documentation

Food Allergy Follow-Up Visit Note Template for Allergy Practices (Reactions, Epinephrine Plan, Treatment Status and School Plan)

2026-10-30 · 7 min read

By Pankaj Sabharwal · Co-founder, Medora

Food Allergy Follow-Up Visit Note Template for Allergy Practices (Reactions, Epinephrine Plan, Treatment Status and School Plan)

The short answer: the food allergy follow-up note needs five things. It

records what happened since the last visit: any reactions, accidental

exposures and epinephrine use. It states the avoidance plan, food by

food. It documents the epinephrine plan and the counseling given. It

records the status of any treatment the patient is on or considering,

such as omalizumab or oral immunotherapy. And it carries the **plan outside

the clinic**: school, travel, and days like Halloween.

Food allergy follow-ups are where notes shrink to "peanut allergy, stable,

continue avoidance, EpiPen refilled". That line doesn't tell the next

clinician whether there was an exposure at a party, whether the family

knows when to use the autoinjector, or why a treatment was started or

stopped. This year that last line matters more than usual: Palforzia, the

only approved peanut oral immunotherapy product in the US, ended in the US on July 31,

2026, so some families are in the middle of a treatment decision.

This is a documentation aid, not a treatment protocol. The current

AAAAI/ACAAI practice parameters, the prescribing information and your

practice's own approach come first.

Template 1: interval history

```

SINCE LAST VISIT ([date])

Reactions: [none / number]

For each: date, food (known or suspected), setting [home / school /

restaurant / party / travel], symptoms by organ system, onset after

exposure [minutes]

Epinephrine used: [yes / no]; doses: [ ]; who gave it: [ ]
EMS called / ED visit: [ ]
Accidental exposures without symptoms: [ ]
New foods tolerated since last visit: [ ]
New foods avoided "just in case": [ ]
Other atopic conditions today: [asthma control / eczema / rhinitis]

```

Two lines are easy to skip and worth keeping. "New foods tolerated" stops a

food from staying on the avoid list by default. And asthma control belongs

in the same note, because a reaction in a patient whose asthma is poorly

controlled is a different conversation. If any reaction was anaphylaxis,

the anaphylaxis follow-up note template

covers the detail that visit needs.

Template 2: the avoidance plan

```

FOODS TO AVOID (confirmed)

[food]: basis [history / skin test / specific IgE / challenge / date]
[food]: basis [ ]

FOODS UNDER QUESTION

[food]: plan [test / challenge / reintroduce / keep avoiding]

FOODS IN THE DIET (confirmed tolerated)

[food]: [ ]

COUNSELING

Label reading reviewed: [yes / no]
Cross-contact and eating out reviewed: [yes / no]

```

Writing the basis next to each food is what makes the list useful a year

later. "Avoid tree nuts" with no basis can't be revisited; "cashew:

reaction 2025, specific IgE positive; almond: tolerated at home" can.

Medora keeps this kind of list across visits as part of each patient's

allergen profile, for the clinician to review.

Template 3: the epinephrine plan

```

EPINEPHRINE AUTOINJECTOR

Prescribed: [yes / no]; dose: [ ]; weight today: [kg]
Number of devices: [ ]; expiry checked: [yes / no]
Carried today: [yes / no]

COUNSELING

When to use reviewed: [yes / no]
When to call EMS reviewed: [yes / no]
Trainer device practiced in clinic: [yes / no]
Barriers to carrying (cost, size, access): [ ]
Written emergency plan given or updated: [yes / no; date]

```

Weight goes on the dose line because children move between dose sizes.

"Carried today" is a quick, honest check, and it is the question families

expect you to ask. A written plan with a date makes it clear which

version the school has.

Template 4: treatment status

```

CURRENT FOOD ALLERGY TREATMENT

None / omalizumab / oral immunotherapy (product or protocol: [ ]) /

other: [ ]

OMALIZUMAB (if on it or considering it)

Indication: IgE-mediated food allergy; food(s): [ ]
Started: [date]; setting of first doses: [ ]
Avoidance continues: [counseled yes / no]
Epinephrine plan continues: [counseled yes / no]

ORAL IMMUNOTHERAPY (if on it or considering it)

Food: [ ]; phase: [up-dosing / maintenance / paused]
Dose today: [ ]; reactions to doses: [ ]
Product change or discontinuation discussed: [ ]
Shared decision documented: [ ]

```

The omalizumab lines come straight from the February 2024 US approval

announcement. Xolair was approved "for immunoglobulin E-mediated food

allergy in certain adults and children 1 year or older", and the

announcement stressed that it "is not

approved for the immediate emergency treatment of allergic reactions,

including anaphylaxis." It also said that "Patients who take Xolair must

continue to avoid foods they are allergic to." The label's boxed warning

adds that "Xolair should only be started in a healthcare setting equipped

to manage anaphylaxis", which is why the template asks where the first

doses were given.

