Thread by @AllergyKidsDoc

10% of people reading this believe they are allergic to penicillin, but >95% of you are not actually allergic.

Inappropriate labeling of penicillin allergy is rampant and leads to unnecessary avoidance, use of less effective alternatives, & antibiotic resistance. Thread⬇️

Too many unqualified people have the ability to label someone as having penicillin allergy, which stays on the medical record forever.

The fact is, true allergy is much more rare than suspected. Side effects are common, as are other symptoms, which get mislabeled as ‘allergy’

Simple questions can stratify risk for penicillin allergy.
No increased risk or reason to avoid based on:
-Family history (drug allergy not inherited)
-Received again without problems
-Diarrhea, upset stomach, yeast infections (side effects)
#nationalpenicillinallergyday

Common scenario (especially in kids) but low risk for actual allergy: Delayed onset rash while taking penicillin.

>95% can simply receive again without problems - dose graded challenge very useful👍
Anaphylaxis exceptionally unlikely with this history. jamanetwork.com/journals/jama/…

Even if history is suggestive for anaphylaxis or immediate allergy to penicillin, clarification w skin testing should still occur.

-History may be misleading
-True allergy can wane over time
-Can provide list of safe alternatives
jamanetwork.com/journals/jamap…
mdedge.com/familymedicine…

In summary, ANYONE with suspected penicillin allergy should be evaluated to clarify.
-Vast majority will not be allergic
-Simple questions can risk stratify
-We need to STOP blindly labeling patients with penicillin allergy based upon inconclusive history or side effects