Materiały źródłowe

• #1 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  10% of U.S. patients report having a penicillin allergy, but less than 1% of the population is truly allergic. […] Conduct a history and physical exam to confirm a true penicillin allergy (and when appropriate, skin test and challenge dose) before prescribing broad-spectrum antibiotics to a patient thought to be penicillin-allergic. […] The patient’s history and physical examination are important components when evaluating a patient’s drug reactions. […] Penicillin skin testing and challenge doses are reliable and useful methods for evaluating for IgE-mediated penicillin allergy. […] A positive result means the patient is likely to have a penicillin allergy. If negative, a skin test is usually followed by an oral penicillin class challenge (like amoxicillin) to safely rule out an IgE-mediated penicillin allergy.

• #2 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Penicillin is also one of the most frequently reported medication allergies. […] Identification of true penicillin allergy is critical as 80% to 90% of people once considered allergic are ultimately able to tolerate penicillins resulting in the decreased need for broad-spectrum antibiotics and development of multi-drug resistant organisms. […] Describe interprofessional team strategies for improving care and outcomes in patients with penicillin allergy. […] Penicillin allergy can be serious and result in a life-threatening anaphylactic reaction. […] Nursing staff should be vigilant on the intake so that this mistake is never made, but also should have the patient clarify any prior allergic reaction to penicillin drugs. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #3 3.5 Penicillin – Nursing Pharmacology-2e

  https://wtcs.pressbooks.pub/pharmacology2e/chapter/3-5-penicillins/

  Penicillins are prescribed to treat a variety of infectious processes such as Streptococcal infections, Pneumococcal infections, and Staphylococcal infections. […] Clients receiving penicillins are at risk for developing superinfections such as C-diff or yeast infections. Probiotics may be encouraged to prevent these superinfections. […] There is a cross-sensitivity for clients allergic to cephalosporins, meaning they may also have an allergic reaction to penicillin. […] Common side effects for penicillin include nausea, vomiting, gastrointestinal (GI) distress, and diarrhea. Other signs of hypersensitivity may include rash (maculopapular to exfoliative dermatitis), urticaria, laryngeal edema, and anaphylaxis. If an allergic reaction occurs, penicillin should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management support.

• #4 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication. […] The presence of a penicillin allergy label considerably reduces prescribing options for affected patients. Moreover, penicillin allergy labels lead to the use of more expensive and less effective drugs and can result in adverse consequences, including longer length of hospital stay and increased risk for infection. […] Evaluating a patient who reports a penicillin or another -lactam antibiotic allergy involves three steps: 1) obtaining a thorough medical history, including previous exposures to penicillin or other -lactam antibiotics; 2) performing a skin test evaluation by using the penicillin major and minor determinants; and 3) among those who have a negative penicillin skin test, performing an observed oral challenge with 250 mg amoxicillin before proceeding directly to treatment with the indicated -lactam therapy.

• #5 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/afp/2021/0615/p760.html

  Penicillin allergy is the most commonly documented drug allergy in medical records, with a prevalence of approximately 10% of all patients. However, in up to 90% of patients with a reported allergy, penicillins are tolerated on allergy testing. As a consequence of patients being labeled as having a penicillin allergy, alternative (typically broader-spectrum) antibiotic classes are often used, with potentially poorer efficacy and safety profiles. This leads to increased multidrug-resistant organisms, treatment failure, and health care costs and prolonged hospitalizations. […] A formal drug challenge is the preferred test for investigating immunoglobulin E-mediated penicillin hypersensitivity (type I hypersensitivity); skin testing is also a commonly used validated tool. A number of studies have been performed to develop clinical prediction rules using features of the allergy history to help determine which patients labeled as having a penicillin allergy can safely be given a beta-lactam antibiotic.

• #6

  https://umiamihealth.org/en/treatments-and-services/allergy-and-immunology/penicillin-allergy

  You have a penicillin allergy if your immune system reacts abnormally when you take penicillin or any medicine containing penicillin. Signs and symptoms of penicillin allergy usually occur within an hour of taking a medication containing the substance. In some cases, you may experience symptoms hours, days, or even weeks later. […] Signs and symptoms of penicillin allergy include: Skin rash, Hives, Itching, Fever, Swelling, Shortness of breath, Wheezing, Runny nose, Itchy, watery eyes, Anaphylaxis*. […] You should call 911 immediately or go to the nearest hospital emergency room if you experience this serious symptom. […] If your body is currently reacting to penicillin but your reaction is not life-threatening, your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine (Benadryl) that can block immune system chemicals that are activated during an allergic reaction.

