Managing Penicillin Allergy

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Penicillin “allergy” is reported in 10% of the US population; however, 95% of these patients do not have a clinically significant allergy and actually tolerate this drug class.

The American Academy of Allergy, Asthma and Immunology, the Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America recently published a guideline for evaluating and managing penicillin allergy. Most patients who say they are allergic to penicillin report stomach symptoms, a family history of allergy, itching without rash, or a 10-year or longer unknown reaction history. Amoxicillin or an amoxicillin challenge can be tried in these low risk patients, assuming their cardiovascular and pulmonary functions are stable, and they are not pregnant. All other penicillin allergic patients are at medium to high risk and should get allergy skin testing or a referral to an allergy/immunology specialist. Before a penicillin is prescribed for a “penicillin allergic” patient, get a detailed allergy history. If the patient is low risk, amoxicillin can be prescribed. If it is tolerated, take penicillin off their allergy list and educate the patient accordingly.

These steps can reduce unnecessary use of broad-spectrum antibiotics, their side effects, and the development of antibiotic resistance.

• Shenoy ES. JAMA 2019; doi:10.1001/jama.2018.19283

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