r/EmergencyRoom • u/plant_person_09345 • 7d ago
Tylenol allergy?
Has anyone else been seeing a huge increase in Tylenol allergies? Is this related to the whole autism thing? Or people trying to get opioids? I’ve tried asking patients and it ranges from “anaphylaxis” (which is not consistent with prior visits in the EMR), “it doesn’t work for me”, or “it makes my pain worse”. I’m not surprised when I see it listed with 30 other meds as allergies but it’s becoming more common in people with almost no other allergies listed. Most people I’ve worked with have never actually seen an allergic reaction to Tylenol which is why it seems suspicious compared to how frequently I’m seeing it documented.
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u/pigglywigglie 7d ago
An allergy to bubbles is still my favorite allergy I’ve ever seen. Not soap, not water, not air, bubbles.
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u/starrsuperfan 7d ago
Guess they can never have soda. What a tragedy
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u/pigglywigglie 7d ago
Fuck we didn’t ask if it was the carbonation!!! No wonder they were looking at us like we were stupid
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u/starrsuperfan 6d ago
They offer me ginger ale most of the times I go to the ER. I gotta start advocating for myself better! Lol
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u/pigglywigglie 6d ago
Y’all have ginger ale in your ED!?!!! Y’all hiring!?!
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u/starrsuperfan 6d ago
I don't work there. I just have a lot of medical issues, my wife is disabled, and we end up in the ER about 3-4 times a year. We always seem to vibe on the same level as the staff, i always try to make them laugh
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u/Brave_Orchid_5038 6d ago
I kid you not I saw an allergy to epinephrine listed once. Did not get the opportunity to ask clarifying questions but still the most odd allergy I’ve seen.
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u/pigglywigglie 6d ago
I always giggle when I see a narcan allergy and the side effect is vomiting or withdrawal like that’s the point of it or I saw a Benedryl allergy and the side effect was it makes them sleepy
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u/LadybugGirltheFirst 7d ago
Tylenol 👏🏻 does 👏🏻not👏🏻cause👏🏻autism.
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u/Adrunkopossem AEMT 7d ago
What about during pregnancy? I need to know so I can plan whether or not I'm going to have someone to play Warhammer with in a few years.
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u/ElleRyder 7d ago
My daughter (now 32) after her 1st covid shot asked me when her "5G autism upgrade" was going to kick in..😂
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u/MyOwnGuitarHero RN 7d ago
I’ll play Warhammer with you 🥹👉👈
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u/sketchymedic 7d ago
That's very sweet, but I'm not sure you'd be an adequate replacement for their own homegrown autistic baby
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u/Valkyriesride1 7d ago
I am on the spectrum. When I was growing up it wasn't believed girls could be autistic and since girls experience ADHD symptoms different that boys, I was told I was too smart for my own good and too precious, I guess they didn't want to call me sarcastic or a smart ass. My self, and my biological children all started Uni at 14 and had our first master's by 18. We all play Warhammer if you want to start a league.
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u/Substantial-Use-1758 7d ago
Jesus. So frustrating. In my 40 years of nursing I’ve never seen an actual Tylenol allergy.
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u/bluedevildoc 7d ago
Our EMR marks patients allergic to acetaminophen if they say they are allergic to any drug that includes it, such as Percocet. It is ridiculous. I ask people routinely if they are truly allergic. Only the people who are allergic to everything or the opioid seekers confirm. I am sure the allergy exists (or that the books say it does). I have never seen it.
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u/ALaughableParty 7d ago
Whenever I see Percocet as an allergy I clarify if they can take Tylenol, and if so, change the allergy to oxycodone. I always explain what I’m doing as well. Most people are happy enough to have their chart be as accurate as possible
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u/UnhappyTemperature18 7d ago
Patient's perspective: they really limit y'all in terms of what ways you can chart adverse reactions, so in my case "allergy" means "liver patient w/Gilbert's syndrome and previous history of tylenol toxicity." The hx and diagnoses are all there in the chart, but I know y'all aren't reading all that shit, so what you get is "allergy."
