ACCP PRESS RELEASE
For release: October 17, 2000
PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY USUALLY TEST NEGATIVE AND CAN USE DRUG SAFELY
Most patients with a history of allergy to penicillin show a negative reaction to a skin test for the drug and can safely use penicillin, according to a pilot study in the October issue of CHEST. The authors also recommend skin testing as a way of reducing the spread of antibiotic resistance and improving patient care.
Writing in the peer-reviewed journal of the American College of Chest Physicians, Alejandro C. Arroliga, M.D., of the Pulmonary and Critical Care Department, The Cleveland Clinic Foundation, Cleveland, Ohio, along with five associates, said that most patients with histories of penicillin allergy are placed on alternative antibiotic therapy to try to avoid the risk of severe reaction to penicillin. However, a penicillin skin test on a person with a history of allergy to the drug is a safe and reliable method of actually determining the patient's true risk of an immediate systemic allergic reaction.
"Penicillin skin testing has a reaction rate between 0.3 percent and 1.2 percent with no serious adverse side effects," said Dr. Arroliga. "A person with a history of penicillin allergy and a negative reaction to a skin test may be able to use a penicillin compound that could reduce the use of certain alternative antibiotics and cut down on the increasing emergence of resistant microorganisms."
According to the study, infections caused by multidrug-resistant pathogens are associated with increased severity of illness and higher mortality rates.
Approximately 10 to 20 percent of the patients admitted to a hospital have histories of allergic reaction to penicillin, the authors note. Many patients do not remember the type of reaction they developed to penicillin.
For example, in this study group of patients admitted to the intensive care unit, about half of those tested could not remember the characteristics of their allergy. Some recalled a skin rash and another group had developed an itchy skin eruption when given penicillin 30 years ago. The average age of the patients was almost 65.
"In addition, it is important to remember patients with allergy tend lose their sensitivity to penicillin over time, as demonstrated by a negative skin test," said Dr. Arroliga.
In the Medical Intensive Care Unit at Cleveland Clinic, the investigators found 24 of 257 patients (9 percent) admitted to the unit from April 1 to June 30, 1999, with a history of penicillin allergy. They had been started on other antibiotics before entering the center. Three of the 24 had histories of recent immediate reaction (type I reaction) to penicillin and were not tested. Twenty of the 21 remaining patients showed a negative reaction to a skin test. The researchers switched 10 to penicillin, which produced no negative side-effects.
"It has been estimated that penicillin compounds are responsible for the majority of all drug-mediated anaphylactic deaths in the United States," said Dr. Arroliga. "Skin testing is the most reliable method for the evaluation of IgE-mediated penicillin allergy. When a skin test is done by personnel skilled in performing and interpreting the test, 97 percent of patients with negative reactions to the skin test will tolerate a penicillin compound. Penicillin skin testing can be a safe and effective strategy to reduce the use of broad spectrum antibiotics, as well as a useful strategy to modify antibiotic use."
CHEST is published by the American College of Chest Physicians, which represents 15,000 members who provide clinical, respiratory and cardiothoracic care in the U.S. and throughout the world.
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Reporters may wish to contact Kimberly Lynch of the ACCP at (847) 498-8341 for a copy of the article. She can be reached by email at [email protected]. Dr. Arroliga can be reached by phone at (216) 445-5765, or by email at [email protected].
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