Most patients labeled with allergic penicillin are not

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Most people with a medical history who say they are allergic to penicillin are not intolerant, an allergist said Thursday during the first day of sessions of the Meeting of Internal Medicine of the American College of Physicians (ACP) 2021.


Dr. Olajumoke Fadugba

Maletting has implications for patient outcomes and efforts to combat antibiotic resistance, said Olajumoke Fadugba, MD, director of the University of Pennsylvania Health System’s Allergy and Immunology Fellowship Program. in Philadelphia.

Approximately 10% of the general population has a history of penicillin allergy (up to 15% of hospitalized patients), but up to 90% of patients with this label are able to tolerate penicillin, he said. dir Fadugba. Wrong labeling is due well because reactions were characterized incorrectly at first or people have overcome allergies.

“There are data indicating that IgE-mediated penicillin decreases over time and that after 10 years of avoiding a drug, more than 80% of patients have a resolution of their IgE penicillin.”

The data also show that patients overcome their reactions to aminopenicillin (including those of amoxicillin noted that parenteral penicillin reactions are faster than parenteral ones.



Dra. Josune Iglesias

This was stated by Josune Iglesias, MD, assistant professor of internal medicine at Rush University Medical Center in Chicago, Illinois Medscape Medical News he often sees patients saying that their parents told them when they were children that they were allergic to penicillin and that information continues to enter their records.

He said doctors are aware that the allergy label to penicillin is not always accurate, but there are doubts to challenge them.

“We are cautious because of the possible side effects and the damage we could cause if we label the patient,” he said. “I think having this information will help us properly label these patients so that we don’t cause harm.”

In addition, the threat to antibiotic resistance is real, he said, when unnecessarily removing penicillin as an option.

When a person is labeled as allergic to penicillin, treatment options usually go for broad-spectrum antibiotics that are more expensive, have potentially worse side effects, and can contribute to resistance.

“It’s really important, especially with older people, patients with chronically ill diseases, to make sure we really label them. [who are not truly penicillin-allergic]”Iglesias said.

According to Fadugba, the label can also cause damage in the hospital setting and worsen outcomes.

She notes that the penicillin allergy label has been linked to a longer hospital stay, a higher readmission rate, acute kidney injury, a multidrug-resistant organism such as MRSA, and nosocomial infections included Clostridioides difficult.

Getting an effective medication history is an important part of determining who really has a penicillin allergy.

A questionnaire should ask whether the patient is likely to have had immediate hypersensitivity to penicillin, such as hives or anaphylaxis, which would be more worrying than a delayed eruption.

Knowing the time period of the reaction helps determine the likelihood or likelihood that people will still have the allergy, Fadugba said.

“We also want to ask, have they received a penicillin antibiotic from this initial reaction and tolerated it?” she said.

She continued, “If a patient received amoxicillin 2 weeks ago and tolerated it, you can basically remove the allergy label and basically change the patient’s potential hospital course, immediate course, or future outcomes.” .

After getting the story, there are options to make.

If a patient is not allergic, he said, the next step is to remove the label and document the reason so that, in the future, another clinician will not see the deleted label and put it back on.

If the antecedents consider that a person is allergic, physicians should document the nature of the reaction and, if the patient needs beta-lactam during a hospitalization or in a clinic, make a decision based on the type of beta-lactam. lactam you need, he said.

“Generally, for a fourth-generation cephalosporin, for a distant history of penicillin allergy, you can probably give the full dose or, if you’re conservative, give it with caution, maybe 10% initially and then control it because cross-reactivity is known to be low, about 2%. “

If the patient needs a penicillin antibiotic specifically, the options are guided by resources.

If a doctor has staff or an allergy specialist available, skin tests may be an option and “if it’s negative, you can rule out the allergy,” Fadugba said.

“If this is not available and the patient really needs penicillin, you can consider desensitization,” he said.

However, he said: “If the patient is at a very high risk, you have no choice but to use an alternative, especially if you cannot desensitize yourself.”

Fadugba is a consultant for the Administration of Health Resources and Services. Iglesias has not disclosed any relevant financial relationship.

Internal Medicine Meeting of the American College of Physicians (ACP) 2021: Allergies in Admitted Adult Patients: Fact That Separates Fiction. Filed April 29, 2021.

Marcia Frellick is a Chicago-based freelance journalist. She has previously written for the Chicago Tribune, Science News and Nurse.com and was editor of the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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