Penicillin allergy is an issue that requires patient education and public awareness. Although about 10% of the population report having this drug allergy, only about 1% are actually allergic. That’s why the College promotes penicillin allergy delabeling regularly, but especially on National Penicillin Allergy Day every year on Sept. 28. (That’s the anniversary of the day penicillin was discovered by Sir Alexander Fleming in 1928.)
It is the most commonly reported drug allergy, and many allergists have seen patients who report they are allergic to penicillin but with a deeper evaluation are truly not allergic! Allergy experts are in a unique position to address this issue and can help make sure patients get an accurate diagnosis.
Once it is determined that a patient is not allergic, the “penicillin allergy” note can be removed from their medical history – known as “delabeling.” The patient will then be in a better position to receive the best antibiotic for any future infection.
Patients with penicillin allergy labels in their records are at risk for suboptimal treatment with antibiotics, poorer clinical outcomes, drug-resistant infections, and adverse drug events. Penicillin is still the drug of choice for many infections and is prescribed at a higher rate than any other class of antibiotics.
The popular podcast Freakonomics produced an in-depth look at this problem – including real-life examples of how it can affect patients – earlier this year. One example: It is common for a pregnant woman to be given penicillin at the time of delivery to prevent Group B strep from passing on to the baby. If she can’t have penicillin, there are many possible complications for both mother and baby – from unintended C sections to time in the ICU for the newborn.
To support College members in testing for penicillin allergy, our Penicillin Toolkit is a great place to start. The toolkit focuses on four fronts: testing and treatment; billing/coding; outreach to patients; and informing primary care physicians. It has everything you need to conduct penicillin allergy testing in your practice, including insurance guidelines, worksheets and consent forms. Also check out our patient brochure.
Other resources found at the College Learning Connection include:
AllergyTalk Episode 25: Is Cefazolin Safe in Penicillin Allergic Patients? (Non-CME)
The Importance of Proactively Addressing and De-labeling Antibiotic Allergy
Drug Allergy Protocol Online Library
Read more on penicillin allergy in Annals of Allergy, Asthma and Immunology:
- A quality improvement initiative to improve primary care referral rates for penicillin allergy delabeling
- Safety and outcomes of penicillin allergy evaluation in pregnant women
Several recipients of The Allergists’ Foundation Community Grants have focused their projects on penicillin allergy.
Timothy Chow, MD – 2021 grant recipient – led a 12-month project on delabeling penicillin allergy in the primary care setting that evaluated risk-stratification and direct amoxicillin challenges in an outpatient pediatric primary care clinic, while assessing implementation barriers and their impact on referrals for outpatient allergist evaluation.
Sara Anvari, MD, MSc, FACAAI – 2022 grant recipient – led a 12-month project to develop a protocol to ensure that low-risk patients in the Texas Children’s health care system are properly evaluated for penicillin allergy.
Lulu Tsao, MD – 2022 grant recipient – led a 12-month project to assess and bridge the gaps in knowledge, perceptions, and barriers to prenatal penicillin allergy evaluations among obstetrics (OB) providers and pregnant patients.
National Penicillin Allergy Day is a great time to reach out to your community through social media and your practice newsletter. Let people know that it’s common for them to believe they are penicillin-allergic and encourage testing. You can also spread the word to patients who test negative to penicillin allergy to follow up with their physician, pharmacist and other HCPs to make sure the penicillin allergy label has been removed everywhere it needs to be.
