Penicillin Drug Allergy Clinical Pathway — All Settings

History and Physical

Allergy to PCN is the most common reported drug allergy and it is the leading cause of drug induced anaphylaxis. However, only 10% of patients labeled as having PCN allergy truly have an allergy; these patients are at risk of being exposed to broad spectrum antibiotics.

A careful clinical history can sometimes exclude the diagnosis of PCN allergy. This can be challenging as symptoms of drug allergy can overlap with those due to routine viral illness. Thus, referral to an allergist for evaluation and possible skin testing may benefit the patient.

History	Drug, Exposure, Indications, Timing What penicillin drug was associated with the reaction Dose, route, and indications for taking the medication Were there any symptoms c/w a viral illness at the time Previous exposure to same drug Any other concurrent medications, new or not Timing of reaction onset From initiation of the drug From last dose Age at the time of the reaction
	Symptoms, duration of symptoms, especially rash Gnl Anxiety, sense of impending doom Skin Urticaria, hives Bullae, desquamation, etc. Fixed vs. migratory Pruritic vs. non-pruritic Angioedema ENT, Mouth Mucosal involvement (ocular, oral) Angioedema Peri-orbital, lip, tongue, uvula Itching, tingling Throat Itching, tingling, dysphagia Change in Voice Respiratory Dyspnea, tachypnea, stridor, wheeze, cough CV Dizzy, light-headed, syncope Tachycardia, hypotension GI Nausea, vomiting, diarrhea Abdominal pain Musculoskeletal Arthralgias, arthritis
	Evaluation, if performed CBC: Eosinophilia, atypical lymphocytosis CMP: Hepatitis
	Treatment, treatment duration Antihistamines Steroids Epinephrine
	Family History PCN or other drug allergy
	Previous Exposure Symptoms with previous exposure
Physical	VS, General exam

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Penicillin Drug Allergy Clinical Pathway — All Settings

History and Physical

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Penicillin Drug Allergy — History and Physical — Clinical Pathway: Inpatient, Outpatient Specialty Care, Primary Care

Penicillin Drug Allergy Clinical Pathway — All Settings

History and Physical