Algorithm to identify patients at low risk

for penicillin/beta-lactam allergy

 

Our next set of questions is to determine which of the following 3 groups this patient falls into:

 

1) Acute Symptoms:

 Onset: 2 h or less after most recent dose was administered

AND

 One or more symptoms of:

  • Urticaria, angioedema

  • Wheeze, dyspnea,

  • throat tightness/swelling, voice change

  • Dizziness, syncope, hypotension

  • Vomiting/diarrhea

AND

 Duration of symptoms: Less than 24 h after discontinuing antibiotic

2) Delayed symptoms

 Macular rash OR Maculopapular rash OR Urticaria

AND

 Onset: After 1st day of therapy or Over 2 h after most recent dose

AND

 Duration of symptoms: Longer than 24 h

AND

 None of the severe symptoms from the prior page of questions

3) I don’t know if it is acute or delayed because:

 There is no history OR

 There is a poor historian, or the individual providing the history did not see the rash OR

 Does not fit into acute or delayed symptom categories