How to write allergies and adverse reactions in an OET letter
In an OET Nursing letter, include an allergy or adverse reaction when it affects what the reader will do, such as giving medicines, dressings or food. Name the substance, describe the reaction briefly and say how serious it was, for example: 'She is allergic to penicillin, which caused a widespread rash in 2019.' If the notes say 'no known allergies' and nothing in the plan depends on it, you can usually leave it out.
When an allergy belongs in your letter
Allergies are safety information, but that does not mean every allergy line in the case notes goes into the letter. Ask one question: will the reader give, prescribe or choose something that this allergy affects?
| Situation in the notes | Include the allergy? |
|---|---|
| Patient going home on new antibiotics; allergic to another antibiotic | Yes, it explains the choice and protects future prescribing |
| Community nurse will dress a wound; patient reacts to adhesive tape | Yes, the reader needs it at the first visit |
| Care home will provide meals; patient has a nut allergy | Yes |
| Patient had anaphylaxis to a medicine | Yes, and consider stating it early |
| Hay fever, no treatment changes | Usually no |
| "NKDA" and the letter has no medicine content | Usually no |
This follows the same rule as all case-note selection: keep what changes the reader's next step. See how to select case notes.
What to say about the reaction
A useful allergy sentence has up to three parts:
- The substance: the medicine, product or food, named exactly as in the notes.
- The reaction: rash, swelling, breathing difficulty, vomiting.
- The severity or date, if the notes give it and it helps the reader judge the risk.
Examples:
- "Mr Ali is allergic to penicillin, which caused a widespread rash in 2018."
- "She had an anaphylactic reaction to a contrast dye in 2021."
- "His skin reacts to adhesive dressings, so a silicone dressing has been used."
- "She developed nausea with codeine and has been switched to paracetamol."
The last two show a useful pattern: reaction + what was done about it. That tells the reader both the risk and the current plan.
Allergy, intolerance or side effect?
Use the wording in the notes. Changing "intolerance" into "allergy", or "rash" into "anaphylaxis", is inaccurate and costs Content marks.
| Notes | Accurate letter wording |
|---|---|
| Allergy: penicillin – rash | "allergic to penicillin (rash)" |
| Codeine – nausea, not tolerated | "did not tolerate codeine because of nausea" |
| Metformin – GI upset → MR formulation | "had stomach upset with metformin, so a modified-release form was started" |
| Latex sensitivity | "has a sensitivity to latex" |
Where to put it
There is no single correct place. Two common choices:
- In the medicines or treatment paragraph, when the allergy explains a choice: "She has been prescribed doxycycline as she is allergic to penicillin."
- Early in the letter, after the opening, when the reaction was severe: "Please note that Mr Ruiz had an anaphylactic reaction to a contrast dye last year."
Avoid a separate one-line "Allergies:" heading in the middle of a letter. OET letters are written as connected paragraphs, not forms. See organisation and layout.
Worked example (invented case)
Case summary (invented): Mr Daniel Ferreira, 58, plumber, admitted 2 September with cellulitis of the right lower leg. Allergies: penicillin (widespread rash, 2016); adhesive tape (skin blistering). Treated with IV clindamycin, now oral clindamycin until 12 September. Leg redness reduced; wound on shin from initial injury, 3 cm, dressed with silicone dressing and crepe bandage, change every 2 days. Diabetes type 2, metformin. Lives with partner. Plays in a band at weekends. Knee arthroscopy 2010. Discharge 7 September. Task: write to the community nurse for wound care.
Selection decisions:
- In: cellulitis and improvement, both allergies (the antibiotic and the dressing choice depend on them), oral antibiotic and end date, wound size and dressing plan, diabetes (affects healing).
- Out: band, knee arthroscopy, details of IV treatment.
Sample letter body (main paragraphs):
Dear Community Nurse,
Re: Mr Daniel Ferreira, aged 58
I am writing to refer Mr Ferreira, who is being discharged home today after treatment for cellulitis of his right lower leg, for ongoing wound care.
Mr Ferreira was admitted on 2 September, and the redness in his leg has since reduced. As he is allergic to penicillin, which caused a widespread rash in 2016, he has been treated with clindamycin and will continue this orally until 12 September. He also has type 2 diabetes, which may slow healing.
He has a 3 cm wound on his right shin. His skin blisters with adhesive tape, so the wound has been dressed with a silicone dressing and a crepe bandage, which should be changed every two days.
I would be grateful if you could continue his dressings and monitor the leg for any return of redness. Please do not hesitate to contact me if you require further information.
Yours sincerely,
Each allergy appears next to the decision it explains, so the reader understands both the risk and why the plan looks the way it does.
Practise a full case under timed conditions at /writing/, or check a letter you have written for an estimated mark on each criterion.
Mistakes to avoid
- Copying "NKDA" or "Allergies: nil" by habit. Include it only when it helps the reader.
- Naming the allergy without the reaction. "Allergic to penicillin" is fine; "allergic to penicillin (rash)" is more useful when the notes give it.
- Changing the severity. Report exactly what the notes describe.
- A form-style line in the letter. Write the allergy into a sentence.
- Separating the allergy from the decision it explains. Put it where the reader will need it.
Related: medications in OET letters, wound care letters and infection and antibiotics.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines and reactions are invented for practice and must not be used to guide care. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.