What penicillin antibiotic is the patient allergic to?
What other penicillin antibiotic is the patient allergic to?
Does the pt have an allergy to a cephalosporin?
Examples:
Cephalexin (Keflex) Cefuroxime (Ceftin) Cefpodoxime (Vantin) Cefdinir (Omnicef) Cefixime (Suprax) Ceftriaxone (Rocephin)
Yes
No
What reaction did the patient have to the cephalosporin?
STOP
You chose none of the above AND another option ([cheph_rx]). Please modify your choice.
Since the initial reaction to the penicillin, has the patient taken any of the following antibiotics WITHOUT having a reaction?
What other penicillin antibiotic did the patient take?
STOP
You chose none of the above AND another option (______ ). Please modify your choice.
OK to use full dose:
penicillin, dicloxacillin, nafcillin, oxacillin, etc
Avoid other penicillins
Please proceed with the rest of the app
OK to use full dose: amoxicillin (Amoxil), amoxicillin/clavulanate (Augmentin), ampicillin, and/or ampicillin/sulbactam (Unasyn)
penicillin, dicloxacillin, nafcillin, oxacillin, etc
Avoid other penicillins
Please proceed with the rest of the app
Patient reported tolerating ______ after the previously reported allergic reaction to ______ . They have demonstrated that they can safely take ______ .
Because the patient tolerated a penicillin antibiotic, this rules out hypersensitivity to the beta lactam ring. OK to use full dose of penicillin, dicloxacillin, nafcillin, oxacillin.
Because some penicillin antibiotics have side groups that can cause hypersensitivity reactions independent of the beta lactam ring, and the patient has not demonstrated tolerance of one of those antibiotics, additional evaluation is necessary.
UW Medicine Antimicrobial Stewardship and Allergy recommend prescribing the narrowest appropriate antibiotic for the shortest appropriate duration.
Please update penicillin allergy in the EMR to reflect which penicillins they have tolerated.
Patient reported tolerating ______ after the previously reported allergic reaction to ______ . They have demonstrated that they can safely take ______ .
Because the patient tolerated an antibiotic capable of causing hypersensitivity reaction either due to beta lactam ring or due to a side group found in several other antibiotics, it is OK to use most other penicillin antibiotics including penicillin, dicloxacillin, nafcillin, oxacillin, amoxicillin (Amoxil), amoxicillin/clavulanate (Augmentin), ampicillin, and/or ampicillin/sulbactam (Unasyn).
Because some reactions to piperacillin/tazobactam (Zosyn) is due to its unique side group not present in other penicillin antibiotics, additional evaluation is necessary.
UW Medicine Antimicrobial Stewardship and Allergy recommend prescribing the narrowest appropriate antibiotic for the shortest appropriate duration.
Please update penicillin allergy in the EMR to reflect which penicillins they have tolerated.
Does the patient remember what happened when they took the penicillin antibiotic they are allergic to?
Yes
No
Does the medical record list a penicillin antibiotic allergy which the patient denies?
Yes
No
Did the patient seek help from a healthcare provider for the reaction?
Yes
No
Do not recall
Was the unknown reaction:
more than 10 years ago
less than 10 years ago
do not recall
Did the patient have:(these are reactions that can include skin peeling when the rash is resolving) DRESS syndrome - drug reaction with eosinophilia and systemic symptoms SJS - Stevens-Johnson Syndrome TEN - toxic epidermal necrolysis AIN - acute interstitial nephritis serum sickness - fever, rash, arthritis
STOP
You chose none of the above AND another option (______ ). Please modify your choice.
Within 6 hours of taking the penicillin, did the patient have any of the following:
Anaphylaxis is defined as having 2 or more of the following
Please do not include delayed symptoms in this section (ie. symptoms that occurred > 6 hours after taking a dose)
Did the patient have a delayed rash, hives, or swelling (a reaction occuring more than 6 hours after the penicillin was taken)?
Yes
No
Had rash, hives, or swelling but do NOT recall timing
Was the reaction less than 5 years ago?
Recent IgE mediated reaction is defined as occuring less than 5 years ago
Yes
No
Do not recall
STOP
You chose none of the above AND another option (______ ). Please modify your choice.
Did the rash involve extensive sloughing off of skin or mucosal membranes (mouth, etc)?
Yes
No
Do not recall
Would the patient describe the rash, hives, or swelling as mild?
