WWYD if GP prescribed medication that your child should not have due to an allergy

[UncomfortableSilence]

Just want to see what others would do in this situation.

DD16 had a phone consult today for an update on how she's getting on with her Pill. She has horrendous periods and is under the hospital too. She hasn't been getting on great with it so the nurse suggested she change to a different brand, same ingredients.

DD read the information leaflet and it specifically says it must not be taken if you have a Soya/Peanut allergy. DD has a peanut allergy. I immediately rung the surgery but she wasn't available, I briefly explained and asked for her to call me. Instead she text DD and told her to throw away the pill and put her back on the one she was on before that she is having trouble with.

Obviously this could have had terrible consequences.

How would you deal with this as my DM has gone batshit that I was only going to put a complaint into the practice manager?

If I'm prescribed a new medication my GP checks to see if it's ok to take with my regular medications.

I've never been told it's the responsibility of the patient to check whether or not a medicine is appropriate. However, I always check the information leaflet and every time my husband points out I'm probably one of the few that does.

I'd flag it to the GP as another patient may not realise.

Your gp should know her allergies your dd should also have mentioned and also the medication should be clearly labelled that is not suitable for nut allergies. People have died eating food not clearly labelled so medication should be clearly labelled.
I think you should raise it not complain about the gp but the fact the medication needs to be clearly labelled and that your dd medical records . Your right this could be a fatal error for someone.

Who actually prescribed this the GP or the nurse ?

They cannot know the inert ingredients every medications. The pharmacist is the expert and would have asked your dd at the time of collection, are you taking/prescribed any medications? If she didn't mention the epipen it would not have triggered the pharmacist to enquire further. I certainly had medication that the pharmacist knew had an interaction but gp wasn't aware because it's not their specialty

My son has a peanut allergy and tbh we always have to flag it to the GP during appointments, this is despite there being numerous consultant letters on file and the GP regularly giving us repeat prescriptions for epi pens.

I always read labels and check with the pharmacist in terms of medication.

I think when you have an allergy you just have to get used to checking everything. A doctor can't possible know all the ingredients of all medications. I always mention it to the doctor and then again to the pharmacist, just to be sure.
I'm actually surprised that peanuts would be an ingredient in a medication.

@TheOldestCat

I have a nut allergy and was recently prescribed HRT - when writing the prescription, the GP said the system flagged up a warning for the tablets because of soy as an ingredient. So she changed the scrip to patches.

So presumably a safeguard like this can be put in place? I don’t know how it works. While the previous posters are right that we allergic types should check everything, it is easy to make mistakes like this. You’re not being dramatic - you’re worried, rightly. Flagging this up to the surgery is the right thing to do.

I have just been prescribed HRT and have anaphylactic nut allergy. Nothing was said and I read the leaflet thoroughly. It simply says don't take if you are allergic to any of the ingredients. I'm not allergic to soya and it doesn't mention nuts.

I have just read further online about this capsule and it says nobody with peanut allergy should take.

Thank you @UncomfortableSilence because had I not seen this thread I would have started taking it. I will ring the GP back.

I don't think there's a reason to complain here.

I would ask the GP to raise it as an internal clinical incident.

There are over 30,000 medications in the BNF, a GP cannot be expected to know the ingredients for each one. They will have an electronic prescribing system that should cross check allergies with the medication they are intending to prescribe, I would simply ask them to investigate why that system failed.

Hi which medication was it?

I've just checked and some meds do flag up if a patient has peanut allergies or soya allergies. But obviously only if it is on her records.

I think its important you flag this up and make sure it is listed on her records if it isnt already that she is allergic to these ingredients.

Its impossible to know the ingredients of every medication. But the computer usually does a very good job of flagging it up when you prescribe the medication as long as it's on her records.

Thanks for all your comments.

It was the GP she saw not the nurse, this is because it is being used temporarily to try to give her some relief while she waits for further Gynae Tests/Appts.

I have raised it with the practice manager, of course I don't expect a GP to know the ingredients of every medication they prescribe. I'm just surprised that nowhere along that chain would it flag up, at the GPs, on her notes, at the pharmacy, on the front of the medication rather than in tiny print at the bottom of the information leaflet.

Surely there must be better ways to notify of these ingredients. DD has done a fab job of taking responsibility for her allergy as she has grown up in restaurants and when buying food for example. I will be honest and say I didn't expect this in this type of medication but further reading shows other common medication such as some ear drops are made with peanut oil so we will have to be extra vigilant.

To the poster who said I'm being dramatic no other response to a comment as ignorant as that. I nearly lost my daughter at the age of 3 when she found a peanut on the floor and suffered such a severe reaction just from putting the dust from the nut to her mouth. There needs to be things in place to prevent something like this from happening and this is not taking away from the personal responsibility we need to take.

I think that’s definitely worthy of a complaint.

