Penicillin Allergy

Penicillin is an antibiotic used to treat certain infections caused by bacteria such as pneumonia and other respiratory tract infections, scarlet fever, and ear, skin, gum, mouth, and throat infections. This antibiotic is known to cause various allergic reactions in many individuals. Penicillin allergy is the most common drug allergy, affecting up to 10% of the population. Many patients lose their sensitivity over time, but there are some that continue to live with the allergy. Penicillin allergies are commonly over-reported and result in the unnecessary use of stronger antibiotics. This is why it’s important to test for this allergy after a certain amount of time to confirm or disprove a previous label of penicillin allergy.

Although about 80% of patients lose their sensitivity after 10 years, penicillin is still one of the most common causes of anaphylaxis. Drug eruptions, an adverse reaction of the skin, have also been reported. In this case, cutaneous reactions appear as mild symptoms and disappear when the drug is withdrawn. More serious drug eruptions include organ injury. That’s why it’s important to seek a proper diagnosis and treatment of penicillin allergy from a board-certified allergist.

Penicillin Allergy Symptoms

• Skin rash
• Hives
• Itching
• Swelling
• Shortness of breath
• Wheezing
• Anaphylaxis

If you experience any of these symptoms after taking penicillin-containing medication, contact your doctor immediately. Symptoms usually emerge instantly; however, it’s not uncommon for symptoms to appear hours later. It is also common for allergic reactions to occur after the second exposure. The first time you take penicillin, your body might not register it as a harmful substance.

Common Penicillin Medications

• Amoxicillin
• Ampicillin
• Piperacillin
• Oxacillin
• Dicloxacillin
• Nafcillin

These medications are administered by shot or orally. They are all effective in treating bacterial infections. Amoxicillin is more popular than other penicillin-containing medications. It is inexpensive and widely available. If a doctor suggests amoxicillin for treatment, be sure to request an allergy panel first.

There are also some differences among the penicillin-containing medications. Ampicillin and oxacillin are semi-synthetic penicillins and are taken orally. They are used to fight bacteria that are more resistant to antibiotics.

Piperacillin is administered by shot and used in cases where the bacteria is hard to kill, such as urinary tract infections. It’s usually given with amoxicillin. Dicloxacillin and nafcillin are naturally resistant to some bacteria.  If you are allergic to one penicillin-containing medication, you cannot take any of the other medications. You should ask about a penicillin alternative to treat your infection.

Penicillin Alternatives

• Trimethoprim
• Nitrofurantoin
• Doxycycline
• Erythromycin
• Clarithromycin
• Cotrimoxazole

Trimethoprim and nitrofurantoin can be alternatives for piperacillin, treating urinary tract infections. Doxycycline, erythromycin, and clarithromycin treat upper respiratory infections; and cotrimoxazole is available as an alternative to treat abdominal infections. Your doctor will explain which penicillin alternative fits your situation.

Penicillin Allergy Diagnosis

An allergist will use either a skin prick test or intradermal testing to diagnose a penicillin allergy; Since many patients still receive a negative result from a skin prick test even if it is believed they are allergic, intradermal testing is used more widely for this diagnosis. In this case, an allergist will introduce the allergen beneath the skin to test for a reaction.

In addition, a penicillin challenge may be performed. A dose of penicillin-containing medication (usually amoxicillin) may be administered in the office under careful observation to confirm a negative dose. This is done only as a last option, as penicillin is known to cause severe allergic reactions. Your doctor will have epinephrine and other allergy medications on hand to treat any symptoms. Never attempt to perform a penicillin challenge on your own.

Penicillin Allergy Treatment

Avoidance is the best treatment for any allergy. There are many alternative medications available to treat your bacterial infections. If you avoid penicillin, there is a chance that your sensitivity will disappear or weaken. In the meantime, visit your allergist for recommended allergy medications to treat minor symptoms.

For more serious allergies, desensitization is another treatment option. Your doctor will gradually administer the medication by mouth or as shots to build tolerance of the drug. Desensitization is recommended for patients that require treatment with penicillin, such as those suffering from neurosyphilis. This chronic condition can only be treated with penicillin-containing medication. Ask your allergist if desensitization is necessary for you.