Centers for Disease Control And Prevention Urges Patients To Confirm Penicillin Allergy

In a new video, the U.S. Centers for Disease Control and Prevention (CDC) suggests that doctors evaluate patients who report penicillin allergy for true penicillin allergy. 

Recent studies indicate about 10 percent of U.S. hospital patients say they are allergic to penicillin; most, however, are actually not.  Less than 1 percent of the population has a true drug allergy to penicillin.

"Some patients who report penicillin allergies may never have had true allergies. They may have had side effects or a symptom of the underlying illness that was interpreted as an allergy, such as a viral exanthema or rash in a child on amoxicillin," says Katherine Fleming-Dutra, M.D., the CDC epidemiologist who is featured in the video.

Fleming-Dutra advises physicians how to rule out penicillin allergy before prescribing alternative or broad spectrum antibiotics (such as fluoroquinolones). "Even patients with true penicillin allergies may lose the allergy over time," she says.  "In fact, about 80 percent of patients with a penicillin allergy lose their sensitivity by 10 years after their reaction." 

The CDC joins other experts in suggesting penicillin allergy evaluation for people who report a history of penicillin allergy.  In the CDC guide for hospitals (Antibiotic Stewardship in Acute Care:  A Practical Playbook) the agency states that hospitals should "establish guidance for antibiotic allergy assessment (e.g., a penicillin allergy assessment protocol, including recommendations on which patients might benefit from skin testing." Others raising awareness on the issue include the American Board of Internal Medicine; the American Academy of Allergy, Asthma and Immunology; and the U.S. Department of Veterans Affairs, among other institutions.

"Getting tested is critical, since the research shows that an unconfirmed penicillin 'allergy' is linked to longer hospital stays and higher prevalence of dangerous, drug-resistant infections," says Eric Macy, M.D., from Kaiser Permanente Southern California, who has published multiple studies on penicillin allergy.  "Most people can be safely tested for penicillin allergy, which will lead them to more appropriate antibiotic use, lower healthcare costs, and better clinical outcomes."

In the CDC video, Fleming-Dutra says doctors should ask specific questions of patients who report being penicillin-allergic: 

• What medication (s) were you taking when the reaction occurred?
• What kind of reaction occurred, such as rash, hives, diarrhea, or difficulty breathing?
• What treatment was given; for example, was epinephrine or an EpiPen® used?

Penicillin allergy testing is one of the key strategies to improve antibiotic stewardship in hospitals nationwide, according to the CDC Playbook.

For more information on penicillin allergy testing see www.prepen.com

^1,2,3 Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259‐273.

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