How do I know if I’m re­ally al­ler­gic to peni­cillin?

Irish Independent - Health & Living - - ADVICE - WITH DR NINA BYRNES drn­ina@in­de­pen­dent.ie

AI have al­ways be­lieved my­self to be al­ler­gic to peni­cillin, as my mother told me I had a bad re­ac­tion as a tod­dler to an an­tibi­otic. Grow­ing up, doc­tors and phar­ma­cists were told that they must pre­scribe me an al­ter­na­tive drug and, to the best of my knowl­edge, I haven’t had peni­cillin since. I’m now in my thir­ties and I’ve been read­ing lately that many peo­ple who be­lieve them­selves to be al­ler­gic to peni­cillin are not ac­tu­ally al­ler­gic, and that this is dan­ger­ous, as other an­tibi­otics are not as ef­fec­tive. It wor­ries me as I age that my op­tions for treat­ment in a med­i­cal emer­gency are lim­ited. Is it pos­si­ble that I could have grown

out of this al­lergy, or that I was never al­ler­gic in the first place? Is there a safe way of find­ing out? TRUE al­lergy oc­curs when the im­mune sys­tem re­sponds to a sub­stance that is not nor­mally harm­ful. It is over-sen­si­tive and re­leases chem­i­cals, which re­sult in a re­ac­tion. A sub­stance that causes such a re­ac­tion is called an al­ler­gen. A true se­vere al­lergy to a sub­stance can re­sult in a con­di­tion called ana­phy­laxis. This is a life-threat­en­ing, se­vere, whole­body re­ac­tion that re­sults in swelling of the lips, tongue and air­way, dif­fi­culty breath­ing, and changes in the heart and blood pres­sure, lead­ing ul­ti­mately to col­lapse and a risk of death. It is a med­i­cal emer­gency that re­quires im­me­di­ate re­sponse and at­ten­tion.

Peni­cillin is an im­por­tant and ef­fec­tive an­tibi­otic and it is well-known that many cases of re­ported re­ac­tion are not in fact a true al­lergy. Up to 10pc of pa­tients re­port peni­cillin al­lergy when, in re­al­ity, the true fig­ure is closer to 1pc to 5pc in 10,000 doses pre­scribed.

Dis­cussing the symp­toms you had with your GP may clar­ify whether there is in fact have an al­lergy at all or whether it is sen­si­tiv­ity or an­other med­i­cal con­di­tion. If there was a def­i­nite re­ac­tion, such as a rash clearly caused by the sub­stance, or there was wheeze, short­ness of breath or col­lapse, then it is highly likely that there is a se­ri­ous al­lergy to the al­ler­gen. There are also other forms of peni­cillin al­lergy that re­sult in skin and blood changes or kid­ney issues. Peni­cillin will also usu­ally be avoided in these cases.

If symp­toms ap­pear later in the course of peni­cillin, it is less likely to be a true peni­cillin al­lergy. For ex­am­ple, those who have glan­du­lar fever may de­velop a rash if given amox­i­cillin, which is a form of peni­cillin. These peo­ple are not re­act­ing to the peni­cillin, but rather the drug trig­gers an­other im­mune re­sponse with the virus.

If the his­tory of re­ac­tion is def­i­nite, but vague in de­tail, it is usu­ally rec­om­mended to avoid tak­ing

My 76-year-old mother has just been di­ag­nosed with con­ges­tive heart fail­ure, but the doc­tor did

not seem to be overly con­cerned. What is the out­look for heart-fail­ure pa­tients at her age?

