Saloon DFGSM3 Listening 5 – Is This Patient Really Allergic to Penicillin?

Watch the video & take notes on a sheet of paper

 

Once you have registered on Medscape, reach the page http://www.medscape.com/viewarticle/868552
When you have finished, click on each item below to see the answer.

 

Is This Patient Really Allergic to Penicillin? – Medscape – Sep 08, 2016.

 

1. Evaluation & diagnosis of penicillin allergy – Facts & Figures

- ≈ 10% of all US patients report allergic reaction to a penicillin-class antibiotic in the past
- < 1% of population has immunoglobulin E (IgE)–mediated reaction to penicillin, indicating true drug allergy - Difference between the number of patients reporting penicillin allergies & number of patients who actually have penicillin allergies ← some patients who report penicillin allergies may never have had true allergies but side effects or symptom of underlying illness interpreted as allergy ( viral exanthema or rash in a child on amoxicillin) - Even patients with true penicillin allergies may lose allergy over time - ≈ 80% patients with IgE-mediated penicillin allergy lose their sensitivity by 10 years after reaction

2. Importance of revisiting penicillin allergies when alternative antibiotics can be used:

- Broad-spectrum antibiotics (macrolides & fluoroquinolones) often used as alternatives to penicillins
- → Correctly identifying patients not actually penicillin-allergic can reduce unnecessary use of broad-spectrum antibiotics

3. Questions to evaluate patient for true penicillin allergy:

- What medication or medications were you taking when the reaction occurred?
- What kind of reaction occurred, such as rash, hives, diarrhea, or difficulty breathing?
- When did this happen? What treatment was given?
[2]
For example, was epinephrine or an EpiPen® used?

4. Characteristics of an IgE-mediated reaction:

- Occur immediately or within 1 hour of exposure
- Signs and symptoms: hives, angioedema, wheezing, shortness of breath, anaphylaxis (occurs when 2 or more organ systems are affected)
- Penicillin skin tests should not be performed on patients with other severe hypersensitivity reactions to penicillins (Stevens-Johnson syndrome or toxic epidermal necrolysis)

5. When should you consider penicillin skin testing for a patient?

- If patient has a history consistent with an IgE-mediated reaction to penicillin → consider penicillin skin test
- Skin tests done when patient is well & does not need ATB, then if patient becomes ill later → penicillin antibiotic can be used if indicated
- Penicillin skin testing can be performed when patient requires treatment with a penicillin
- Penicillin skin testing should be done by a provider trained in penicillin skin testing and challenge doses, and prepared to treat anaphylaxis
- If you suspect patient has penicillin allergy but you are not experienced with penicillin skin tests & challenge doses → refer patient to allergist

6. Read the transcript under the screen as you play the video again, then prepare a brief summary, you will have 2 mins to transfer the information to a colleague. Remember to adopt a top-down approach.

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