Happy at "A Happy Hospitalist" blog recently wrote about a colleague who thinks the presence of four or more drug allergies is a good indicator of fibromyalgia.
I'm reminded of an ER doc and I who were marvelling about a patient he was seeing who had a full page of drug allergies, about 40 drugs. Patients like that are extremely time-consuming and difficult to treat.
Entirely separate from the fibromyalgia issue, I've long thought that having numerous drug allergies or sensitivities is a marker for psychiatric disease. The more allergies, the more severe the psychiatric disease.
I'm not sure which psychiatric diagnoses would most likely be present in a patient with too many drug allergies. Hypochondriasis? Histrionic personality disorder? Somatiform disorder? Somatization disorder? Obsessive-compulsive disorder? [This is more than just anxiety or depression.]
Undoubtedly, there are exceptions. People with extremely poor health (who go to doctors) or history of serious disease (e.g., cancer) are exposed to many more drugs than fortunate people who rarely go to the doctor. They WILL have more legitimate drug allergies than the general population. And some people just have odd immune systems.
[Remember the old "multiple chemical sensitivity sydrome" from 20 years ago? Is it still around?]
I spent five minutes at PubMed looking for data to back me up, and found none. With more time, I bet I'd find it. If not, there's an opportunity here for someone to do the research and have a clinical sign named after himself.
Do you agree with me that having too many drug allergies raises a flag for possible psychiatric issues?
And what's "too many"? Four's not enough. Forty's too many. I suggest six.
And which psychiatric diagnoses are associated with numerous drug allergies?
[Whoever earns naming rights for the syndrome will have to determine sensitivity and specificity limits, as well as specify what constitutes a "drug allergy." It's probably easiest to simply ask the question (or put it on a form), "Are you allergic to any medications? Which ones?" Boom, there's your answer.]
-Steve Parker, M.D.
PS: For any patients reading this, continue to share all your drug allergies and sensitivities with your doctors. Your life could depend on it.
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You may be on to something. Purely anecdotal, but I can think of quite a few of our frequent fliers who have major psych issues & numerous drug allergies. They all are extremely dependent upon their dilaudid -- watch the clock for it. Most interesting case was having psychogenic seizures.
I neglected to report my sulfite allergy before a procedure and immediately had a serious problem from propofol as soon as it was injected. This wasn't intentional--I didn't realize it would be in medicines rather than food. I already carried epinephrine for sulfites--I had a terrifying anaphylactic reaction to dried fruit (twice before I realized that's what it was) and also to insect bites.
In my early 20s, I had myself allergy tested for the antibiotics I reacted to as a child in case I'd outgrown them or we were wrong. Turns out they had to stop each test partway through because I was too allergic to continue. It's embarrasing to list them and I worry about my credibility going down as soon as someone glances at the top of my history form.
I think a lot of people list side effects as allergies. After I threw up on morphine, my spine doctor said I should add that to my allergy list--I said no, that was just a side effect! Not a true allergy.
Multi-drug allergy syndrome is difficult and dangerous; my mother has it and my kids have developed some of the same allergies as infants even though they are really healthy otherwise. Some of us in our family just seem to have weird genetics that give us all kinds of immune system problems.
And my sulfite allergy is a true allergy; most people with the sulfite issues have a reaction rather than histamine-mediated reaction.
"Prevention is Better than Cure", as always, Lately, I had an allergy every time I eat seafoods. My mother encourage me to take some allergy pill, she bought a 2 elisa kits for my allergy. good thing, I am now feeling well. i can eat sea foods, but not much. As i said, though the kit is effective, still, prevention is better than cure. LOL..just sharing my thoughts about my experienced.
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