good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne.

I'm your host Mark Evans tonight a subject I've never covered before.

I'm not even sure if we've covered it on HealthLine in general over the last 20 or so years.

The show has been on the air but we're talking about penicillin allergies.

You'll be surprised about how many people in the United States actually have it might even be a relative or a friend of yours.

Phone lines will be open 866 (969) 27 two zero call any time in the next half an hour we'll intercept your call and we don't stop down for commercials because we are public television.

So we'll get to you as soon as possible and please call to answer or to ask those questions to be answered.

Our special guest tonight he's been on the show before.

In fact we talked about HIV and AIDS about a year ago.

Duncan was a doctor.

That's correct.

As I think June of last year.

OK, well it's great to have you back.

It's Michael J. Davis.

He's a deal doctor of Osteopathic medicine and he's also has a master's in public health .

So it's great to have you here on the show.

>> Yeah, it's a pleasure to be back.

Great.

And you did a great job last time we had several phone calls so let's hope that those phones will light up with more questions for you.

You know, receive sometimes some helpful hints from the doctors as far as what they would like to talk about on the program.

I did receive lots of information from you so thank you for that.

He also mentioned in that information that penicillin has been a hot topic, had a lot of infectious disease conferences lately.

>> Why is that?

Yeah, so you know, penicillin it's been a hot topic because what we found is there there's a ton of people that are labeled as penicillin allergy but in reality we probably don't have that many penicillin allergies among the public that we really think we do and people may be actually mislabeled and receiving worse antibiotics than they really should be getting.

>> OK, and as I mentioned at the top of the show, you might be surprised that there are more people who have it than not.

But apparently they are finding some situations where no, you really don't have a penicillin allergy.

Well, that's one of the reasons I guess we're doing the show so we decide for the difference.

>> That's great.

>> So let's just get started.

First of all, Alexander Fleming pretty much discovered this antibiotic.

>> Can you give us some history about penicillin and what's what is actually used for ?

Yeah, so the history penicillin is actually quite fascinating.

So this goes back to the 1920s when I was first actually discovered I think I was nineteen twenty eight we just came out of World War One.

We didn't really have anything to treat these these battle wounds for these soldiers.

I'm coming from the war and a lot of people were dying from infections from their wounds and so Alexander Fleming, you know, he was working through World War One came out of the war and his first goal was you know, I got to find a better way to treat people than just putting antiseptics on the wound and hoping for the best.

And so he really took this back to his lab back in London and you know, he was trying to study different different molecules to try to find a way to treat these infections and he actually discovered this on accident penicillin.

>> You know, one night he got tired.

He had a petri dish of the bacteria staph aureus or you heard of staph infections and this bacteria was on the petri dish he discarded it came back the next morning and you know, there's a mold growing on this petri dish.

He's like what the heck?

You know?

And when he looked at that petri dish a little bit closer, he saw that the bacteria was actually being killed off by this by this mold in this mold that he discovered that was killing the staph aureus on this petri dish was was a mold called Penicillium RuBo and through more discovery and testing he found it is actually secreting a molecule which he now termed penicillin which actually kills bacteria and this led to this huge explosion of antibiotics afterwards and penicillin really became the wonder drug.

It was saving lives and they've been able to adapt it through time to a bunch of different formulations and things like amoxicillin ampicillin which are probably the most common ones that people actually hear about but even ones that people don't hear about that target things like staph infections, strep infections or even, you know, people coming into the hospital that are coming in septic and we need an antibiotic that treats very broadly something called pipper Rassilon is probably one of the most prescribed antibiotics when you come into a hospital.

>> Wow.

Yeah.

And I was going to ask you in fact you just touched on it there briefly about the fact that there's more than one type of penicillin antibiotic.

>> How many do you think that there are?

Yeah, so there's probably about six or seven that get used nowadays.

So we have our basic old penicillin which still gets used today.

You know it's good for things like strep infections and syphilis infections.

You know there's been a syphilis epidemic in the United States and has our main go to drug well we have amoxicillin which most people probably heard of this one you know, you get strep throat as a kid.

That's my son that you're getting and it was a penicillin that's really targeted towards, you know, strep also good for things like sinusitis, skin infections called cellulitis.

