Do you have a penicillin allergy?

This leaflet has been produced with grateful acknowledgement to the Scottish Antimicrobial Prescribing Group (SAPG), Healthcare Improvement Scotland.

You have been told you have a penicillin allergy. This leaflet explains:

• what a penicillin is

• what the difference is between an allergy and a side effect

• what the symptoms are if you have a penicillin allergy; and

• how you can be tested to see if you are allergic to penicillin.

We hope this leaflet helps to answer some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

What is a penicillin?

A penicillin is an important type of antibiotic that can be used to treat many common infections.

The first penicillin was discovered many years ago by Alexander Fleming. Since then many other penicillin type antibiotics have been developed. Penicillin antibiotics are often the first choice antibiotic for common infections like pneumonia, skin infections, and tonsillitis. They are widely used both in hospital and in the community.

What is a penicillin allergy?

A penicillin allergy occurs when the body’s immune system responds unusually to a penicillin type antibiotic.

• Examples of penicillin antibiotics include:

  • phenoxymethylpenicillin (penicillin V)

  • amoxicillin

  • flucloxacillin

  • co-amoxiclav (Augmentin).

What is the difference between an allergy and a side effect?

All medicines may cause unpleasant side effects, such as a skin reactions / rashes, vomiting, or diarrhoea. Side effects are different to allergic reactions. Having side effects to penicillin, whilst unpleasant, does not mean you need to avoid penicillin antibiotics completely. This is particularly true in severe infections, where penicillin may be the best antibiotic. In these cases, it is often best to have penicillin and manage the side effects if they happen.

What are the symptoms of a penicillin allergy?

As with all medications, some people may experience side effects when taking penicillin. For example:

• an unpleasant mild skin reaction; or

• a rash that develops slowly after several hours or days of taking the medicine.

However, sometimes a severe allergic reaction can occur called anaphylaxis. Anaphylaxis is extremely rare but can be life threatening.

How common is penicillin allergy?

• Approximately 1 in 100 people have a genuine penicillin allergy.

• The most severe allergy is anaphylaxis. This occurs in about 1 in 10,000 people taking penicillin. It is extremely rare.

• Despite real penicillin allergy being uncommon, about 1 in 10 people have either been told or have assumed they have a penicillin allergy.

• Most people (about 9 in 10) recorded as having a penicillin allergy are not actually allergic.

I have had a recorded penicillin allergy for a long time. Why should that change now?

Penicillins are very effective treatments for many infections, including skin and chest infections. They are also commonly used in patients having a surgical procedure. Being unable to take penicillin may put you at a disadvantage, especially if you are admitted to hospital with a severe infection.

What are the benefits to me of finding out whether I have a real allergy to penicillin antibiotics?

We can carry out a simple test in the hospital that will tell you if you have a penicillin allergy. If your test results show that you are not allergic to penicillin your medical records will be updated.

• If you do not have a penicillin allergy, treatment will not be delayed as we will not need to test you first. See 'What does the test for penicillin allergy involve?' below.

• Removing the penicillin allergy label from your record means you can be given penicillin when you really need it.

• It also means you will have more treatment options if you have an infection or need antibiotics before an operation.

What does the test for penicillin allergy involve?

Your medical team will ask you about the symptoms you had in the past that led to the penicillin allergy label. If they decide you may have been incorrectly recorded as having an allergy, they will offer you a test to decide if the allergy label can be removed. You will only be offered this test if the medical team believe that it is safe to do so, and there is a very low chance of you having an allergic reaction.

The test involves giving you a penicillin antibiotic tablet under careful supervision in hospital. Your pulse and blood pressure will be monitored for one hour after you take the tablet.

What happens after the test?

At the end of the test the hospital team will discuss with you what your test results mean.

• If you have not had any reaction, a letter will be sent to your GP telling them the result of your test. Your GP will be asked to remove the penicillin allergy label from your GP record. We will also give you an information leaflet to take home with you explaining the results and what they mean for your future care. If you need an antibiotic now or in the future for either treatment or before surgery, your doctor will have the option to use a penicillin antibiotic.

• If the test confirms that you are allergic to penicillin, we will tell your GP the test result and ask them to record this in your GP record. We will also give you a leaflet about avoiding penicillin in future. If you use any other healthcare services outside the NHS (for example a private dentist), please tell them you are allergic to penicillin.

Things to think about when deciding if you want to have a penicillin allergy test

Do I have to take this test?

The benefits of having the test have already been outlined. If you do not want to be tested, please let your medical team know. Your decision will not affect your ongoing care. However, please bear in mind that if you cannot be treated with penicillin, infections may not be fully cured or may take longer to recover from.

Are there any risks or side effects?

There is a small chance that you may have an unpleasant side effect, such as nausea (feeling sick) or an allergic reaction. Allergic reactions will usually be mild but a severe allergic reaction including anaphylaxis, although highly unlikely, is possible.

You will be closely monitored during the test by staff trained in the recognition and treatment of allergic reactions and other side effects. In the unlikely event you have a severe allergic reaction, the medical team will give you treatment to reverse the reaction.

What will happen if I do agree to have the test?

One of your medical team will ask you to read and sign a permission form indicating your consent to proceed with the test. The doctor will also sign this form and it will be kept in your medical notes, as a record of your agreement to the test.

What will happen if I do not have the test?

If you don't have the test your medical notes will continue to state you are allergic to penicillin. You will not be given penicillin when you are treated for an infection or have a surgical procedure in the future. You can re-consider having the test at any time.

This leaflet has been produced with grateful acknowledgement to the Scottish Antimicrobial Prescribing Group (SAPG), Healthcare Improvement Scotland.

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

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• Patient Voice Team
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