Allergic to Penicillin? Don't Make Rash Judgments

Penicillin Allergy Testing Services celebrates two years of helping patients and families get to the truth about penicillin allergies.

Seeing a rash on your child is obviously a sign of concern for parents. When that rash may be caused by an antibiotic, it raises a number of other issues, especially how to treat an infection in the future. But it’s possible that the antibiotic is not the culprit.

Recent studies have shown that 95 percent of children who were thought to be allergic to penicillin will not have a reaction when tested, which can be very confusing for parents and patients.

To help clarify the situation, Cincinnati Children’s began offering The Penicillin Allergy Testing Services (PATS) two years ago this month for patients admitted to the hospital or seen in outpatient clinic appointments. PATS tests for an allergy to an antibiotic by giving a dose of the antibiotic by mouth and watching for a reaction. If there is no reaction, the child is not allergic.

What is the testing like?

According to Kimberly A. Risma, MD, PhD, who leads the Drug Allergy Program, the testing is simple and should be offered to all children who are labeled as having a penicillin allergy. Patients orally take amoxicillin (the most commonly prescribed form of penicillin), and staff observe them for an hour to make sure that there is no reaction. If there is a history of more serious symptoms, staff may give a skin test before trying amoxicillin.

New patients coming to the PATS outpatient clinic will have penicillin testing done that same day in most cases. These children may also be seen when sick with an illness for which amoxicillin is the preferred antibiotic or at a scheduled time when they are healthy.

Additional opportunities for same-day visits will be provided for patients who are currently experiencing a reaction while taking an antibiotic. Many of these children go to the emergency room to be seen, with up to 40 percent of infants returning for a second visit within 24 hours if they have not improved. These children may now be seen at the PATS outpatient clinic.

“Every day, patients come to the emergency room who are being treated with amoxicillin and have a rash, like hives and lip or eye swelling. In the winter, we may get two or three patients a day, and they often return the next day with more concerns. We will intentionally hold clinic slots open for these patients who have an urgent need to be seen. Usually, caregivers simply need a clear plan for symptom relief and information on how long the condition will last,” said Risma.

Inpatients labeled with penicillin allergy can be tested, and if they have no reaction, they may be treated with amoxicillin for their infection.

PATS is a service that is changing the outcome for many kids in our community.

Getting Results

PATS has evaluated 612 children and 95 percent were non-allergic in the past 2 years.

Every reaction occurring during testing is very mild, often not requiring any treatment. Of the 612 evaluated, 41 were evaluated while admitted to the hospital and 100 percent were non-allergic. This often meant that they could be transferred to the preferred antibiotic (a penicillin) and discharged sooner.

Learn more about penicillin allergy testing.

The Ehrnschwender family: Mom Leah, Bryce (in front), Gavin, and dad Steven.

One Family's Story

When my son Bryce was 1½ years old, he had bilateral ear infections and was put on augmentin. Toward the end of his round of antibiotics, I went to change his diaper and noticed these big, red blotches on his face, trunk, and legs.

I called my mom who is a nurse and told her what I was seeing. She automatically said, “Oh it's a reaction to the antibiotic.”

I was really confused because he was almost done with the antibiotic, and he had been fine up to that point. But she said that sometimes these things are delayed.

I took him back to the pediatrician, and they said yes, he must have an allergy. We gave him Benadryl for a couple of days, and eventually, the blotches went away, and he was fine. From then on, we told everyone that he was allergic and couldn’t have any amoxicillin products.

Fast-forward a few years, and at Bryce’s checkup, our pediatrician mentioned that we should get him tested at Cincinnati Children’s PATS clinic to be sure he had a true penicillin allergy.

I was able to get in right away, and they were wonderful! They tested him and gave him the medicine. He had no reaction—no redness, no splotches—nothing.

We had to give him more doses at home for a couple of days to make sure there was no recurrence. There was not, so we could officially say he does not have an allergy. This means he can take amoxicillin or penicillin or any of those medications, which is great.

I had never heard of anything like the Penicillin Allergy Testing Services. Everyone we met was so nice. It was a pleasant experience from start to end, and I'm very thankful that we got to do it.” --Leah Ehrnschwender

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