Allergy Action Plan

## Allergy Action Form **Patient Name:** John Smith **Date:** 1 November 2024 **Date of Birth:** 12/03/1988 **Allergen:** Peanuts **Severity of Reaction:** Severe **Signs and Symptoms:** * Hives * Swelling of the lips and tongue * Difficulty breathing * Wheezing * Vomiting **Action Plan:** 1. **Mild Symptoms:** * Administer antihistamine (e.g., Benadryl) - Dosage: 25mg * Observe for worsening symptoms. 2. **Moderate Symptoms:** * Administer antihistamine (e.g., Benadryl) - Dosage: 25mg * Administer epinephrine auto-injector (e.g., EpiPen) - Dosage: 0.3mg (if prescribed). * Call emergency services (999). 3. **Severe Symptoms (Anaphylaxis):** * Administer epinephrine auto-injector (e.g., EpiPen) - Dosage: 0.3mg. * Call emergency services (999) immediately. * Position the patient flat or in a position of comfort. * Administer oxygen if available. * Monitor vital signs (pulse, breathing). **Medications:** * Antihistamine (e.g., Benadryl) - Dosage: 25mg, Route: Oral * Epinephrine auto-injector (e.g., EpiPen) - Dosage: 0.3mg, Route: Intramuscular **Emergency Contact Information:** * **Name:** Jane Smith * **Relationship:** Wife * **Phone:** 07700 900000 **Physician Signature:** Dr. Emily Carter **Date:** 1 November 2024