A growing number of allergists and public health officials across the country are pushing to prove that most people who believe they are allergic to penicillin are in fact not allergic to that antibiotic and can use it without any problems.
The so-called allergy “removal of the label,” doctors said, will have a big impact on health: faster, more effective treatments for people who have spent their lives avoiding penicillin and other medicines, including amoxicillin, such as also the possibility of reducing the growing resistance to antibiotics.
“There is an evolution in the direction of moving from a reactive approach to penicillin to a proactive one,” said Dr. Cosby Stone, assistant professor of Allergy and Immunology at Vanderbilt University Medical Center, in Nashville, Tennessee. “It’s telling patients: ‘I think I should do an allergy test. because (the alleged penicillin allergy) is going to be a problem for you now or in the future.
About 10% of the United States population has reported having an allergy to penicillin, according to the Centers for Disease Control and Prevention (CDC). In most cases, people have been told they are allergic to penicillin, usually after developing a rash several days after taking the antibiotic as an infant or toddler.
Others simply assumed they were allergic because their siblings or another family member was.
But the CDC said that less than 1% of the population is actually allergic.
“Some of the things we thought were allergies weren’t,” Stone said. “The other thing is that even true allergies go away over time.”
Stone is leading efforts at Vanderbilt to test patients whose medical records show they have a penicillin allergy. People receive small doses of the antibiotic in a controlled environment and are monitored for their reaction.
“We have to test 100 people so we can find one” that is really allergic, Stone said.
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Although some of the reactions may be severe, most are not. People may develop a rash, diarrhea, or feel nauseous.
“Those are just side effects” of the antibiotic, explained Dr. Gerald Volcheck, chair of allergic diseases at the Mayo Clinic in Rochester, Minnesota.
Volcheck said testing people for penicillin allergies has increased in recent years. “It really seems like a national effort to take down the banner (of this supposed allergy).”
Although there are no national guidelines for removing the “allergy” sign to penicillin, the CDC has closely followed this initiative and encourages the population to undergo testing.
“Eliminating a false allergy opens up treatment options for patients and reduces the use of antibiotics, which further contribute to antimicrobial resistance,” Melinda Neuhauser, a pharmacist and critical care officer at the Office of Administration, said in an email. of CDC Antibiotics.
Doctors must find other antibiotic options when treating bacterial infections in patients allergic to penicillin. But those drugs don’t always work well.
“We know that patients they are receiving the wrong antibiotics“said Stone.
Patients who cannot be given penicillin are often given broad-spectrum antibiotics that may not work as well, and should be reserved as a last resort for more serious bacterial infections.
Patients may need to take these other antibiotics for a longer time. By being less effective, bacteria have the opportunity to get stronger and develop more forms of resistance to the drugs that do act against them.
With fewer and fewer options
It was just a week ago that Claire Woerner, 33, of Hendersonville, Tennessee, discovered during a test at Vanderbilt that she is not, in fact, allergic to penicillin, a diagnosis she had been given as a child.
Woerner’s mother, she said, saw her covered “from head to toe” in hives after she received penicillin when she was 18 months old.
The family turned to other antibiotics as Woerner grew older. “My friends would get strep throat, go to the doctor, get a penicillin shot, and go back to school practically the next day,” she said. “I had to take 5, 6 and 7 day courses of antibiotics.”
Other antibiotics also caused side effects, such as hives and nausea.
Her doctors were running out of antibiotic options to treat Woerner, who is prone to sinus infections. She also suffers from asthma, which increases the risk of pneumonia.
Woerner said she realized the seriousness of the situation several years ago, when another sinus infection led her to the doctor.
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“They were trying to decide which antibiotic to give me.”, he explained. “The doctor looked at me and said, ‘You have to figure this out. Because if you get really sick, I’m not sure what they can give you to treat you.'”
Vanderbilt’s penicillin testing strategy works in two ways, depending on the patient’s history with the antibiotic. Most people say they developed a rash after taking penicillin as children. These patients are given an oral tablet of amoxicillin and are monitored for 90 minutes for any reaction.
A few, Cosby said, may develop another rash. “But having one doesn’t necessarily mean you have an allergy,” he said.
The team deals more carefully with patients who have a history of severe reactions to penicillin. That process can take up to three hours.
They start with a small injection of penicillin. If there is no reaction, doctors then perform an intradermal test, injecting the antibiotic just under the skin. After that, if there is no reaction, they are given an amoxicillin tablet.
When Vanderbilt doctors tried five different versions of penicillin on Woerner, nothing happened. No hives. No rash. No swelling. No itching.
It seems that Woerner has grown out of her allergy or that she was never allergic.
“At two years old, a low-risk penicillin allergy was added to his history,” said Stone, who treats Woerner. “For more than 30 years, this meant that every time she got sick, her doctors had to find other ways to treat her“.
“The ideal would have been to test her allergy to penicillin when she was a child,” he added.
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Dr. Kimberly Risma, professor of Pediatric Allergy and Immunology at Cincinnati Children’s Hospital, takes that approach with her young patients.
According to Risma, there are tens of thousands of children in the hospital system who are allergic to antibiotics, including penicillin.
Sometimes children develop swelling or a rash that can last several days after receiving an antibiotic. Risma said this is an understandable concern for families, who subsequently ask doctors to give them different antibiotics.
However, those allergic symptoms may not be due to an allergy to the medication, but rather an immune reaction to the infection being treated, he explained.
In their testing protocol, children – sometimes even infants – are given a dose of liquid amoxicillin and closely monitored for 48 hours. His team has been doing this type of testing since 2016.
“More than 95% of children are not actually allergic when they are tested again,” Risma said. “It’s a completely new situation for these families.”
