Got first allergy shot, told later it was only saline???

I started allergy shots, and the doctor without me knowing it, gave me pure saline for the first allergy shot!

Then when I came in for the next shot, I was asked whether I'd had a reaction to the first shot.  I said I had felt kind of hazy afterwards (but there were other things going on that also make me feel hazy).  

Then the doctor told me that the first allergy shot is plain saline, they want to see if the patient will have a reaction anyway.  He said something about not wanting to treat people if it's a psychological issue (although I did have positive allergy tests).  

Is this considered ethical, and have you heard of an allergist doing this?

It bothers me, because I'm in a crisis situation because of allergies, I desperately need to get desensitization - NOT shots of saline!  And I took the time to ride my bike there and back - for a shot of saline.  AND I'm sure he will bill me for the shot of saline.  

People do get a "nocebo" effect when they believe they've been given something they expect an subjective adverse reaction to, like having a headache or feeling tired.  

This does NOT mean that subjective adverse reactions (like a headache or feeling tired) are "all in the head".  It does suggest that part of the subjective adverse reaction may come from one's expectation.

So him doing this seems pointless.  He should expect that if someone gets an allergy shot, and allergy shots made them feel bad in the past, they're likely to feel (somewhat) bad even if it's just saline. 

And, I'm the one who has to decide if an allergy shot makes me feel too sick to raise the dose.  It's not a dangerous reaction.  Even if feeling bad after the shot is partly "in my head", I have to go by that feeling.  

Also, he deceived me in doing this.  How am I supposed to believe what this doctor says, since he deceived me?  Perhaps he has other problems with being truthful.

I'll probably talk to the doctor about it, but I doubt it will help.  I should find another allergist but it's difficult around here. 

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I guess every profession has got tests etc. you don't talk about immediately. You can feel cheated, Luara, but you can also feel protected.

They do have to screen people for dangerous systemic reactions to allergy shots, like breathing difficulties. 

But if someone had breathing difficulties after a saline injection - what does it help to know that they can generate those breathing difficulties mentally? 

If that person later has breathing difficulties after a real allergy shot, they would still have to reduce the dose (or whatever they do) simply for the sake of caution - because it could still be a dangerous systemic reaction.  So I don't know what a fake allergy shot accomplishes. 

This scenario is possible - I've heard that asthma can be psychologically influenced.  

There's an ethical way of doing what he did, that would also be a better-designed experiment.  That would be to tell the patient "One of your first five allergy shots is going to be a placebo" before starting the allergy shots.

Knowing the situation ahead of time makes all the difference - one could discuss why the doctor wants to do this, and either accept it or not. 

It would also be better-designed, because if you know you might be getting a placebo, there will be less inclination to attribute anything negative to the allergy shot, or to have a purely mental reaction. 

It's actually very easy to fake someone into experiencing an adverse reaction.
In one study 

More than two-thirds of an unselected sample of 34 college students reported mild headaches when told that a (nonexistent) electric current was passing through their heads.

So if they were to exclude everyone who can be faked into experiencing an adverse reaction, they would likely be excluding the majority of their allergy patients!

I did actually have a reason to feel hazy.  I've been trying to desensitize my delayed food allergies with small amounts of the food, and I usually feel hazy, somewhat out of it, about 4-5 hours after eating the food.  I just thought the hazy feeling was likely coming from the (fake) allergy shot. 

All of this might be true. However im sure that your going to be charged outrageously for salt water. 

im sure that your going to be charged outrageously for salt water.

Not really, I was told their office visit for allergy shots is only $39. What bothers me more is that he's borrowing the blind challenge technique from research - but distorting it and overinterpreting it.

Distorting it by not telling people they might be getting a nocebo (negative placebo), and by not excluding people who are otherwise sick. 

Overinterpreting it because he seems to think this indicates people are "making up" a reaction if they can be suggested into something like it.  Just because people can be suggested into mild headaches, doesn't mean that mild headaches are all psychological. 

Sometimes I think I might have been exposed to an allergen, but I don't know for sure.  Like yesterday when I was checking my food for mold and found something that was maybe mold.  Since my allergic reactions can take 4-5 hours to come on, I keep asking myself in the few hours afterwards, if I'm starting to feel worse.

I do tend to feel a bit hazy in those few hours, even if it turns out to be OK.  But as I forget about my negative expectations, the somewhat-hazy feeling dissipates and I feel OK.  My actual allergic reactions last several days, and when I haven't actually been exposed, I don't create the whole allergic reaction experience for myself. 

It's easy to make too much of the suggestibility effect.  I read a paper in which the researchers investigated people who reported food hypersensitivities (food allergies with negative testing for classical food allergy).  They did double-blind placebo-controlled food challenges on them, and only a few of them passed. 

But when they used ultrasound to watch the reaction in their small intestine after eating the food they said they were allergic to, many more of those people had a response similar to people who were known to be allergic. 

This suggests that when someone fails a DBPCFC, it is not good evidence that they don't really have a food hypersensitivity.  The converse - if their allergy is confirmed by DBPCFC, they DO really have a food hypersensitivity - is true. 

