2023-06-20 17:00:00
Are you allergic to penicillin? The question is regularly asked by the doctor, when writing his prescription. 10 to 15% of patients answer yes. In reality, only 5 to 10% of them have actually developed an allergy. This is manifested, in its benign form, by urticaria, a simple rash. In the event of a severe reaction, the person may experience acute asthma or anaphylactic shock.
A side effect rather than an allergic reaction
How to explain such a rate of false allergies? “Penicillins writ large often have disturbing side effects that patients think are an allergic reaction, explains Dr Françoise Pirson. This can be diarrhea or vaginal yeast infection after treatment with amoxicillin and clavulnic acid or stomach aches with treatment with amoxicillin.
The pulmonologist-allergist of the Saint-Luc university clinics offers another explanation: some patients who have heard of people who have had a serious form of allergy to penicillins say they are allergic to the slightest reaction to protect themselves from this risk. “When asked about their allergic reaction, they remain vague, unable to specify the time, the type of reaction and the name of the drug “, emphasizes Dr. Pirson.
Penicillins – among the most prescribed include Augmentin, Amoxicillin – have a very important interest in general medicine because they act on many germs, including intra-hospital germs. “They are used for many pathologies, ranging from sinusitis to bronchitis, urinary infection or digestive infection. The spectrum of action is extremely broad.”
Alternative treatment
Faced with a patient who claims to be allergic to penicillins, the general practitioner or specialist has no choice but to prescribe an alternative treatment. These are mainly antibiotics from completely different families, not always as effective, much more expensive and which promote the appearance of resistance. “because they act on many microbes which, once exposed to these antibiotics, will develop defenses against them. This amounts to cutting the branch on which we are sitting. Those who say they are allergic to penicillins cut themselves off from the possibility of being treated very many times with easily accessible and relatively inexpensive antibiotics.“, summarizes the pulmonologist.
A balance sheet is needed, very quickly
In order to confirm or rule out a drug allergy, an assessment should ideally be carried out within six months of the first reaction, recommends Dr. Pirson. And this assessment must be carried out in a specialized center, in a hospital environment.
“These are essentially skin tests carried out after a very detailed questioning of the patient. Blood tests prove to be unprofitable in terms of diagnosis in the context of penicillin allergy. If the skin tests are more or less contributory, we can move on to provocation tests to demonstrate that there is indeed an allergic mechanism or not. In some cases, a reintroduction test will be done to demonstrate that the patient can really receive penicillin.”
These tests are largely reimbursed by the Inami. The patient is issued with an allergy certificate, attesting that he is allergic to such antibiotic or such family of antibiotics and mentioning the drug alternatives. The allergy is mentioned in his computerized medical record
Penicillin allergy is not hereditary. The number of people with allergies is relatively constant over time. Drug allergy is managed by pulmonologists or dermatologists.
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