Allergy and Reaction Record

Who this is for

Your own record of what you react to. The first table lists each substance with what happened, when it was first noticed, how it was confirmed and what you were told to avoid; the second keeps individual episodes in date order; the third records who has been told, because an allergy nobody knows about is not on any record at all.

Anyone with a drug, food, material or sting allergy, parents and carers holding the record for somebody else, and people who have to repeat the same explanation at every new practice, dentist, pharmacy and school.

What this helps you track

• Each substance with what actually happened, in your own account
• When it was first noticed and how it was confirmed
• What you were told to avoid, in the words you were given
• Individual episodes with dates, what was done and who saw you
• Which practices, pharmacies, schools and employers have been told

How to use it

1. Fill in your details and an emergency contact at the top.
2. List each substance separately, however small the reaction seemed at the time.
3. Describe what happened plainly, and say how it was confirmed — a test, a clinician's assessment, or your own observation, which is worth noting as exactly that.
4. Write what you were told to avoid using the words you were given, without adding to them.
5. Log each episode as it happens in the second table, with the date and who saw you.
6. Use the third table to record everyone who has been told, and tick it off once they confirm it is on their records.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Does the sheet say what to do if I react?

No. It carries no treatment, no plan and no guidance of any kind. What to do in a reaction comes from the clinician who assessed you, and if you have been given a written plan, keep this sheet with it rather than instead of it.

What if I am not sure something is an allergy?

Write it down and say in the notes that it is unconfirmed. An honest record of a suspected reaction is useful; a confident label that nobody ever tested is the thing that causes trouble later.

Why record who has been told?

Because the information has to be on each set of records separately — practice, pharmacy, dentist, hospital, school, employer. Ticking them off is the only way to know which conversation you have not had yet.

Is this the same as a medical alert card?

No. This is the full record; a card is the short version you carry. Many people keep both, with the card in a wallet and this sheet with their documents.