The oral immunotherapy lines are there because of Palforzia. The Allergy &

Asthma Network reports that "The peanut allergy treatment Palforzia® was

discontinued on July 31, 2026", and quotes the manufacturer's notice: "This

voluntary discontinuation is not related to product safety, quality, or

efficacy." Its advice to families is direct: "Do not start or stop peanut

allergy treatment on your own." For a patient who was on it, the note

should say what was discussed and what the clinician and family decided,

with the date, so the reason for the next step is on the record.

Template 5: the plan outside the clinic

```

SCHOOL / CHILDCARE

Written plan on file at school: [yes / no; date]
Epinephrine at school: [yes / no]; who is trained: [ ]

TRAVEL, EVENTS, HOLIDAYS

Upcoming: [travel / camp / party / Halloween / holiday meals]
Plan discussed: [ ]

FOLLOW-UP

Testing planned: [skin testing / specific IgE / challenge / none]
Next visit: [interval]

```

Days like Halloween are a good prompt for this section. FARE's Teal

Pumpkin Project asks households to put "a teal-painted pumpkin outside as

a visible signal" that non-food treats are available, and says that

"offering the option of non-food trinkets and toys in a separate bowl

makes Halloween safer and more fun for all trick-or-treaters." A line in

the note that the family's holiday plan was discussed is better than a

line that says nothing.

If a challenge is the next step, the

oral food challenge note template

covers that visit, and the

allergy ICD-10 coding guide

has the codes.

Where Medora fits

Medora is an AI copilot built only for allergy and immunology practices,

built with a working allergy practice, Allergy Affiliates in Bradenton,

Florida.

Medora Copilot listens to the visit and drafts an allergy-structured

SOAP note, including pertinent negatives, so "no reactions since the last

visit" and "no epinephrine used" make it into the draft. It has visit

templates built for allergy, including follow-up and food challenge

visits.

Each assessment item in the note carries its suggested ICD-10 code, for

the clinician to review. It also drafts patient instructions from the

visit, and the clinician reviews them before the family takes them home.

Patient Intelligence keeps a structured allergen profile for each

patient (medications, foods and environmental allergens) that builds

across visits, and at a follow-up it shows a snapshot of the prior visit.

The clinician reviews, edits and signs every note. Medora doesn't

diagnose food allergy and doesn't decide on epinephrine, omalizumab or

oral immunotherapy. Those stay with the clinician and the family.

In a 60-day pilot at Allergy Affiliates, the time an allergist spends

signing off each skin-test visit dropped sharply

(the case study).

Frequently asked questions

What should a food allergy follow-up note include?

The reactions and accidental exposures since the last visit, including any

epinephrine use; the foods to avoid, each with its basis; the foods now

tolerated; the epinephrine plan and the counseling given; the status of any

treatment, such as omalizumab or oral immunotherapy; and the school, travel

and holiday plan, with the next testing and follow-up.

Does omalizumab replace avoidance or epinephrine for food allergy?

No. The February 2024 US approval announcement says Xolair is not approved for

the immediate emergency treatment of allergic reactions, including

anaphylaxis, and that patients who take it must continue to avoid the foods

they are allergic to.

Palforzia was discontinued. What should the note say for a patient who was on it?

What was discussed, what the clinician and family decided, and the date.

The Allergy & Asthma Network reports that Palforzia was discontinued on July

31, 2026, for reasons the manufacturer says were not related to safety,

quality or efficacy, and advises families not to start or stop peanut

allergy treatment on their own.

Who makes the decisions when Medora drafts the note?

The clinician. Medora Copilot drafts the visit note for the clinician to

review, edit and sign, and the clinician makes the assessment and every

treatment decision.

Try it on your own visits

*Sources: U.S. Food and Drug Administration press announcement on Xolair

for food allergy, February 16, 2024 (read at

https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-help-reduce-allergic-reactions-multiple-foods-after-accidental).

Allergy & Asthma Network, "With Palforzia® Ending, What's Next for Peanut

Allergy Patients?", revised August 3, 2026 (read at

https://allergyasthmanetwork.org/news/palforzia-discontinued/). FARE, Teal

Pumpkin Project (read at

https://www.foodallergy.org/our-initiatives/awareness-campaigns/living-teal/teal-pumpkin-project).

All read 2026-10-30. Quotes are from these sources. Check the full

prescribing information and the current practice parameters, and follow

your own protocols.*