Double Check Urged on Patients with 'Penicillin Allergy'

Peter Russell

September 28, 2018

The majority of people who think they have an allergy to penicillin are not actually allergic to it, the National Institute for Health and Care Excellence (NICE) said this week.

It said doctors should check documented penicillin allergies to reduce the number of cases of MRSA and C difficile.

There were also announcements this week from NICE on treatments for emphysema and ulcerative colitis.

Penicillin Allergy

People who incorrectly believe they are allergic to penicillin may be at a higher risk of developing meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C difficile), NICE warned.

It said that wrongly identifying people as allergic could also contribute to antimicrobial resistance because these patients were more likely to be given broad-spectrum antibiotics instead.

The warning comes in a new medicines evidence commentary on UK research published earlier this year in The BMJ, based on 301,399 adults.

It concluded that around 95% of patients with reported penicillin allergies were found to be penicillin tolerant.

Those people were 69% more likely to develop MRSA and 26% more likely to develop C difficile, it found.

The findings underline the need for healthcare staff to check that only bona fide penicillin allergies are recorded, NICE said.

Prof Gillian Leng, deputy chief executive of NICE said: “Lots of people think they are allergic to penicillin because it gave them a rash when they were a child, their mum or dad told them they were allergic and it has stayed in their notes for decades. That is a very different thing to having a true penicillin allergy, which can result in a life-threatening anaphylactic reaction.

"If healthcare staff use NICE guidance to distinguish properly between the two, that could help stop the spread of both MRSA and antimicrobial resistance."

Human Alpha-1-proteinase Inhibitor for Treating Emphysema

Treatment using human alpha-1-proteinase inhibitor (Respreeza, CSL Behring) for emphysema in adults with severe alpha-1-proteinase inhibitor (A1PI) deficiency was rejected in draft guidance.

Human alpha-1-proteinase inhibitor (A1PI), which can supplement the missing protein in people with A1PI deficiency, is a lifelong treatment given by intravenous infusion once a week at an average annual cost of £57,200 per patient.

It is estimated that between 200 and 600 people in England with A1PI deficiency would be eligible for treatment.

NICE accepted that people with A1PI deficiency were at high risk of emphysema as a result of infections and environmental toxins and supporting evidence that it slowed progression of lung tissue damage compared with placebo. However, it said the cost was too high to be recommended for routine NHS use in England and Wales.

A consultation period will end on October 17, 2018, with final guidance due in February 2019.

Tofacitinib for Ulcerative Colitis

NICE issued an update on its appraisal of the clinical and cost effectiveness of tofacitinib (Xeljanz, Pfizer) for treating moderately to severely active ulcerative colitis.

The Janus kinase (JAK) inhibitor does not currently have a marketing authorisation in the UK for treating this condition.

NICE said it expected to issue guidance on January 30, 2019.

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