• #7

  https://umiamihealth.org/en/treatments-and-services/allergy-and-immunology/penicillin-allergy

  You have a penicillin allergy if your immune system reacts abnormally when you take penicillin or any medicine containing penicillin. Signs and symptoms of penicillin allergy usually occur within an hour of taking a medication containing the substance. In some cases, you may experience symptoms hours, days, or even weeks later. […] Signs and symptoms of penicillin allergy include: Skin rash, Hives, Itching, Fever, Swelling, Shortness of breath, Wheezing, Runny nose, Itchy, watery eyes, Anaphylaxis*. […] You should call 911 immediately or go to the nearest hospital emergency room if you experience this serious symptom. […] If your body is currently reacting to penicillin but your reaction is not life-threatening, your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine (Benadryl) that can block immune system chemicals that are activated during an allergic reaction.

• #8 Penicillin Allergy: Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/16624-penicillin-allergies

  A penicillin allergy is a common allergy. It occurs when your immune system reacts negatively to the antibiotic penicillin. You may experience a skin rash, swelling or difficulty breathing shortly after taking penicillin. An allergic reaction can be a medical emergency, so contact your healthcare provider or call 911 if symptoms are severe. […] A penicillin allergy can affect anyone whose immune system is sensitive to the medicine. You may have a higher risk of having a penicillin allergy if you have an underlying medical condition like hay fever, asthma or eczema. […] The most dangerous reaction to penicillin is anaphylaxis, which is a severe, life-threatening allergic reaction. If you have any of the following symptoms, call 911, your local emergency services or visit the emergency room (ER): Swelling throughout your body. Wheezing or difficulty breathing (dyspnea). Dangerously low blood pressure. Tightness in your chest. Diarrhea. Nausea and vomiting. Feeling dizzy or light-headed. Fast or irregular heartbeat. Fainting or loss of consciousness (syncope).

• #9 Penicillin allergy: a practical approach to assessment and prescribing – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/penicillin-allergy-a-practical-approach-to-assessment-and-prescribing.html

  Penicillin allergies are not always lifelong. Approximately 50% are lost over five years. A reaction to penicillin during a childhood infection is unlikely to be a true allergy. […] In many cases, with appropriate assessment and allergy testing, it may be possible to remove the penicillin allergy label. […] The key to both prescribing and de-labelling for patients with a history of penicillin allergy is an accurate assessment. This involves an understanding of the allergy particularly the severity, timing and tolerance. […] An understanding of the severity of an allergy includes obtaining a description of its type. Information can be obtained by asking about how the reaction was managed, for example, was the patient hospitalised? […] The timing of the reaction is important to determine if it was delayed (e.g. T-cell mediated reaction) or immediate (e.g. IgE-mediated reaction).

• #10 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics

  It is important to distinguish nonallergic adverse reactions from true allergic reactions. Some people report that they are allergic to penicillin when actually they have had a nonallergic side effect. As a result, the person may avoid drugs in the penicillin family and related antibiotics unnecessarily and be treated for a particular infection with a less effective or more toxic antibiotic. This can lead to antibiotic failure or resistance, which can be costly and prolong illness. […] Anyone who is uncertain if a past allergic reaction was truly caused by allergy should avoid the antibiotic until they have discussed the situation with their health care provider. […] A past history of these types of reactions is important because the person might develop a more severe reaction, such as anaphylaxis, if they were to take the antibiotic again. Mild-to-moderate allergic reactions to penicillins occur in 1 to 5 percent of people taking the medication.