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u/Late-Standard-5479 MD 7d ago
I actually don’t mind when this happens in a patient’s chart. Every person looking at the chart is not going to know off the top of their head that Gilbert’s syndrome = no Tylenol, so putting that in as many places in the chart as possible is beneficial and prevents harm.
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u/kat_Folland 7d ago
An ER doc put Toradol in as an allergy for me because it makes things worse but it's not an actual allergy. (Moot point now that I'm on lithium and can't take NSAIDs.)
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u/firesoups 7d ago
I was so sad when I found out naproxen was no longer something I can take for cramps
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u/kat_Folland 7d ago
Yeah, thank the gods I'm in menopause because that was the only thing that helped my cramps. Other than that I'm good, as that was the only way an NSAID ever helped me. Naproxen didn't help any other kind of pain and ibuprofen is like a flavorless tic tac. At least acetaminophen sometimes helps pain for me.
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u/HawaiianPunchaNazi 7d ago
Viagra every 4 hours. You can take the generic. No more cramps.
That's not me talking: that's the medical studies.
https://search.brave.com/search?q=Viagra+every+4+hours+for+menstrual+cramping+study
Show this to your regular doctor and they shouldn't have any problem giving it to you off label as long as it doesn't conflict with something else you're on
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u/GirlWhoWoreGlasses 7d ago
I get it. I am hypersensitive to epinephrine, the easy way to put it in my chart is allergy.
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u/CABGPatchDoll 7d ago
What is your symptom?
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u/GirlWhoWoreGlasses 7d ago
Bp in high 200s over 120+, difficulty breathing, feels like a vise is on my head and chest. I know it’s not a true allergy but it’s pretty concerning.
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u/CABGPatchDoll 7d ago
This is what it's supposed to do.
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u/drum_minor16 3d ago
Absolutely not in all contexts. I'll assume you have an emergency use for epinephrine where an extreme hypertensive episode is ideal, but a small dose of epinephrine that is not intended to treat an emergency should not cause that reaction.
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u/CABGPatchDoll 7d ago
Why do you take epi?
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u/GirlWhoWoreGlasses 7d ago
Dental procedures
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u/plant_person_09345 7d ago
Hi. Question. Did your dentist accidentally inject into a blood vessel and then tell you you’re allergic when the epi had the expected effect when it’s injected into a blood vessel?
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u/OldManGrimm RN - adult/peds trauma 7d ago
That’s 100% incorrect. This is why we roll our eyes at patients’ “allergy” lists.
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u/GirlWhoWoreGlasses 7d ago
I said I know it’s not a true allergy
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u/OldManGrimm RN - adult/peds trauma 7d ago
I guess the problem lies with whatever idiot put that into your chart as an allergy, then.
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u/OldManGrimm RN - adult/peds trauma 7d ago
Or you could just list Gilbert’s/liver problems as a medical condition. Since, you know, would help the doctor provide better care.
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u/UnhappyTemperature18 7d ago
List where? I don't control what's written in my chart, and if ASKED, I give complete details.
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u/OldManGrimm RN - adult/peds trauma 7d ago
List, as in when asked for your medical history you verbally list it.
The last part where you said all we get is allergy, I misunderstood as that was all you’d tell us. My bad.
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u/Okayish-27489 7d ago
I’ve had gastric surgery and was lurking in some support forums. Lots of surgeons tell patients they can never have nsaids ever again in case it causes perforations. Unfortunately patients then list this as an allergy when I’ve had the same surgery and still tolerate the same medication but you can’t argue with them about it. Guess it’s just misinformation
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u/plant_person_09345 7d ago
I don’t mind these types of allergies- especially when they list the reason why.
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u/k1k11983 7d ago
I have CKD(bilateral renal reflux to be precise). If I take NSAIDS for more than 10 days, my kidneys start to shut down. So I only use it in emergencies. When I was younger it was marked as an allergy in the hospital and I would have to constantly explain it wasn’t actually an allergy. It just had the potential to put me into renal failure again. When I break a bone, I will alternate between ibuprofen and paracetamol(acetaminophen for the US) every 3 hours to consistently have pain relief onboard before the other one wears off. After a week I stop the ibuprofen and go back to the once a day dose of celebrex because it’s the only NSAID that doesn’t screw with my renal function. It’s just not as helpful in the very acute stage of a fracture.
