OPINION — More than 30 million people in the United States – approximately the population of Texas – unnecessarily avoid taking penicillin antibiotics, and this poses a significant and growing public health problem.

These folks believe they are allergic. But as a pharmacist, I can tell you that they probably aren’t.

According to the Centers for Disease Control and Prevention, 10 percent of people in the U.S. report having a penicillin allergy, but less than 1 percent of the population are truly allergic to penicillins. Recent studies reported by the American Academy of Allergy, Asthma and Immunology suggest that the number of truly allergic individuals might be even smaller.

Penicillin allergy is the most commonly reported drug class allergy; however, several studies found that 80-90 percent of individuals with self-reported penicillin allergy are actually able to tolerate penicillin after undergoing evaluation for penicillin allergy.

So how do so many people become labeled “penicillin allergic”?

One common way that people – especially kids – earn the label is that they get sick and take a penicillin antibiotic such as amoxicillin, augmentin or ampicillin, and when they get a rash about five days later, the doctor’s office determines that they are allergic.

For a friend of mine who recently discovered they were misdiagnosed, it was the result of a college staff nurse telling them not to take penicillin ever again because they had a rash toward the end of a course of antibiotics for a sinus infection.

However, the likelihood that a rash is a true allergy and not a side effect of the medication or symptom of the disease for which the person is taking the medication is small. And while the distinction might seem unimportant, it is increasingly essential to know whether a medication will cause some unpleasant side effects.

If someone is sick and a penicillin would be the best treatment for the illness, side effects can be managed. Of course allergies can be dangerous. This is one reason reported allergies are rarely questioned. Once the penicillin allergy is listed in the electronic health record, it can be difficult to find someone willing to remove it.

But does this even matter? Aren’t there other antibiotics besides penicillin?

If someone can’t take – or just doesn’t take, in the case of a misdiagnosis – the most specific antibiotic for an illness, which in many cases is a narrow-spectrum drug such as a penicillin, they have to take a broad-spectrum antibiotic. Those medications work for a wider variety of illnesses, but they are more expensive, have more side effects, might not work as well for a specific illness, and are major contributors to antibiotic resistance.

Antibiotic resistance is a global threat to health, food security and development. According to the CDC, at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die in the United States of a resistant infection each year. Correctly identifying those who are not truly penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics.

So what can we do about it?

If you think you or your child is allergic, talk with your physician. He or she will discuss the medication history and offer advice about testing. For penicillin allergy, a healthcare professional can perform skin testing, just as for environmental allergens such as pollen and cat dander. The testing will let the professional know how likely it is that you would have a reaction if you take penicillin.

Knowing whether you are actually allergic to penicillin can improve your health care, save you money and prevent the development of life-threatening antibiotic resistance.

Submitted by DR. CODY BLACK, St. George, Utah.

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