How Nurses Can Help Dispel Penicillin Allergy Myths—and Save Millions of Dollars
By Jennifer Mitchell, contributor
Nurses frequently care for patients who say they're allergic to penicillin. In fact, penicillin is the most commonly reported drug allergy, according to the Infectious Diseases Society of America (ISDA). Recent research has shown that many people with self-reported penicillin allergies may not be truly allergic. This has important implications for patient care and antibiotic stewardship, and nurses can play an important role in dispelling myths about penicillin allergies.
The truth about penicillin allergies
The Centers for Disease Control and Prevention (CDC) reports that nearly 10 percent of patients in the United States say they've had an allergic reaction to penicillin. However, the vast majority of people with self-reported penicillin allergies aren't actually allergic. As the CDC notes, fewer than 1 percent of the population has a true, IgE-mediated reaction to penicillin.
Why do so many patients report an allergy they don't have? The Mayo Clinic explains that patients may mistake common side effects of penicillin, such as headache, mild nausea or diarrhea, for an allergic reaction. In addition, when children have infections, they may develop rashes, and these rashes may be mistaken for an allergic reaction to penicillin, reports an article published in JAMA Pediatrics.
The CDC explains that patients with true penicillin allergies will usually have a reaction to the drug within one hour. Hives, angioedema, wheezing, shortness of breath and anaphylaxis are some signs of an allergic reaction. Interestingly, many people who've had an IgE-mediated reaction to penicillin in the past may no longer be allergic. After 10 years, about 80 percent of penicillin-allergic people lose their sensitivity to the drug.
Identifying true penicillin allergies
Since many patients with self-reported penicillin allergies aren't truly allergic, nurses may be tasked with correctly identifying penicillin-allergic patients. The CDC recommends asking questions about patients' past experiences with antibiotics. Ask your patients what drugs they were prescribed, what kind of reaction occurred and how the reaction was managed. When you're traveling, your assignment facilities may provide penicillin allergy questionnaires to help you evaluate patients.
Penicillin skin testing (PST) is another method for identifying true penicillin allergies, though it's typically performed in outpatient allergy clinics. University of Georgia researchers recently explored the use of this testing in a hospital setting, and their findings were published in Open Forum Infectious Diseases. During this study, nurses at Candler Hospital in Savannah, Georgia, performed PST on 100 patients with self-reported penicillin allergies and determined that 98 weren't actually allergic. Of these 98 patients, 71 percent were switched to a more appropriate antimicrobial regimen. These results show that PST can be a useful part of a hospital's antimicrobial stewardship program.
Why dispelling penicillin allergy myths matters
Correctly identifying penicillin allergies plays an important role in antibiotic stewardship. The American Academy of Asthma, Allergy and Immunology reports for many infections, penicillins are the safest, most effective antibiotics. In patients with a history of penicillin allergy, doctors often prescribe broad-spectrum antibiotics instead. The CDC cautions that using broad-spectrum antibiotics can increase antibiotic resistance, and correctly identifying people with penicillin allergies can reduce the unnecessary use of these drugs.
When patients are wrongly labeled penicillin-allergic, they may have reduced health outcomes. Penicillin-allergic patients have a higher risk of adverse events in a hospital setting, ISDA warns. Not only do these patients have longer hospital stays, they have a 30 percent higher incidence of Vancomycin-resistant Enterococcus infections, and a 14 percent higher incidence of Methicillin-resistant Staphylococcus aureus infections. By dispelling myths about penicillin allergies, nurses can provide better patient care.
Dispelling myths about penicillin allergies may even save patients money. In the PST study, University of Georgia researchers found an average cost savings of $350 per patient tested, and that includes the cost of the skin test. The average savings were even greater — $556.91 — for patients whose antimicrobial regimens were changed as a result of the skin test. Nationwide, these findings could mean millions of dollars in savings for patients.
When you're traveling, you'll care for many patients who report a penicillin allergy. While some of these patients are truly allergic, many self-reported penicillin allergies aren't accurate. Ask your assignment facility about the programs and questionnaires it uses to root out these incorrect allergies and provide better patient care.