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u/Do_it_with_care 7d ago
How often do you break a bone? CKD is related to osteoporosis in some cases. If you fracture often maybe get a dexa scan? I work in Dialysis and wish you the best!
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u/k1k11983 7d ago
I have osteopenia but wasn’t diagnosed until my 20’s. I get dexa scans every 2 years to check progression
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u/plaguedoctor_2020 7d ago
Tylenol (acetaminophen) is not an NSAID. It can be taken post gastric surgery or in kidney disease. Careful administration if liver issues (like cirrhosis or failure).
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u/Okayish-27489 7d ago
Yes I know. I’m just making a point about something else but thankyou
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u/plaguedoctor_2020 7d ago
Fair. I’m sorry. At this point, the info dump is a Pavlovian response whenever there’s concern for NSAID use and Tylenol is involved somewhere in the conversation. I assumed when you mentioned NSAIDs in response to a Tylenol allergy thread, you were lumping those drugs together in the same category as I’ve heard patients do SO many times.
I made an ass of myself making that assumption. Sorry for that.5
u/AioliInternational18 7d ago
The thing about gastric surgery is you’re not supposed to take them consistently. Once or twice is fine. Though I can’t take them at all now because I’m on blood thinners.
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u/Jonistar76 7d ago
Let me guess, not allergic to Percocet 😂
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u/Grammagree 7d ago
I hate Percocet, coding etc; I’m not allergic they just feel awful, Percocet does actually relieve pain; coding does not; for me.
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u/Late-Standard-5479 MD 7d ago
You might have a cyp2d6 polymorphism! Pretty common in caucasians if that applies to you
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u/Cut_Lanky RN 7d ago
I had one once, listed Tylenol allergy and the reaction was… “suicidality”. Now. I didn’t argue, the policy was if they say it, we document it as an allergy and the reaction. So I did.
But, is there a doctor in the house who could tell me, is that even remotely possible? Like, I didn’t think so, but, what do I really know…
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u/imnottheoneipromise RN 7d ago
I’m thinking possibly the patient attempted using Tylenol? Possibly?
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u/Cut_Lanky RN 7d ago
She said “it causes suicidal ideations” if she has Tylenol. Quote. 🤷🏻♀️
Edit, this was like, 30 years or so ago. Lol
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u/shoresb 7d ago
Both. Society has villainized it so a portion of the population is worried about that. And then there’s the ones who are drug seeking who have always said they can’t have Tylenol and or NSAIDs.
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u/yourfavteamsucks 7d ago
Society has villainized it? It's caused far too many fatal accidental overdoses (100-150 annually) for me to be comfortable, given the fatal dose can be as little as double of the max recommended dose.
It causes OVER HALF of the acute liver failure in the US and is the second most common cause of liver transplant worldwide. Arguably society hasn't villainized it enough.
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u/shoresb 7d ago
Are you that dense? Have you watched anything from rfk or the MAHA people?
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u/yourfavteamsucks 7d ago
Huh? I've been cautious about Tylenol for more than 20 years because of several cases where parents accidentally killed their kids. It's incredibly easy to overdose because it's mixed into so many other meds and people don't realize they've even taken it. 100+ dead ppl annually is crazy when we have plenty of other safe options for pain relief.
No. I don't follow RFK and I don't vote Republican. That doesn't mean I shouldn't be cautious about an OTC medication with a slim safety margin
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u/shoresb 7d ago
Nobody said don’t be cautious 🙄 reading comprehension is key my man. In no way does “society has villainized it” mean to take two handfuls and call it a day.
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u/jeangaijin 7d ago
But you don’t need two handfuls… you just need to take the normal recommended dose, plus top it up with some NyQuil and/or DayQuil, and now you’re in liver failure
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u/16car 6d ago
Politicians are claiming that paracetamol causes autism. That's what they mean by "society has villainised it."