• #11 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  A thorough exam and appropriate diagnostic tests are essential for an accurate diagnosis. A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. […] Your doctor will conduct a physical examination, ask questions about your symptoms and order additional tests. […] If you are allergic to one type of penicillin, your doctor may recommend a graded challenge with a type of penicillin or cephalosporin that’s less likely because of known chemical properties to cause an allergic reaction. This would enable your doctor to identify an antibiotic that can be used safely. […] During a drug challenge, your doctor provides careful supervision, and supportive care services are available to treat an adverse reaction. […] If your doctor determines that you have a penicillin allergy or likely allergy discontinuing the drug is the first step in treatment.

• #12

  https://www.nursingcenter.com/cearticle?an=00006205-202209000-00007&Journal_ID=54012&Issue_ID=6435935

  Abstract: Antibiotics are frequently reported as allergies by patients, particularly antibiotics from the penicillin family. Most of these reported allergies are benign, and the consequences of alternative therapies can be significant. This article will deliver background information on penicillin allergies and serve as a guide to penicillin allergy management. […] The intent of this review is to educate NPs on the consequences of reported penicillin allergies as well as different approaches to delabeling erroneous allergies that can be utilized in clinical practice. […] Delabeling reported penicillin allergies often starts by simply taking a detailed history of the reported allergy. This can be confidently carried out by general practitioners. […] The most important points to establish in an allergy history are as follows: (1) what medication caused the reaction, (2) what reaction or symptoms occurred, (3) how soon after taking the medication did the reaction occur, (4) how many years ago did this reaction happen, and (5) subsequent tolerance of similar antibiotics.

• #13 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics

  Anaphylaxis is a sudden, potentially life-threatening allergic reaction. Symptoms include those of an allergic reaction, such as hives and swelling, as well as very low blood pressure, difficulty breathing, abdominal pain, swelling of the throat or tongue, and/or diarrhea or vomiting. […] Skin testing for penicillin allergy is the most reliable way to determine if a person is truly allergic to penicillin. Approximately 90 percent of people will test negative (meaning they do not have a penicillin allergy) because they either lost the allergy over time or they were never allergic to it in the first place. […] Research has shown that patients who are labeled penicillin allergic are more likely to receive antibiotics with a broad range of activities that are not necessary for the treatment of their particular infection.

• #14 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics

  Anaphylaxis is a sudden, potentially life-threatening allergic reaction. Symptoms include those of an allergic reaction, such as hives and swelling, as well as very low blood pressure, difficulty breathing, abdominal pain, swelling of the throat or tongue, and/or diarrhea or vomiting. […] Skin testing for penicillin allergy is the most reliable way to determine if a person is truly allergic to penicillin. Approximately 90 percent of people will test negative (meaning they do not have a penicillin allergy) because they either lost the allergy over time or they were never allergic to it in the first place. […] Research has shown that patients who are labeled penicillin allergic are more likely to receive antibiotics with a broad range of activities that are not necessary for the treatment of their particular infection.

• #15 Penicillin Allergy – what do you need to know?

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/penicillin-allergy

  Penicillin allergy can be evaluated by an allergist / immunologist, who will obtain a careful history and perform skin testing. […] If these tests are negative, it is very unlikely that a penicillin allergy is present. […] In cases of a positive penicillin test, either the skin prick or intradermal test will produce a red, raised bump, signifying the presence of an allergy to the medication. […] Penicillins need to be avoided and a different antibiotic will be needed to treat infections. […] If a penicillin is needed, a desensitization procedure can be performed under the care of an allergist / immunologist to temporarily allow the drug to be used.

• #16 Pediatric Antibiotic Allergy Testing Service (PATS) | Drug Allergy Program

  https://www.cincinnatichildrens.org/service/a/allergy-immunology/programs/drug-allergy/PATS

  Penicillin Allergy Testing video. […] Recent studies have shown that it is safe to re-expose children to antibiotics implicated in allergic reactions and that 95% of children who were thought to be allergic will not have a reaction when tested. […] According to Kimberly A. Risma, MD, PhD, who leads the Drug Allergy Program, the testing is simple and safe and should be offered to all children who are labeled as having an antibiotic allergy. […] New patients coming to the PATS outpatient clinic will have antibiotic testing done that same day in most cases. […] For example, patients with a concern for penicillin allergy will take a dose of amoxicillin (the most commonly prescribed form of penicillin) at the beginning of the appointment, and our allergy staff observe them for an hour to make sure that there is no reaction.