Yes
No
Do not recall
What other reactions did the patient have?
OK to use full dose: any penicillin
The penicillin allergy should be removed from the EMR.
This tool is not intended to assess cephalosporin allergies.
Refer to Allergy for drug allergy evaluation.
Additional information about beta-lactam allergies is available in OCCAM if interested.
This tool is cannot be used to evaluate penicillin allergy based on a history of a positive skin test alone.
Refer to Allergy for drug allergy evaluation.
Additional information about beta-lactam allergies is available in OCCAM if interested.
OK to use full dose: Cephalosporins Aztreonam Carbapenems Non beta-lactam antibiotics OK to administer after drug challenge*: Penicillins
*For drug challenge procedures, refer to Allergy.
OK to use full dose: Cephalosporin with different side chains (ex cefazolin, ceftriaxone, cefpodoxime) Carbepenems Aztreonam Non beta-lactam antibiotics
If a penicillin or a cephalosporin with similar side chain is indicated, consult Allergy for further assessment .
OK to use full dose: Non beta-lactam antibiotics AVOID: Penicillins Cephalosporins Carbapenems Aztreonam
Please update allergy label with the reaction history.
Refer to Allergy and/or Infectious Disease if a beta-lactam or aztreonam is indicated.
Patient had positive skin test without any known reaction to taking penicillin. A skin test does not diagnose an allergy, however further assessment is outside the scope of this app.
UW Medicine Antimicrobial Stewardship and Allergy recommend considering a referral to Allergy.
Patient had a reaction outside of hypersensitivity reactions included in this app.
UW Medicine Antimicrobial Stewardship and Allergy recommend considering a referral to Allergy regarding future use of beta-lactam antibiotics.
Patient reported history of a possible allergic reaction to cephalosporins. Cephalosporins have a variety of potential interactions which are more complex than can be evaluated with this tool.
UW Medicine Antimicrobial Stewardship and Allergy recommend reviewing the beta-lactam guidelines or considering a referral to Allergy.
Patient had ______ (an anaphylactic/severe IgE mediated reaction) after taking a penicillin in the past. Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction.
UW Medicine Antimicrobial Stewardship and Allergy recommend use of cephalosporins with dissimilar side chains with no additional assessment needed. This includes cefazolin. Please see beta lactam crosseactivity chart. If penicillins or cephalosporins with similar side chains are indicated, please consult Allergy.
For non-IgE mediated severe risk reactions to a cephalosporin (severe cutaneous reactions, see the Assessment of Penicillin Allergy algorithm, section in red), avoid other cephalosporins regardless of side chain similarity
Patient had ______ (an anaphylactic/severe IgE mediated reaction) after taking a penicillin in the past. Hypotension is severe enough to treat as anaphylaxis.
Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction.
UW Medicine Antimicrobial Stewardship and Allergy recommend use of cephalosporins with dissimilar side chains with no additional assessment needed. This includes cefazolin. Please see beta lactam crosseactivity chart. If penicillins or cephalosporins with similar side chains are indicated, please consult Allergy.
For non-IgE mediated severe risk reactions to a cephalosporin (severe cutaneous reactions, see the Assessment of Penicillin Allergy algorithm, section in red), avoid other cephalosporins regardless of side chain similarity
The patient had a reaction without any features concerning for an anaphylactic or recent severe IgE mediated reaction.
Multiple studies have shown that patients with this type of reaction can tolerate penicillins, and this can be assessed with a drug challenge procedure. Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction.
UW Medicine Antimicrobial Stewardship and Allergy recommend assessing tolerance of penicillins with a test dose procedure. Other beta-lactam antibiotics can be safely given without further assessment.
Patient had ______ (a mild, nonallergic reaction) after taking penicillin in the past.
UW Medicine Antimicrobial Stewardship and Allergy recommend prescribing the narrowest appropriate antibiotic for the shortest appropriate duration.
Patient has a history of ______ after taking a penicillin. This is considered a severe risk, potentially life threatening reaction.
UW Medicine Antimicrobial Stewardship and Allergy recommend avoiding all beta-lactam antibiotics.
If a beta-lactam or aztreonam is indicated consult ID and Allergy.
Patient does not recall their reaction to penicillin but needed treatment by a healthcare provider for the reaction.
Multiple studies have shown that patients with an unknown, remote (>10 years ago) history of a penicillin allergy, for which they did NOT seek medical care, can safely take cephalosporin and carbapenem antibiotics.