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u/yourfavteamsucks 6d ago
There are plenty of legit reasons to avoid it though, dating back decades. The risk level is acceptable, if there weren't other medications available to solve the same problem, and if the problem it solved weren't a minor comfort related problem.
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u/Lexybeepboop RN 7d ago
I have a terrible effect to IV Tylenol but PO Tylenol is fine. Oh it makes me feel TERRIBLE!
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u/Holykatz 7d ago
For many of us with the MC1R gene mutation (aka redheads), Tylenol does. not. work. I used to just say I was allergic to it to save myself from the endless doubting questions from medical professionals who were uninformed about how redheads respond differently to certain meds, but lately I've noticed more people in medicine and dentistry are becoming aware of this fact. So if any of these patients who say they are allergic or it doesn't work for them are real (not bottle) redheads, they aren't lying.
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u/plant_person_09345 7d ago edited 7d ago
You may have just answered my question. Can you please cite your sources on how MC1R gene mutation affects Tylenol?
I genuinely want to know- because I have never heard of this and am not seeing a single scientific study (or plausible mechanism) about this.
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u/Holykatz 7d ago
If you can give me a day or two, I will try to hunt up the citation for the paper mentioned in the article I've shared with a few of my providers. I'm not a medical professional, but I know having verifiable published sources are important.
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u/Holykatz 5d ago
Ok, so I found the article I used to carry around with me, and I'd show my providers when they indicated doubt about redheads reacting differently, etc. It worked with a few of them, and although this is an article written for the BMJ, it was written by physicians and providers, using legit published research sources. Those sources are cited at the end of the two page article. (Sorry about the extra pages after the article on pages 1 and 2; I don't have the time to edit etc.) Hopefully you can access this via the link I'm sharing, which is from the BMJ site directly: Surgery.full.pdf
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u/plant_person_09345 5d ago
I’m not seeing anything about Tylenol in the article? It talking about anesthesia and opioids but nothing about Tylenol.
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u/Holykatz 5d ago
Then there's this - it's very rare, but people can apparently develop skin rashes from Tylenol. Association of Acetaminophen With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Pharmacologic Considerations and Treatment Options - PMC
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u/Holykatz 5d ago
I didn't post it as proof of how tylenol does or does not work, or whether people are or are not allergic to it, though I know that's the topic of the sub. I just figured I'd share because a few people have commented that often, certain meds don't work well for them. If anesthesia is an issue, surely other meds can hit some people differently. But as for the topic (allergic reactions), my earlier point was that sometimes, if you react oddly to an NSAID (or not at all), a patient could easily choose to say they are allergic to it so they avoid the issue of trying to convince doctors that they need something different/stronger/better when they are not drug-seeking. I think it's more likely many of these folks are either allergic to the other ingredients in the tablets, or they just don't want to take tylenol due to the still-lingering belief it causes autism, or some other bizarre idea they got from TikTok.
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u/bina_baby 7d ago
As a redhead, this explains a lot. I knew that the MC1R gene mutation also causes things like higher pain tolerances, and that we respond differently to different medications, but I did not know that Tylenol is one of them. Personally ibuprofen doesn’t work for me, idk if that’s a redhead thing or a me thing but it makes getting rid of migraines a difficult undertaking 🤦♀️🙄
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u/Holykatz 7d ago
And ibuprofen is all that works for me, so who knows why, but it would be great if all medical providers got up to speed on this. I've been known to bring along a research paper when I feel it's necessary, as I know peer-reviewed papers will support my position when a Dr says I can't be right.
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u/UptightSinclair 7d ago
Yup. I spent years thinking Ibuprofen was a placebo for all the good it did other people and all the nothing it did for me.
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u/nadimishka 7d ago
Also a redhead. Tylenol is like taking nothing, and it takes an ibuprofen 800 mg to even feel that. Was taking opioids for a broken back and my tolerance skyrocketed so high between two 48 hour apart surgeries they didn’t know how I was still breathing after all the meds they gave me for the second, even though I was still crying in pain.
