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Anaphylaxis medications should be available
1.2.1 Epinephrine 0.2-0.5 mg IM or SC Q5 minutes as needed Pediatrics: 0.01 mg/kg (maximum 0.3mg)
1.2.2 Diphenhydramine 25-50 mg IV Pediatrics: 1-2 mg/kg
1.2.3 Albuterol 2.5-5 mg nebulized
F. Patient Interview
Potential questions to ask a patient/family member when investigating a medication
allergy include:6
Patient’s age at the time of the reaction
Patient’s recall of the reaction or who informed them of it
Time of onset of the reaction after beginning the penicillin (e.g., after 1 dose or
several days)
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
Route of administration (oral or IV)
Indication for penicillin (or cephalosporin)
Concurrent medications
Did the reaction abate after the penicillin (or cephalosporin) was discontinued
Had the patient taken other penicillins (or cephalosporins) before or after the
1.9.1 If yes, what was the outcome
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
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 maker’s 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