worth feeling like crap in order to treat an infection. 

Disodium edetate (and its relatives) will make me break out in hives (worse reactions if it's in food), it's important that I not be given IV clindamycin.  I'm not allergic to the drug, but I'll react severely to the additive found in the IV form.  I make this clear and will argue if a doctor tries to write down "allergic to clindamycin", because I can take the capsule/tablet form just fine.

I think that most people aren't really up on what's an allergy, what's a normal side effect, and what's an intolerance. Medical professionals have to take that into consideration.   Ibuprofen makes me hallucinate, which is utterly bizarre and makes no sense whatsoever on any level.  I state that when asked about drug allergies and that it's not an allergy, per se, but it's also not something I can safely take.

I get the most questions about the latex allergy.  Is it REALLY that weird for medical professionals?  I STILL encounter offices where there are no non-latex gloves or safe blood pressure cuffs.

[CMdeux]

Well, krasota, even THAT one is not that odd.  That they ask, I mean-- not that they don't have non-latex gloves.  That part IS weird.  What is this, a local barber/surgeon's office??   

There are many, many people with occupational exposure that have a delayed type hypersensitivity to latex-- that is, they are "allergic" in that it is an immune-modulated response, but it isn't IgE modulated.  They basically can't wear latex gloves or they'll get a WHOPPING poison ivy-like rash that can even spread to non-contact sites.  But they don't have difficulty breathing, etc.

Most people in that camp, as I noted above, tend to be "non-anaphylaxers."  There are a few odd ducks like myself that started out that way, but eventually developed an IgE response to go along with the delayed one.  Bonus.   

[YouKnowWho]

See I understand the allergic/intolerant issue.

Dh thought the office chair was going to eat him and was pretty convinced he fell into the potty and was flushed on codeine.  Trippy reactions are not fun and generally make him feel much more miserable than the pain/cough he had to begin with.

DS2 vomits on codeine and DS1 gets migraines.  To me, those are more general side effects.  And I never say allergy to them, just that they have odd reactions to them that are not necessarily allergic in nature and list the reactions. 

DS2 has odd reactions to a lot of meds - like the .0001% of the reported reactions.  He is violent on Zyrtec, violent and crazy, eats until he vomits and begs for more food after on prednisolone (like the usual side effects multiplied by about 1000%) and Sudafed was a disaster years ago.  I think it was part of the reason his body went haywire when vax'ing - we have a strong family history of strong reactions and allergies to so many meds.

I think doctor's question my reactions to Sulpha (which my dad is ana to) and ibuprofen in such a way that I fear they will prescribe them.  I try to only see my physician when I need pain meds because she gets that I am not drug seeking.  When I mention my allergies to pain meds you can see the hint of an eyeroll with other doctors and then more often than not, questions about drug abuse.  Really?  Not fun when you spend time on and off in a hospital during pregnancy and post. 

[YouKnowWho]

Come to think of it, I am not exactly free of the list of odd issues with drugs in my family.

Benadryl and many anti-nausea meds give me the feeling and need to constantly urinate - odd side effect but it is listed way down under the freak category.  I have wet myself thinking I could not possibly have to go again - apparently I could 

Was on one anti-depressant to cause my eyesight to fail, apparently one of the much lesser known side-effects that my opthmalogist figured out as opposed to the pyschiatrist who gave me an anti-pyschotic when I mentioned that one.  The antipyschotic was possibly giving me muscle tremors (another great side effect that meant you were supposed to discontinue med because they could become permanent) - his answer was to add a downer. 

NQ: I swear that man just wanted me to kill myself and stop bothering him (despite having strong suicidal urges and a plan he told me to go home and think about it, refused to give his approval to checking into the pyschiatric center, sigh).

[krasota]

The high risk pregnancy office (which is also the ultrasound lab for this area) is the most recent place to not have latex-free options.  They did have gloves, but they had to search for them. 

And yeah, I know that Type IV reactions are more common in the medical field.  But I always remember this and I state up front that I have anaphylactic reactions to natural rubber latex, so I think that they can surmise that it's not Type IV.  I actually react both ways (Type I and Type IV), but type IV is just an afterthought given the immediate situation with the other.

Don't even get me started on labs which store the latex-free tourniquets in a baggie/drawer with the latex ones.

[AllergyMum]

We have never had anyone question my son's drug allergies.  And I always make them check for dairy or egg as an ingredient in any drug that they do prescribe him

[momma2boys]

I work in a pharmacy.  When we ask this question, I would say based on the response, about 90% of them are NOT allergic.    A good chunk of them say they are allergic to every single generic drug because they only want brand names.

[aggiedog]

I work in a pharmacy.  When we ask this question, I would say based on the response, about 90% of them are NOT allergic.    A good chunk of them say they are allergic to every single generic drug because they only want brand names.

ditto for my practice.  Dh for years said he was allergic to erythromycin.  I finally asked him what happens.  "I get a stomach ache."  Well, duh, that is a common side effect, NOT an allergy.

A not small number of patients will say they are allergic to "eye drops" in an effort to not be dilated.

[Janelle205]

I have a few drug allergies and a few intolerances.  Whenever I've gone to the doctor, I always write down my intolerances (doxycycline and zithromax) in the allergy section, but specify that they are GI intolerances.  My doctor has chosen just to keep them in the allergies list, since they are bad enough that I pretty much refuse to take either of them - the one time I took doxycycline, a months worth for lyme disease, I threw up almost every time that I took it.  Zithromax will have me living on the toilet.  Since I tolerate other antibiotics, it just isn't worth it.

My actual drug allergies are toradol, and likely mepivicaine.  I don't know what it is with dentists, YKW, but but I've had a few argue with me over the mepivicaine allergy as well.  I really don't care what they think - after explaining my reaction to three different allergists, none of them were comfortable with even testing me more mepivicaine.  We just did tests for other drugs in the same family so I can keep a list of safe options.  I know that lidocaine is a little bit more complicated for the dentist, but it does not run the risk of killing me.

[GingerPye]

My son is def allergic to the eye drops used at his eye exam some years ago.  Two days worth of eye swelling/redness/itchiness.  The eye dr insisted it was not the eye drops and it could not have been an allergic reaction. 

I changed to a different eye dr.  NOT dealing with someone like that who thinks he knows it all.  My son DEF had a reaction, and who better to recognize a reaction than a mom/parent who has two very allergic children??  Why dispute that?   

New dr does not use eye drops.  I've told him not to; not going through that again.

[Mookie86]

I asked the doctor this exact question.  They said that some people consider an upset stomach to be an allergic reaction to the medication, so medical staff is trying to weed out unnecessarily ruling out classes of medication.  Every time I say that I've gotten hives from penicillin and sulfa medicines, they nod and write me down as allergic to them.

[aggiedog]

GP, it's definitly possible to be allergic to a component of one of the many drops we use.  It's just not likely to be allergic to all eye drops, like some folks claim.

I do have patients allergic to some of the drops I use.  We work around it.