Penicillin allergy need not be forever

Of all hospitalised patients at Royal Brisbane and Women’s Hospital (RBWH), around 50 per cent will receive antibiotic treatment at some point in their stay. Of these 50 per cent, a little under half have an antibiotic allergy label and approximately half of these are for a penicillin allergy.

Research has shown that patients with a penicillin allergy can report an increased length of stay, higher risk of surgical site infections and in rare cases, increased mortality. This is due to having to take broad spectrum antibiotics rather than penicillin, a first line antibiotic. Using penicillin alternatives has also been linked to increased risk of the patient developing antibiotic resistance.

An appointment with the RBWH Infectious Diseases Allergy Clinic to test penicillin sensitivity could reveal they no longer need these allergy labels.

The small multi-disciplinary team at RBWH has made it their purpose to de-label patients of their penicillin allergy through safe, robust and repeatable testing. The team consists of Infectious Diseases Physician Dr Andrew Redmond, Penicillin De-Labelling Pharmacist Renee Palise and Registered Nurses Alice Young and Emily Hallas.

“Patients can be diagnosed with a penicillin allergy as children, however research has revealed that sometimes these people actually had a virus interacting with the penicillin or in the case of really old allergies from the 1950s reacting to the additives that once were in penicillin and not penicillin itself. However re-challenging allergies should always only be undertaken by a specialist,” Renee said.

“While there are alternatives to penicillin antibiotics, they are generally not the best option.

“We realised there was an opportunity to retest these people and potentially change the effectiveness of their future healthcare, so the clinic was commenced in 2017.

“When patients are de-labelled for penicillin allergies it completely changes their treatment plan and has positive impacts for both the patient and the health service.”

The clinic relies on interhospital and GP referrals, so the team encourages people with penicillin allergies to see their GP and ask for a referral.

“Ideally, the clinic will connect with perioperative services in the future to target patients with a penicillin allergy before they have their surgery. If we can de-label their allergy prior to surgery, we can increase their overall healthcare experience by being able to prescribe penicillin,” Renee said.