• #17 Penicillin allergies: What parents need to know | Children’s Mercy Kansas City

  https://www.childrensmercy.org/parent-ish/2024/03/penicillin-allergies/

  Antibiotic allergy testing is done at Children’s Mercy Kansas City’s Infectious Disease Antibiotic Challenge Clinic (for allergy testing to penicillin and amoxicillin only) and at Children’s Mercy Allergy Clinic for these and other antibiotics. […] If your child does not react during the visit, they are unlikely to have a serious immediate reaction when they receive this antibiotic in the future. […] It’s important to know. Ask your child’s primary care provider about a referral for penicillin allergy evaluation at Children’s Mercy.

• #18 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  A thorough exam and appropriate diagnostic tests are essential for an accurate diagnosis. A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. […] Your doctor will conduct a physical examination, ask questions about your symptoms and order additional tests. […] If you are allergic to one type of penicillin, your doctor may recommend a graded challenge with a type of penicillin or cephalosporin that’s less likely because of known chemical properties to cause an allergic reaction. This would enable your doctor to identify an antibiotic that can be used safely. […] During a drug challenge, your doctor provides careful supervision, and supportive care services are available to treat an adverse reaction. […] If your doctor determines that you have a penicillin allergy or likely allergy discontinuing the drug is the first step in treatment.

• #19 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing. […] If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] You’re carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.

• #20 Penicillin Allergy – Symptoms, Causes, Treatments

  https://resources.healthgrades.com/right-care/allergies/penicillin-allergy

  Seek immediate medical care (call 911) for serious symptoms, such as sweating and severe difficulty breathing, difficulty swallowing, or sudden swelling of the throat, tongue or lips. […] Seek prompt medical care if you are being treated for penicillin allergy but mild symptoms recur or are persistent. […] The mainstay of treatment for mild to moderate penicillin allergy reaction is antihistamine medications to reduce symptoms related to inflammation of the skin, such as hives, swelling, itching or rash. […] Respiratory symptoms, such as breathing difficulty and wheezing, are treated with bronchodilators. […] Corticosteroids may be administered to reduce inflammation either of the skin or airways. […] For severe penicillin allergy responses that include anaphylaxis, epinephrine is given subcutaneously or intramuscularly. […] You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you.

• #21 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing. […] If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] You’re carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.

• #22 PCN allergy — The Center for Allergy & Immunology

  https://www.kcallergycenter.com/pcn-allergy

  Nearly everyone knows someone who says they are allergic to penicillin. Up to 10 percent of people report being allergic to this widely used class of antibiotic, making it the most commonly reported drug allergy. […] Understanding penicillin allergies is important for a variety of reasons. […] Allergists, experts in the treatment and diagnosis of allergies and asthma, may want to know if childhood allergic reactions persist in their adult patients, to establish more complete medical histories and treatment options. […] These symptoms require immediate attention at the nearest Emergency Room. Epinephrine, the therapy of choice, will be given in this urgent care setting, but should also be self-administered via autoinjector as soon as possible by patients who have already been prescribed and are wisely carrying this device.

• #23 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing. […] If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] You’re carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.

• #24 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics

  Testing for penicillin allergy is especially important in the following situations: […] People who have a suspected penicillin (or closely related antibiotic) allergy and require penicillin to treat a life-threatening condition for which no alternate antibiotic is appropriate (eg, syphilis) […] People who have frequent infections and have suspected allergies to many antibiotics, leaving few options for treatment […] People who are immune compromised and therefore more likely to develop infections and need antibiotics […] Desensitization can be done for people who are truly allergic to penicillin but require treatment with it or a closely related antibiotic. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction.

• #25

  https://umiamihealth.org/en/treatments-and-services/allergy-and-immunology/penicillin-allergy

  In the case of more serious reactions, your doctor may recommend oral (by mouth) or injected corticosteroids to treat inflammation associated with penicillin allergy. […] If you need to take penicillin or a penicillin-containing medication and no alternatives are available, your doctor may recommend you undergo drug desensitization under their close supervision. This involves taking a very small dose of penicillin, and then progressively larger doses every 15 to 30 minutes over the course of several hours or a few days. If you reach the desired dose with no reaction, you can continue the treatment with penicillin. […] Your doctor will perform a comprehensive physical exam including a health history to help diagnose your penicillin allergy. […] Your allergist will inject a tiny amount of penicillin into your skin in a controlled environment and then watch for an allergic reaction. If you are allergic to penicillin, a red, itchy, raised bump will appear.