Those are kind of the big things for amoxicillin.

Ampicillin is a common one we used in the hospital for certain pneumonias and then there's other penicillins that been adapted to treat staph infections which people probably don't know about these as much because they're mostly used in the hospital things like Nafez so on clocks Asil and so on.

A lot of Silens here and then our big one hypersaline which we use when people come in with sepsis.

>> Oh wow.

OK, well you know those are all wonder drugs like you mentioned.

>> But people there are people out there who have allergies against them.

So how common is the allergy for any type of penicillin type drug or antibiotic?

>> Yeah so there there was a great review that covered this topic in about twenty nineteen from the Journal of the American Medical Association or JAMA and they estimated that about 10 percent of the United States actually has a label of a penicillin allergy which I mean that equates to like thirty thirty to thirty four million people across the country.

>> Wow.

>> So with that said why so many is the penicillin allergy genetic?

Are people inheriting this?

>> So that's a good question and we get that question a lot.

May people in my office I don't know that there's a lot of great data to say that it's a genetic thing.

But what we do see is a lot of time people get penicillin early on in life especially as a kid.

And you know, when we're growing up as kids our biggest fear is getting a bacterial infection and so antibiotics may get overprescribed in some circumstances and so people may actually get a reaction to the antibiotic just because they have a virus going on instead.

>> You know, I forgot about that that that particular antibiotic can be over prescribed.

>> When do they discover that?

I mean, you know, you have this wonder drug wonder antibiotic that's been rolled out and I'm sure they were using like crazy especially after that war to fight off a lot of infections.

>> So they found the adverse that you can you can probably get too much.

>> Mm hmm.

Yeah.

And that's the interesting thing and kind the reason why some of these these changes in the penicillin molecule have happened is because you know, penicillin is a wonder drug you give it to everyone first came out but you know, as we give more antibiotics out, what we find is the bacteria actually learn to adapt and they develop resistance to antibiotics which is probably one been one the biggest issues across the country right now there's new bacteria that are coming out that are resistant to every antibiotic that we have available in our arsenal which makes things very challenging.

>> I know when I get occasional sickness during the wintertime and it is actually conducive to get an antibiotic sometimes I was told that because I already had one maybe the year before or maybe not too long ago for something else and they said we're just going to skip on the antibiotic this time.

>> Yeah.

And that's a it's a very common scenario where you know, it's probably where antibiotics get prescribed the most mouse's respiratory infection.

>> That's exactly what it was so does it make it worse or it just gets to the point that it doesn't help at all?

Yeah.

So the more you get exposed to antibiotics in life the more your bacteria learn to resist.

Right.

And so it it gets worse and that you have to use other antibiotics to treat it which may be more toxic and may cause other issues and drive more resistance down the road.

>> Yeah.

>> So what would be the best thing to do is just wait it out for a while and try other things for that patient.

What would you do in that situation?

>> You as the doctor.

So a lot of times what we've kind of noticed as you know with these infections it doesn't usually start off as a bacterial infection.

It commonly is a virus that triggers this.

And so usually I say, you know, if you just having some low grade fevers, you know, kind of wait it out for the next seven days but if it starts suddenly getting worse, that could be a sign that you're getting a bacterial infection because a lot of times what happens is these viruses you know, they in fact you they actually lower your immune system and damage some of the tissues and your rest retract so your so your nose going all the way into your lungs and that really sets the stage for bacteria to start causing issues and causing infections.

>> So penicillin doesn't do anything for viruses then.

>> Yeah.

So antibiotics they don't treat viruses.

The treatments for viruses are actually very, very few.

>> The antibiotics really are just for bacteria.

Interesting.

So what are the symptoms or the allergic responses a patient might have if they're allergic to penicillin type of antibiotic?

>> Yeah that's a that's a great question because this is where people struggle to find what is an allergy but classically a true allergic reaction to antibiotic.

As you know you get the antibiotic and then usually it's within an hour actually they start developing certain symptoms most commonly you might get some itching, you might get some rash, you might feel short of breath the more severe reactions that we look out for that can be life threatening or things like anaphylaxis where your body just goes into overdrive, your blood pressure starts dropping and it's almost like you're getting septic.

