Doctors at the UNC School of Medicine, including Mildred Kwan, MD, PhD, and Cincinnati Children’s collaborate to develop an innovative, patient-initiated online platform designed to remove the penicillin allergy label from misdiagnosed pediatric patients.
Here’s the scene. Your child appears to be sick. You take their temperature. Fever is over 100. Their throat hurts. You immediately wonder if this could be some type of infection. Urgent care test results determine it is indeed strep throat, and the provider prescribes penicillin as the treatment. The child takes the drug and eventually develops a rash. You take them to the pediatrician to explain the symptoms. The doctor confirms that your child could be allergic to penicillin and makes a note on the child’s medical chart. From then on, you tell everyone that your child is allergic, and they can never be prescribed penicillin or amoxicillin products again, ever.
The child is now deemed to be penicillin allergic. But what if that diagnosis was wrong?
According to the American Academy of Allergy Asthma & Immunology, approximately 10% of patients report an allergy to penicillin. However, the majority of those patients may not truly be allergic.
assistant professor of medicine
“A lot of kids get penicillin or amoxicillin when they get sick because that is the normal tendency to treat respiratory infections,” said Mildred Kwan, MD, PhD, assistant professor of medicine. “The problem is that children can get rashes with infections, especially viral infections, even without treatment with antibiotics. But if they got a penicillin to treat the infection, the practitioner attributes the rash to the use of the penicillin. One major issue is that many providers have a misperception about what is considered to be a drug allergy,” said Kwan, who is also director of Quality Improvement in the UNC Division of Rheumatology, Allergy, and Immunology, UNC Department of Medicine.
Most children with a penicillin allergy history are found not to be truly allergic when they are formally tested. Rashes can often develop when an infection appears, and this can lead to a penicillin allergy misdiagnosis. A true penicillin allergy can look quite different with a full range of symptoms.
“When a child is having an allergic reaction to a penicillin, the symptoms may be consistent with either anaphylaxis (severe allergic reaction) that is an immediate onset of symptoms following the ingestion of the penicillin that can be life threatening or a severe cutaneous adverse reaction that may result on oral and other mucosal ulcers, skin peeling off, and/or other severe symptoms,” said Kwan. “Rash or hives only or fever, joint pain/swelling alone are not true allergic reactions to penicillins,” she said.