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Penicillin allergy that persisted after 66 years: case report

Evon Anukam1, Jenny Zhu2

  • 1Clinical Pharmacy, Providence Health & Services, Milwaukie, Oregon, USA evon.anukam@providence.org.

European Journal of Hospital Pharmacy : Science and Practice
|June 15, 2022
PubMed

Insights

Most penicillin allergies diagnosed in childhood are not true allergies. A 74-year-old woman with a childhood penicillin allergy history experienced an allergic reaction upon rechallenge with amoxicillin/clavulanate.

Area of Science:

  • Allergy and Immunology
  • Clinical Pharmacy
  • Infectious Diseases

Background:

  • Penicillin allergy is frequently reported but true allergies are rare (<1%).
  • Antimicrobial stewardship utilizes pharmacist-led protocols for penicillin allergy rechallenge.
  • Published data support successful penicillin rechallenge and desensitization.

Observation:

  • A 74-year-old woman with a childhood penicillin allergy history was rechallenged with amoxicillin/clavulanate.
  • The rechallenge was for a urinary tract infection, with amoxicillin/clavulanate identified as the optimal empirical treatment.
  • A low likelihood of reactivity was anticipated due to the allergy's distant history.

Findings:

  • The patient developed an allergic reaction after a single oral dose of amoxicillin/clavulanate 875/125 mg.
  • This occurred despite the allergy being documented over 60 years prior.

Implications:

  • This case highlights the potential for unexpected allergic reactions even after long-standing reported penicillin allergies.
  • It underscores the need for caution and careful consideration during antibiotic rechallenge protocols.
  • Further investigation into the persistence and clinical significance of childhood penicillin allergies is warranted.

Keywords:
CLINICAL MEDICINECase ReportsCommunicable DiseasesDrug MonitoringPHARMACY SERVICE, HOSPITAL

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