Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population

Abstract

Penicillin P enicillin allergy remains the most common drug allergy reported, with a prevalence of ϳ8 -12% depending on the specific population evaluated. 1-3Higher rates are noted in individuals receiving more health care, including female patients and with increasing age.2,3 Symptoms associated with reported penicillin allergy classically include rash and/or itching, nausea, vomiting, shortness of breath, and anaphylaxis. However, often reported symptoms are either classified as unknown or representative of non-IgE-mediated reactions, such as nonurticarial rashes resulting from underlying viral illnesses. 4 The Choosing Wisely campaign recommends appropriate evaluation of patients with a history of penicillin allergy rather than avoidance or use of alternative antibiotics that can increase medical costs, patient morbidity, and potentially contribute to further antibiotic resistance.5,6 After a complete evaluation, up to 90% of individuals with a history of penicillin allergy are able to tolerate penicillins.1 Despite these favorable statistics, drug allergies are very rarely confirmed or removed from the medical record, and penicillin allergy is overdiagnosed with the antibiotic class avoided as part of a "safe rather than sorry" approach. 2,4,7 It is therefore important to study the epidemiology of penicillin allergy, because it may help practitioners better identify the patients at risk for true drug allergy. Relatively few studies have examined the characteristics of penicillin allergy in various patient populations. A 20-year retrospective study published by Ponvert et al. is the largest to report on ␤-lactam allergy in children. They showed that a history of severe skin symptoms such as acute generalized Stevens-Johnson Syndrome (SJS), serum sickness-like reactions, and anaphylaxis were risk factors for ␤-lactam allergy, although age, gender, and a history of atopy were not contributing factors. 8 In contrast, the largest retrospective study of both children and adults with self-reported antibiotic allergy by Macy et al. found that female gender and older age were associated with a higher rate of self-reported allergy, albeit without confirmation by skin and challenge testing.2 Despite these reports, there are still few published data on the epidemiology of penicillin allergy in the outpatient population of the United States.

A Study of Adverse Drug Reactions in Patients Treated with Penicillins in a Rural Tertiary Care Hospital

“…[10,11] The absence of organized continuing medical education programs and problematic physician attitude are other problems that add to under reporting of the adverse drug reaction. [12] There was predominance of female sex for adverse drug reactions which was similar to a study conducted by Albin S et al 13 The mean age of patients was 38.37 years which was less as compared to another study conducted by Jakob E. Borch et al [14] Amoxicillin and clavulanic acid combination was the most common penicillin causing ADRs. But studies done by Sara et al and Trubiano et al showed amoxicillin alone as most common penicillin causing ADRs.…”

“…Most common system affected was dermatological which was in line with other studies. [13,14] This increased reporting of dermatological ADRs could be due to easy recognition of dermatological reactions than involving other organ systems. [17] Most of the reactions were of probable causality according to WHO criteria since drug rechallenge was not done in any of the cases.…”

Investigation of Atopy in Primary Cutaneous CD30+ T-Cell Lymphoproliferative Disorders

“…The frequency of allergic drug reactions were similar for both LyP and pcALCL subsets (28% overall) with reactions to penicillin type drugs reported most often in both cohorts. When compared to the 11.46% frequency of penicillin reactions reported by Albin, [15] only the pcALCL cohort had a significantly higher allergy rate (P= 0.012).…”

“…Specifically the calculated rates for allergic rhinitis/hay fever, asthma and eczema were 38.2% (1139/2982), 10.32% (443/4291), and 7.21% (156/2163), respectively. For the prevalence of allergic reactions to penicillin or derivatives, we used the 11.46% (1348/11,761) frequency from Albin's survey [15]. IgE-t levels were compared against several published series of non-atopic controls [2, [16][17][18][19][20][21][22][23].…”

Penicillin allergy

“…Albin and Argarwal [32] at Mount Sinai in New York reviewed the EHRs of 11 761 internal medicine clinic patients and noted that 1348 (11.5%) carried a history of penicillin allergy. They confirmed that penicillin allergy was more common in elderly female patients.…”