• #26 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing. […] If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] You’re carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.

• #27 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  For persons who have a positive skin test reactive to penicillin (either to the major or minor determinants), treatment with a -lactam antibiotic is not usually advised, and other effective antimicrobials should be used. […] Desensitization is required for persons who have a documented penicillin allergy and for whom no therapeutic alternatives exist (e.g., syphilis during pregnancy and persons with neurosyphilis).

• #28 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Penicillin is also one of the most frequently reported medication allergies. […] Identification of true penicillin allergy is critical as 80% to 90% of people once considered allergic are ultimately able to tolerate penicillins resulting in the decreased need for broad-spectrum antibiotics and development of multi-drug resistant organisms. […] Describe interprofessional team strategies for improving care and outcomes in patients with penicillin allergy. […] Penicillin allergy can be serious and result in a life-threatening anaphylactic reaction. […] Nursing staff should be vigilant on the intake so that this mistake is never made, but also should have the patient clarify any prior allergic reaction to penicillin drugs. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #29 Penicillin allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

  Penicillin allergy is an abnormal reaction of your immune system to the antibiotic drug penicillin. Penicillin is prescribed for treating various bacterial infections. […] Common signs and symptoms of penicillin allergy include hives, rash and itching. Severe reactions include anaphylaxis, a life-threatening condition that affects multiple body systems. […] See your doctor as soon as possible if you experience signs or symptoms of penicillin allergy. It’s important to understand and discuss what is an allergic reaction, what is a typical side effect and what you can tolerate in taking a medication. […] Call 911 or emergency medical help if you experience signs of a severe reaction or suspected anaphylaxis after taking penicillin. […] If you have a penicillin allergy, the simplest prevention is to avoid the drug. Steps you can take to protect yourself include the following: Inform health care workers. Be sure that your penicillin allergy or other antibiotic allergy is clearly identified in your medical records. Inform other health care professionals, such as your dentist or any medical specialist. […] Wear a medical alert bracelet that identifies your drug allergy. This information can ensure proper treatment in an emergency.

• #30 Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-021-01465-1

  PCPs and patients appear insufficiently aware of potential harms associated with incorrect penicillin allergy records. […] Some of the problems experienced by PCPs could be reduced by ensuring the details of newly diagnosed reactions to antibiotics are clearly documented. […] In order for PCPs to overturn more incorrect penicillin records through appropriate use of allergy services, more information and training about these services will be needed. […] Patients reported reflecting on the extent to which they believed their allergy record, taking into consideration the timing of symptoms and symptom severity. […] Patients also queried why they had developed an allergy, especially if they were previously able to take penicillin. […] Most patients were unsure whether their allergy status could change over time.

• #31 Penicillin allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

  Penicillin allergy is an abnormal reaction of your immune system to the antibiotic drug penicillin. Penicillin is prescribed for treating various bacterial infections. […] Common signs and symptoms of penicillin allergy include hives, rash and itching. Severe reactions include anaphylaxis, a life-threatening condition that affects multiple body systems. […] See your doctor as soon as possible if you experience signs or symptoms of penicillin allergy. It’s important to understand and discuss what is an allergic reaction, what is a typical side effect and what you can tolerate in taking a medication. […] Call 911 or emergency medical help if you experience signs of a severe reaction or suspected anaphylaxis after taking penicillin. […] If you have a penicillin allergy, the simplest prevention is to avoid the drug. Steps you can take to protect yourself include the following: Inform health care workers. Be sure that your penicillin allergy or other antibiotic allergy is clearly identified in your medical records. Inform other health care professionals, such as your dentist or any medical specialist. […] Wear a medical alert bracelet that identifies your drug allergy. This information can ensure proper treatment in an emergency.