Probably the reason why some people would fail a DBPCFC even when they have a real food hypersensitivity, is that they were trained into a reaction and had anxiety about the test that tended to generate their symptoms. 

And I think this doctor should obtain patients' consent before doing an experiment on them. 

Probably the reason why some people would fail a DBPCFC even when they have a real food hypersensitivity, is that they were trained into a reaction and had anxiety about the test that tended to generate their symptoms.

This actually brings up the question of whether things like multiple chemical sensitivity might be real reactions generated by the chemical, not just a purely psychological phenomenon.  MCS is generally considered to be psychological, since the double-blind challenges that have been done, haven't verified it. 

MCS is less plausible than food hypersensitivity, because reacting to very tiny traces of chemicals is unlikely.  Also because food hypersensitivities that don't show up with allergy testing, have been confirmed by double-blind challenges.

It probably makes a person who claims MCS anxious to be given a double-blind test, and maybe out of anxiety they would have symptoms even with the placebo. 

To be a real hypersensitivity to a chemical, it should be confirmable over time, though.  You might imagine a setup where someone was sent repeatedly sent vials with tiny traces of the chemical or plain air, and they decide which they think it was.  Over time their anxiety would wear off, and they could see if they really have that sensitivity or not.  It might save thousands of dollars for some of the MCS sufferers who have done extensive renovations, etc. to feel better. 

Luara, speaking as a fellow allergy-prone person, I can understand why you are frustrated. Medical personnel have pulled similar "tricks" on me too (including the saline ruse). Every time I go to a new doctor, I have to fight to convince them that I have true allergies, even though I've almost died twice from anaphylactic shock and I have the medical bills to prove it.

But remember - you know yourself, but they don't. You know that you are a reasonable and reality-based person. This is really quite rare in this world. There are a lot of non-reality based people out there, even very smart ones. We all have to deal with them, but medical professionals get more than their fair share. Even if this "test" is poorly designed, I'm sure this is one of the ways they try to sort them out.

I've learned it's best sometimes to simply play the game. You might be in the right, but if you like this doctor and that office staff, I'd just put up with it. Tell them you understand. Acting in that way will increase your reputation (with them) as an objective and reasonable person. Your main goal is to be treated, and that can still happen.

That being said, I'd still call around (anonymously) to other allergists or maybe the medical board of ethics and see if this is generally accepted practice. For all the reasons you state, it seems like a very poor way of determining somebody's legitimate condition.

Good luck my friend!

I've gotten allergy shots from two other allergy practices and this wasn't done - and I haven't heard of other allergists doing this. 

You would think with positive allergy tests they would believe me. 

All I wanted was a place to get allergy shots and Xolair shots that would be more safe with my awful dog allergy.  Getting allergy shots means going to the doctor once a week, and it's too likely that someone will walk in with a service dog or purse dog, and make me sick for days. 

I have an allergist in NYC who I don't think would do this kind of thing, but I can't travel to NYC every week for shots.  And his building has dogs living in it - it's in Manhattan and I guess the building doubles as living space.  So I get very sick when I see him. 

I was getting Xolair shots at my family doctor, but I did get sick one time because a dog had been there earlier.   I tried to get him to arrange things so any people with service dogs would be scheduled after me, but he didn't want to deal with the issue. He goes silent when there's something he doesn't want to deal with, and he did that this time and wasted a lot of time while I politely waiting for him to respond - and I need to get my dog allergy desensitized as soon as I can.  So I'm angry at that doctor as well. 

So then I sought out this allergist, thinking that an allergist's office would be more accommodating about my dog allergy (which they have). 

I wrote a letter to this allergist telling him why his "test" isn't good for anything, and also to never deceive me again.  It is not OK with me for personal reasons also, and I need to be able to trust any doctors I see.  So I'll give it to him next allergy shot and maybe talk about it with him then.  And ask him a few pointed questions, such as whether he knows of any other allergists who do this. 

It does seem "ethically challenged" because I'm paying for a service from him - allergy shots - and got something else.  Yes, what is usual practice means a lot in medicine. 

I can probably find another family doctor or internist to give me the shots, so I don't really need this guy. 

It's difficult when you have mostly subjective symptoms from allergy.  I've suffered a LOT of that fuzzy head from allergies.   It's ambiguous - it took me 20 years or so to suspect that it was allergies and go to an allergist. 

I read an article which explained how the late phase of allergic reactions could be so extremely sensitive.  For me the late phase reaction (several hours after being exposed) is far more sensitive than the immediate reaction.  They said there are IgE receptors on antigen presenting cells, and those receptors are very very good at binding with IgE/antigen complexes, so that a very tiny quantity can "maximally stimulate" the T cells.  So the late phase symptoms probably come from substances released by the T cells. 

Good luck my friend!

Thanks :)

There are a lot of non-reality based people out there, even very smart ones. We all have to deal with them, but medical professionals get more than their fair share.
But why would medical professionals get more than their fair share?  A lot of the complaints that are written off by doctors may be real, just not yet understood. 

