A Note on Drug Allergies

How is it that a person can tell you they are allergic to a medication, and then pressure you to give them that exact (or closely related) medication when they come with a prescription?

The classic example is codeine. They state that they are allergic. A hospital Dr. writes a prescription for Dilaudid, and they are begging you to fill it. Of course they are in pain, of course they need something ASAP. Most of the time this is fine, they are not "truly" allergic to Codeine anyways (aka GI upset, nausea, stomach pain, vomiting), and they most likely have already been given Dilaudid in the hospital anyways, so we can go ahead and fill it.

But say they had a reaction to codeine such as hives, or swelling around the face: they don't want you to take the time to call the doctor, they know it will take awhile to hear back, so they just want you to give it to them.

It's amazing the types of rationale these people follow. Pain is terrible and it can lead you to make rash decisions, but if it could potentially KILL you?? That's something to pay attention to! The best story was one lady told me: "Yes, I swell up every time I take codeine, but then I bought some Dilaudid on the street and I wasn't allergic to that."

OK, first of all, how can I know FOR SURE that it was Dilaudid that you got on the streets? And second of all, if you can buy it on the streets, what will stop you from SELLING it on the streets? (Maybe she was just looking to sell it all anyways)

Luckily what most people report as an allergy is usually just a bad stomach episode (side effect), so things usually work out just fine. The worst is when the person doesn't actually remember what happened to them!
"Ummmmm it was about 45 years ago, and I don't know what happened"

Okay, so I want to err on the side of caution obviously, but it does involve calling their doctor and ME sounding stupid. "The patient reports an allergy to this med, but they don't know the reaction. What should we do? " This is where i really feel sorry for MD's! I don't know what I would do in their shoes. Especially if it's a pen allergy. If you are going to err on the side of caution, you would be eliminating LOTS of different meds from your arsenal. Most of the time I just see the doctor say "go ahead' and we fill the rx, and they don't react to it.