Many physicians whose patients have “penicillin allergy” in their charts don’t know that frequently, a penicillin allergy diagnosis is given to a child as the result of a rash, but without any follow up testing.
A study presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, examined 276 surveys of physicians at Rochester Regional Health. They found more than 80 percent of the general practitioners surveyed acknowledged the need for allergy consultation, but had never referred their patients to an allergist, or had only done so with one patient a year.
“The survey showed us there is a lack of understanding among internists and general practitioners regarding the need for testing the large numbers of people who report penicillin allergy but have never been tested,” says Dipekka Soni, MD, lead author of the study. “Unfortunately, specialty physicians and non-internal medicine physicians had an even lower rate of referring those with reported penicillin allergy to an allergist for testing, 93 percent and 88 percent respectively.”
About 10 percent of Americans carry a label of penicillin allergy, and others have an “allergic history” to other antibiotics. As a result, they are often prescribed more toxic, dangerous and expensive antibiotics that might not be necessary. “More than 90 percent of patients with a penicillin allergy can tolerate penicillin-like antibiotics, yet our survey showed that only 30 percent of the physicians responding to the survey knew that,” added infectious diseases pharmacist Mary Staicu, PharmD, study co-author.
“Our research found a poor understanding of penicillin allergy among non-allergists,” says allergist Allison Ramsey, MD, study co-author and ACAAI member. “Less than half of those surveyed understood that a penicillin allergy can resolve over time. Only 20 percent identified appropriate patients for penicillin skin testing from the descriptions provided.”
It’s vital that doctors understand the importance of confirming penicillin allergy, but it’s even more critical that those who carry the label be tested by an allergist to be sure. An allergist will work with you to find out if you’re actually allergic and determine what medications you have available for treatment if you are. If you’re not, you’ll be able to use medications that are safer, often more effective, and less expensive.
Abstract Title: A clinical perspective: The prescriber’s true understanding of the “penicillin allergic” patient
Author: Dipekka Soni, MD