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1.2 Anaphylaxis medications should be available 1.2.1 Epinephrine 0.2-0.5 mg IM or SC Q5 minutes as needed 18.104.22.168 Pediatrics: 0.01 mg/kg (maximum 0.3mg) 1.2.2 Diphenhydramine 25-50 mg IV 22.214.171.124 Pediatrics: 1-2 mg/kg 1.2.3 Albuterol 2.5-5 mg nebulized F. Patient Interview 1.0 Potential questions to ask a patient/family member when investigating a medication allergy include:6 1.1 Patientâs age at the time of the reaction 1.2 Patientâs recall of the reaction or who informed them of it 1.3 Time of onset of the reaction after beginning the penicillin (e.g., after 1 dose or several days) 1.4 Signs/symptoms of the reaction 1.4.1 Was an antidote given 1.4.2 Did it require a visit to emergency room 1.4.3 Was there a loss of consciousness 1.5 Route of administration (oral or IV) 1.6 Indication for penicillin (or cephalosporin) 1.7 Concurrent medications 1.8 Did the reaction abate after the penicillin (or cephalosporin) was discontinued 1.9 Had the patient taken other penicillins (or cephalosporins) before or after the reaction 1.9.1 If yes, what was the outcome References 1. Solensky R, Earl H, Gruchalla RS. Clinical approach to penicillin-allergic patients: a survey. Ann Allergy Asthma Immunol 2000;84:329-33. 2. Solensky R. Drug desensitization. Immunol Allergy Clin N Am 2004;24:425-43. 3. Park MA, Li JTC. Diagnosis and management of penicillin allergy. Mayo Clin Proc 2005;80:405-10. 4. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendations for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 2005;115:1048-57. 5. Gruchalla RS, Pirmohamed M. Antibiotic allergy. NEJM 2006;354:601-9. 6. Salkind AR, Cuddy PG, Foxworth JW. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy. JAMA 2001;285:2498505. 7. Bernstein IL, et al. Executive summary of disease management of drug hypersensitivity: a practice parameter. Ann Allergy Asthma Immunol 1999;83:665700. 8. Puchner TC, Zacharisen MC. A survey of antibiotic prescribing and knowledge of penicillin allergy. Ann Allergy Asthma Immunol 2002;88:24-9. 9. Gallelli JF, Calis KA. Penicillin allergy and cephalosporin cross-reactivity. Hosp Pharm 1992;27:540-1. 10. Grabenstein JD. Predicting allergy to penicillin: a decision makerâs dilemma. Hosp Pharm 1993;28:1020-5. 11. Robinson JL, Hameed T, Carr S. Practical aspects of choosing an antibiotic for patients with a reported allergy to an antibiotic. CID 2002:35:26-31. 12. MacLaughlin EJ, et al. Cost of beta-lactam allergies. Arch Fam Med 2000;9:722-6. 13. Sade K, et al. The economic burden of antibiotic treatment of penicillin-allergic patients in internal medicine wards of a general tertiary care hospital. Clin Exp Allergy 2003;33:501-6.