Drug:
Route: PO IV SC topical
Prior exposure? Reaction before? Had it since?
Most recent rx?
Sx: wheeze, SOB, rash, angioedema, GI, cardiovascular
Rash - desquam, location, itch,
Timing after exposure:
Duration:
Treatment: hospital, epi, antihist, etc
Other exposures: (ie other drugs, herbals, bites)
Cofactors: alcohol, exercise, nsaids, infection, poor sleep

Impression:

ix:
PEN-FAST score
?histamine / tryptase
Skin test - only penicillin, rest not great
if currently in a Type 4 rx, order markers of end organ damage

Mx:
is it true?
avoid? challenge? desensitizie?

Summary:

WIP

section for other drugs until another page is made:

iron reactions

Mechanisms: IgE (fairly rare), direct mast cell activation, Fishbane reaction (usually consist of acute chest and back tightness and joint pain without severe symptoms, such as hypotension, wheezing, stridor, or laryngeal edema) Testing: no skin tests are reliable in this case. Only an IV challenge is helpful. Management:

1. if direct mast cell => usually try another agent and go very slow
2. if Fishbane, can stop infusion for 15 mins and observe and treat with Tylenol; if improves can run slower

NSAID

generally NSAID induced AAE occurs within 2-3 hours of NSAID ingestion

Ddx is true IgE mediated vs pharmcologic class effect

-Isolated urticaria within 2 hours of NSAID ingestion on repeated exposures is consistent with NSAID induced urticaria which is a cyclo-oxygenase -1 (COX-1) mediated reaction (pharmacologic class effect).
-Consider challenge with celebrex whcih is a cox-2 selective
-As such, we have advised to continue to avoid all NSAIDs moving forward as at higher doses they may cause repeated urticaria. 
-They can continue to take tylenol without issue. 
-Should he require NSAIDs in the future (beyond topical and low doses which can be administered without issue) he can be re-assessed with a supervised challenge

The patient does not have a history of asthma or nasal polyps
The patient does not have a history of chronic urticaria
Their reaction is most in keeping with COX-1 mediated