Millions falsely think they are allergic to penicillin

DAbbie Roth

id you know that more than 29 million people in the United States — a little more than the population of Texas — unnecessarily avoid taking penicillin antibiotics?

These folks believe they are allergic. But they probably aren’t. And, recently, I learned that I’ve been one of them.

Earlier this year, I learned the following statistic: 10 percent of people in the U.S. report penicillin allergy, but 90 percent of them aren’t truly allergic. This is according to the Centers for Disease Control and Prevention. Recent studies reported by the American Academy of Allergy, Asthma and Immunology suggest that the number of truly allergic individuals might be even smaller. One study found that, in a group of children older than 7 whose previous reactions were not life-threatening, only 2.6 percent had a true allergy diagnosed by taking a small amount of the drug under supervision of a physician.

So how do so many people become labeled “penicillin allergic?”

One common way that people, especially kids, earn the label: They get sick, take a penicillin antibiotic such as amoxicillin, augmentin or ampicillin, about five days later they get a rash, and the doctor’s office determines that they are allergic. For me, a college staff nurse told me not to take penicillin ever again because I had a rash toward the end of a course of antibiotics for a sinus infection.

However, the likelihood that a rash is a true allergy and not a side effect of the medication or symptom of the disease is small. And while the distinction might seem unimportant, it is increasingly essential to know whether a medication will cause an allergic reaction or if it will cause some unpleasant side effects.

If someone is sick and a penicillin would be the best treatment for the illness, side effects can be managed. Allergies can be dangerous. This is one reason reported allergies are rarely questioned. Once the penicillin allergy is listed in the electronic health record, it can be difficult to find someone willing to remove it.

But does this even matter? Aren’t there other antibiotics?

If someone can’t, or doesn’t, take the most specific antibiotic for an illness, in many cases a narrowspectrum drug such as a penicillin, they have to take a broad-spectrum antibiotic. Those medications work for a wider variety of illnesses, but they are more expensive, have more side effects, might not work as well for a specific illness, and are major contributors to antibiotic resistance. Antibiotic resistance is a global threat to health, food security and development. According to the CDC, at least 23,000 people in the United States die of a resistant infection each year.

So what can we do about it?

If you think you or your child is allergic, talk with a physician who specializes in allergy and immunology. He or she will discuss the medical history and offer advice about testing. For penicillin allergy, an allergist can do skin testing, just as for environmental allergens such as pollen and cat dander. The testing will let the allergist know how likely it is that you would have a reaction if you take penicillin.