Penicillin Challenge
By Elyse Hutchinson
About 10% of the population report that they are allergic to penicillin. But studies consistently show that the vast majority of those allergies are not real or are no longer present. Only a small minority are truly allergic.
Having an inaccurate “penicillin allergy” label in your medical record often forces clinicians to use broader-spectrum or second-line antibiotics. Those alternatives can be less effective, more toxic or more expensive and they contribute to a bigger public-health problem: antimicrobial resistance. Also, patients with a penicillin allergy label may face worse outcomes including longer hospital stays, increased risk of drug-resistant infections, higher cost of care, and more complications.
Because of these concerns, many experts and institutions say that penicillin-allergy evaluation and “de-labeling” should be part of standard care.
Who Should Take the Penicillin Challenge?
Patients with a history of penicillin allergy, especially those whose reported reaction was mild, vague, long ago or likely not a true allergy, including adult patients:
- With a history of benign reactions (i.e. GI upset, rash or itching)
- With an unknown reaction history if last penicillin exposure was over one (1) year prior
- With delayed onset of isolated symptoms (i.e. GI upset, rash or itching)
- Family history of penicillin allergy
Patients with a severe reaction history to penicillin (i.e. anaphylaxis, angioedema, severe hives or bronchospasm), any penicillin reaction within 12 months of evaluation and pediatric patients should NOT take the Penicillin Challenge.
What Does the Penicillin Challenge Involve?
A provider will oversee this appointment. A nurse will administer a low dose of Amoxicillin, then observe the patient for 20 minutes for any signs of adverse reaction. If no reaction is observed, the nurse will administer the another dose of the Amoxicillin and observe the patient for an additional hour. If no reaction occurs following the second dose, the patient will be informed that their penicillin allergy label will be removed from their medical record, and with the provider’s approval the patient will be released.
How Long will the Penicillin Challenge Take?
Appointments are scheduled for two hours to ensure there is plenty of time to monitor for any reaction. Appointments will be scheduled first thing in the morning.
How Can I Schedule a Penicillin Challenge?
Call 970.625.1100 to schedule an appointment at Grand River Health in Rifle or Battlement Mesa.
