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History of opioid allergy: what significance?

Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba, Australia

Alison M Ridge, BPharm

Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba, Australia

Objective. To assess how health professionals would manage a patient’s pain when the patient is labelled as allergic to opioid analgesics.

Methods. A clinical case scenario, describing a patient obviously requiring opioid pain management but reporting a morphine allergy, was designed and pretested. This was distributed to medical (students, interns/residents, registrars, consultants) and nursing staff of Toowoomba Health Service District. All staff had some experience in pain management, though this varied widely. Respondents were asked to review the history and briefly comment on how the patient’s pain should be managed.

Results. Overall response rate was 46%. Doctors returned 47% (39/83) of scenarios, with 53% requesting further information on the nature of the allergy before using opioids. Nurses response rate was 45.2% (42/93), with only 21.4% requesting more information. Eighty three per cent (15/18) of doctors and 60% (20/33) of nurses, who didn’t query the nature of the morphine allergy, recommended opioid medication. No one specifically suggested using structurally dissimilar opioids to morphine if an allergy really existed.

Conclusion. Many health care staff either missed or ignored the allergy or assumed it was really an adverse effect and not significant, potentially placing the patient at risk of serious consequences, including anaphylaxis. Despite the low incidence of true opioid allergy, health professionals must fully investigate purported allergies to determine their validity. Patients should never be administered medications until their likelihood of experiencing a true allergy is determined.

Key Words: opioid allergy • morphine • allergy • scenario

Journal of Oncology Pharmacy Practice, Vol. 10, No. 3, 183-186 (2004)
DOI: 10.1191/1078155204jp131oa


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