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Identifying patients who are truly allergic to penicillin, other medications
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PHILADELPHIA — About 95% of patients who say they are allergic to penicillin are really not, according to a presentation at the American College of Physicians Internal Medicine Meeting.
This is a distinction that must be made, John M. Kelso, MD, division of allergy, asthma and immunology at the Scripps Clinic in San Diego, California, told Healio Primary Care Today.
“Alternative antibiotics are typically more expensive, less effective, more prone to side effects and likely to contribute to antibiotic resistance,” he said in an interview.
Kelso added the confusion likely stems from the patient having a family history of penicillin allergy or having an adverse, but non-skin related, event tied to taking the medication.
The misconception regarding allergy status also extends to NSAIDs, asthma pills or opioids, according to Kelso.
“Patients who have non-skin reactions after taking one of these medications may think they are having an allergic reaction. But these non-skin episodes are pharmacological events, rather than immunological events,” Kelso said.
Penicillin allergy, or any medication allergy status, can be confirmed through a multi-step process: obtaining the patient’s specific reactions to medications; administering either a blood test or a skin test to gauge the patient’s reaction; or providing amoxicillin orally and then observing the patient for about an hour to see if there is a skin-based reaction, Kelso said. If the patient makes it through all three tests without such an occurrence, he or she is almost certainly not allergic, he continued.
A report by the Association of American Medical Colleges cited physician shortages in a number of states across a broad spectrum of medical specialties, including allergists. The problem is usually exacerbated in rural areas, making some patients wait extended periods of time to see an allergist.
Kelso said internists and primary care physicians can fill this gap by asking the same questions an allergist would start their appointments with.
“Ask the patient why he or she thinks they have an allergy. If the patient tells you they have reactions like headaches or stomach discomfort, that is much more likely to be intolerance rather than allergy and the allergist appointment can be averted,” he said. – by Janel Miller
Reference:
Association of American Medical College Center for Workforce Studies. “Recent studies and reports on physician shortages in the US.” Accessed April 12, 2019.
Kelso J. “Drug allergies: Predicting, desensitizing and managing them.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.
Disclosures: Kelso reports no relevant financial disclosures.