Assessing whether a patient is allergic to penicillin is important to prescribing appropriate, and perhaps cheaper, medicines, an Upstate pharmacist writes.

Lessons from Upstate: Pharmacists can help verify penicillin allergy

Penicillin allergies are among the most commonly reported allergies – yet only 10 percent of the people who say they are allergic are truly allergic.

Upstate infectious disease pharmacist Wesley D. Kufel, PharmD, addresses this issue, writing with colleagues in the journal Pharmacy. Kufel is also a clinical assistant professor at Binghamton University’s School of Pharmacy and Pharmaceutical Sciences.

Wesley Kufel, PharmD

He says by avoiding penicillin in patients who are not truly allergic, doctors often end up prescribing broad-spectrum antibiotics. These drugs can be less effective and cost more. They can lead to adverse reactions, such as severe diarrhea, for the patient. Their use also contributes to development of bacterial resistance.

Penicillin allergies are often misdiagnosed. Or, if an allergy exists, it may diminish over time. About 80 percent of people lose the sensitivity of their initial allergic reaction after 10 years, Kufel points out.

Allergy assessment and penicillin skin testing can be used to clarify whether someone is allergic. It’s important to know because it can influence what medications can be prescribed. Skin testing is more common for patients who are hospitalized, but Kufel says “this process is becoming increasingly important in the outpatient setting.”

He argues that pharmacists could be enlisted to help, especially since many people already seek medical advice at community pharmacies. “Skin testing is a reasonable, safe procedure that is already being performed in outpatient allergy clinics but has a potential to reach even more patients with pharmacist involvement,” he writes. Some states have laws that would allow for this. Other states, including New York, would need to modify laws.

In the journal, Kufel suggests that pharmacists ask patients open-ended questions to learn about the severity of any previous reaction to penicillin. Also, because many patients may be unaware that they have since tolerated antibiotics that are similar to penicillin, he advises pharmacists to name a variety of these medications to help jog the person’s memory.

When the patient cannot remember details of previous reaction or if they are at high risk for a true allergic reaction, a skin test may be necessary.

Kufel adds that patient education is an important component. Unless people understand they are not allergic to penicillin, they may mistakenly continue to report a penicillin allergy.