Research finds nine out of 10 with penicillin allergy not allergic

It is a common scenario.
 
A patient presents with a bacterial infection requiring antibiotics, but their records show they are allergic to penicillin.
 
New research has cast fresh doubt on the likelihood that records accurately reflect a patient’s true penicillin allergy.
 
The research, presented at a scientific meeting in Houston, Texas, found that nine out of 10 Americans who think they are allergic to this antibiotic have either outgrown the allergy, or were never allergic in the first place.
 
But even when people tested negative to a penicillin test, their ‘allergy’ often remains on medical records and pharmacy charts.
 
‘Our study found that of the 52 patients who tested negative to penicillin and were interviewed, 98% understood they were not allergic to penicillin,’ Dr Sonam Sani, allergist and immunologist, and lead study author, said.
 
‘Of those, 29% still had a penicillin allergy label in their electronic medical record, and 24% still carried the label in their pharmacy records.’
 
These results do not surprise Dr Evan Ackermann, GP and past Chair of the RACGP Expert Committee – Quality Care (REC–QC).
 
He told newsGP the incorrect labelling of patients in Australia with penicillin allergies has been a long-term issue that happens very easily, and that penicillin allergies in general are recorded ‘very, very frequently’.
 
This occurs for a number of reasons.
 
Firstly, according to Dr Ackermann, some patients ‘lose’ their allergy to penicillin with time – but retain the label on their records nonetheless.
 
Conversely, others are incorrectly attributed with an allergy in the first place, such as after developing a rash for a viral infection.  
 
‘So there are a lot of people labelled as being allergic to penicillin [who actually are not],’ Dr Ackermann said.
 
Dr Sani also noted that, once a patient has tested negative for penicillin allergy, collaboration is needed between patients, doctors and pharmacists in order to ensure records reflect their safety to resume the antibiotic as needed.
 
‘Anyone who has tested negative for penicillin allergy should have confidence in their test results and be able to use penicillin antibiotics for future infections,’ he said.
 
Dr Ackermann agrees that steps need to be taken for medical records to more accurately reflect patients’ allergy status.
 
‘Properly labelling people’s allergies and their adverse events, and the documentation of that, is important,’ he said.
 
However, Dr Ackermann notes the challenge lies in accurately assessing a person’s allergic status in the first place, and that the current system – whereby a referral to an allergist for a patient to receive formalised testing is needed – is a ‘long process’.
 
‘It’s hard to organise allergy testing,’ he said.
 
Instead, Dr Ackermann believes allergy testing for penicillin needs to be made ‘more mainstream’ and attract proper Medicare Benefits Schedule (MBS) rebates.
 
And while there is no system in place to universally deal with this issue, one way general practices can address it is to perform an audit of all patients with penicillin allergies.
 
Dr Ackermann suggests that practice nurses could then contact patients to organise testing and ensure medical records are updated accordingly, in a similar vein to the way in which chronic obstructive pulmonary disease and smoking are tackled.
 
He did note, however, that funding such a system might not be practical and there is no clear-cut answer to this issue.
 
‘[But] we need to make testing for allergy more mainstream and easier, and support that,’ Dr Ackermann said.
 
As it currently stands, Dr Ackermann is concerned that patients listed as having a penicillin allergy are contributing to antibiotic resistance, as more ‘broad spectrum’ antibiotics may be needed in such cases.
 
Recent research confirms this idea, with a paper published in The BMJ Journal last year finding that people labelled as having a penicillin allergy have a 69% increased risk of developing ‘superbug’ infection methicillin-resistant Staphylococcus aureus (MRSA), and a 26% increased risk of contracting C. difficile.
 
Dr Ackermann believes this is an important issue that doctors need to consider when seeing patients whose records state they have a penicillin allergy, as to whether further steps are taken to ascertain its validity.  
 
‘It’s a problem that should be solved,’ he said.

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