How to Confirm Allergies and Interactions at Medication Pickup

By Joe Barnett On 30 Dec, 2025 Comments (13)

When you walk up to the pharmacy counter to pick up your prescription, you might think the hardest part is waiting in line. But behind the scenes, a critical safety check is happening-one that could prevent a life-threatening reaction. Confirming allergies and drug interactions at pickup isn’t just a formality. It’s the last line of defense against a medication error that could land you in the hospital.

Why This Step Can’t Be Skipped

Every year, about 6.7% of hospital admissions are caused by adverse drug events, according to a 2022 study in JAMA Internal Medicine. Many of these happen because someone was given a drug they’re allergic to-or one that dangerously interacts with something they’re already taking. That’s why pharmacists are required to verify this information before handing over any prescription. It’s not just policy. It’s law.

The Centers for Medicare & Medicaid Services (CMS) and The Joint Commission both require pharmacies to screen for drug-allergy interactions at every dispensing point. And it’s not just about penicillin. Allergies to sulfa drugs, NSAIDs, or even inactive ingredients like dyes and fillers can trigger reactions. Interactions between blood thinners and common painkillers, or antidepressants and migraine meds, can cause internal bleeding, seizures, or heart rhythm problems.

What Pharmacists Check Before They Hand You the Bottle

Pharmacists don’t guess. They use layered systems to catch risks. Here’s what happens in those 90 seconds before your prescription is filled:

Review your EHR allergy list-This is the first check. The system pulls your documented allergies from your electronic health record. But here’s the catch: 32.7% of these records are outdated, according to a 2023 University of Michigan study. If you said you were allergic to penicillin five years ago, it might still be in the system-even if you’ve never had a reaction since.
Run a drug interaction scan-The pharmacy system checks your current meds against the new prescription using databases like Lexicomp or Micromedex. These tools flag over 1,000 known drug-drug interactions, 300+ drug-food issues, and more than 2,000 drug-condition conflicts. For example, if you’re on warfarin and get a new prescription for ibuprofen, the system will scream a warning.
Check for inactive ingredient triggers-Some people aren’t allergic to the active drug, but to the dye, lactose, or gluten in the pill. Systems that screen only by drug name (not NDC codes) are better at catching these. But they also create more false alarms. A 2023 study found NDC-based systems miss 12.7% of true reactions because they don’t track inactive ingredients.
Ask you directly-No system is perfect. That’s why pharmacists are trained to ask: “Has anything changed since your last visit? Any new rashes, swelling, or trouble breathing after taking meds?” This simple question has reduced inappropriate antibiotic substitutions by 37% at Mayo Clinic, according to their 2023 report.

The Problem with False Alerts

You might think more alerts mean more safety. But too many warnings backfire. A 2024 study in BMJ Quality & Safety found pharmacists override 68.4% of allergy alerts. Why? Because too many are useless.

Many systems flag interactions with dyes like FD&C Red No. 40 or fillers like lactose-even if the patient has no history of reacting to them. One pharmacist on Reddit wrote: “I had a patient flagged for a dye allergy because she once had a rash after eating Skittles. She’s never had a reaction to a pill. But the system won’t let me dispense unless I override it.”

This is called alert fatigue. When warnings become noise, people stop paying attention. That’s dangerous. A 2024 FDA initiative is pushing for standardized allergy labeling in drug packaging by December 2025, so systems can better distinguish real threats from noise.

Pharmacist asking a patient about allergies while holographic alert overlays float in the background.

What You Can Do to Help

You’re not just a patient. You’re part of the safety team. Here’s how you can make this process work better:

Update your allergy list every time you see a doctor-If you had a reaction to a drug, write it down. If you think you’re allergic but never got tested, say so. Many people think they’re allergic to penicillin when they’re not. Only 10-20% of those labeled as allergic actually have a true IgE-mediated reaction, according to the American Academy of Allergy, Asthma & Immunology.
Bring a current list of all meds-Including supplements, OTC painkillers, and herbal products. A 2023 survey found 42% of pharmacy technicians reported patients didn’t mention their daily aspirin or fish oil-both can interact with blood thinners.
Ask questions at pickup-If the pharmacist says, “We’re checking for interactions,” don’t just nod. Say: “Is this safe with my blood pressure pill?” or “I used to have a rash with this, but I’m not sure if it’s still a problem.”
Know your triggers-If you’re allergic to sulfites, gluten, or certain dyes, tell the pharmacist. Don’t assume they’ll know from your chart. Many systems don’t link food allergies to drug ingredients.

