>Users:   login   |  register       > email     > people    

Oral Testing of Reported Penicillin Allergies?
By Jeffrey E. Keller MD
Published: 12/30/2019

Pills Penicillin is miraculous. It was discovered in 1928 by Alexander Fleming (founding the modern era of antibiotic medicine) and is still the most common antibiotic prescribed in my jails. The dentist and I use Penicillin VK as our preferred initial agent for dental infections. I prescribe PCN VK, as well, for strep throats. I use amoxicillin occasionally for sinus infections and UTIs and even amoxicillin/clavulanate (Augmentin) occasionally.

Because penicillin is so useful (and inexpensive), I hate to hear the words “I’m allergic to penicillin.” If a patient with a dental infection can’t take penicillin, for example, the dentist commonly prescribes clindamycin, which is expensive, a pain to administer three times a day and has potentially bad side effects. I have seen more than one patient who developed C. difficile after getting a broad-spectrum antibiotic because of a reported penicillin allergy–probably unnecessarily!

This problem is pretty common since about 10% of the adult population will report a penicillin allergy. However, research has shown that, when tested, more than 90-95% of patients who state that they have a penicillin allergy really do not. These patients can be harmed by giving them an inferior antibiotic more likely to cause them harm than plain old penicillin.

The test most commonly used to gauge true allergic status is Penicillin Skin Testing (PST). No jail or prison that I know of does skin prick tests. We also don’t refer patients reporting penicillin allergy to an allergist for testing. We just groan and prescribe an inferior antibiotic.

However, this could potentially change based on research published this year on the safety and efficacy of “Direct Challenge” penicillin allergy testing. Direct challenge means giving a low-risk (this is important) patient an oral dose of whatever penicillin you want to prescribe and observing them for an hour for an allergic reaction. This has been done in studies and has been reported to be safe and effective.

Comparing Direct Challenge of Penicillin Skin Testing for the Outpatient evaluation of Penicillin Allergy: A Randomized Controlled Trial was published this year. These researchers randomized 159 patients with a low-risk history of penicillin allergy to either skin testing (ST) or Direct Challenge (DC) and then observed them for about an hour. The results showed that “DC was negative in 76 of 79 (96.2%) patients.” Equally important (in my book anyway) was that all three positive reactions were minor. Their conclusion: “In low-risk patients, DC provided a safe and effective alternative to PST in delabelling penicillin allergy. Compared with PST, DC may also take less time, cost less money and lead to fewer penicillin allergy evaluations with false-positive results.” What’s not to like about that?

Here’s another: Direct oral amoxicillin challenge without preliminary skin testing in adult patients with allergy and at low risk with reported penicillin allergy. These researchers concluded: “This study added to the accumulating body of evidence that supports the safety and efficacy of direct provocative challenge without preliminary skin testing to exclude penicillin allergy in individuals at low risk.”

Evaluating Penicillin Allergies Without Skin Testing concludes “Direct oral amoxicillin challenges in low-risk individuals are well accepted by patients and a safe and effective part of penicillin allergy delabelling.”

Finally, Evaluation and Management of Penicillin Allergy: A Review, was published in JAMA this year and says “Direct amoxicillin challenge is appropriate for patients with low-risk allergy histories.” Also, “Evaluation of penicillin allergy before deciding not to use penicillin or other Beta-lactam antibiotics is an important tool for antimicrobial stewardship.”

If you decide to do a Direct Penicillin Challenge in your facility, I highly recommend downloading and reading the JAMA article in its entirety. The most important aspect emphasized by all of these articles is that the patients must be low-risk. According to JAMA. low-risk patients are those who report non-typical allergic symptoms, such as GI upset, itching without rash, or unknown reactions that occurred greater than ten years ago (e.g. “My Mom told me I was allergic.”). You then must obtain informed consent and then monitor the patient after administering the penicillin for about an hour in your medical area (they should not be sent back to their dorms). You need to be able to treat an anaphylactic reaction, should one occur.

As always, what I have written is my opinion, based on my training, experience and research. I could be wrong! If you think that I am wrong, please say why in comments!

Corrections.com author, Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of practice experience before moving full time into the practice of Correctional Medicine. He is the Medical Director of Badger Medical, which provides medical care to inmates in several jails throughout Idaho. He is also the author of the "Jail Medicine" blog

Other articles by Keller


  1. joanmelda on 02/14/2020:

    Custom Writing Services has become a significant challenge owing to the complexity of these Custom Research Paper Writing Services and in other cases lack of time and knowledge needed to complete Custom Coursework Writing Services.

  2. ajay maurya on 02/13/2020:

    Nice Post, I want to read more! Veteran led, quality-driven.This was a good message that you have shared through this post.Its full of information I am looking for and I love to post a comment that "The content of your post is awesome" jio-rockers thiruttuvcd

  3. leahmelda on 02/13/2020:

    Companies offering Nursing Research Paper Writing Services should help students perform well by delivering papers prior to deadline as early delivery of Custom Nursing Research Papers and Nursing Term Paper Writing Services is very important.

  4. luce on 02/12/2020:

    I wasnt fully aware that there is an issue happening with regards to this matter. Only when our Real Estate Specialists Miami told us. Hoping it can also do something for stem cell therapy in cincinnati for low back pain .

  5. Peter on 02/12/2020:

    I think they should reconsider this initiative, oral testing to humans of any kind of medicine is inhumane. It could lead to fatal results. Authorities should come up with a meeting in meeting room hire newcastle, and proceed with the alternative solutions.

  6. joanmelda on 02/12/2020:

    Custom Writing Services has become a significant challenge owing to the complexity of these Custom Research Paper Writing Services and in other cases lack of time and knowledge needed to complete Custom Coursework Writing Services.

  7. BulkCheapAmmo on 02/12/2020:

    Bulk ammo Cheap ammo

  8. florahmelda on 02/10/2020:

    Any student who may need Biology Writing Services Online is free to request our writers for assistance from Biology Essay Writing Services as they are committed to helping clients when they visit Legitimate Biology Writing Services Center.

  9. lewis on 02/08/2020:

    Publix store basically known as Publix supermarket is an American chain of supermarkets. It was founded on 6th September 1930 that was 87 years ago in Winter Haven, Florida. publix survey

  10. Suryi_Priyat on 02/07/2020:

    Penicillin is a miracle to humankind in the 21st century. But to my surprise, penicillin allergy is becoming a reality right now. So, what should we do next?Read More...

  11. leonamargret on 02/07/2020:

    hai [url=https://www.google.com]nice![/url] https://www.google.com www.google.com "hai":https://www.google.com [create debates!](http://createdebate.com)

  12. leonamargret on 02/07/2020:

    hai [url=https://www.google.com]nice![/url] https://www.google.com www.google.com "hai":https://www.google.com [create debates!](http://createdebate.com)

  13. carmelo58247 on 02/07/2020:

    This should be looked into and they should be treated properly with their allergies. Vigrx plus reviews

  14. simran12 on 02/06/2020:

    You want to participate in Tellpayless survey, but you don't know the details about the survey no need to worry we will figure out your problem. Payless Survey

  15. florahmelda on 02/04/2020:

    We not only provide Psychology Writing Services for our clients but help them understand Psychology Coursework Writing Help procedures so that they can gain Custom Psychology Writing Services knowledge.

  16. adeline on 02/03/2020:

    Robux is the online currency of Roblox. If you are planning to get the most out of Roblox, you’ll have to upgrade your avatar and buy special abilities. Robux is required at this time. watch here online robux generator 2020

  17. Steffan876 on 02/03/2020:

    If you received a receipt that included an invitation to participate in the Raising Cane’s Customer Satisfaction Survey, you will be prompted to complete a short survey. Raising Cane’s Survey

  18. Antony on 02/02/2020:

    You can find many legit essay writing service on Reddit. This website is a massive community that is home to many students and writing services. The communities on Reddit are known as “subreddits”. There are dedicated subreddits which feature legitimate essay writing services. Some of the most popular include “DoMyHomework”, “HomeworkHelp”, and “PaperMarket”.

  19. amnaseo on 01/31/2020:

    Business leaders want to be certain that the needs of the consumers are met and they are satisfied with the products and services that they offer. NC Strippers For Hire

  20. florahmelda on 01/31/2020:

    It has become vital that students seek Engineering Writing Services assistance from genuine and experienced Professional Engineering Writing Help service providers if they intend to get the best pay for Custom Engineering Writing Services in the market.

  21. Top Online Casino on 01/28/2020:

    Just what I needed! Thank you for sharing! nba 생중계 스포츠 생중계

  22. BestOnlineCasino on 01/17/2020:

    Top Recommended Online Casinos in Korea - 토토사이트

  23. polcelery on 01/16/2020:

    This web site is really a walk-through for all of the info you wanted about this and didnt know who to ask. creditos rapidos con asnef

  24. elizabethjneal2 on 01/14/2020:

    Thank you very much for this useful article. I like it. https://foreignpolicyi.org/start-your-musician-career-with-right-spotify-promotion-strategy/

  25. elizabethjneal2 on 01/11/2020:

    Very useful post. This is my first time i visit here. I found so many interesting stuff in your blog especially its discussion. Really its great article. Keep it up. http://imuabanbds.mystrikingly.com/

  26. garyri tterm on 01/11/2020:

    Fildena Professional Buy Fildena Professional White 100 MG used to cure erectile dysfunction for Men's with 0% Side Effects. Check side effects, 100% verified buyers reviews Fildena Super Active Buy Fildena Super Active online which is the best choice for erectile dysfunction patients & Check out Dosages, Buyers Reviews, Price & 🤑 20% OFF OFFERS

  27. OnlineCasino on 01/11/2020:

    토토사이트추천 토토사이트

  28. Ben johnson on 01/09/2020:

    mywifiext.net helps us to keep the network, PC and mobile phones connected with a guarded connection. https://wifiextassist.com/mywifiext/

  29. Ben johnson on 01/09/2020:

    looking for netgear extender setup guide and netgear_ext? check out step-by-step instructions to complete new extender setup or call +1 866-606-3055 for more quries... mywifiext net is a local ip to set up your router for mac or ios devices. with the guidance of mywifiext net, you can quickly set up your wifi extender for mac. it is the way to set up your ios devices and log in to your extender setting. https://wifiextassist.com/mywifiext/

  30. Jack Reigns on 01/08/2020:

    Best Restaurants in San Jose:- For all you Steak Fanatics, Uncle Ed's is all about Steaks, and Angus is the meat of choice. Cut to please and aged to perfection, our steaks will melt in your mouth! Fridays are Prime Rib Night – best in town – hot off the grill, and cut to order! Visit:- https://localbest.com/listing/usa/california/san-jose/restaurants

  31. elizabethjneal2 on 01/08/2020:

    All the contents you mentioned in post is too good and can be very useful. I will keep it in mind, thanks for sharing the information keep updating, looking forward for more posts.Thanks solar companies in the greater phoenix area

  32. RoBerti on 01/08/2020:

    In stressful working hours, your work is too stressful. We always create a sense of comfort for you so you have a relaxing time. You try dinosaur game an extremely fun game. thank you!

  33. Try Scuba Diving Key West on 01/07/2020:

    Thanks for your sharing for your fantastic posting.Try Scuba Diving Key West

  34. tekrysbyuis on 01/07/2020:

    Fildena 100 Mg Tablet #1 Magical USA ED Pills which is used to treat erectile dysfunction for men. Check reviews, side effects, price & dosage

  35. mistyterry on 01/06/2020:

    While I delighted in this element, I had an inclination that I was left dangling. What were the other four guidelines Hemmingway gotten as a whelp columnist for the Kansas City Star? eHealtHow

  36. elizabethjneal2 on 01/06/2020:

    Thanks for your insight for your fantastic posting. I’m glad I have taken the time to see this. CITY Immobilienmakler Hannover

  37. elizabethjneal2 on 01/06/2020:

    Good post but I was wondering if you could write a litte more on this subject? I’d be very thankful if you could elaborate a little bit further. Appreciate it! Judi Slot

  38. Jane Smith on 12/30/2019:

    You can read quality content on Penicillin Allergies by using the Google search engine. I would recommend you to use the du home internet while using Google as it will help you searching faster.

Login to let us know what you think

User Name:   


Forgot password?

correctsource logo

Use of this web site constitutes acceptance of The Corrections Connection User Agreement
The Corrections Connection ©. Copyright 1996 - 2020 © . All Rights Reserved | 15 Mill Wharf Plaza Scituate Mass. 02066 (617) 471 4445 Fax: (617) 608 9015