So, what should practitioners do when they have a patient with a past history of penicillin allergy, who now needs a penicillin to treat an infection? As with most medical conundrums, the answer is not that simple. Certainly, practitioners can give every patient with a penicillin allergy a skin test. Research has shown that these tests are simple, quick, and work to increase appropriate beta-lactam use. However, Dr. Jeffres feels that the test has low clinical utility. The penicillin skin test only identifies Immunoglobulin E (IgE) reactions, and results of the test would not de-label a patient as penicillin allergic, unless they have a history of IgE reaction. She states that cephalosporins or carbapenems can be safely used in these patients without administering a penicillin skin test.
Due to the importance of side chains, Dr. Jeffres advised her colleagues to not accept a penicillin, cephalosporin, or carbapenem allergy listed on a patient chart. Practitioners should push further to find out the specific medication to which the patient showed an allergic reaction. Dissimilar cephalosporins and carbapenems should be utilized, and, practitioners should be sure to update the patient’s allergy label if a beta-lactam is tolerated, even if the tolerance is unrelated. The more data that is made available to all clinicians interacting with the patient, the easier it is to make informed and appropriate decisions about that patient’s care.
Although these actions may amount to some small extra steps for the practitioner, they could amount to greater positive outcomes for the patient, and more appropriate antibiotic use, which ultimately positively impacts the entire population.
- Jeffres MN, Narayanan PP, Shuster JE, Schramm GE. Consequences of avoiding β-lactams in patients with β-lactam allergies. J Allergy Clin Immunol. 2016;137:1148-1153.
- Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol. 2014;133:790-796.
- Picard M, Bégin P, Bouchard H, et al. Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital. J Allergy Clin Immunol Pract. 2013;1:252-257.
- Li M, Krishna MT, Razaq S, Pillay D. A real-time prospective evaluation of clinical pharmaco-economic impact of diagnostic label of “penicillin allergy” in a UK teaching hospital. J Clin Pathol. 2014;67:1088-1092.
- Romano et al. J Allergy Clin Immunol. 2016 Jul;138(1):179-186.
- Antunez et al. J Allergy Clin Immunol 2006;117:404-10
- Gaeta et al. J Allergy Clin Immunol 2015;135:972-976.
- Kula et al. CID 2014;59:1113–1122
To stay informed on the latest in infectious disease news and developments, please sign up for our weekly newsletter.