Identifying and Managing Patients’ Allergies (Podcast)

Allergic reactions can escalate from mild discomfort to life-threatening emergencies within minutes, making vigilant allergy management a cornerstone of patient safety. For nurses — often the first to notice subtle warning signs and the last line of defense — accurate documentation, clear communication and proactive allergy prevention are essential components of high-quality care.

"Good allergy management starts with asking the right questions," says Jeanette Kubicki, CNS, a clinical nurse specialist in Allergy and Clinical Immunology at Cleveland Clinic. "Ultimately, it's an act of advocacy that protects patients when they’re most vulnerable.”

In this episode of Nurse Essentials, Kubicki shares her expertise on identifying and mitigating allergies, which can affect everything from the food and medications patients receive while in the hospital to the devices and implants used in surgery. She discusses:

• Understanding the difference between an allergy and an intolerance
• Safe medication administration and effective documentation
• Avoiding diet-related allergic reactions
• And more

Click the podcast player above to listen to the episode now, or read on for a short, edited excerpt. Check out more Nurse Essentials episodes at my.clevelandclinic.org/podcasts/nurse-essentials or wherever you get your podcasts.

Podcast excerpt

Podcast host Carol Pehotsky, DNP, RN, NEA-BC: How can nurses help their inpatients avoid food allergens, and how do we communicate their needs to cafeteria and food service staff?

Kubicki: This is a valid concern. A patient with a peanut allergy might wonder if their meal was handled by somebody who didn't change their gloves after making a peanut butter and jelly sandwich. I [urge caregivers] to verify allergies at every single step. Document, document, document – and be highly specific about any previous allergic reactions the patient has had. What happened? And communicate clearly…ensure that anyone who handles patient food is properly trained on cross-contamination.

Pehotsky: Patients often present with stories about [unconfirmed] allergies, which can sometimes limit treatment. How do we make sure… patients’ needs are being met while also [helping them] understand their options?

Kubicki: Ideally, you want to confirm that the reported allergy is real by obtaining a detailed history of [any prior reactions]. If I determine the patient is low risk, I might suggest they try [the medication again] in a monitored setting: Let's see how you do this time.

Imagine you have an inpatient with neurosyphilis, for instance. The patient needs penicillin but reports a prior anaphylactic reaction to the medication. This would be a good time to consult the allergy team, who can do penicillin allergy skin testing. If the patient passes, you can proceed with the penicillin challenge.

On the other hand, if the patient has a positive skin test…we can induce a temporary tolerance to the medication, which takes several hours. You start with very small doses and gradually give [more] until the therapeutic dose has been reached. The tolerance is only temporary, though…just enough to get them through. About 48 hours later, the patient is allergic to penicillin again.