• #32 3.5 Penicillin – Nursing Pharmacology-2e

  https://wtcs.pressbooks.pub/pharmacology2e/chapter/3-5-penicillins/

  Clients should be instructed to report a rash or any signs of superinfection such as vaginal itching or discharge (indicating a yeast infection) or loose or foul-smelling stool (indicating a possible C-diff infection). […] SAFETY: If an allergic reaction occurs, penicillin should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management.

• #33 Guidelines for Antibiotic Allergy with special reference to Penicillin and Beta Lactam Allergy

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/drug-interactions/guidelines-for-antibiotic-allergy-with-special-reference-to-penicillin-and-beta-lactam-allergy.html

  Allergies and anaphylaxis can occur with any medication. Allergies to antimicrobials are most likely with penicillins and cephalosporins. […] Ensuring known allergens are avoided requires patient education and prescriber caution, aided by prescription safety technology where available. Check allergy history immediately before prescribing any antimicrobial. […] Ensure the patient understands the nature of their allergy, which medication they should not have, and that they need to communicate this to all healthcare providers. […] If a patient believes they have an allergy to an antimicrobial, but the history is inconsistent with this, ensure the risks and benefits of the proposed treatments and alternatives are discussed with the patient and the patient expressly agrees to receive the proposed medication. Update all records and ensure the patient clearly understands the change in their allergy status.

• #34 3.5 Penicillin – Nursing Pharmacology-2e

  https://wtcs.pressbooks.pub/pharmacology2e/chapter/3-5-penicillins/

  Clients should be instructed to report a rash or any signs of superinfection such as vaginal itching or discharge (indicating a yeast infection) or loose or foul-smelling stool (indicating a possible C-diff infection). […] SAFETY: If an allergic reaction occurs, penicillin should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management.

• #35 3.5 Penicillin – Nursing Pharmacology-2e

  https://wtcs.pressbooks.pub/pharmacology2e/chapter/3-5-penicillins/

  Clients should be instructed to report a rash or any signs of superinfection such as vaginal itching or discharge (indicating a yeast infection) or loose or foul-smelling stool (indicating a possible C-diff infection). […] SAFETY: If an allergic reaction occurs, penicillin should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management.

• #36 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing. […] If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] You’re carefully monitored during the intervention, and supportive care is available to treat reactions. Desensitization is not always successful, and there is a risk of serious reactions.

• #37 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication. […] The presence of a penicillin allergy label considerably reduces prescribing options for affected patients. Moreover, penicillin allergy labels lead to the use of more expensive and less effective drugs and can result in adverse consequences, including longer length of hospital stay and increased risk for infection. […] Evaluating a patient who reports a penicillin or another -lactam antibiotic allergy involves three steps: 1) obtaining a thorough medical history, including previous exposures to penicillin or other -lactam antibiotics; 2) performing a skin test evaluation by using the penicillin major and minor determinants; and 3) among those who have a negative penicillin skin test, performing an observed oral challenge with 250 mg amoxicillin before proceeding directly to treatment with the indicated -lactam therapy.

• #38 Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-021-01465-1

  Six percent of patients are allergic to penicillin according to their medical records. […] Removal of incorrect penicillin allergy may have positive health consequences for the individual and the general population. […] Patients made sense of their allergy status by considering the timing and severity of symptoms. […] Diagnosis of penicillin allergy was reported to be imperfect with PCPs relying on patient reports and incomplete medical records. […] PCPs and patients often suspected that an allergy record was incorrect, but PCPs were reluctant to change records. […] PCPs had limited knowledge of allergy services. […] Both patients and PCPs differed in the extent to which they were aware of the negative consequences of incorrect penicillin allergy records, their relevance and importance to their lives, and management of penicillin allergy.

