Allergy History Form

The Allergy History Form is a dedicated template for thorough documentation of all patient allergies and hypersensitivity reactions. It categorizes allergies into four domains: drug allergies (antibiotics, NSAIDs, opioids, anesthetics, contrast agents), food allergies (nuts, shellfish, dairy, gluten, soy), environmental allergies (pollen, dust mites, mold, animal dander, insect venom), and contact allergens (latex, adhesives, nickel, fragrances). Each allergy entry captures the specific allergen, reaction type, severity grading, age of onset, and whether the reaction has been confirmed by testing.

Accurate allergy documentation is one of the most critical patient safety measures in clinical practice. Drug allergy misinformation leads to unnecessary antibiotic avoidance, suboptimal prescribing decisions, and increased healthcare costs. This form distinguishes between true IgE-mediated allergies, drug intolerances, adverse drug reactions, and drug sensitivities -- a distinction that many general intake forms fail to make but that has significant clinical implications.

The template includes sections for allergy testing results (skin prick, intradermal, serum IgE, patch testing), current immunotherapy or desensitization protocols, emergency action plans for anaphylaxis-prone patients, and epinephrine auto-injector prescriptions. It is used by allergy and immunology practices, primary care clinics, emergency departments, and any practice where prescribing safety depends on accurate allergy records.