Table 2 Important clinical questions to clarify a beta-lactam adverse reaction history

1. When did the reaction occur?

2. Which medication was prescribed, and what was the route of administration?

3. What was the indication for the medication?

4. How many courses of this medication or a related medication have been administered?

5. How many doses were received prior to onset of reaction?

6. How soon after the most recent dose did the reaction occur?

7. Were there any concurrent medications administered?

8. What was the nature of the reaction? Specifically ask about:

 Raised, erythematous, pruritic rash with each lesion typically lasting less than 24 h? (hives/urticaria)

 Swelling of the tongue, mouth, lips, or eyes (angioedema)

 Respiratory or hemodynamic changes (anaphylaxis)

 Lesions or ulcers involving the mouth, lips, or eyes; skin desquamation (Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and other severe type IV reactions)

 Organ involvement such as hematologic, renal, or hepatic (cytopenias, Acute Interstitial Nephritis (AIN), transaminitis)

 Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, and other severe type IV reactions)

 Joint pain (serum-sickness like reaction)

 Rashes that were not hives, were mild, or delayed in onset (mild type IV reaction or morbilliform rash)

 Nausea, vomiting, diarrhea, minor laboratory abnormalities or local injection reactions

9. Was the medication stopped?

10. Was medical attention sought in an emergency room or from a community physician?

11. How was the reaction managed?

12. Were there symptoms of unexplained fever, arthritis/arthralgia, lymphadenopathy, skin exfoliation or mucous membrane involvement?

13. How long did symptoms last?

14. Were any symptoms consistent with a severe cutaneous adverse drug reaction (e.g., SJS, DRESS or AGEP)?

15. Has the same medication been taken subsequently? If yes, was there a reaction?