For example, a researcher called Lidy Pelsser studied children with ADHD and found that for most of them, their ADHD symptoms got better on a hypoallergenic elimination diet.  Many parents have talked about the drastic improvements that eliminating certain foods can have on their children's behavior - and that talk has been dismissed as illusion by many.  But it seems there's truth in it. 

"A lot of the complaints that are written off by doctors may be real, just not yet understood."

Yes, I agree with this, and know about this personally. I grew up in a time when doctors thought menstrual cramps were "all in a woman's head." That was until more women became doctors and started doing some legitimate research. I also have an autistic son, which in the generation before me was chalked up to "refrigerator mother." Doctors thought autism, which now can be shown as brain abnormalities on scans, was purely the result of an emotionally cold mother. I even had some doctors tell me this in the 80's! Luckily I had the sense to ignore them as idiots.

So I'm not disregarding this. But I also know that there are a lot of people who seek medical attention for reasons other than a real, physically based, reactions. For example, one of my friends' sister suddenly announced she was allergic to peanuts. She has always tested negative for peanut allergy (she confesses) but she is still sure she has it. She's been to the ER at least 3x because she was sure she couldn't breathe, and that she must have gotten a peanut somewhere. The doctors could never confirm this, but they treated her anyway. This kind of thing happens so much that doctors and nurses can get a bit jaded. (My husband works in a hospital, and hears these kind of stories all the time.)

I really do believe that there are many more unreasonable and easily fooled people in our world, than there are reasonable people. I'd be willing to bet that professionals who are there to help those in distress, like cops and medical personnel, see many more fooled people that reality-based people. It is still no excuse to treat everyone like they are children, but it does explain the impulse to treat us that way - at least until they get to know us better.

I grew up in a time when doctors thought menstrual cramps were "all in a woman's head."

For a long time it was thought that when people said they couldn't think well during an allergic reaction, they were imagining it. Then research showed otherwise.
Also, it was thought that the "fuzzy head" from an allergic reaction was because people with allergies weren't able to sleep well.

This never made any sense to me, because if I'm exposed to an allergen in the early part of the day, the fuzzy-headed feeling (which I've come to loathe) comes on several hours later.  And I've had plenty of sleep. 

What bothers me a lot is when people don't know the cause of something, so they attribute it to the person's self-deception.  Especially if the person is a woman.  If they were honest they would say they don't know. 

When somebody says they DO know that someone else wrongly interprets their experience of their own body - and they don't actually know that - it's an "I'm right, you're wrong" message that involves egotism.  And when doctors say this kind of thing, maybe it comes from a doctor-God complex.  The allergist who gave me the fake allergy shot has a very boastful webpage. 

Yes, there is a huge amount of irrationality.  I'm not sure though, how common it is for someone to psych themselves into feeling bad when it really is purely psychological.  Because nobody knows!  For example, the cause of chronic fatigue syndrome is unknown. That's one problem that's terribly liable to the "just drink coffee" type of suggestions from doctors

She has always tested negative for peanut allergy (she confesses) but she is still sure she has it. She's been to the ER at least 3x because she was sure she couldn't breathe, and that she must have gotten a peanut somewhere.

It's possible to have allergies that don't show up on allergy tests, they are local in a particular organ. When it's in the nose, this is called "local allergic rhinitis".  There's a 2010 paper on local allergies, Entopy: local allergy paradigm which discusses the evidence for local allergy in "nonallergic" asthma.  If you would like to see the full text, I can send it to you. 

So it's possible that she does indeed have a peanut allergy.  If someone has "nonallergic" asthma that's really local allergic asthma, it would help them a lot to identify the triggers. 

Yes, ER's probably see a fair number of people who are there for non-medical reasons.  And a lot of people who are there for medical reasons but wouldn't be there if the rest of their life were going OK.  e.g. people who have harmed themselves somehow, etc.

Something slightly different:  A few years ago, outside a health food store, a woman started talking to me.  She was radiating fear.  She said she'd been bitten by a raccoon - lots of rabies around here.  She'd been to the ER but she was afraid to get the rabies vaccine, and left.  She was afraid she would have an allergic reaction to the vaccine - she told me she had celiac disease (gluten intolerance) and she'd had anaphylactic reactions, and doctors didn't know how to handle people like her, with celiac disease and extreme sensitivities.  She'd been using only herbal medicine for 10-20 years.  I talked with her a bit about celiac disease and allergies, told her the ER could handle an anaphylactic reaction to the vaccine.  She assured herself that she would be OK without the vaccine, she would just take the chance of getting rabies.  And the conversation ended there.

This freaked me out later - that someone would take the risk of a gruesome death, that she would be so alienated from mainstream medicine that she wouldn't use it even in an emergency!   A modern werewolf. 

She was perhaps harmed by doctors' tendency to tell someone with not well understood problems that they're imagining things.  I met many people with celiac disease or food hypersensitivities who were bitter and alienated from doctors. 




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