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Exclusion Criteria for Observed Oral Dose

If patient or healthcare setting meet any of the exclusion criteria below, patient should be referred to Allergy Clinic for further evaluation.

  • Patient/family does not give permission
  • Patient is <12 months of age
  • Patient reaction was < 8 weeks ago
  • Patient is currently receiving another antibiotic
  • Patient with current asthma exacerbation or supplemental oxygen requirement beyond baseline
  • Patient with current symptoms of vomiting, diarrhea, rash, swelling, wheezing, or trouble breathing
  • Patients who have received an antihistamine within last 5 days
  • Patients who have received a systemic steroid (oral, IM, or IV) within the last 2 weeks
  • Patients with immunodeficiency or receiving immunosuppressive therapy
  • Patients who are pregnant (adolescents)
  • Patients with clinically significant heart disease
  • Emergency medications not available (epinephrine autoinjector, antihistamine, oxygen)
  • Inadequate nursing staff to monitor patient for 60 minutes after dose is given
  • Clinical staff not accustomed to treating anaphylaxis

Note some additional concomitant medications may mask symptoms of a reaction. If patient is currently taking any of the following they should be referred to Allergy Clinic for further evaluation:

  • Ace inhibitors (e.g., captopril, enalapril, lisinopril)
  • Atypical antidepressants/sedatives (e.g., buproprion, mirtazapine, quetiapine, tazodone, zolpidem)
  • Benzodiazepines (e.g., clonazepam, diazepam, lorazepam)
  • Beta blockers (e.g., atenolol, carvedilol, metroprolol, propranolol, sotalol)
  • Tricyclic antidepressants (e.g., amitriptyline, clomipramine, doxepin, imipramine, nortriptyline)

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

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Exclusion Criteria for Observed Oral Dose