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Case Scenarios

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Martin

Martin is 58 years old and visits his GP with symptoms of a bacterial urinary tract infection (UTI) requiring antibiotic treatment. Martin firmly believes that he is allergic to penicillin as he was told this by his mother as a child, although he does not recall an incident. He reminds his GP of this whenever medications are prescribed, and the GP’s clinical information system has an alert for this allergy.

Due to the long length of time since Martin's possible last reaction, the GP determines Martin to be "low risk", which according to ASCIA Guidelines for the Assessment and Management of penicillin allergy in adults, enables the GP to conduct a direct oral challenge to penicillin. The results of this challenge show that Martin is not allergic to penicillin and is cleared of his penicillin allergy. The GP updates Martin’s electronic health record by:

  • Removing “penicillin” from Martin’s list of allergies

  • Updating the assessment outcome details with “confirmed not allergic”

  • Recording the method of confirmation (direct oral challenge), date of the assessment and the name of the GP

  • Activating an alert to inform clinicians that Martin has been confirmed as not allergic to penicillin

The GP also communicates the results of the assessment to Martin and explains to him that he is no longer penicillin allergic and is at no higher risk of developing allergic reactions to penicillins than the general population.

Doctor typing at a desk in a medical office while a male patient in glasses and a pink shirt sits attentively across from him.

Tara

Tara is 30 years old and visits her GP to confirm her penicillin allergy label, which she has had since childhood. Through conducting a risk assessment and following the risk criteria on the ASCIA Guidelines for the Assessment and Management of penicillin allergy in adults, the GP deems Tara to be of higher risk of having a true allergy. The GP sends a referral to a clinical immunology/ allergy specialist for further assessment.

The clinical immunology/ allergy specialist performs a skin test and confirms allergy to amoxicillin but can show that Tara can tolerate all other penicillins.

The clinical immunology/ allergy specialist updates Tara's record to "confirmed" allergic to amoxicillin. They also record the method of confirmation (skin prick test), the date of the assessment and the name of the clinical immunology/ allergy specialist. The alert on Tara’s electronic health record is updated to amoxicillin allergy.

Tara presents to the emergency department with a skin infection 8 months later, and the clinician can see that the verification status for amoxicillin allergy only and was immediately administered the alternative penicillin antibiotic flucloxacillin.

Woman with curly hair smiling at a healthcare professional in a medical office. A clock is on the wall and a computer is on the desk.
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