Review questions below with patient and call ASP team afterwards
Who told you that you have a pencillin allergy (more than one may apply)?
Parents or relatives
I don't know
No one told me
I know I have an allergy
Have you ever had a penicillin allergy skin test?
Yes => Go to #3
No => Go to #4
If YES to #2, the test result was:
When did you last receive penicillin?
> 10 years ago
1-10 years ago
Days to months ago
When was your last allergic reaction to pencillin?
What was the nature of your reaction to penicillin?
Anaphylactic reaction (BP problems, difficulty breathing, tongue/lip swelling)
How quickly did the reaction develop after the penicillin was taken?
Minutes to hours
Hours to days
More than 1 week
Have you ever been diagnosed with Stevens Johnsons syndrome or toxic epidermal necrolysis related to penicillin?
(Prompt for clarification: skin peels off; involvement of mouth, anus, eyes; requires hospitalization or ICU stay)
Call ASP Team: Monday to Friday 8am - 5pm
Call ASP Pharmacist
Call ASP Physician