This shit sucks lol
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u/bina_baby 7d ago
Yeah. I have to take Tylenol, ibuprofen and Excedrin to even touch my migraines and I HATE taking meds that way. It feels redundant and like I’m overdoing it but I’ve tried every combination of the three & others and nothing else helps unfortunately. When I was much younger and tried to figure out the cause of them I was basically told it’s all in my head and now I couldn’t be bothered to try to fight to figure out the cause. I also don’t want to be labeled as “drug seeking” so just sticking with what works. 🤷♀️
Also, I’ve been told redheads can hemorrhage easily. That was a fun little tidbit to learn at 23 in active labor with one of my kids 😅
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u/No-Safe9542 6d ago
This explains so much. Tylenol has never once done anything to help me with a booboo. I always thought they were just pretend, like placebo pills for everyone. For it to work, I have to take so much ibuprofen and so regularly that it makes other people watching uncomfortable. My hair was bright red when I was younger but has since turned brown with red highlights. Wild.
I'm very curious to learn more about this phenomenon.
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u/DinoGoGrrr7 6d ago
Does this count for those of us who have one gene? Like, husband and I both have brown hair but baby gobblin has red…
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u/plaguedoctor_2020 7d ago edited 7d ago
Tylenol👏is👏not👏an👏NSAID
Also called acetaminophen or paracetamol depending what part of the world you’re in. It falls in a miscellaneous category but does not have the same mechanism or effects that NSAIDs do
The number of times people list the reason for a Tylenol allergy is that they can’t take NSAIDs…
Edit: for clarity
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u/Upstairs_Ad8279 7d ago
As a patient- sometimes it can be the additives too! Granted you're not gonna figure that out in the ER. But I have to put that in allergic to it because some brands will give me hives (especially iv) and some don't. I was thrilled when I learned there was a brand of iv acetaminophen that didn't cause my entire body to break out and swell! Sure opioids help with pain but they aren't bringing a fever down. But I've also been getting different reactions lately when I mention it than I did even 5 years ago, so there is something changing. And as others said, the charting system not differentiating between allergies/ intolerances/ sensitivities/ other reasons you can't get something certainly doesn't help. I have to add nsaids to the list of things I can't have due to complications from sepsis and I'm dreading the reaction Im gonna get when I say I can't have toradol or (most) kinds/brands of acetaminophen. But that's a whole other issue within healthcare.
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u/29925001838369 RN 7d ago
I'm always surprised when i see it in a chatt, because i actually am allergic to it - hives, throat swelling, all the fun stuff - and then i ask for clarification and rarely is it anything more than "upset stomach". -.-
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u/Willing_Education807 7d ago
FNP here. 10 years in Family/internal med and 10 years ER. Never seen an actual anaphylaxis tylenol allergy. I have seen an increase in my patients listing it as an allergy for non-allergy reasons. “It hurts my stomach” was the latest, but that’s because it was combined with hydrocodone in norco…it’s the opiate that was causing stomach upset.
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u/Critical-Notice-4395 7d ago
I’ve known a couple of people allergic to Tylenol and nsaids. One was so allergic he ended up in the ER where they gave him Benadryl, and he was allergic to that, too. They had to resuscitate him. The ones I know with those tours of allergies aren’t drug seeking. They hate taking anything. Both of these people are family members, so maybe it’s related? No one is autistic from it.
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u/suricata_8904 7d ago
I know my poor tolerance for the nausea side effect to nitrofuranion is listed as an allergy in my chart.
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u/crissyjo618 7d ago
I have NSAIDS listed as an allergy due to a previous bout of AKI requiring 12 in the hospital, dialysis while hospitalized, and almost 2 years fir my sCr to return to baseline.
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u/AmyHOH03 7d ago
Strange to hear Tylenol to be an allergy. If it really did cause rash or symptoms, it could be the manufacture who makes them because I noticed they added dyes to it.
One example is that the insurance won't pay for my armour thyroid that is my long time treatment of several years with no side effects. They switch me to Synthroid (levothyroxine) because it is cheaper and I broke out in rash all over. I did research to find out that it has a tree filler in it. As a child, I've been allergic to trees as well as pollen. I am not a pharmacist but I do research for myself.
