The majority of Australians who report a penicillin allergy are not truly allergic, prompting the peak body for immunologists to change its guidelines in a bid to reduce hospitals stays and tackle antimicrobial resistance.
Penicillin, one of the most commonly prescribed antibiotics in Australia, was thought to cause allergies in 10% of Australians, or about 2.8 million people.
But the latest evidence shows up to 90% of those 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, give the first peer-reviewed and updated advice to GPs and other health professionals about how to diagnose and manage the allergy, and when to refer to a specialist.
Prof Michaela Lucas, a clinical immunologist, said misdiagnosis occurs for a number of reasons, with people sometimes experiencing a rash or nausea after taking penicillin and assuming it’s an allergy, or doctors wanting to be cautious and recording side-effects as allergies.
Other people were told by a parent that they suffered a reaction when they were a child and carry that diagnosis through to adulthood without questioning it, she said, while some side-effects may also be due to the illness itself and not the medicine.
Penicillin is an important antibiotic option, as it treats common infections, said Lucas, a professor at the University of Western Australia’s medical school.
“It is also what is known as a narrow spectrum antibiotic, which means it is targeted at the bug specifically causing the infection,” she said.
“Once you have to avoid narrow classes of drugs, you have to use broader spectrum antibiotics which have a bigger impact of your gut microbiome as they are associated with also killing good bacteria and allowing superbugs to come in and take residency.”
Superbugs are strains of bacteria that are highly resistant to multiple standard treatments.
“Antimicrobial resistance matters beyond the individual patient, because resistant bacteria can spread between people and through communities,” Lucas said.
“If someone develops a serious infection that is resistant to several antibiotics, doctors can be left with very limited treatment options.”
Dr Nick Cooling, the chair of the Royal Australian College of General Practitioners’ allergy special interest group, said the guidelines were based on the latest evidence, and a consensus report from a range of medical specialities.
He hopes the guidance will cut health costs in the community and ease the burden on immunologists.
“We know that people who have a penicillin allergy label go to hospital more,” he said.
“They spend longer in hospital, and they also cost the system more.”
This is because of more treatments needing to be trialled, side-effects from those treatments, and delays in finding alternative treatments.
“The ability to clarify that with these patients will reduce hospital costs but also the whole health system cost,” he said.
“We need all health professionals to be involved in this because if we’re going to de-label some 2.8 million people in Australia, you can’t just rely on the 300 immunologists to do that.”
Cooling urged affected patients to raise the question of a penicillin allergy with their GP, and with cases where the potential risk of harm is low, doctors could give their patient penicillin and monitor for symptoms.
But he warned: “No one should try taking penicillin themselves to find out whether they are allergic. Antibiotics should only be taken when prescribed for the individual taking them.”
For Tammy Prescino, the issue of penicillin allergy is a very real concern. She welcomes the changes, with her 70-year-old mother and 12-year-old daughter both diagnosed.
Prescino worries that if her mother were to get an infection, she could miss out on the benefits of penicillin. She plans to see a doctor and to get her family reassessed.
“Because if she doesn’t have the penicillin allergy, then we wouldn’t have to withhold medicine … that could help her,” Prescino said.
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