Rationale: Approximately 10% of the population report having a penicillin allergy. However, true penicillin allergy is rare and likely affects less than 1% of individuals. It is therefore crucial to determine whether a patient has a real penicillin allergy, as an inaccurate allergy label can significantly limit future treatment options for bacterial infections. Choosing alternative antibiotics often leads to the use of broader-spectrum agents, increasing the risk of side effects and antimicrobial resistance. Symptoms such as nausea, discomfort, and loose stools are not allergic reactions to penicillin. A mild maculopapular rash that develops after several days of treatment rarely indicates an increased risk of anaphylactic reactions. However, in adults, there is a relatively high likelihood of recurrence of the rash. A systematic assessment can help categorize the risk of a true penicillin allergy. In cases of low risk, penicillin preparations can be used unless specific concerns dictate otherwise. In moderate-risk cases, further evaluation with skin testing and/or amoxicillin challenge may be necessary. If it is determined that the patient does not have a genuine penicillin allergy, it is important to document this in the medical record to prevent the perpetuation of incorrect information.
References
- Blumenthal, Kimberly G., Jonny G. Peter, Jason A. Trubiano, and Elizabeth J. Phillips. 2018. “Antibiotic Allergy.” The Lancet, December. https://doi.org/10.1016/S0140-6736(18)32218-9.
- Li, M., M. T. Krishna, S. Razaq, and D. Pillay. 2014. “A Real-Time Prospective Evaluation of Clinical Pharmaco-Economic Impact of Diagnostic Label of ‘Penicillin Allergy’ in a UK Teaching Hospital.” Journal of Clinical Pathology 67 (12): 1088–92.
- Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019 Jan 15;321(2):188–99.
Links
- Penicillinallergi eller ikke? Allergiske straksreaksjoner og forsinkede hypersensitivitetsreaksjoner (RELIS)
- Penicillinallergi (Antibiotika.no)
- Allergy evaluation for immediate penicillin allergy: Skin test-based diagnostic strategies and cross-reactivity with other beta-lactam antibiotics (UpToDate)