Oral Penicillin Challenge

Introduction

Dear Dr. [Referring Doctor's Last Name], I had the pleasure of seeing [insert patient's name] on [insert date] in the allergy clinic for diagnostic testing with amoxicillin.

Problem List

[insert the following text: Adverse Reaction to ______:] [Provide a detailed narrative of the patient's presenting symptoms, including onset, duration, frequency, severity, and any associated symptoms. Include any relevant past medical history, treatments tried, and their effectiveness. Mention any known triggers or lack thereof, any specialists previously consulted] [Insert the following text: There is some concern for an immediate allergy, and therefore we will proceed with intradermal testing and possibly a challenge for diagnostic clarification. The history is not concerning for immediate or delayed life-threatening allergy, and so we will proceed with an oral challenge for diagnostic clarification.]

Interval History

[insert the following text: There are no coughs, fever or new rashes today. The patient is/not taking a beta-blocker medication. There are no absolute contraindications to an oral challenge today.]

Past Medical History

[List the patient's past medical conditions.](list the medical history and number them) For example: 1. [Condition 1] 2. [Condition 2] 3. [Condition 3]

Medications

[List the patient's current medications and their dosages.] (list medication, include dosage and number them) For example: 1. [Medication 1] [Dosage] 2. [Medication 2] [Dosage]

Physical Exam

[Insert the following text: BP: [insert BP], HR: [insert HR] BPM There is no conjunctivitis. The oropharynx is healthy. The respiratory examination is clear and there is no clubbing. Heart sounds are normal and peripheral pulses are palpable and equal. The abdomen is non-tender. There are no rashes. The examination at discharge was unchanged from baseline.]

Social History

[Provide details about the patient's lifestyle, including smoking, alcohol use, occupation, and any relevant social factors.]

Environmental History

[Describe the patient's living environment, including details about their home, heating, presence of pets, and how often they wash bedding.]

Investigation

[insert the following text: The risks and benefits of the procedure were explained, and written informed consent was obtained.]

Challenge

[insert the following text: Drug: Time: Dose: Vitals (see initial examination) Summary: [insert the patients name] received a dose of amoxicillin . [He/she/they] [was/were] observed for 1 hour following the dose. No IgE-mediated symptoms were observed.]

Impression and Plan

[Insert the following text: No current evidence for allergy to penicillins: The history of a remote rash was not concerning for life-threatening immediate or delayed type allergies. He tolerated an oral challenge today, definitively ruling out IgE-mediated allergy to this class of medications. The patient will contact the clinic if they notice any delayed reactions, such as rash. I noted that there is a 5-10% recurrence rate for delayed rashes with amoxicillin; providing there are no signs or symptoms concerning for life-threatening delayed forms of drug allergy (SJS/TEN, DRESS, serum sickness, etc.), this is not a contraindication to subsequent courses. I will submit a form to PharmaNet to remove this label from the provincial record. [Patient Full Name] can have this medication in the future if clinically indicated. We reviewed signs and symptoms of immediate (hives, swelling, problems breathing, vomiting, lethargy) and delayed (desquamation, mucus membrane involvement, fevers) reactions that should prompt discontinuation of a medication, presentation to a health care provider, and a later return to our clinic for review.

Impression and Plan

[Insert the following text: No current evidence for allergy to penicillins: The history of a remote rash was not concerning for life-threatening immediate or delayed type allergies. He tolerated an oral challenge today, definitively ruling out IgE-mediated allergy to this class of medications. The patient will contact the clinic if they notice any delayed reactions, such as rash. I noted that there is a 5-10% recurrence rate for delayed rashes with amoxicillin; providing there are no signs or symptoms concerning for life-threatening delayed forms of drug allergy (SJS/TEN, DRESS, serum sickness, etc.), this is not a contraindication to subsequent courses. I will submit a form to PharmaNet to remove this label from the provincial record. [Patient Full Name] can have this medication in the future if clinically indicated. We reviewed signs and symptoms of immediate (hives, swelling, problems breathing, vomiting, lethargy) and delayed (desquamation, mucus membrane involvement, fevers) reactions that should prompt discontinuation of a medication, presentation to a health care provider, and a later return to our clinic for review.

Follow-up

[Insert the following text: I did not make formal arrangements, but would be happy to see this patient again if any new concerns arise.]

Closure

I appreciate the opportunity to participate in [Patient First Name]'s care, and I hope my suggestions are helpful. If any questions arise, please feel free to contact my office.