The majority of Australians who report a penicillin allergy are not truly allergic, prompting the peak body of immunologists to change its guidelines in a bid to reduce hospital stays and combat antimicrobial resistance.
Penicillin, one of the most commonly prescribed antibiotics in Australia, is thought to cause allergies in 10% of Australians, or around 2.8 million people.
But the latest evidence shows that up to 90% of people reporting a penicillin allergy do not have one.
The changes to the Australasian Society of Clinical Immunology and Allergy guidelines, which have been published in the Journal of Allergy and Clinical Immunology, provide the first peer-reviewed and updated advice to GPs and other healthcare professionals on how to diagnose and manage allergy, and when to refer to a specialist.
Professor Michaela Lucas, a clinical immunologist, said misdiagnoses happen for a number of reasons: people sometimes experience a rash or nausea after taking penicillin and assume it is an allergy, or doctors want to be cautious and record side effects as allergies.
Other people were told by a parent that they suffered a reaction as a child and carried that diagnosis into adulthood without questioning it, she said, while some side effects may also be due to the illness itself and not the medication.
Penicillin is an important antibiotic option because it treats common infections, said Lucas, a professor at the University of Western Australia’s medical school.
“It is also a narrow-spectrum antibiotic, meaning it specifically targets the microbe causing the infection,” she said.
“Once you have to avoid narrow classes of medications, you need to use broader-spectrum antibiotics that have a greater impact on your gut microbiome, because they are also associated with the destruction of good bacteria and the entry of superbugs.”
Superbugs are strains of bacteria that are very resistant to several standard treatments.
“Antimicrobial resistance is not limited to the individual patient, as resistant bacteria can spread between people and across communities,” Lucas said.
“If a person develops a serious infection resistant to multiple antibiotics, doctors may be left with very limited treatment options. »
Dr Nick Cooling, chair of the Royal Australian College of General Practitioners Allergy Special Interest Group, said the guidelines were based on the latest evidence and consensus reporting from a range of medical specialties.
He hopes these guidelines will reduce healthcare costs in the community and ease the burden on immunologists.
“We know that people with penicillin allergies are going to the hospital more,” he said.
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“They spend more time in the hospital and also cost the system more. »
This is due to more treatments needing to be tested, the side effects of these treatments, and delays in finding alternative treatments.
“The ability to clarify this with these patients will reduce hospital costs but also the cost of the entire health system,” he said.
“We need all health professionals to be involved in this project, because if we want to de-label some 2.8 million people in Australia, you can’t just rely on the 300 immunologists to do it.”
Cooling urged affected patients to raise the issue of a penicillin allergy with their GP, and in cases where the potential risk of harm is low, doctors could administer penicillin to their patient and monitor the symptoms.
But he warned: “No one should try to take penicillin themselves to find out if they are allergic. Antibiotics should only be taken when prescribed to the person taking them.”
For Tammy Prescino, the issue of penicillin allergy is a very real concern. She welcomes the changes, since her 70-year-old mother and 12-year-old daughter have both been diagnosed.
Prescino worries that if her mother got an infection, she might miss out on the benefits of penicillin. She plans to see a doctor and have her family reevaluated.
“Because if she’s not allergic to penicillin, we wouldn’t have to deny her the medications … that could help her,” Prescino said.
Gn Health
