Am I Really Allergic to Penicillin? Can I Be Tested? Does it Matter? Yes or No, Yes and Yes!

When I take a medical history on patients that come to my office in New York or Long Island for various allergic problems, I always review their drug allergy history. A large portion of my patients that have a history of a childhood reaction to Penicillin, and have avoided using this antibiotic for decades because they were told they could have a severe reaction if used again. The truth is that many of these patients probably no longer are allergic to Penicillin and are avoiding its use without cause.

It has been shown in medical articles that even if patients were allergic to Penicillin as a child, this allergy can disappear after many years of non-exposure. The question I’m sure you are now asking is: Is there a way to find out if I’m allergic to Penicillin? The answer is yes! There are simple skin tests that as an allergist I can do in the office in one session that will predict with over 90% accuracy if you are allergic to Penicillin and if it is safe to use. This allergy testing in NYC is convenient, has important medical implications and, most importantly, gives peace of mind to my patients.

Today, there are many antibiotics that can be used by a physician to treat infections anywhere in the body, in contrast to 50 years ago when Sulphur compounds and Penicillin were the only game in town. Penicillin was so valuable that in the early days of its use in hospitals, the doctors would collect the urine of patients given Penicillin and boil it down to extract the Penicillin and use it for other patients—it sounds horrific, but it did save lives. We are in a much better place today with antibiotics widely available in our country and many choices. However, the new antibiotics are very powerful – sometimes too powerful – and have side effects that are not widely known.

With Quinolones for example, you may recognize the names Cipro or Levaquin, which are new, potent antibiotics that treat a wide array of infections. A side effect not commonly appreciated is that these antibiotics have an enzyme that can cause tears in your tendons. Podiatrists and Orthopedic surgeons are acutely aware of the Quinolones causing these problems – especially Achilles tendon rupture. Another common antibiotic, Zithromax is good for mild respiratory infections, but it doesn’t kill bacteria (the medical term is bactericidal) it just slows it down (bacteriostatic). Zithromax is not good enough against the bacteria called anaerobes – the type found in your mouth and gut. Penicillin, as I learned in medical school, has the special properties of killing bacteria’s cell wall and thoroughly clearing an infection. In truth, when Penicillin was used for many years some resistance developed to its use and derivatives of Penicillin were made to add to its potency. The medications like Amoxicillin, Ampicillin and Cephalosporin’s took over the place of just giving the original. These medications work very well and have a long history of safe use. If someone is allergic to Penicillin they also may be allergic to these medications, but again allergy testing will help determine if these are safe to use.

The question, “Does it matter if I am Allergic to Penicillin?” the answer is yes. There are many situations where use of antibiotics are needed prophylactically (before the surgical procedure) and penicillin is still one of the best choices. For example, a patient that has a heart murmur should be treated with antibiotics before dental surgery. The bacteria in the mouth can enter the bloodstream and if heavy enough can lodge on a heart valve that is compromised – this causes a condition called Endocarditis which can be fatal. Another common situation is anyone that has “hardware” in their body – artificial hips, knees, etc. These replacement parts can become infected after a “dirty” procedure like dental work or surgery in another location involving the bowel. Penicillin and Cephalosporin’s are excellent antibiotic coverage to keep the bloodstream clean.

There is an appropriate place for some of the new antibiotics that are very powerful – especially in the hospital where bacterial resistant infections are more common. However, good or” Penicillin still has its place in the doctor’s black bag (I still have one) and knowing if you are allergic can make a difference in your care. Contact one of our allergists of New York today for more information or to be tested.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

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