What About My Penicillin Allergy?

A common concern we get from patients is their penicillin allergy. Penicillin reported allergy is the most common drug allergy in the United States. Estimates range from 10%-25% of the population have a penicillin allergy reported on their medical record.

However, even though you might have a penicillin allergy reported on your medical record it doesn’t necessarily mean you have a true allergy. In fact. over 90 percent of patients with a reported penicillin allergy are found to not actually have any allergy when formally tested.

LESS THAN 1 in 10 of reported penicillin allergies are truly allergic

WHY ARE THERE SO MANY FALSE PENICILLIN ALLERGIES?

One of the more common reasons that a penicillin allergy might be posted on a medical record is if a patient took penicillin as a baby and a rash appeared. Rashes are common in sick children and there is a good chance that it was unrelated to the medication. Also, many patients outgrow this kind of sensitivity.

80% of patients who may have once been allergic lose their penicillin sensitivity after 10 years

WHY DOES IT REALLY MATTER? I CAN JUST USE A DIFFERENT KIND OF ANTIBIOTIC.

There are a few reasons why a false penicillin allergy matters. Using the right first-line-directed therapy is in the best interest of the patient. Other medications may be more prone to secondary complications like causing an overgrowth of bacteria in the gut called clostridiodes difficile. C. diff infection causes a difficult to treat diarrheal illness. In addition, other treatments may not be as effective resulting in worse outcomes, longer hospital stays, and higher costs.

HOW DO I KNOW IF MY ALLERGY IS REAL OR NOT?

Your primary care provider can provide a referral to an allergy specialist. The specialist can perform tests including skin testing and even potential treatments like desensitization. If the skin test is negative, then you can safely remove the penicillin allergy from your medical record!

 

Check out these additional resources:

Is it Really a Penicillin Allergy?

Think You’re Allergic to Penicillin? Why You May Be Mistaken

Antibiotic Stewardship…Part 2

Some people may feel that it is irresponsible for physicians to prescribe antibiotics for emergency use. They favor withholding these critical medications due to a fear of creating antibiotic resistance if inappropriately used.

Let’s turn to the evidence. Studies over the years have looked at so-called “pocket prescriptions” and their effect on antibiotic use amongst pediatric and adult populations. A “pocket-prescription” is when your health care provider is unsure whether antibiotics are appropriate for your infection, so they write you a “just in case” prescription. They tell you that if the symptoms worsen over the next 24-48 hours, you should fill the prescription and begin taking the prescribed antibiotics. It turns out that this type of care leads to LESS antibiotic use by the patients. This is because they feel empowered to decide the best course of action for their own care. They don’t have to go to the next primary care office, urgent care, or emergency department until they find someone willing to give them antibiotics. Instead, they keep the prescription, knowing that they can fill it if needed—most of the time they don’t.

Antibiotic stewardship is not simply withholding antibiotics from patients. It is also prescribing and using antibiotics when appropriate. It is part of a wholesome physician-patient relationship. One where patient and physician work together to make the best decision on behalf of the patients’ wellbeing. It is also why anyone seeking a prescription through Jase Medical is first evaluated to ensure they are appropriate candidates. In addition, they can contact us any time to follow up with their prescribing physician should they have any questions about the use of the medications prescribed.

A few of the studies referenced above:

Martin Edwards, M. E. (2003). Patients’ responses to delayed antibiotic prescription for acute upper respiratory tract infections. British Journal of General Practice, Nov(53(496)), 845–850. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314726/

Del Mar CB. Delayed prescription reduced antibiotic use in the common cold. ACP J Club. 2002 Nov-Dec;137(3):116. PMID: 12418856.

American Family Physician POEM. (2014). Delayed Prescription Strategies Decrease Antibiotic Use. American Family Physician. Published. https://www.aafp.org/afp/2014/0715/p110.html