>> And I noticed that on some other notes here that if you have that you need to see a doctor right away.

You probably need to go to the emergency room.

In fact, they're even advising you on this from the CDC to call nine one one because it can be really serious.

>> So anaphylaxis is a very serious is life threatening and I think where people see this more commonly and hear about it as well things like bee stings or peanut allergies where he prescribing EpiPen because it can lead to those kind of reactions.

>> So you've told us about the responses and symptoms.

What about the long term impacts of penicillin allergy?

>> What happens then?

Yeah, so what we know with these penicillin allergies as I say a lot of them are low risk are non severe reactions that people have things like a delayed rash after like four or five days or some nage.

Those are kind of the common things that we see.

But what we know is about ninety five percent of people that have those kind of low those less severe reactions actually probably still can tolerate penicillins fine.

And even those people that have an allergic reaction within an hour of getting administered the antibiotic, about 80 percent of those people will lose the allergy over 10 years.

And so a lot of these people that are diagnosed with a penicillin allergy or early in life , they may not actually have the allergy anymore.

>> I was going to ask you if you can outgrow it so to speak ,penicillin allergy just to answer that question.

So I don't know that's kind of good news.

So you have to get tested I'm sure by what an allergist or an immunologist to to realize that and to realize that you are allergic to penicillin.

So what are the testing procedures?

>> Yeah, so the testing procedures it depends on how severe the reaction is.

So for some of these more minor reactions where you know may have been a rash or some itching, maybe some nausea, you know, we can really just go to a giving you a dose of amoxicillin and watching for an hour.

So the typical procedure is, you know, you come into a clinic usually it's going to be an asthma allergy or an allergy clinic, sometimes infectious disease clinics too because they've been picking up the mantle on this as well and they check your vitals, give you a dose of amoxicillin and then they monitor you for about an hour because that's about the time frame where you should get reaction if it's a true allergic response that seems like it's fairly fast.

>> It is so you should hit you pretty quick.

>> OK, so what are you going to be experiencing if that backfires on you speak so well what would be the symptoms or the responses?

>> Yeah so in these kind of these low risk situations where we give the amoxicillin thing I usually tell people to watch out for as you know let me know if you have any kind of rash itching if you if you feel like your mouth is welling up, your face is swelling, you're getting short of breath and then also we're going to watch your your vitals but your heart rate starts going up.

>> Those could all be signs that you're having an allergy allergic reaction.

So it seems practical to me if you didn't know if you had a penicillin allergy or not and I know because I just went to the doctor recently pardon me one of the first questions they ask you during the pre screening for the physician comes in what are your allergies?

Of course mine are all listed in the system.

Codeine is one I just can't do codeine.

That's just it just makes me very, very sick.

So luckily that's the top of the list.

I make sure they know when I go in had a bad experience with that but they seem to be very interested in your past history.

But my question is if someone had never really had a reason to have penicillin before and they're like they might be scared they might even have seen the show and say oh I'd better ask about that next time we go to the doctor, would it be practical to do a penicillin type test before you actually were given a full dosage of it ?

>> Yeah, that's that's always an option.

And I'd say with with no history of a reaction, you know, typically we can go to an amoxicillin challenges what we call it.

We take a dose but for people that have more severe reactions in the past, sometimes what we'll do is we'll be a bit more cautious.

>> We'll actually do skin testing.

It's a little it's basically what's involved with that is it's a couple of on the skin and they actually put a little bit penicillin on one of those spots and then they have test site in a control site to see if you're actually having reaction.

Oh, and if you have a if you're not having the reaction then they kind of proceed to doing that amoxicillin challenge if you wanted that done I mean is it OK to bring that up to the doctor?

>> Can we test it out first you or you know for instance long story short, I'm not allergic to the selling but my brother is OK and so is my grandfather on my mom's side.

That's why I was asking you might have been inherited.

So if you have a family history of that they probably wouldn't be a bad idea to test it out if you've never had penicillin before.

>> Yeah, it definitely would be reasonable to go ask your doctor and see if you can get checked and you know potentially go through the testing.

