Q:

11/20/2012
Do you have any suggestions for how to explain/disclose to patients that they will undergo a SINGLE-BLINDED drug challenge? For example, there are patients who see me for evaluation for allergy to local anesthetics/preservatives, and some of these patients would be best evaluated by blinding the patient to what I am giving them during the subcutaneous-challenge phase of the evaluation. I would give a saline challenge first, then after two saline SC challenges, I would proceed to challenge with the anesthetic and/or preservative.

Do happen to have any documents/forms explaining this protocol to a patient, and if you do not, can you forward my request to an allergy office that does a lot of drug testing and does some blinded drug allergy evals?

If a patient, such as patient (who is an R.N) whom I need to evaluate, asks the nurse in my office, "What are you injected now?"-- I want the nurse to NOT tell her "Oh, this is saline", b/c of course that would mess up the challenge, and it would no longer be single-blinded. But, at the same time, I don't want the nurse to lie. I figure maybe the best strategy is to inform the pt. that it will be blinded, so the nurse is not "allowed" to tell the pt. what is in the syringe and therefore will not tell the pt. even if asked to do so by the patient. What do you think is the best strategy?

A:

Thank you for your inquiry.

There are published handouts to give to patients prior to drug challenge testing. I am aware of two such forms, both of which are quite extensive. The links below will take you to the forms, which you can use as is or adapt for your needs. One is from Australia and the other from England.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology