Priya Nori, M.D.
Albert Einstein College of Medicine; Deputy Editor, Antimicrobial Stewardship and Healthcare Epidemiology
Brad Langford, Pharm.D.
University of Toronto; Associate Editor, Antimicrobial Stewardship and Healthcare Epidemiology
Millions of Americans carry a “label” that could be both unnecessary and harmful: a penicillin allergy. But here’s the surprising truth — many of these diagnoses are inaccurate or outdated. According to allergy researchers, up to 90% of people who believe they are allergic to penicillin actually aren’t.[i] As healthcare professionals and members of the Society for Healthcare Epidemiology of America (SHEA), we believe it’s time to reconsider that label.
A penicillin allergy documented in your medical record isn’t just a minor inconvenience. It often leads to the use of broader-spectrum and more expensive antibiotics with a greater risk of side effects. To make matters worse, these alternative antibiotics contribute to the growing problem of antibiotic resistance, a public health crisis that threatens our ability to treat both simple and life-threatening infections. When penicillin is unnecessarily avoided, patients miss out on its benefits. Penicillin belongs to a broad group of antibiotics called beta-lactams.; Beta-lactams are often the first choice and most effective treatment for life-threatening bacterial infections, like sepsis. When patients are allergic to one beta-lactam, prescribers and patients may avoid the whole group, yet this is one of the most effective antibiotic classes available.
Many people are initially labeled as allergic to penicillin due to reactions from childhood, like rashes, which are often mistakenly attributed to an allergy. Over time, individuals outgrow their sensitivity, but the allergy label sticks. In fact, studies show that within 10 years, approximately 80% of those with a true penicillin allergy will no longer be allergic.
This is where delabeling comes in—a process where people who have been labeled as allergic to penicillin undergo an evaluation to confirm whether they are still truly allergic. Delabeling can be as simple as a few quick questions about the nature and timing of the reaction. This can be followed by a ‘test dose’ of a penicillin to carefully monitor for reactions, which are usually infrequent. The majority of penicillin allergies can be delabled this way. For some, a skin test may be required, where small doses of antibiotic are injected to check for a reaction. This is safe, quick, and accurate. If negative, penicillin can once again become an option. This not only broadens the arsenal of effective antibiotics but also helps in reducing the spread of resistant bacteria through receipt of more targeted antibiotics.
So, what should you do if you carry a penicillin allergy label? Talk to your healthcare provider about delabeling, especially if your allergy was diagnosed more than 10 years ago or if you don’t recall the specifics of your initial reaction. Delabeling can open the door to safer, more effective treatment options.
Inaccurate penicillin allergies are more than a personal issue—they’re a public health concern. By delabeling, you’re not just taking care of your own health; you’re contributing to the fight against antibiotic resistance. It’s time to reexamine that penicillin allergy and ensure it’s based on current, accurate information.
[i] Blumenthal, Kimberly G et al. Antibiotic allergy. The Lancet, Volume 393, Issue 10167, 183 – 198. https://doi.org/10.1016/S0140-6736(18)32218-9