>> OK, very good advice.

>> So you talked about a little bit about what happens when you go in to see the allergist or the immunologist.

>> I mean the skin test it doesn't sound like it's that big of a deal typically now if the symptoms you're typically going to have with us in reaction is usually some itching, some swelling at the site which might feel a little uncomfortable, those are probably a big symptom.

>> That's that's sounds like it's essential wouldn't be a big deal.

I'd rather be safe than sorry to be honest.

>> Exactly.

Hey, we've got a call coming in.

Got Wesley on line five actually he's asking for us to read the question which will be more than happy to do.

He's asking I used to have a sensitivity to penicillin and my doctor told me that I had one to say something Salta antibiotics as well.

>> Is there a connection between the two ?

Do you know what he's talking about?

Yeah.

So that's a good question.

So sulfa antibiotics are also a very common antibiotic.

Also a lot of history behind that one as well.

We won't get into that but there's another one that we commonly see we'll see allergies to or reactions too.

I wouldn't say that there's a connection between penicillin allergies and a sulfa allergy.

They're different and even you'll actually see sulfa within a lot of other medications beyond just off antibiotics as well.

>> So no real connection there but there are some good testing guidelines for the penicillin, the sulfa testing.

>> That's something that that's still being explored in the allergy space.

Yeah, I think the should maybe spend some time on that.

>> We are talking to Dr Michael J. Davis who is a doctor of osteopathic medicine and he is a specialist when it comes to allergies, penicillin type allergies and you do a lot of presentations at conferences and so forth and you know this information like the back of your hand which obviously you should as a doctor but we appreciate of sharing that information tonight.

And Wesley, thank you by the way for your phone call.

We still have about oh I'd say seven or eight more minutes if you have a question about penicillin, allergies, the telephone numbers on your screen 866- (969) 27 two zero.

>> So Doctor, if if you touched on this before but I want to make sure we talk about this before the show ends if I'm allergic to penicillin but I have an infection where only penicillin will work, what do I do?

>> What are the safe alternatives to that penicillin?

Yeah, so that's a really good question.

So penicillins are our first line agents for you.

>> The vast majority of infections if you have a really bad you know, penicillin allergy, there are other options available.

We do have some other safe antibiotics to use if you do have the allergy, it's a very common class of antibiotics that we end up using or things like syphilis.

Orrin's heard of it.

So if anyone's ever heard of Keflex that which is a very common one that we use for skin infections and a bunch of other indications those those antibiotics don't really cross react with the penicillin all that much.

It's very low like less than one percent.

So those are very safe antibiotics as well also very similar to penicillin.

>> And why wouldn't you use those in the first place to perhaps skirt any penicillin allergies now that's a good question.

>> I say in the immediate situation a lot of times we will we'll just go to the Sapho spawns because they are safer they're safe antibiotics as well.

But in the meantime, you know, we do want to make that to get rid of that penicillin allergy if we can or figure out if it is truly an allergy because there are some cephalosporins that might interact or it might have caused a reaction similar to penicillin and so it does limit the options of this L'Esperance to some degree and you say syphilis but I'm going to talk about syphilis right now the Keflex is that how you pronounce it?

>> I pronouncing that correctly Catholics.

Yeah.

OK, does that fight syphilis?

So cephalexin so there's actually only one drug that has the indication to treat syphilis and it's penicillin.

It is penicillin.

And so you know this has been a big issue over the last few years as you know syphilis it's it's been an epidemic recently and we actually had a penicillin shortage recently over this last couple of years and so we didn't really have a lot of great agents available to us and so a lot of doctors across the country are trying to come up with other regimens and testing out different regimens and hopefully we'll see the data come from that to see what other options we have.

>> But right now the only main drug we have is penicillin.

OK, do do I need to avoid any other drugs if I might be on another drug type protocol for being treated for something else, do I need to avoid any other drugs if I'm allergic to penicillin now that's a good question.

>> So I would say no, there's not a lot of cross reactivity with penicillin and other medications.

You do see it with other antibiotics though.

So the question from Wesley earlier sulfa antibiotics that's a good that's a good thing to know because there is some cross reaction to things like people's blood pressure medications or water pills.