• #39 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Penicillin is also one of the most frequently reported medication allergies. […] Identification of true penicillin allergy is critical as 80% to 90% of people once considered allergic are ultimately able to tolerate penicillins resulting in the decreased need for broad-spectrum antibiotics and development of multi-drug resistant organisms. […] Describe interprofessional team strategies for improving care and outcomes in patients with penicillin allergy. […] Penicillin allergy can be serious and result in a life-threatening anaphylactic reaction. […] Nursing staff should be vigilant on the intake so that this mistake is never made, but also should have the patient clarify any prior allergic reaction to penicillin drugs. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #40 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication. […] The presence of a penicillin allergy label considerably reduces prescribing options for affected patients. Moreover, penicillin allergy labels lead to the use of more expensive and less effective drugs and can result in adverse consequences, including longer length of hospital stay and increased risk for infection. […] Evaluating a patient who reports a penicillin or another -lactam antibiotic allergy involves three steps: 1) obtaining a thorough medical history, including previous exposures to penicillin or other -lactam antibiotics; 2) performing a skin test evaluation by using the penicillin major and minor determinants; and 3) among those who have a negative penicillin skin test, performing an observed oral challenge with 250 mg amoxicillin before proceeding directly to treatment with the indicated -lactam therapy.

• #41

  https://www.nursingcenter.com/cearticle?an=00152193-202305000-00008&Journal_ID=54016&Issue_ID=6648474

  The financial burden of penicillin allergies on the healthcare system should also be taken into consideration. […] Delabeling reported penicillin allergies often starts by simply taking a detailed history of the reported allergy. […] Once a full penicillin reaction history is obtained, the reported allergy can be properly risk-stratified. […] In certain situations, high-risk patients with severe IgE-mediated reactions may need to receive penicillin as it may be their only treatment option. […] While some patients with listed penicillin allergies may have had prior severe reactions to penicillin, most have not and could safely receive penicillin without complication.

• #42

  https://www.nursingcenter.com/cearticle?an=00006205-202209000-00007&Journal_ID=54012&Issue_ID=6435935

  Once a full history of the reaction is obtained, the reported allergy can be properly risk-stratified. […] Moderate-risk patients include those with minor skin rashes and true allergic symptoms (isolated urticaria or angioedema without systemic or anaphylactic reaction). […] Any patient with reported anaphylaxis, multiple/recurrent antibiotic allergies, or prior positive penicillin skin tests should be considered high-risk and referred to an allergist for evaluation. […] In certain situations, high-risk patients with severe IgE-mediated reactions may need to receive penicillin as it may be their only treatment option. […] While some patients with listed penicillin allergies may have had prior severe reactions to penicillin, most have not and could safely receive penicillin without complication. The benefit of fully evaluating a questionable allergy often outweighs risks of alternative therapies.

• #43

  https://journals.lww.com/journalofinfusionnursing/fulltext/2025/01000/getting_to_the_bottom_of_a_patient_s_penicillin.5.aspx

  Patients with low-risk allergic histories may have their penicillin allergy delabeled after a simple single-dose amoxicillin challenge that can be performed in an office-based setting. […] The antibiotic cefazolin may be used across the spectrum of allergic histories, even in those with recent IgE mediated reactions to other beta-lactams.

• #44

  https://www.cheo.on.ca/en/resources-and-support/p6289.aspx

  The best way to test penicillin allergies is called the penicillin or amoxicillin challenge. Just like many other allergy tests, this means giving a very small dose of the antibiotic in a supervised setting to see if an allergic reaction occurs. […] Being in a hospital is the safest place to do this penicillin challenge. Only patients who are at the lowest risk for a reaction are tested. […] If you show any signs or symptoms of an allergic reaction, you will immediately be assessed and if necessary, treated with the right medications to help. […] If you don’t show any signs or symptoms of an allergic reaction, this means you have successfully passed the penicillin challenge! Your care team will remove the penicillin allergy label from your medical chart. They will also give you a document that you can bring to your family doctor and pharmacy so that your records can be updated there, too.

• #45 Penicillin allergy delabelling: A multidisciplinary approach for improved patient care – Hospital Pharmacy EuropeHospital Pharmacy Europe

  https://hospitalpharmacyeurope.com/clinical-zones/immunology/penicillin-allergy-delabelling-a-multidisciplinary-approach-for-improved-patient-care/

  Penicillin allergy assessment and delabelling (PAD) seeks to investigate a penicillin allergy history, remove the allergy designation where possible and/or desensitise the patient to future penicillin therapies. […] Successful PAD programmes require a systems-level approach. […] A cohesive strategy is needed where all clinicians, not just allergy specialists, feel comfortable performing delabelling, he says. […] Driven by a desire to ensure patient safety, participants felt that PAD should be a multidisciplinary responsibility, shared between doctors and pharmacists and supported by pharmacy technicians and nurses. […] Its clear that penicillin allergy delabelling is an essential component of AMS, with important implications for patient care and public health. […] Ultimately, development of well-resourced MDTs and evidence-based guidelines will facilitate a safe and effective delabelling process, ensuring that patients receive the most appropriate treatment for their condition, all while minimising the risk of adverse reactions and keeping patients safe.

