How to Confirm Allergies and Interactions at Medication Pickup

Why Confirming Allergies and Interactions at Pickup Matters

Every time someone walks up to the pharmacy counter to pick up a prescription, there’s a silent checkpoint that could mean the difference between healing and hospitalization. This isn’t just a formality-it’s the last line of defense against a preventable medical error. In the UK and across the US, an estimated 6.7% of hospital admissions are caused by adverse drug events, many of which happen because allergies or dangerous drug combinations weren’t caught before the medicine left the counter.

Pharmacists don’t just hand out pills. They’re trained safety officers who verify that what’s in the bottle won’t hurt the person taking it. And that means checking two things: does this patient have a documented allergy to any ingredient in this drug? and does this new medication clash dangerously with anything else they’re already taking?

It sounds simple. But in practice, it’s messy. Patients forget to update their allergy lists. Systems flag harmless ingredients like food dyes. Doctors miss updating records after a skin test clears a long-standing penicillin label. And with pharmacies handling hundreds of prescriptions a day, the pressure to move fast can make the right checks feel like a burden.

The Four-Step Verification Process

According to the American Society of Health-System Pharmacists (ASHP), every pharmacist should complete a verified checklist in under 90 seconds at pickup. Here’s how it breaks down:

1. Confirm the allergy record is current. If the patient’s allergy list hasn’t been reviewed in over 12 months, it’s outdated. Many patients still carry labels like “penicillin allergy” from childhood, even after testing proved they’re not allergic. Pharmacists must check the EHR for the last update date.
2. Run the interaction check. The pharmacy system pulls up Lexicomp or Micromedex data to scan for known drug-drug, drug-food, or drug-condition interactions. For example, mixing warfarin with certain antibiotics can spike bleeding risk. A statin combined with grapefruit juice can cause muscle damage.
3. Check for inactive ingredient triggers. Some patients react to dyes, lactose, or aspartame-not the active drug. Systems often flag these, but too many false alerts lead to alert fatigue. Smart pharmacies now use custom picklists that ignore low-risk fillers unless the patient has a known sensitivity.
4. Ask the patient. No system is perfect. A quick, direct question-“Has anything changed since your last visit? Any new rashes, swelling, or stomach issues after taking meds?”-can catch what the screen misses. Many patients don’t realize their reaction to a cough syrup was an allergy, not just a side effect.

How Systems Get It Wrong (And How to Fix It)

Electronic Health Records (EHRs) are supposed to make this safer. But they often create more noise than clarity. Here’s why:

• NDC-based screening checks every ingredient down to the filler. It catches 99.8% of real allergies-but generates false alerts for things like cornstarch or titanium dioxide. One pharmacy in Bristol reported 14 alerts per prescription, 11 of which were irrelevant.
• Drug name screening looks at the active ingredient only. It’s smarter, catching 3.2 times more clinically relevant warnings, but it’s slower. Pharmacists spend 28% more time reviewing each alert.
• Outdated records are the biggest problem. A 2023 University of Michigan study found over a third of patient allergy records were older than five years. Someone who had a rash from amoxicillin at age 7 might still be flagged as allergic at 45, even after a negative skin test.

Top-performing pharmacies fix this by:

• Using SNOMED CT terminology for allergies (e.g., “IgE-mediated penicillin allergy” instead of just “penicillin allergy”) to reduce false triggers.
• Implementing “allergy timeouts” for complex cases-pausing dispensing to review history with the patient or call the prescriber.
• Training staff to override alerts only with documented reasons, like “skin test negative” or “no reaction in 10 years.” These override notes now automatically sync with EHRs for future providers.

What Patients Can Do to Help

You don’t have to rely on the pharmacist to catch everything. You can make this process faster and safer:

• Keep your own list. Write down every medication you take, including supplements, and every reaction you’ve had-even if you think it’s minor. Bring it to every appointment.
• Ask if your allergy label is still valid. If you’ve been told you’re allergic to penicillin, ask your doctor if you’ve ever been tested. Studies show 90% of people who think they’re allergic aren’t.
• Speak up at pickup. If you’ve had a new reaction since your last visit, say so. Even if you think it’s unrelated. A rash after taking ibuprofen? That’s worth mentioning.
• Don’t assume the system knows. If you’ve switched pharmacies, your allergy history might not have transferred. Confirm it’s there.

Real Stories from the Counter

Pharmacists see the gaps every day.

One patient in Bristol came in for a new antibiotic for a sinus infection. The system flagged a “penicillin allergy” from 2012. The pharmacist asked if she’d ever had a reaction. She said no-just that her mom said she was allergic. A quick call to her GP confirmed she’d never been tested. The pharmacist dispensed amoxicillin. She got better in two days.

Another patient was on warfarin and picked up a new OTC painkiller. The system flagged an interaction. The pharmacist noticed the patient had been taking it for months without issue. Turns out, the patient was taking a different brand of ibuprofen that didn’t interact. The system flagged all ibuprofen brands. The pharmacist adjusted the warning to match the specific product.

These aren’t rare cases. They’re routine. And they only happen when someone takes a second to ask.

The Future: Smarter Systems, Fewer Alerts

Change is coming. In 2024, Epic rolled out “allergy severity stratification”-if you have 10 allergies, the system stops flagging low-risk ones. Google Health’s pilot program used AI to scan clinical notes for hidden allergies, catching 31.7% more cases than standard systems.

The FDA is also stepping in. By December 2025, all drug labels must use standardized formats that clearly separate active ingredients from allergens. That means fewer false alerts from dyes or fillers.

But the biggest shift won’t be technological. It’ll be cultural. More pharmacies are training staff to treat verification not as a checkbox, but as a conversation. The goal isn’t to block every alert. It’s to make sure the right ones get heard.

What Happens When You Skip the Check?

Skipping verification sounds harmless. But the consequences aren’t theoretical.

In 2023, a patient in Leeds was given cefdinir for an ear infection. The system showed a “cephalosporin allergy” from 2010. The pharmacist didn’t question it. The patient had a severe reaction and ended up in the ER. Later, it was found: the allergy was a mislabeled rash from a childhood virus. The drug was safe.

That’s not just a mistake. It’s a system failure. And it’s preventable.

Every time a pharmacist confirms an allergy or interaction at pickup, they’re not just following protocol. They’re stopping a potential disaster.