Beyond the Label: Rethinking Penicillin Allergy in General Practice

The Good GP

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In this episode of The Good GP, host Dr Maria Li welcomes Dr Arthur Price, an immunologist based in Wellington, New Zealand, to discuss penicillin allergy—one of the most frequently reported and commonly misunderstood drug allergies in general practice.

Dr Price clarifies the true prevalence of penicillin allergy, explaining that while approximately 10% of patients admitted to hospital carry a penicillin allergy label, only about 10% of those actually have a genuine allergy. Emphasising that most patients with a penicillin allergy label can be safely de-labelled after proper assessment.

They address the typical presentations of penicillin allergy. Outlining three main patient groups: those who clearly are not allergic based on history (such as patients with only gastrointestinal side effects or late-onset rashes), those with uncertain or vague histories (including childhood reactions where details are unclear), and those with definitive immediate or severe delayed reactions (such as anaphylaxis or severe cutaneous adverse reactions like Stevens-Johnson syndrome). Dr Price provides practical advice on history-taking to help GPs risk stratify and identify true penicillin allergy, including key questions to ask about timing, symptoms, and the nature of the reaction.

Discussing the investigation and referral pathways for suspected penicillin allergy. Dr Price recommends that patients with unclear or potentially significant histories should generally be referred to an immunologist for assessment, rather than managed solely in primary care. He highlights the limitations of current tests and the importance of specialist input.

For general practitioners, Dr Price advocates a proactive approach to reviewing penicillin allergy labels and encourages considering referral for possible de-labelling where appropriate. They highlight the value of accurate documentation and patient education in ensuring safe and effective future care.

Links & Resources:

The ASCIA guidelines Arthur referred to in the podcast:

https://www.allergy.org.au/images/stories/hp/info/ASCIA_HP_Consensus_Penicillin_Allergy_2020.pdf

Aimed at immunologists, so while GPs may find it useful for context and interest, it’s not something intended for day-to-day practice in primary care

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