This site is intended for health professionals only

Nine-in-10 patients with penicillin allergy listed in GP record not allergic

Nine-in-10 patients with penicillin allergy listed in GP record not allergic

Millions could be missing out on the most effective antibiotic choice because they mistakenly believe they are allergic to penicillin, prolonging their recovery and even leading to hospital admission.

Individuals should check their GP record to make sure they are not wrongly labelled as being allergic to penicillin, the Royal Pharmaceutical Society has warned.

Figures show around 6% of people have a penicillin allergy label on their medical record, equating to 4 million people in the UK.

But research has shown that around 90% of people do not have an allergy when properly assessed.

The RPS also pointed to research published in 2019 that showed being labelled allergic to penicillin is associated with a higher mortality rate of an extra 6 deaths per 1000 patients in the year after treatment.

The researchers had estimated that that incorrect penicillin allergy records affect 2.7 million people in England.

Another study in 2018 had patients with a penicillin allergy listed in their notes were more likely to catch superbug infections such as MRSA.

People may believe they are allergic to penicillin for a variety of reasons because they had suffered common side effects of antibiotics such as nausea or diarrhoea but also because symptoms of the infection such as a rash could have been wrongly attributed to the medicine.

Some patients may have had an allergy reported many years ago, perhaps in childhood, but which is no longer an issue, the RPS added. But once on someone’s medical record, the penicillin allergy label can remain for years without being questioned, they added.

RPS spokesperson Tase Oputu said: ‘Every medicine has benefits and harms and I urge patients to ask questions about a penicillin allergy label on their medical record.

‘Many individuals are at low, or very low risk, of having a genuine penicillin allergy and we often find that after careful investigation that they can take penicillin safely.

‘Others, who may have had a severe reaction in the past, will need allergy testing and in some cases may never be able to take penicillin.’

She added: ‘Patients should talk to their pharmacist or other health professional to help understand the difference between side effects and allergic reactions, which can sometimes look similar, so they receive the most effective treatment for their needs.’

Allergy UK said it was an issue that needed to be examined more closely.

Amena Warner, Head of Clinical Services for Allergy UK said: ‘Many people have had a label of having a penicillin allergy from early childhood often after having a rash with antibiotics.

‘This label can be carried with them the rest of their lives, without it ever being investigated.

‘There is now a national effort to look into this and the best way to do this. Allergy UK welcomes this issue being explored more closely and will ensure the patient voice and perspective is represented.’


Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.


Please note, only GPs are permitted to add comments to articles

James Cuthbertson 28 September, 2023 5:58 pm

Is it possible to test for a penicillin allergy (surely if they’ve not had it for years there will be a negative IgE)

George Moncrieff 28 September, 2023 6:05 pm

One of the best ways to avoid getting an erroneous label of ‘penicillin allergy’ in the first place, would be if we all stopped treating viral infections with antibiotics. Many of these go on to develop an exanthem a few days later, casuing loads of unnecessary anxiety.

David Church 28 September, 2023 6:26 pm

Well said George !
It is RPS have it wrong here. There is no point in ‘people’ checking their GP record for erroneous allergy labels – I presume RPS are implying these have been fallaciously or maliciously applied by GPs!
RPS have failed to realise that the medical terminology ‘gets a little nausea or rash if given Trimethoprim’ is translated by patients into ‘patient-speak’ as ‘severely allergic to penicillin’.
This is not the fault of the GPs, who often will have spent time explaining about it being a viral rash that would have happened anyway, and trimethoprim is NOT a penicillin anyway, but patients and their aunties and social media freinds know better, and they know Trimethoprim is a pencillin, and so is Doxycycline, and if you have a rash after an antibiotic, it cannot be caused by the virus, because the penicillin kills all viruses, so it must be an allergy.
Just like if you eat too many curries and cream cakes and get diarrhoea, it must be a lactose allergy, caused by the gluten in the rice !

David Banner 28 September, 2023 9:39 pm

Patient- “But Dr, I’m allergic to penicillin “
GP- “Nah, it’ll be fine”
Coroner-“So Dr, you prescribed penicillin despite her records clearly stating “allergic to penicillin”?
GP- “Well, errr, y’see, 9 in 10 aren’t actually allergic, it sounded like a mild side effect to me”
GMC- “Hand in your gun and your badge, your career’s over”
GP- “D’oh!!”

Born Jovial 29 September, 2023 5:37 am

Why don’t we refer all the Penicillin allergic patients to allergy clinics and let them determine if true allergy or not as once patient or family say they are Penicillin allergic it would be medico legally indefensible to prescribe them Penicillin without proving otherwise.

This may not make difference to “prevalence” of Penicillin allergy as I cant imagine those 4 million people with Penicillin allergy will be seen by allergy clinic within their lifetime with present waiting times.

Dylan Summers 29 September, 2023 8:28 am

@David makes the most important point.

If the idea is that these patients should have a clear test like specific IgE then great, I’m on board.

But if the idea is that we just use our clinical judgement to decide when to give penicillin to a patient with a documented allergy… I don’t think so!

Steven Berg 29 September, 2023 1:16 pm

In the late 1960’s, I remember that the Professor of Pharmacology at Manchester used to teach that as penicillin was bactericidal not bacteriostatic, the effect was to disrupt the bacterial cell wall and therefore release the contents into the patient’s circulation.
He therefore claimed that if you didn’t get a rash on a penicillin, it probably wasn’t being effective in treating the infection.
However, nowadays all of the folks who either get a viral rash or the rash described by the Prof. would be recorded as ‘allergic’.
But I agree with all the others who have stated that it would be medico-legally indefensible to prescribe against a recorded allergy as that patient will probably prove to be the 1 in 10 and goodbye career.

Michael Green 29 September, 2023 7:56 pm

Refer them all to the allergy clinic then. What a load of crap. Fed up of this rubbish