Drug Challenge in the Hospital
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ALERT: Call 9-1-1 if serious reactions happen after leaving the hospital!
• If penicillin was listed as an allergy but has low risk for a reaction.
• A caregiver stays with the patient for 1 hour after the dose.
• The nurse will check to see how the patient is doing with the medicine.
• If the patient has had a serious or life-threatening reaction to the drug in the past.
• When you are sick or have coughing, wheezing or breathing problems.
• If the patient is taking beta blocker medicines for high blood pressure, migraine headaches, or eye drops for glaucoma. Common names are: Propranolol, Metoprolol, Atenolol, Timolol or Betaxolol.
• If the patient is taking steroids or antihistamines for asthma or allergies. Common names are: prednisone, Benadryl® (diphenhydramine), Zyrtec® (cetirizine), Claritin© (loratadine), Allegra® (fexofenadine), Xyzal® (levocetirizine), Clarinex® (desloratadine), Vistaril®/Atarax® (hydroxyzine).
• Mild reactions: Rash, a few hives, eczema that gets worse, diarrhea, sneezing, stuffy nose, runny nose, a change in behavior or a headache.
• Serious reactions are very rare, but are very serious. They can lead to death if not treated. Tell the nurse right away if you have any of the following:
o Hives. Rash, swelling or itching of more than one part of the body.
o Swelling. Any part of the body, inside or out. This includes the mouth, tongue or throat. It can be one or many parts of the body.
o Breathing problems. Shortness of breath, coughing, wheezing or chest feeling tight.
o Other. Constant sneezing, feeling dizzy, stomach ache, throwing up, or just not “feeling right.”
o Anaphylactic shock is the most serious allergic reaction. It can be of any of the above symptoms and can be life threatening. It can happen in a few minutes or up to 24 hours after the medicine has been given. It is important to watch for this, but it is very rare.
• The patient should not use that medicine. They should talk with their doctor.
• If there is a serious or anaphylactic reaction, medicine will be given right away. The medicine is called epinephrine.
• The medicine can be used.
• The patient does not need to report it as an allergy anymore.
• The medicine will be taken off of the patient’s allergy list.
Watch for a delayed reaction. If there is a reaction at home:
• Contact your primary doctor.
• Go to the emergency room if serious reaction.
• The patient will still need to avoid it.
What is an oral drug challenge?
This is done to see if the patient can take a medicine that may have caused a reaction in the past.When is a drug challenge done?
• When medicine is needed for treatment.• If penicillin was listed as an allergy but has low risk for a reaction.
What happens during a drug challenge?
• The patient takes one dose of the medicine.• A caregiver stays with the patient for 1 hour after the dose.
• The nurse will check to see how the patient is doing with the medicine.
Who should not have a drug challenge?
A drug challenge should not be done:• If the patient has had a serious or life-threatening reaction to the drug in the past.
• When you are sick or have coughing, wheezing or breathing problems.
• If the patient is taking beta blocker medicines for high blood pressure, migraine headaches, or eye drops for glaucoma. Common names are: Propranolol, Metoprolol, Atenolol, Timolol or Betaxolol.
• If the patient is taking steroids or antihistamines for asthma or allergies. Common names are: prednisone, Benadryl® (diphenhydramine), Zyrtec® (cetirizine), Claritin© (loratadine), Allegra® (fexofenadine), Xyzal® (levocetirizine), Clarinex® (desloratadine), Vistaril®/Atarax® (hydroxyzine).
What reactions are possible?
Risks are rare but may include:• Mild reactions: Rash, a few hives, eczema that gets worse, diarrhea, sneezing, stuffy nose, runny nose, a change in behavior or a headache.
• Serious reactions are very rare, but are very serious. They can lead to death if not treated. Tell the nurse right away if you have any of the following:
o Hives. Rash, swelling or itching of more than one part of the body.
o Swelling. Any part of the body, inside or out. This includes the mouth, tongue or throat. It can be one or many parts of the body.
o Breathing problems. Shortness of breath, coughing, wheezing or chest feeling tight.
o Other. Constant sneezing, feeling dizzy, stomach ache, throwing up, or just not “feeling right.”
o Anaphylactic shock is the most serious allergic reaction. It can be of any of the above symptoms and can be life threatening. It can happen in a few minutes or up to 24 hours after the medicine has been given. It is important to watch for this, but it is very rare.
What happens if a reaction happens?
• The patient will be treated for the reaction.• The patient should not use that medicine. They should talk with their doctor.
• If there is a serious or anaphylactic reaction, medicine will be given right away. The medicine is called epinephrine.
What happens after a drug challenge?
If there is no reaction during the challenge:• The medicine can be used.
• The patient does not need to report it as an allergy anymore.
• The medicine will be taken off of the patient’s allergy list.
Watch for a delayed reaction. If there is a reaction at home:
• Contact your primary doctor.
• Go to the emergency room if serious reaction.
• The patient will still need to avoid it.
Draft Number: 1882Revision Date: January 1, 2024
This content was created to help you care for your child and/or family member. It does not take the place of medical care. Talk with your healthcare provider for diagnosis, treatment and follow-up.