Documentation of Drug Allergy

Red Flags Requiring Immediate Recognition and Documentation

The American Academy of Allergy, Asthma, and Immunology recommends documenting anaphylaxis criteria, including acute onset with skin/mucosal involvement and any of the following: respiratory compromise, reduced blood pressure or end-organ dysfunction, or severe gastrointestinal symptoms 1, 2
The British Society for Allergy and Clinical Immunology suggests documenting severe cutaneous adverse reactions, including Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis, Acute Generalized Exanthematous Pustulosis, and Drug Reaction with Eosinophilia and Systemic Symptoms 3, 4

The European Academy of Allergy and Clinical Immunology recommends recording the exact date when the first symptom or sign appeared, not just when the rash was noticed, to determine the index date 3, 5
The American College of Allergy, Asthma, and Immunology suggests documenting the timing of drug exposure, including the date of occurrence of the reaction, all drugs taken over the previous 2 months, and the date when each treatment was started or stopped 1, 2, 5

The World Allergy Organization recommends recording severe reactions, including anaphylaxis, Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis, and Acute Generalized Exanthematous Pustulosis, as high priority 1, 2, 6
The European Academy of Allergy and Clinical Immunology suggests recording non-severe reactions, including symptoms from a single organ system, as lower priority 1, 2, 4

The American Academy of Allergy, Asthma, and Immunology recommends documenting immediate laboratory studies, including full blood count with differential, erythrocyte sedimentation rate, and C-reactive protein, during an acute reaction 3, 4, 6
The British Society for Allergy and Clinical Immunology suggests documenting tissue diagnosis, including skin biopsy, to confirm the diagnosis of severe cutaneous adverse reactions 3, 9

The American College of Allergy, Asthma, and Immunology recommends documenting minimum required information, including specific symptoms, date of the reaction, concurrent medications, and relevant comorbidities, to ensure accurate diagnosis and treatment 5, 6, 8
The European Academy of Allergy and Clinical Immunology suggests documenting distinguishing true allergy from non-allergic reactions, including symptoms not compatible with allergic reaction and no temporal association between drug exposure and symptom onset 3, 4, 5

The World Allergy Organization recommends avoiding incomplete temporal documentation, confusing extent of erythema with extent of detachment, and missing cross-reactivity considerations to ensure accurate diagnosis and treatment 1, 2, 3, 4
The American Academy of Allergy, Asthma, and Immunology suggests avoiding failing to document negative findings, inadequate follow-up planning, and premature skin testing to ensure comprehensive care 1, 2, 3, 5, 6, 8, 9