Allergy or Side Effect?

This post was originally published HERE on DoomandBloom.net.

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A medical caregiver has many responsibilities in a disaster. Everyone knows that their duty is to deal with injuries and illness, but few are aware of their obligation as medical archivist; that is, they are responsible for knowing the medical history of the people under their care. Part of that medical history includes what medicines to which a patient is allergic.

 

Many people will report that they are allergic to a particular drug. The reasons for this could be:
• It causes symptoms that makes them feel unwell.
• A family member was once diagnosed as being allergic to the drug, and they assume that they might be also.
• Their parents told them about an incident in their childhood that resembled an allergy, so better safe than sorry.
• They read something negative about it online or saw it on TV, and they don’t want to ever take it.
• They are philosophically opposed to a particular type of drug (antibiotics,psychotropics).
• They might actually be allergic to the drug.

 

I place an actual allergy to a drug last on this list as less than 10% of reactions to medications really relate to allergies (World Allergy Organization). Most symptoms that people get after taking medicine are what we call  adverse or “side” effects.

 

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What’s the difference? A drug allergy is a negative response by your immune system after exposure to a medicine. An adverse reaction is a documented negative consequence of its use in a percentage of patients. In an allergic reaction, the immune system recognizes a substance as foreign. This starts a cascade of reactions that is normally protective, but when excessive, may be harmful. If a drug normally causes, say, intestinal spasms in a percentage of cases, then cramps would be a side-effect instead of an allergy.

 

For more information on signs and symptoms of severe allergies, see my recent article:

http://www.doomandbloom.net/anaphylactic-shock-in-austere-settings/

 

Usually, the body will not respond immunologically the first time it’s exposed to a drug. In order to respond “allergically”, the body normally needs to be primed to the allergy-causing substance (also known as an “allergen”). I have heard of people claiming an allergic response the “first” time, but I believe this occurred, if a true allergy, due to an unknown or inadvertent previous exposure.

 

Allergies to many substances, including some drugs, can be determined by skin or blood tests; why, however, is it important to know whether a symptom is related to a side effect or an allergy?
Here’s an example: A man has chest pain and a history of heart disease. You suspect a heart attack, but he says that he is allergic to aspirin, the only medicine you have available. Do you give it?

 

Here’s another: A woman has a severe infection that has proven resistant to many antibiotics, leaving you with one or two options, both of which are listed as allergies in her medical history. What do you do?
Give the medication in the two cases above, and you may save the patient. Unfortunately, you also might kill the patient if they are truly allergic. To claim a side effect as an allergy ties a medical provider’s hands, and can cause a big difference in the final outcome.

 

An additional issue relates to antibiotic resistance. If a person claims an allergy to penicillin-family medications, other antibiotics may be given that are less effective for the particular illness. This may lead to survival of more bacteria that would otherwise have been eliminated. Indeed, the Journal of Allergy and Clinical Immunology reported last year that Penicillin-allergic patients had higher rates of “superbug” infections.

 

If you’re the medical historian for your family or community, have your “allergic” members tested to determine if the immune system is really involved. This will give you an idea of the amount of anti-allergy meds likeEpi-Pen and others to have on hand and give you the most freedom in determining the safest course of action.

 

Joe Alton, MD

 

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4 Comments

  1. Dr. Bones is spot-on with his info. I would just like to add a couple things. On a great day, allergy tests are semi-accurate. It’s sometimes difficult to find fresh/active samples of each allergen and also present it to the person in the same way that causes them to elicit a negative immune respose. Most allergy tests are performed by pricking the skin (just the surface, not to draw blood) with a needle and placing a small amount of freshly-prepared allergen over the damaged skin, and then waiting for the response to occur. A positive response is demonstrated with redness, swelling and slightly raised skin around the site. The problem is that sometimes the test allergen will cause what looks like a positive response and be scored as positive, but actually is just due to irritation of the skin. So, there are typically a lot of false positive “allergic” responses and people would rather be safe then sorry (given the cost of malpractice insurance, I don’t blame the doctors), so you are designated as “allergic” to that particular agent – and even if the doc says it’s not an allergic response, if the patient sees any hint of change in their skin, they will consider themselves allergic.
    With all that said, most of these tests only help determine contact allergies, and most “drug” allergies can only be tested by ingesting and breaking down the actual drug. Unfortunately, there is no safe way to test for this type of allergy, because if the patient is actually allergic to the drug, you could kill them if they ingest it – way too risky. However, there are different levels of allergic responses. Worst case scenario, the patient goes into anaphylaxis (immune system goes completely haywire and basically nukes the allergen, causing self-destruction). Less life-threatening, the patient may just develop “hives” (red swollen circular skin welts that are extremely itchy) and/or swelling of different parts of the body. Sometimes if the facial and throat area swells, this can cause closure of the windpipe, which could lead to asphyxiation and death, if not treated (though this typically takes 30 min to1 hour after ingestion, and can be treated with the right meds).
    So, the brass tacks…You should make sure that you have lots of benadryl (the liquid capsules are faster acting but won’t last over time like the powdered pill form) in your med kit. Quick tip: keep ranitidine on hand as well – administering benadryl with ranitidine (common over-the-counter indigestion drug – check the labels first!) will have a better affect than benadryl alone – good for treating general allergies (I would be happy to explain why). If you can, also keep several Epi-Pens and some steroids, such as prednisone, on hand. If someone shows signs of anaphylaxis: Epi-Pen first, immediately followed with benadryl, ranitidine and steroids (in the correct amounts) – these drugs may save their life. Hope this info helps some.
    MacDaddy – Allergic, Research Immunologist

  2. Good information .. I worked and raised kids in an urban environment .. for some years after leaving the country ..
    I thought I knew everything I was allergic to.. Then I moved back out to country THANK GOD.. way out..
    Low and behold I was not allergic to things I used to be .. or less or differently .. and was WAY allergic to to at least one other..
    The crux being .. along with knees not working, hair dropping off my head and growing in my ears and on my shoulders 🙂 We develop allergies as well.. through exposure.. as implied above.. I suspect part of it is moving 70 miles East and different plants maybe.

    Working with an allergist using a protocol from the Univ Chicago .. we took some shots over a year and de-sensitized the one most worrisome by gradually taking small doses over time.. I have no idea whether similar protocols would work for other allergies. Works for rattle snake venom too.. but i won’t be doing that one.

    Keeping those epi-pens handy though .. Just in case natural selection has other ideas

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