Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Patient Questionnaire

Use the questions below to assess the likelihood of true penicillin or beta-lactam allergy

If assistance required, please contact your pharmacist.

Question 1

Who told you that you have a penicillin/beta–lactam allergy (more than one may apply)?

Question 2

What was the nature of your reaction to penicillin/beta-lactam?

High Risk

Lower Risk

Question 3

How quickly did the reaction develop after the penicillin/beta-lactam was taken?

Onset of IgE mediated (true allergic) reaction is usually less than an hour.

Question 4

When was your last allergic reaction to penicillin/beta-lactam?

Even among those with real documented penicillin allergy, hypersensitivity declines over time rendering the majority of patients (90%) non-allergic after 10 years

Question 5

When did you last receive penicillin/beta lactam?

Probe to determine if patient has safely received any beta-lactam since their last allergic reaction.

Question 6

Have you ever had a penicillin/beta-lactam allergy skin test?

Question 7

If "Yes" to Question 6, the test result was:

Question 8

If skin test was negative, was an oral challenge given?

Question 9

If "Yes" to Question 8, was the oral challenge tolerated?

Assessment complete

Refer to management algorithm for next steps