Are You Truly Allergic to Penicillin?

Penicillins are a widely used group of antibiotics that play an important role in treating bacterial infections. Among other uses, penicillins are often used to treat ear infections, strep throat, and sinus infections. They are also the most commonly reported drug allergy. Unfortunately, the symptoms of the allergic reaction can sometimes be confused with symptoms of the infection the penicillin is being used to treat. Because penicillins are the safest and most effective antibiotics for many infections, it is important to talk to your primary care provider about testing if there is cause for concern.

Symptoms of Penicillin Allergy and Treatment
Allergic reactions to penicillins can occur immediately or usually within one hour after receiving a dose of the medication. However, they can also occur in patients who have previously tolerated penicillin without issues. Symptoms frequently involve the skin and include:

• Hives (also known as welts or urticaria – a raised, itchy rash)
• Swelling (also known as angioedema, commonly occurs around the face and extremities)
• Wheezing and shortness of breath

Treatment of these reactions usually involves an antihistamine and sometimes an oral or injected corticosteroid.

In rare cases, more serious symptoms that suggest anaphylaxis can occur, in at least two of the following systems:

• Skin: Hives, flushing, itching, and/or angioedema
• Respiratory: Cough, shortness of breath, chest tightness, and/or sensation of throat closure or choking
• Cardiovascular: Hypotension, faintness, tunnel vision, chest pain, and/or loss of consciousness
• Gastrointestinal: Nausea, vomiting, abdominal cramping, and/or diarrhea

These symptoms require immediate treatment with epinephrine, which can be given by an auto-injector, and/or at the nearest emergency room. Additional treatments may include albuterol to treat respiratory symptoms, IV fluids, and corticosteroids.

Keep in mind that if you are unsure about symptoms and you need advice, our 24-Hour Help Nurses are just a phone call away. These nurses are available to assist Medical Associates Clinic patients and Medical Associates Health Plan members who have health-related questions, need medical advice, or need to reach a Medical Associates physician. Click here to learn more.

So why the confusion and what’s the concern?
Penicillin allergies and misdiagnosis often begin at childhood, where common childhood infections may contribute to or be confused with an allergy. Another contributor to the confusion is immune system changes. As we grow, our immune system continues to develop. Approximately 80% of those with a true penicillin allergy will lose sensitivity after 10 years. Although approximately 10% of the population reports a penicillin allergy, less than 1% of the whole population is allergic.

Lastly, medications can sometimes cause people to feel unwell, have an upset stomach, and cause other discomforts that may seem like an allergy when they are just normal side effects.

People with a penicillin allergy on their medical record are often given broad-spectrum antibiotics as an alternative to penicillins. Such antibiotics may be as effective, but they often have more side effects and toxicities. They are also associated with higher healthcare costs and increased risk for antibiotic resistance.

Penicillin Allergy Testing
Penicillin allergy can be evaluated by an allergist/immunologist, who will obtain a careful history and perform skin testing. Skin testing for a penicillin allergy is a three-step process: first is a scratch test, then intradermal testing, and finally a test dose of penicillin while under observation. The physician will only proceed to the next step if the previous test reaction was negative. Penicillin skin testing identifies the presence or absence of IgE antibodies to penicillin. After completion of any testing your doctor will advise you on whether you can receive penicillin antibiotics.

If you suspect you have a penicillin allergy or are unsure about your allergy status, schedule an appointment with our Allergy Department today for a comprehensive evaluation and guidance on managing your condition. Understanding whether you are truly allergic to penicillin is important for your health both now and in the future.

Allergy, Asthma, & Immunology Department

Sources:
https://www.cdc.gov
https://www.health.harvard.edu
https://www.aaai.org