How detecting false penicillin allergies helps physicians fight antibiotic resistance

More than 32 million U.S. patients have a documented penicillin allergy, but studies have found more than 95 percent can be treated safely with this class of antibiotics. Providers can use several practices to verify a documented penicillin allergy and avoid spreading drug resistance, researchers report in JAMA.

The study comes from a consensus development of the American Academy of Allergy, Asthma and Immunology; the Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America. 

The common use of penicillin and related antibiotics, called beta-lactams, is behind the frequent documentation of penicillin allergy, said lead author Erica Shenoy, MD, PhD.

"Many reported penicillin allergies are established during childhood, when it is by far the most commonly prescribed antibiotic. If a penicillin is prescribed for what is actually a viral rather than a bacterial infection, a rash that develops may be caused by the virus but attributed to a penicillin allergy, which then is documented in the patient's chart and never questioned again," Dr. Shenoy said.  

When alternatives are used, it can lead to increased risk of treatment or prevention failure, as well as increased risk of resistant pathogens such as Clostridium difficile.

To ensure penicillin allergies are properly evaluated and managed, the researchers suggest providers take a comprehensive history of the reaction that led to allergy documentation, which can help identify the patient's risk level and appropriate procedures for testing.

"A simple history can often distinguish intolerances — for example, headaches or nausea — from allergies," said senior author Kimberly Blumenthal, MD. "Side effects should be judged by their severity, and after discussion with the patient, clinicians should consider the safety of a potential drug challenge."

The study authors said some form of evaluation of a documented penicillin allergy can and should be carried out in any clinical setting for all patients with this documentation.

"If such allergies are routinely evaluated, patients will not needlessly avoid the beta-lactams that may be the best treatment for their infection and reduce the development of antibiotic resistance," Dr. Blumenthal said.

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