7 responses to “Specialists and Family Practice: Tackling the Pseudo-Penicillin Allergy Epidemic Together”

  1. What is the dosage of oral Penicillin taht we shoujld administer for the office oral challenge?

  2. In addition to the previous question re: penicillin dose, how long should they stay in the office after the office oral challenge?

  3. For adults, I challenge with amoxicillin 250mg POx1 dose and monitor for 1 hour post.

  4. I love this! Thank you for this article! I was previously encouraging patients to see their GPs about allergy testing in the case of a doubtful penicillin allergy – however, after reviewing the recent publication about the PEN-FAST penicillin allergy risk scoring system (https://pubmed.ncbi.nlm.nih.gov/32176248/) and related evidence, I have started doing oral challenges in the Emergency Department for patients who fall into the lowest-risk PEN-FAST category and who meet the low-risk criteria outlined in the article. Like the authors, I use amoxicillin 250mg po x 1 dose and observe for about an hour.
    The major cautions that have been raised regarding fluoroquinolones recently have dramatically increased my use of beta-lactam options for respiratory and urinary infections and increased the urgency to de-label these patients when possible.

  5. Great topic!
    I am wondering if family physicians should score their patients using the PEN-FAST score, and if <3, send them to a specific penicillin allergy clinic at an urgent care centre. This centre would be well-equipped to handle any problems that may arise, even though the chance is small.

  6. Thank you for this practical article! My question: can this be done in pregnancy? About 27% of term women are Group B strep positive and recommended to have IV penicillin in labour — with the alternative for pen-allergic women being clindamycin (or cephalexin if the clinician is brave). Women are screened by perineal swabbing at 36w gestation. Could GBS+ women labelled pen-allergic have confirmatory oral challenges to rule out pen allergy in the month prior to labour? I know BC Women’s has a pen allergy de-labelling clinic.

  7. I would also love to hear the answer about oral challenges in pregnancy. We often use Ancef if the reaction sounds low risk but this could provide us the ability to use Penicillin in labour and de-label the patient.

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