>> There are some cross reactions there but penicillin not typically OK if I do have a reaction and what was it was Anna Fellus.

>> Alexis, you're the doctor, not me.

If I had that or any other type of reaction to penicillin, those pins are they call those those EpiPen epi pens and should I carry one of those around just in case I have one in my car or at least available?

>> I mean would they work?

So that's a good question.

So epi pens, epinephrine, epinephrine is the treatment for severe allergic reactions of any kind.

So most commonly you're thinking about bee stings, peanut allergies.

Good to carry it for that.

Typically with penicillin you know you're going to be taking penicillin and most people if they've had a reaction usually they're having a reaction in a controlled setting and in those controlled settings you usually have epinephrine on hand just in case.

OK, and so I wouldn't say you would need an EpiPen unless you already have a documented penicillin allergy.

>> All right.

And that's something maybe you should talk to your physician about just to have a backup system.

>> There was a question regarding a patient's chart I think that you wanted me to ask you something about the making sure that the you or if you're a parent making sure that that is documented.

I told you about when I went to my doctor well, you know, my allergies are right there.

>> That's very important, isn't it for the for parents to tell the doctors especially if they don't have any medical records available, they got to get in there and tell that doctor to Hank.

>> By the way, I think we've got a penicillin allergy here.

Yeah, it's definitely a good thing to let your doctors know and hopefully your doctor when when they hear this they'll do a little bit more digging and really try to sort out, you know, is it a true allergy or is it more an intolerance and hopefully then you know, if it sounds like a true allergy, hopefully they're getting connected to an allergist or an infectious disease doctor to really explore and see if it truly is and potentially do some testing because you want to clarify whether it is a trigger action because you don't want to develop severe reactions like anaphylaxis or things like angioedema, which is a fancy word for face swelling which can cause respiratory distress.

>> So but is a good thing to let your doctors know about.

>> Very good.

Listen, the floor is yours.

I always call this section of our program doctors Notes.

So what would you like to leave our listeners our viewers with as far as any advice when it comes to the penicillin reactions or allergies?

>> Yeah, so I think the big take home message is you know, there's a lot of people that have a documented penicillin allergy but what we know is a vast majority of people probably don't have the allergy anymore.

And so I would say explore this with your doctor, talk to them about it and maybe ask them, you know, should I get tested for this so that if I do get a severe infection down the road I have the best antibiotics available to me because inevitably people will get infections at some point in their life , especially as we age and we want to have the best antibiotics available to you and be nice to try to stay with these antibiotics that are proven safe and effective and try to avoid some of those more toxic antibiotics that may actually have black box warnings on them and may actually drive more antimicrobial resistance which has been a big issue across the country with super, super super bacteria.

>> All right.

And of course if you have any questions, please ask your physician as former director over there in the distance how much time do I have?

>> We've got one minute.

I do want to ask you one question before we wrap.

You primarily deal with adults if you don't mind.

Let's go to the line and cross the line here for pediatric medicine.

Yes.

Do antibiotics react differently with children versus adults?

>> Is there any type of difference or is there anything that we should look out for when kids have antibiotics like penicillin and so that's a that's a really good question.

>> I'd say we're very quick to jump to say that it's allergic reaction for kids but really there's not a lot of difference there.

The symptoms may be a little bit more different more severe things like some drooling in the mouth would be a little bit more common with children because they have smaller airways.

They may respond a little bit more severely initially but from a reaction standpoint you typically shouldn't see too many differences as far as how often they happen, I'd say the big things you know is that probably the allergy gets over called because we're overcautious of kids when in reality it's probably a virus that's probably causing some of the rashes that we're seeing.

>> All right.

>> Well, thank you very much, Dr. Davis.

Really appreciate the information tonight.

I learned a lot just talking to you not only just doing some research for the show but lots from you and we appreciate it very much.

>> Please come back.

Yes, maybe next year.

>> Yes.

I've been happy to be here.

All right.

Thank you.

Thank you.

By the way for watching and for your questions coming in.

We'll be back next Tuesday night with another very interesting show called HealthLine here on PBS Fort Wayne.

>> Until then, thanks for watching.

Good night and good