Drug challenge in the hospital (1882)

Key points below

ALERT:  Call 9-1-1 if serious reactions happen after leaving the hospital!

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.  


Discuss with your child’s doctor or nurse if you have any questions or concerns or if your child has special health care needs that were not covered by this information.