However, since this patient sought medical care, UW Medicine Antimicrobial Stewardship and Allergy recommend being more cautious in this situation.
Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction. Please see beta lactam crosseactivity chart. If penicillin or cephalosporin with similar side chain is indicted, please consult Allergy.
Patient does not recall their reaction to penicillin and it was less than 10 yrs ago.
Multiple studies have shown that patients with an unknown, remote (>10 years ago) history of a penicillin allergy, for which they did NOT seek medical care, can safely take cephalosporin and carbepenem antibiotics.
However, since this patient had a reaction less than 10 yrs ago, UW Medicine Antimicrobial Stewardship and Allergy recommend being more cautious in this situation.
Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction. Please see beta lactam crosseactivity chart. If penicillin or cephalosporin with similar side chain is indicted, please consult Allergy.
The EMR has a penicillin allergy label but the patient denies it. UW Medicine Antimicrobial Stewardship and Allergy recommend assessment with an amoxicillin drug challenge. Cephalosporins and carbapenems can be safely given.
Patient does not recall their reaction to penicillin and does not remember seeking treatment by a healthcare provider for the reaction.
Multiple studies have shown that patients with an unknown, remote history (>10 yrs ago) of a penicillin allergy, for which they did NOT seek medical care, can safely take cephalosporin and carbepenem antibiotics.
UW Medicine Antimicrobial Stewardship and Allergy recommend assessing tolerance of penicillins with a drug challenge procedure. Other beta-lactam antibiotics can be safely given without further assessment. For test dose procedure please refer to Allergy.
Patient reported taking ______ after the previously reported allergic reaction to ______ . Therefore, the patient has demonstrated not having an allergy to a penicillin.
Please remove the penicillin allergy label from the EMR
Patient reported tolerating ______ after the previously reported allergic reaction to ______ . They have demonstrated that they can safely take ______ .
Some penicillin antibiotics have side groups that can cause hypersensitivity reactions independent of beta lactam ring. Because reactions to the side groups are very rare, and because those side groups are similar, most patients who tolerated piperacillin/tazobactam (Zosyn) will tolerate all other penicillins.
UW Medicine Antimicrobial Stewardship and Allergy recommend to remove penicillin allergy label if patient tolerated piperacillin/tazobactam (Zosyn).
Please remove penicillin allergy label from the EMR
Patient had sloughing off of skin or mucosal membranes which is concerning for a severe, potentially life threatening reaction, like SJS/TEN.
UW Medicine Antimicrobial Stewardship and Allergy recommend avoiding all beta-lactam antibiotics.
If a beta-lactam is indicated consult ID and Allergy.
This patient had a delayed rash of unspecified severity. Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction. Please see beta lactam crosseactivity chart. If penicillins or cephalosporins with similar side chains are indicated, please consult Allergy. UW Medicine Antimicrobial Stewardship and Allergy recommend use of cephalosporins with dissimilar side chains with no additional assessment needed. This includes cefazolin. If penicillins or cephalosporins with similar side chains are indicated, please consult Allergy. For non-IgE mediated severe risk reactions to a cephalosporin (severe cutaneous reactions, see the Assessment of Penicillin Allergy algorithm, section in red), avoid other cephalosporins regardless of side chain similarity
Patient had a mild rash after taking penicillin in the past.
Multiple studies have shown that patients with this type of reaction can tolerate penicillins, and this can be assessed with a drug challenge procedure. Because cross-reactivity between penicillins and cephalosporins relates to their specific side chains and not the beta lactam ring, cephalosporins with side chains different from those in the culprit penicillin can be safely given in patients with this type of reaction.
UW Medicine Antimicrobial Stewardship and Allergy recommend assessing tolerance of penicillins with a test dose procedure. Other beta-lactam antibiotics can be safely given without further assessment.
For test dose procedure refer to allergy.
In which clinic/facility/hospital is the patient being evaluated?
Optional
Hall Health
Sexual Health Clinic
Outpatient HMC
Inpatient UWMC-Montlake
Inpatient UWMC-Northwest
Inpatient HMC
Other
What location are you at?
Does the patient consent to receiving surveys about their penicillin allergy history?Optional
Yes
No
Please enter the patient's email for surveys.
Today M-D-Y
Please update the allergy section of the EMR with your history and assessment.