Question

A client reports that they are allergic to penicillin. What would be the nurses best response to this information?

Answer 1

• The best response of the nurse is to notify the healthcare provider that the client is allergic to penicillin.
• Further , the nurse can do assessment of the client.

Assessment:

The first step to assessing a possible penicillin allergy before a drug is prescribed is to take a detailed history :

Questions to establish a penicillin allergy

• What was the patient’s age at the time of the reaction?
• Does the patient recall the reaction, and if not, who informed them of it?
• How long after beginning penicillin did the reaction occur?
• What was the route of administration?
• What antibiotics has the patient reacted to in the past?
• What antibiotics has the patient taken and tolerated since the allergy diagnosis?What was the nature of the reaction?
• If a rash was present then: a. Describe the nature of the rash (e.g. pustular, urticarial), b. Could the rash be related to an underlying condition (e.g. viral)? c. How long after commencing the antibiotic did the rash appear?
• Why was the patient taking the antibiotic?
• Did this reaction result in hospitalisation?
• Did the reaction resolve on stopping the antibiotic? If so, what happened after stopping the drug?
• What other medications was the patient taking? Why and when were they prescribed?
• Has the patient taken antibiotics similar to penicillin (e.g. amoxicillin, cephalosporins) before or after the reaction? If so, did anything happen?

Histories can be unreliable and can result in over diagnosis of allergy. Some patients may have been too young to fully remember the reaction and patients who report a vague history of symptoms or gastrointestinal intolerance are probably not truly allergic to penicillins. Approximately 80–90% of patients reporting a penicillin allergy are negative when assessed by skin testing. This test can aid in determining a patient’s allergy status and identifying those at high risk of penicillin reactions.