Penicillin Allergy

Each week, I have patients present to my clinic for the first time with a history of penicillin allergy.  Many of these patients describe first being diagnosed as a child and advised by parents or grandparents that they should never take a penicillin.  However, in fact, when reviewing medication histories, they have over time used an antibiotic from the penicillin family and did not exhibit an allergic response.  With this being said, I feel it is appropriate to discuss penicillin allergy because this in itself is a way to practice better antibiotic stewardship and help ward off the development of drug resistant bacteria in our community.

For those with a true penicillin allergy, we, as clinicians, must choose a more expensive antibiotic to replace penicillin.  Choosing these other antibiotics increases the likelihood of developing a drug resistant strain or eliminating the most appropriate antibiotic therapy.  Penicillin is a very good antibiotic and to list it as an allergy really limits the patient’s treatment options for many presentations.

In fact, it has been stated that 1 out of 10 patients with a reported allergy do not actually have an allergy.  Of those with a known allergy, up to 80% will, within ten years, no longer have the allergy.  As a child grows, they may outgrow the allergen at some point.

With this being said, it’s my recommendation, as always, to seek healthcare guidance from the primary care provider who knows you best.  If in doubt, a simple skin test can be ordered to either confirm or exclude the penicillin allergy.

In closing, let’s discuss true penicillin allergy.   Although most cases of allergy are falsely reported and/or over diagnosed, there are symptoms one may develop following exposure to the penicillin.  One may develop a systemic rash, start wheezing, develop facial, tongue, or throat swelling (even sometimes with a sense of not being able to breathe).  Anaphylaxis can develop with severe allergy and can be life threatening.  As always, consult the healthcare provider who best knows you for further guidance and to see if antibiotic allergy skin testing is an appropriate step in determining true allergy.