Penicillin Allergy Testing

The American Academy of Allergy, Asthma & Immunology (AAAAI) advocates for the increased use of penicillin allergy testing to mitigate the emergence and spread of antibiotic resistance and to ensure the continued availability of effective therapeutics for the treatment of bacterial infections. As clinicians dedicated to the advancement of the knowledge and practice of allergy, asthma and immunology for optimal patient care, the AAAAI recommends patients who believe they have a penicillin allergy or who have documentation in their health record regarding a penicillin allergy should undergo skin prick testing to verify if they are truly allergic to penicillin, before an alternative non-penicillin antibiotic is prescribed. As many as nine of 10 patients who are tested actually do not have an allergy to penicillin.

According to published research, without testing, an unverified history of penicillin allergy can contribute to longer hospitalizations, higher costs, greater risk for adverse effects of alternative (non beta lactam) antibiotics, and increased rates of serious antibiotic resistant infections such as C.difficile and methicillin-resistant Staphylococcus aureus (MRSA). Penicillin allergy testing is safe, effective, and can be performed even in critically ill patients and pregnant women.

As part of the American Board of Internal Medicine Choosing Wisely® program, the AAAAI recommended in 2014 that physicians should not overuse non-beta-lactam antibiotics in patients with a history of penicillin allergy, without an appropriate evaluation.  

The AAAAI has included in its Quality Clinical Data Registry a quality measure on appropriate removal or confirmation of indication of penicillin allergy from a patient’s medical record. A variation of this measure has been shared with a national work group developing quality measures designed to combat antimicrobial resistance.

The AAAAI advocates that federal policies to address the growing threat of antimicrobial resistance should:
• Establish a national strategy working through the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and other Federal agencies to encourage penicillin allergy testing to reduce the large number of patients mislabeled as allergic to penicillin;
• Develop and adopt quality measures, Medicare Conditions of Participation (CoPs), and other federal health and safety standards that target a variety of settings to encourage correct identification of penicillin allergies; and
• Implement the recommendations contained within the Report from the National Institute of Allergy and Infectious Diseases Workshop on Drug Allergy.  

In addition, the AAAAI continues to promote the increased use of penicillin allergy testing in traditional and social media.

The AAAAI Board of Directors and President Robert F. Lemanske, MD FAAAAI have identified penicillin allergy testing as an advocacy priority stating, “Without such testing, there is an unrealized opportunity to improve healthcare outcomes and reduce rising rates of antibiotic resistance.”

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter