Don’t order non-beta lactam antibiotics in patients with a history of penicillin allergy, without an appropriate evaluation.

While a history of penicillin allergy is self-reported by approximately 6-25% of patients, most are able to tolerate penicillin. In those with penicillin allergy, it may remit over time. Patients deemed ‘penicillin-allergic’ are more likely to: be treated with broad-spectrum alternative antibiotics (such as vancomycin, quinolones and clindamycin); experience longer hospital stays; and develop complications such as infections with methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile. IgE-mediated penicillin allergy can be evaluated through skin testing or graded oral challenge.
For more information:

Abrams EM, Ben-Shoshan M. Delabeling penicillin allergy: Is skin testing required at all? J Allergy Clin Immunol Pract. 2019 Apr;7(4):1377. PMID: 30961847.

Castells M, Khan DA, Phillips EJ, et al. Penicillin Allergy. N Engl J Med. 2019 Dec 12;381(24):2338-2351. PMID: 31826341.

Chen JR, Tarver SA, Alvarez KS et al. A Proactive Approach to Penicillin Allergy Testing in Hospitalized Patients. J Allergy Clin Immunol Pract. 2017 May;5(3):686-693. PMID: 27888034.

Macy E, Contreras R. Healthcare Use and Serious Infection Prevalence Associated with Penicillin “Allergy” In Hospitalized Patients: A Cohort Study. J Allergy Clin Immunol. 2014 Mar;133(3):790-6. PMID: 24188976.

Park MA, Markus PJ, Matesic D, et al. Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy. Ann Allergy Asthma Immunol. 2006 Nov;97(5):681–687. PMID: 17165279.

Penicillin Allergy in Antibiotic Resistance Workgroup. Penicillin Allergy Testing Should Be Performed Routinely in Patients with Self-Reported Penicillin Allergy. J Allergy Clin Immunol Pract. 2017 Mar; 5(2):333-334. PMID: 28283158.

Solensky R. Penicillin allergy as a public health measure. J Allergy Clin Immunol. 2014 Mar;133(3):797-798.

Solensky R, Khan DA. Drug Allergy: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259–73. PMID: 20934625.