Recent studies have shown that more than 90% of patients labeled as allergic to penicillin were found to be tolerant of penicillin. Current guidelines encourage routine penicillin allergy verification because of substantial clinical and economic consequences of a penicillin allergy label.However, penicillin testing can be prohibited by time, personnel and resource constraints.
A recent study published in the Annals of Allergy Asthma and Immunology, is encouraging a direct oral challenge of amoxicillin in an allergist’s office in low risk patients who label themselves as allergic to penicillin. Low risk patients are defined as those with a reaction over 1 year prior with a benign rash, other non-specific symptoms or unknown reactions.
If there is a history of blistering skin, drug fever, organ involvement, anemia, hives, swelling or shortness of breath, a direct amoxicillin challenge is not recommended.
If a patient is labeled as penicillin allergic without testing or a strong history, other classes of antibiotics are used (i.e. ciprofloxacin, Z-pack, Clindamycin). These antibiotics are associated with an increased morbidity. More specifically, they spend more time in the hospital, increasing overall health care cost, are exposed to significantly more antibiotics associated with C. diff., and there are increased hospitalization rates and duration.
In addition, many childhood illnesses including ear infections, strep throat, community acquired pneumonia, are optimally treated with penicillin, with the report of penicillin “allergy” leading to avoidance and poorer clinical outcomes.
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If you or a child are labeled as allergic to penicillin, speak to your doctor about a referral to an allergy doctor to have it re-evaluated. Up to 90% of people who are labeled as penicillin allergy are not, and many (90%) of those who are allergic to penicillin, outgrow their allergy in 10 years. A simple skin test or even just a direct oral challenge to amoxicillin may be able to remove the penicillin allergy label.