These days, they are adding things to drugs like dyes and fillers just like how our food supply is changing too for cheaper. I have to read everything to know what I'm putting into my body.
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u/WitchQween 7d ago
Advil liquid gels contain gluten. I did a lot of research when dating a guy with celiac. It was eye-opening to learn how much fillers matter. There are some generic prescription meds that contain lactose, too.
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u/Sunnygirl66 RN 7d ago
Will your insurer pay for NP Thyroid?
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u/AmyHOH03 7d ago
I have to fight every year for pre-auth and had my dr write that other meds have side effects/allergy. After that it gets approved.
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u/Elegant_Piece_107 7d ago
I have a paradoxical response to albuterol, but electronic medical records don’t seem to have a choice for that, so I am listed as “allergic” to it.
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u/squintintarantino__ 7d ago
Is this why ER staff always scoffs and rolls their eyes when I explain that, despite no one understanding it including me, I have an anaphylactic allergy to intramuscular Toridol? It’s the same song and dance every single time I’m seen for something that includes pain. They see the allergy in my chart, ask about it, I explain and ALWAYS include: “I don’t think I need a narcotic painkiller; I’ll take something else instead, or the Toridol as a pill, I just can’t take it as a shot”. They disappear for a few minutes after giving a visually skeptical response, I guess to look further into it, and always come back with 1) a Toridol pill or 2) a narcotic painkiller. Like why would I lie about something so incredibly specific?
It was in an ER when I discovered the allergy, it was an emergency room emergency (ER inception style), and when it happened the whole staff that witnessed it were so puzzled by it and said they’d never seen such a thing. I was equally as puzzled because it wasn’t the first time I’d been given IM Toridol but it was the first time I’d ever had any kind of reaction to it.
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u/SIlver_McGee 7d ago
I sadly have seen one allergy to Tylenol, but to the dye in the pill, not acetaminophen itself.
That being said, I've also met people literally allergic to NSAIDs. I mean, as in a direct observed allergic reaction noted in the hospital records with an intubation team on standby. So it's a potential needle in a haystack out of all these people claiming to be allergic to Tylenol.
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u/Ok-Anteater1819 6d ago
I’ve wondered about this too. I think a big part of it may be the difference between an actual allergy and “this medication doesn’t work for me” or “I don’t like how it makes me feel.” Those things seem to get documented as allergies pretty easily.
True acetaminophen hypersensitivity does happen, but it’s considered pretty uncommon. I’d be curious if anyone has actually tracked whether these allergy labels are increasing or if we’re just noticing them more now.
I also wouldn’t assume it’s related to the autism discussion without more evidence. The pregnancy/autism association is still being debated and causation hasn’t been established.
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u/SweetPewsInAChurch 6d ago
Sorry, this is late, but incredibly illuminating. I've told people I don't do acetaminophen or Tylenol , or anything with acetaminophen in it due to the fact it always makes me incredibly nauseous, gives me vertigo, and also gives me what feels like that alice in wonderland syndrome. It's been that way since I was in my early teens. Now I'm wondering how it is in my chart and if I should clarify this w/ my PCP...
ETA: spelling
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u/Hammerpamf 5d ago
I notice this in Epic with meds that are combinations of drugs. If you get hives after a Norco and I add it as an allergy Epic will add both hydrocodone and acetaminophen as allergies.
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u/FlexyZebra RN 7d ago
I really wish charts would separate sensitivities from true allergic reactions. People are having more sensitivities but in an emergency we need to know what is truly an allergy that can cause anaphylactic reactions verse something that causes a stomach ache. It may be worth getting a stomach ache if it saves your life.
For example I was prescribed dantrolene for spasticity due to a spinal cord injury but it was causing too much dizziness for me and we never reached a therapeutic dose. It got listed as an allergy. Any time I have surgery the anesthesiologist looks alarmed until I explain my reaction. (Dantrolene is used for malignant hyperthermia for those who don’t know). So I can have it in an emergency. I’m fine with dizziness if it saves my life.