What Constitutes an Actual Allergic Reaction?

Patient receiving allergy, vacation vaccination.
Getty Images/ Peter Dazeley

One of the first things we do, in same day surgery, or anytime someone is admitted to the hospital, is to get a list of any medication allergies they might have. We also ask, and I'll soon explain why and what particular reaction they had to that medication. Every time I work, there are many patients who report they are allergic to Lortab or some other narcotic because they experienced severe (full body) itching.

This can be confusing since most allergies are itchy but in truth, a side effect of all narcotics is itching over the entire body and almost all people who take narcotics eventually experience this. Therefore, it is necessary for us to explain to the patient that they are not, in fact, allergic to Lortab. Likewise, many people list codeine as an allergy because they have experienced severe nausea and vomiting, this again is a common side effect of codeine and while uncomfortable does not count as an actual allergic reaction. Many people report that they are allergic to certain antibiotics because they experienced horrible stomach pain, again, a side effect.

If you've experienced severe side effects to a medication we will write it in your chart to avoid these medications being prescribed to you (we don't want you to be uncomfortable either), but it is important for us to know that we are dealing with a side effect and not a life-threatening allergic reaction.

If you're confused, keep reading as I explain just what constitutes an actual allergic reaction.

A true allergic reaction begins with the release of histamine, histamine causes severe itching, redness, swelling and may result in hives or a bumpy rash. This is an important distinction if someone experiences itching and nothing else after taking a narcotic it is a side effect.

If someone experiences itching accompanied by a rash or hives it is the start of a true allergic reaction which could dangerously progress.

With true allergic reactions, a person seems to become more sensitized each time they are exposed to the medication. A rash can progress to widespread swelling. Swelling of the lips and tongue are signs that things are about to become very serious. From there the airway can begin to swell causing difficulty breathing. Increased heart rate and a drop in blood pressure indicate you are going into shock. This is now a life-threatening anaphylactic reaction. If you experience this you should call 911 immediately.

The first medication usually given for a true allergic reaction is an antihistamine. Benadryl is the most common but the newer drug Allegra can also be used for hives and skin rashes. If the reaction has progressed far enough steroid injections such as epinephrine are given to reduce swelling and help restore normal breathing. With quick treatment, anaphylaxis can be reversed.

While the procedure may vary by health care facility, the policy where I work is to write the name of the medication reported on an allergy band, (which is worn around the patient's wrist throughout their stay),  and then write the reaction as described by the patient in parenthesis. So, if you come in and say you're allergic to Lortab because it made you itch I will still put it on  your allergy band alerting others that a different pain medication would be a better option for you; BUT we also know that if Lortab is the only option it will not result in anaphylaxis.

Still confused? Here's another example. With new resistant strains of bacteria, some infections fail to go away after several rounds of different antibiotics, so it is entirely possible that a medication which has given you severe stomach pain may also be the one antibiotic that will kill a certain drug-resistant germ. If we didn't know that you had a side effect that could be alleviated in other ways (sometimes yogurt, or other stomach medications are helpful), and thought you might have a life-threatening reaction we might miss the only opportunity to cure your infection.

In the past, being limited to one particular drug, has been extremely unlikely. Unfortunately, it may surprise many people to know we are currently having a nationwide drug shortage with somewhere around 72 different medications currently listed in shortage on the FDA's website and we know more have likely not yet been reported to the FDA.

If you're confused about whether you've had an actual allergic reaction to a medication or a severe side effect you should discuss this with your doctor or pharmacist so that you can give health care professionals the most accurate information possible. If your child has an adverse reaction to a medication, document it, (both the medication and the effects),  in a place where the child will have access to it as an adult. This will help health care professionals to give the very best care that they can.

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