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SOURCE: Sundquist BK, et al. Proactive penicillin allergy testing in primary care patients labeled as allergic: Outcomes and barriers. Postgrad Med 2017;129:915-920.
I am allergic to penicillin, or at least that’s what I say in healthcare settings when someone asks. My designation as penicillin allergic occurred around age 5 when I developed a rash after a shot of penicillin. The malady I was suffering was called “a respiratory infection,” with the subsequent all-encompassing remedy supplied: a shot of penicillin (at least that’s how it was in 1951). I am told that within the next day or two I developed a rash, and was told to eschew penicillin.
But was I really allergic? Certainly, there are many commonplace viral upper respiratory illnesses afflicting youngsters that can manifest a rash. Subsequently, I have received cephalosporins uneventfully. The literature says that > 90% of patients who report a history of penicillin allergy can tolerate penicillin. Unstimulated penicillin sensitivity wanes over time: By age 10 years, 80% of allergic subjects are no longer allergic.
Sundquist et al recruited patients with a history of penicillin allergy. Skin testing in 37 subjects (prick testing and intradermal testing) identified none as allergic; subsequent oral challenge also demonstrated no positive results. The authors suggested that good antibiotic stewardship supports consideration of clarification of whether patients who report penicillin allergy are allergic. Numerous infectious diseases are best served by penicillin treatment for the sake of cost considerations, specificity, and antibiotic stewardship.
Financial Disclosure: To reveal any potential bias in this publication, and in accordance with Accreditation Council for Continuing Medical Education guidelines, Dr. Brunton reports he is a retained consultant for Abbott Diabetes, Becton Dickinson, Boehringer Ingelheim, Janssen, Lilly, Merck, Novo Nordisk, and Sanofi; he serves on the speakers bureau of AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, and Novo Nordisk. Dr. Kuritzky (author) is a retained consultant for and on the speakers bureau of Allergan, Daiichi Sankyo, Lilly, and Lundbeck. Ms. Coplin, Mr. Springston, and Editorial Group Manager Terrey L. Hatcher report no financial relationships relevant to this field of study.
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