What Happens When a Risk Is Found

If the system flags a problem, the pharmacist has options:

Call your doctor-If a safer alternative exists, they’ll ask your prescriber to switch it. At Mayo Clinic, this reduced unnecessary antibiotic substitutions by 37%.
Perform a drug challenge-For uncertain allergies (like “I got sick once 10 years ago”), some clinics offer supervised dosing to confirm if the reaction was real. This opens up better treatment options for 93% of people mislabeled as penicillin-allergic.
Override with documentation-If the risk is low and the benefit is high, pharmacists can override the alert-but only if they document why. Since 2024, CMS requires these override reasons to be shared with other providers. So if you’re given a drug despite a flagged allergy, your next doctor will know why.

Side-by-side comparison of outdated allergy record and future FDA-labeled pill with ingredient details.

What’s Changing in 2025

The rules are tightening. Starting October 2024, CMS will penalize pharmacies and hospitals with more than a 15% override rate for allergy alerts. That’s pushing systems to get smarter. Epic’s 2024 update now suppresses low-severity alerts for patients with multiple allergies. Google Health’s pilot program used AI to scan clinical notes for hidden allergy clues-and cut missed allergies by 31.7%.

Also, by December 2025, all drug manufacturers must label ingredients using the FDA’s new Structured Product Labeling (SPL) format. This means pharmacy systems will finally know exactly which dyes, preservatives, or allergens are in each pill.

Final Thought: This Isn’t Just a Pharmacy Routine

Confirming allergies and interactions at pickup isn’t about checking boxes. It’s about preventing a preventable crisis. One wrong pill, one missed interaction, one outdated label-and someone could end up in intensive care.

The system isn’t perfect. But it’s getting better. And you have more power than you think. Update your records. Speak up. Ask questions. That simple act turns you from a passive recipient into an active guardian of your own safety.

What should I do if I think my allergy info is wrong in the pharmacy system?

Contact your doctor to update your electronic health record. Then, when you pick up your next prescription, tell the pharmacist directly. Many pharmacies allow you to review and correct your allergy list at the counter. Don’t wait for them to catch it-your safety depends on accurate records.

Can I be allergic to the dye in my pill but not to the medicine itself?

Yes. Some people react to food dyes like Red 40 or Yellow 5, or to fillers like lactose or gluten, even if they tolerate the active drug. This is why newer pharmacy systems check ingredient lists, not just drug names. If you’ve had skin rashes or stomach issues after taking pills but not after IV meds, it could be an inactive ingredient.

Why does the pharmacist ask me the same allergy questions every time?

Because your health changes. New meds, new conditions, or even a new doctor can update your risk profile. Also, systems sometimes pull outdated data. A 2023 study found over a third of allergy records were older than five years. The pharmacist isn’t being repetitive-they’re being careful.

What if I’m allergic to penicillin but need an antibiotic for an infection?

Many people who think they’re allergic to penicillin aren’t. Studies show 93% of those labeled allergic can safely take it after proper testing. Ask your pharmacist if a skin test or oral challenge is an option. If your doctor agrees, you might avoid less effective, more expensive, or more dangerous antibiotics.

Are over-the-counter meds checked for interactions too?

Yes-if you’re buying them at the pharmacy counter. Pharmacists scan OTC drugs like ibuprofen, cold medicine, or antacids against your prescription list. But if you buy them online or at a gas station, those checks won’t happen. Always tell your pharmacist about anything you’re taking, even if you didn’t get it from them.

How to Coordinate Multiple Prescriptions to Avoid Conflicts