Hpeni­cillin un­less the sit­u­a­tion is clar­i­fied. De­tailed al­lergy test­ing in­volves blood and skin patch tests or more de­tailed im­mune as­sess­ment. We have some ex­cel­lent im­mu­nol­o­gists work­ing in the public sec­tor in

eart fail­ure means the pump ac­tion of the heart be­comes in­suf­fi­cient to meet the needs of the or­gans and tis­sue of the body. The amount of blood pumped by the heart be­comes in­ad­e­quate to cir­cu­late through the en­tire body and lungs. This causes pres­sure along the vas­cu­lar sys­tem, lead­ing to fluid leak­ing from our small­est ves­sels, called cap­il­lar­ies. This pool­ing of fluid causes symp­toms such as short­ness of breath, weak­ness, and swelling, par­tic­u­larly of the limbs.

There are many causes of heart fail­ure. Most com­monly it is as­so­ci­ated with un­der­ly­ing Ire­land but un­for­tu­nately wait­ing lists are long. It is im­por­tant that if al­lergy-test­ing is un­der­taken it is done by a spe­cial­ist in a proper clin­i­cal en­vi­ron­ment where all the ap­pro­pri­ate re­sus­ci­ta­tion equip­ment is avail­able

car­dio­vas­cu­lar dis­ease or high blood pres­sure. Other causes in­clude chronic al­co­hol abuse, valve issues and var­i­ous in­fec­tive causes. Heart fail­ure is clas­si­fied into four main types (the New York Heart As­so­ci­a­tion Func­tional Clas­si­fi­ca­tion), largely look­ing at a pa­tient’s ac­tiv­ity and symp­toms. Out­look varies greatly among these types.

The goal of treat­ment in heart fail­ure is to keep the heart beat­ing as ef­fi­ciently as pos­si­ble. Med­i­ca­tion will be pre­scribed to de­crease fluid within the body and to help the heart pump more ef­fec­tively. Life­style man­age­ment such as re­stric­tion of salt and fluid

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in­di­vid­ual cor­re­spon­dence should ana­phy­laxis oc­cur. There are peo­ple in whom skin-al­lergy test­ing may be dan­ger­ous and even bring on a fa­tal al­ler­gic re­sponse. For­mal al­lergy test­ing is usu­ally rec­om­mended in those who have had a clear ana­phy­lac­tic-type re­sponse. Blood or skin test­ing is then of­ten fol­lowed by ex­pos­ing or chal­leng­ing with the drug to clar­ify the ex­tent of sen­si­ti­sa­tion.

As peni­cillin al­lergy test­ing is an in­ten­sive and spe­cialised process, pri­or­ity is usu­ally given to those who have a chronic dis­ease that may re­quire more fre­quent or chronic an­tibi­otic use. If you are not within this group, test­ing may not be war­ranted.

I would ad­vise clar­i­fy­ing the na­ture of your ini­tial re­ac­tion. Dis­cuss this with your GP, who can de­cide whether re­fer­ral for fur­ther test­ing is in­deed war­ranted.

in­take, avoid­ance of ex­cess al­co­hol, stop­ping smok­ing and avoid­ing obe­sity are ex­tremely im­por­tant as all of these things put a fur­ther strain on the vas­cu­lar sys­tem. Those who are di­ag­nosed early in the dis­ease will fare bet­ter than those with a later di­ag­no­sis. A re­cent study sug­gested that about 50pc of those di­ag­nosed with con­ges­tive heart fail­ure are alive five years af­ter di­ag­no­sis. Many car­di­ol­ogy cen­tres have spe­cialised heart fail­ure clin­ics and in­volve­ment in these will im­prove out­look and man­age­ment, ul­ti­mately keep­ing your mother well for as long as pos­si­ble.

Ask all three to com­mu­ni­cate with each other, and to work to­gether as a team, or else you could be in­ter­fer­ing with your progress. Set out a de­tailed plan and set some time lim­its and tar­gets, even if it is only walk­ing a few steps.

In my opin­ion, the most im­por­tant of all is your men­tal ap­proach — you have to be­lieve and ac­cept that you are go­ing to make a com­plete re­cov­ery, no mat­ter what the medics say.

De­tailed al­lergy test­ing in­volves

blood and skin patch tests

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