Allergy Management in Hospital: Things Not To Miss

Starting your nursing career in a hospital setting is exciting, fast-paced, and often overwhelming. Among the many responsibilities you’ll quickly juggle, safe allergy management is one of the most critical and one of the easiest to get wrong if you're not careful.

Good allergy management isn’t just about ticking a box; it’s about protecting your patients from potentially life-threatening reactions. Here’s a practical guide to help you feel more confident managing allergies safely in the hospital environment.

Always Check for Documented Allergies. Every Time.

Before you do anything, administer medications, prepare meals, or even apply a band-aid, always check the patient’s documented allergies. This includes:

• Reviewing the medication chart (especially the allergies section).
• Checking the patient notes or electronic medical record.
• Ask the patient directly if they have any known allergies or intolerances.
• Looking for any allergy alerts on wristbands, charts, or at the bedside.
  

Remember: a patient's allergy status can change during a hospital admission. They might develop a new allergy to something administered in hospital, like antibiotics, adhesives, or contrast media.

Always double-check, even if you think you already know.

Know the Difference: Allergy vs Intolerance

Understanding the difference between an allergy and an intolerance is important for safe care:

• Allergy: An immune response that can range from mild symptoms (like hives) to severe anaphylaxis. Can be triggered by foods, medications, latex, insects, and more.
• Intolerance: A non-immune response that may cause discomfort (e.g., bloating from lactose), but not life-threatening reactions.
  

Treat allergies with extreme caution. For intolerances, you should still adjust care, but the urgency is different.

When documenting or handing over, be specific. For example, saying “anaphylaxis to peanuts” is clearer and safer than just “nut allergy”.

Ordering Meals: The Critical Step Often Missed

Incorrect diet orders are a major risk point for allergy-related incidents in hospitals. In 2018, a 13-year-old boy died after being given a meal with dairy, as his meal had not been ordered correctly on admission.

When completing diet slips or electronic meal orders:

• Double-check allergy information.
• Choose the correct allergy-specific meal plan (e.g., nut-free, dairy-free, gluten-free).
  Alert the food service staff to any severe allergies, especially if the reaction could be anaphylactic.
• Ensure the patient’s meal tray is clearly labelled.
  

Patients should never have to question if their food is safe. If you’re unsure, always clarify with your senior staff or the dietetics team.

Safe Medication Administration: Triple-Check

Medication allergies are one of the most common causes of preventable adverse events in hospitals.

Before administering any medication:

• Check the patient’s documented allergies.
• Check the medication chart for documented allergy warnings.
• Ask the patient (if able) if they have ever reacted to this medication or class of medications before.
  

Important: Sometimes patients are allergic to an entire drug class, not just one medication (e.g., “penicillin allergy” may also mean caution with cephalosporins).

If you’re ever unsure whether it’s safe, stop and clarify with the prescriber or pharmacist. It’s much safer to ask than to guess.

High-Risk Areas to Watch

Some key situations where allergy management requires extra attention include:

• Perioperative care: allergies to anaesthetics, latex, or antiseptics like chlorhexidine.
• Radiology: allergies to contrast dye used in scans.
• Blood transfusions: previous allergic reactions to blood products.
• Topical treatments: reactions to adhesives, wound dressings, creams, and tapes.
  

Always document any new suspected allergy immediately and escalate for formal medical review.

Anaphylaxis: Be Ready

Even with the best prevention, allergic reactions can still happen. You need to be ready to act.

Signs of anaphylaxis include:

• Difficulty breathing
• Hypotension (low blood pressure)
  
• Dizziness or collapse
  

If you suspect anaphylaxis:

1. Call a MET call or Code Blue immediately.
2. Administer intramuscular adrenaline if you are trained and authorised to do so. In Victoria, there are strong guidelines that recommend the patient has their adrenaline autoinjector at their bedside, NOT in the drug room. This is so that the patient can administer it in the case of anaphylaxis.
3. Lay the patient flat (unless breathing is compromised).
4. Follow your hospital’s anaphylaxis management protocol.
   

Anaphylaxis is a medical emergency. Early recognition and rapid treatment save lives.

Communicating Allergies: It’s Everyone’s Responsibility

Good allergy management is a team effort. Always ensure allergies are:

• Clearly documented on admission and updated as needed.
• Handed over at every shift change.
• Communicated to all members of the care team, including doctors, allied health, kitchen staff, and pharmacy.
  

If an allergy is severe or unclear, advocate for a clear management plan to be written in the notes or discussed at ward rounds.

Final Tips for Graduate Nurses

• Slow down: Allergy errors often happen when people are rushed.
• Speak up: If you notice an error or risk, alert your team immediately.
• Educate patients: Encourage patients to speak up if something doesn’t feel right with their medications or meals.
• Stay up-to-date: Hospitals often update allergy documentation systems, and stay familiar with your workplace’s processes.
  
• Keep learning: Ask senior nurses, pharmacists, and doctors questions if you’re ever unsure.
  

Good allergy management is a vital part of safe nursing care. As a graduate nurse, your vigilance, critical thinking, and willingness to ask questions can literally save lives.

Allergy safety is everyone's job, and that includes you.

For further information and free allergy training courses head to the Australian Society of Clinical Immunology and Allergy (ASCIA) www.allergy.org.au