• #46 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/n/statpearls/article-26892/

  All healthcare workers including the nurse practitioner and pharmacist who prescribe/dispense penicillin must ask the patient if he or she is allergic to the medication, as part of an interprofessional team approach to patient care. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #47 Penicillin allergy delabelling: A multidisciplinary approach for improved patient care – Hospital Pharmacy EuropeHospital Pharmacy Europe

  https://hospitalpharmacyeurope.com/clinical-zones/immunology/penicillin-allergy-delabelling-a-multidisciplinary-approach-for-improved-patient-care/

  Penicillin allergy assessment and delabelling (PAD) seeks to investigate a penicillin allergy history, remove the allergy designation where possible and/or desensitise the patient to future penicillin therapies. […] Successful PAD programmes require a systems-level approach. […] A cohesive strategy is needed where all clinicians, not just allergy specialists, feel comfortable performing delabelling, he says. […] Driven by a desire to ensure patient safety, participants felt that PAD should be a multidisciplinary responsibility, shared between doctors and pharmacists and supported by pharmacy technicians and nurses. […] Its clear that penicillin allergy delabelling is an essential component of AMS, with important implications for patient care and public health. […] Ultimately, development of well-resourced MDTs and evidence-based guidelines will facilitate a safe and effective delabelling process, ensuring that patients receive the most appropriate treatment for their condition, all while minimising the risk of adverse reactions and keeping patients safe.

• #48 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  Review allergy status as part of Structured Medication Reviews. […] Review allergy status during New Medicine Service reviews. […] Check the patient medication record against the Summary Care Record. […] On admission to hospital, ensure allergy history is reviewed as part of the drug history and medicines reconciliation process. […] GP practice pharmacy teams can run searches to identify any patients with a documented allergy that have since received penicillin. […] Ensure that the records are updated for any patients with a penicillin allergy label that have since successfully received penicillin without an allergic reaction. […] If trained, carry out an allergy history assessment. […] Set up a penicillin allergy de-labelling service or clinic; the Resources below may help.

• #49 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/n/statpearls/article-26892/

  All healthcare workers including the nurse practitioner and pharmacist who prescribe/dispense penicillin must ask the patient if he or she is allergic to the medication, as part of an interprofessional team approach to patient care. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #50 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Penicillin is also one of the most frequently reported medication allergies. […] Identification of true penicillin allergy is critical as 80% to 90% of people once considered allergic are ultimately able to tolerate penicillins resulting in the decreased need for broad-spectrum antibiotics and development of multi-drug resistant organisms. […] Describe interprofessional team strategies for improving care and outcomes in patients with penicillin allergy. […] Penicillin allergy can be serious and result in a life-threatening anaphylactic reaction. […] Nursing staff should be vigilant on the intake so that this mistake is never made, but also should have the patient clarify any prior allergic reaction to penicillin drugs. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #51 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Penicillin is also one of the most frequently reported medication allergies. […] Identification of true penicillin allergy is critical as 80% to 90% of people once considered allergic are ultimately able to tolerate penicillins resulting in the decreased need for broad-spectrum antibiotics and development of multi-drug resistant organisms. […] Describe interprofessional team strategies for improving care and outcomes in patients with penicillin allergy. […] Penicillin allergy can be serious and result in a life-threatening anaphylactic reaction. […] Nursing staff should be vigilant on the intake so that this mistake is never made, but also should have the patient clarify any prior allergic reaction to penicillin drugs. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

• #52 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/n/statpearls/article-26892/

  All healthcare workers including the nurse practitioner and pharmacist who prescribe/dispense penicillin must ask the patient if he or she is allergic to the medication, as part of an interprofessional team approach to patient care. […] These interprofessional steps can prevent penicillin allergy and prevention is the optimal management strategy.

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