It surely can’t be that hard for a patients records to show an allergy, and the GP should be checking ingredients when they know there’s an allergy. It’s really not that much to expect. I’m shocked at some posters trying to minimise this.

I think reporting it (not complaining) to the practice manager would be good, at it will be a good learning point for all prescribing staff at the surgery, as I imagine many of them will be surprised that a contraceptive pill could contain peanuts.

But complaining and going after someone has a good chance of pushing yet another experienced member of staff over the edge and leading them to quit as everyone is fed up, particularly in general practice where they are so short staffed.

This is not about complaining but it definitely does need highlighting and investigation. From a Critical/Significant Incident investigation point of view there were many opportunities to flag this incompatibility and on this occasion it reached the very last point before it was noticed. Flag on the prescribing software, flag on the dispensing soft way, clear packaging warning, clear PIL warning and all were (presumably) missing. This is not acceptable. Someone needs to escalate this. The GP surgery is a good start. A letter to the manufacturer about their labelling wouldn’t go amiss. Perhaps even complaint to MHRA? www.gov.uk/guidance/medicines-packaging-labelling-and-patient-information-leaflets#complaints-about-labels-leaflets-or-packaging

Hi, I work in a pharmacy.

Our system won't automatically flag up if someone has an allergy and prescribers don't always note this on prescriptions, so you have to make sure she tells the pharmacy that dispenses her medication so that they can make clear notes that pop up every time a prescription is dispensed.

If we know about allergies then we can read through information leaflets and figure out which brands are suitable or offer the GP advice on alternate product.

Also, she should make sure that she mentions her allergy whenever she picks up any medication to make sure that it has been flagged.

She should also open the bag when she picks it up to make sure that the correct brand (whichever one works for her) has been supplied. Its easier to sort it out straight away if there is a problem rather than her having to come back in.

I've never been told it's the responsibility of the patient to check whether or not a medicine is appropriate.

But the onus is on the patient to a certain extent. That’s why every box contains a patient information leaflet. If the GP ignored the computer system flagging it up and prescribed it anyway then there is probably blame there, but they can’t be expected to know the formulation and non-active ingredients for every single brand of drug. It might be worth a query to see whether something was missing on her records or whether that medication can be flagged up to people with peanut allergies.

Ultimately though, like with food or anything else you put on your skin, the onus is on the person with the allergies to thoroughly check the ingredients. It would help if drug companies had allergens clearly labelled on the box though, in the same way that food companies do.

It's the responsibility of the patient to make sure the medicine is appropriate. Your daughter was smart. You're dramatic

And if the daughter wasn't smart or had a learning disability or poor English?

GP's can't know every ingredient but it seems a gap that such a common allergen isn't flagged on the packet as it would be with food stuffs. I've just looked at some of my meds and two have nut oil in the process, none have the box with allergen advice that I'd look for on food stuffs. Maybe food style allergy labeling from the manufacturer makes more sense.

’it seems a gap that such a common allergen isn't flagged on the packet’

This ^ . It’s totally reasonable to talk to the practice manager. It doesn’t mean that it’s the GPs ‘fault’. It flags up that there’s a very commonly prescribed medication with peanut oil in so all the doctors and nurses may be reminded to ask about allergies. The practice may consider flagging the notes of those who use epi pens to prompt a check for allergens before prescribing and they could send out letters or texts to patients who use epi pens reminding them to always check the drug information leaflets for allergens and/or to let their chemist know their allergens so they can check the medication too.

It’s one of those situations where the consequences are so extreme that although you want as many checks as possible you would always want your DD to check for herself too. I can’t imagine the fear you live with over this. The fact that your DD did check should be a comfort that she’s actively protecting herself and didn’t take it for granted that it would be ok.

So as a result of this thread, I just queried my get prescription with the pharmacist who just said she didn't know if I should take it and suggested I ring the number on the drug info leaflet ( no reply).

I think this is a grey area. The info for my tablet online says peanut allergy sufferers should avoid taking it. The leaflet itself just states soyabean lecithin and that's it. I will be more vigilant with drugs in future though. I know I don't have allergies to say penicillin or anything so I've never thought about food allergy and drugs...though I know the casing can be an issue for those with shellfish allergy.

The manufacturer needs to have a full list of ingredients on the box and wn allergy alert, they can do this on food products so why not medication. Many meds contain gluten which some people just wont take. May e gp or pharmacy should complete yellow cards for near misses and highlight this as an issue with the manufacturers. This is the sort of thing the media can highlight that leads to a positive outcome.

@Mumteedum I think it’s because some peanut allergic people can also be allergic to soya or there’s a risk since they are both legumes? I’m allergic to tree nuts so not relevant for me but GP prescribed different HRT anyway.

Hope you get an answer. Like you, I’ve never thought about checking medicine ingredients for nuts. Will do in future!

This is a useful thread!

I agree you should flag it with the PM, but not as a complaint.

A lot of meds contain lactose