Drug allergy: diagnosis and management

[helvella]

NICE Guidance

I have only today found the NICE guidelines on drug allergy! (They have been in existence since 2014.)

We have had numerous members saying that certain formulations cause them issues that we'd commonly call allergic reactions.

But, when they ask a pharmacist to avoid a particular make because of such a reaction, they often get a shoulder-shrugging attitude and "Nothing we can do..."

This is (obviously) entirely wrong in ethical and moral terms. And also goes against this NICE guidance.

The primary action, assuming your issue was not life-threatening, is to record the event and ensure it is visible in your patient records.

I think if you manage to get that step done, you can request a copy (or see it in an NHS or similar app if you have one available), and pass it on to any pharmacist if needed. [I believe this is a feature which is present in both England and Wales NHS apps.]

It should be inconceivable that any pharmacist would dispense in violation of an officially recorded allergic reaction.

Please, also, put in Yellow Card reports for each and every medicine that causes you a problem.

🟨 Making Yellow Card Reports 🟨

healthunlocked.com/thyroidu...

Drug allergy: diagnosis and management

Clinical guideline [CG183] Published: 03 September 2014

nice.org.uk/guidance/cg183

There is a downloadable PDF.

Specialist Pharmacy Service Guidance

The SPS is NHS England's Specialist Pharmacy Service who are supposed to provide many sorts of support and guidance to professionals. (Not us patients, of course!)

They say this:

Handling questions about excipients

Source UKMi Quality and Risk Management Group · Published 26 October 2020

Topics: Excipients

Quality and Risk Management Group

Pharmaceutical excipients are constituents of a medicine that are not used for their direct therapeutic action, but to aid the manufacturing process, such as to enhance stability or bioavailability.

Patients may want or need to avoid certain pharmaceutical excipient(s) for a number of reasons. Medicines free from specific pharmaceutical excipient(s) may be requested for particular patient groups (e.g. neonates), patients with a severe allergy or with particular cultural or religious beliefs. This document aims to assist healthcare professionals in providing safe, effective and timely answers to support that decision. It outlines the steps involved in checking for the presence or absence of the substance in product information; and provides an explanation of the requirements for information about constituent excipients in the product labelling and patient information leaflet.

sps.nhs.uk/articles/handlin...

That page links to this document:

sps.nhs.uk/wp-content/uploa...

That is, they accept that avoidance of some excipients is necessary. They provide some background information. But utterly fail to provide any guidance as to HOW to ensure the avoidance is incorporated into prescribing and dispensing practice other than contacting manufacturers, etc.

  Bellaowl

[Charlie-Farley]

very useful in self advocacy.

[Rita-D]

Thank you so much. This is really useful as I have bad reactions to certain manufacturers. It’s noted on my pharmacy records but unless I take my prescription in and ask for Mercury Pharma, I just get given anything. My GP is constantly trying to get me to have my script sent direct to pharmacy.

This information should help me. Thanks so much.

[helvella Administrator in reply to Rita-D]

If you - or anyone else - does get their allergic-type reactions added to their records, please do let us all know. And especially if you use the record in a pharmacy.

[HealthStarDust]

I have had adverse reactions to drugs marked on my record for some time. Not quite the same as an allergic reaction, but I believe it is easily done by the practice. And, it is easily visible in my records, including in the summary care record. Thankfully, I have not needed to refer to this at a pharmacy as my drugs are specified on prescription anyway.

I am aware of an allergy to a drug that isn’t marked clearly on a patients records of someone I know. So, I guess it depends how good your practice is.

[helvella Administrator in reply to HealthStarDust]

I hope that those who are able do actually take this into their own hands, at least to the extent of ensuring their own records are completed and corrected - if needed.

Absolutely - it shouldn't be necessary. The borderline between proved true allergy issues - obviously including anaphylaxis - and minor irritations, etc., isn't easy to draw. But if anything affects breathing, or other fundamental life processes, they simply must be added.

I am hoping that if everyone affected (whether by colouring agents, mannitol, etc.) gets it recorded, that will provide evidence of the widespread nature of these reactions. If, for example, 50% of patients found a yellow colouring agent intolerable, there is a possibility that its use would first be deprecated then banned.

The two specific issues I have have been in my records for several years and withstood transfer from one GP surgery to another.

[HealthStarDust in reply to helvella]

My own are in relation to specific drugs, rather than ingredients and are recorded as adverse reactions not allergies.

I wonder if the patient information system the practice uses is at play here.

[helvella Administrator in reply to HealthStarDust]

On the system I can now access, it has "Allergies and adverse reactions".

I have no idea what others might see. Perhaps members could check and let us know?

I would have hoped that regardless the system, this would be consistent in content (if not in name) as it is a headline topic which might need urgently to be accessed.

[HealthStarDust in reply to helvella]

I see, and always have seen, “allergies and sensitivities” at the top of my record on some of the apps I use. It is made clear what I have had an adverse reaction to.

Not all health apps that are available to patients have these sections but it doesn’t mean the information does not exists on your record. I think some of this is going to depend on the data systems a practice uses.

The first place to check would be the summary care record which we all (in England at least) should be able to see on the NHS app.

Edit: having checked the NHS app (it’s not my preferred choice) there doesn’t seem to be a summary care record sectioned but at the top once again, there is a section of allergies and sensitivities.

[Regenallotment Ambassador]

excellent! Thanks helvella i will pursue this with GP practice regarding lactose containing meds. 👏🙏🌱