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How To Identify And Get Rid Of An Amoxicillin Rash
An allergic reaction, or rash, to amoxicillin can involve papules or hives. It usually clears after stopping amoxicillin. Anyone with an amoxicillin rash needs prompt medical advice, as some reactions can become life threatening.
Amoxicillin is an antibiotic used to treat bacterial infections. Amoxicillin comes from penicillin, which is known to cause allergic reactions in some people.
The drug comes in many different forms, including capsules, tablets, and liquid. One of the common side effects of amoxicillin is a skin rash. An amoxicillin rash can be mild or severe, depending on how sensitive the individual is to the medication.
It can be red or purple and can spread across the body. Amoxicillin rash may also show up as hives, which are red or white bumps that develop on the skin. Or, it may appear as a maculopapular rash with areas that resemble flat, red patches.
Evidence notes that roughly 1 in 15 people will have an allergic reaction to amoxicillin. In many cases, the allergic reaction is mild and may present as a skin rash.
The type of rash that develops depends on whether the person is experiencing an allergic reaction to amoxicillin or not. Hives can be a sign of an allergic reaction and typically present quickly after ingesting amoxicillin. Hives will typically:
If hives develop after a person takes amoxicillin, it may be because of a penicillin allergy. An allergic reaction can quickly become severe. Anyone who develops hives after taking amoxicillin should seek urgent medical advice.
If breathing difficulties or swelling occur alongside the rash, they should call the emergency services for immediate medical help.
A person may also experience a delayed reaction to amoxicillin that can also present with a rash, known as a maculopapular rash. This rash will usually:
In addition to developing a rash, other adverse reactions to taking amoxicillin can include diarrhea, vomiting, and nausea.
Read on to learn more about possible side effects of amoxicillin.
A rash can be a sign of an allergy, so a person should consult a doctor immediately if a rash appears after starting amoxicillin. The doctor may tell them to stop taking the medication. Then, the rash will usually disappear.
A person who develops amoxicillin rash should follow any instructions given to them by their doctor. If the rash disappears by itself, a doctor may recommend finishing the course of medication.
If symptoms worsen or the rash is very itchy, a doctor will likely recommend the person stops taking amoxicillin and takes a different drug instead.
Home and over-the-counter (OTC) remediesIf a rash is itchy, the following may provide relief:
Read on to learn more about remedies for itchy skin.
A severe reactionIf a person has an allergic reaction to amoxicillin, symptoms could worsen quickly.
If a person experiences an allergic reaction to amoxicillin, they may experience:
The dosage of amoxicillin for adults and children varies, depending on what condition it is treating and the form of amoxicillin. The usual strength of amoxicillin capsules are 250 milligrams (mg) and 500mg. Generally, the dosage for an adult is higher than a prescription for a child.
People are usually given amoxicillin orally, by injection, or by intravenous infusion directly into a vein.
Both adults and children can experience either type of amoxicillin rash.
Other known side effects include:
An amoxicillin rash happens due to a drug allergy, or drug hypersensitivity reaction. Skin reactions, such as rashes, are the most common form of allergic drug reaction.
A true allergic reaction to amoxicillin occurs to due an IgE mediated reaction. This refers to when the body responds to antigens of amoxicillin by producing a specific type of antibody called IgE.
This is a type of hypersensitivity reaction that causes an immediate response after exposure to an antigen. When a person experiences a true hypersensitivity reaction to amoxicillin, symptoms usually appear within 30–60 minutes after taking the drug.
However, many people who report an IgE mediated reaction to antibiotics, such as penicillin, do not have a true IgE mediated reaction, and many others with an allergy to amoxicillin may eventually lose their sensitivity.
A person may also experience a non-immediate reaction to amoxicillin, known as non-immediate hypersensitivity. Symptoms of these reactions typically occur more than 1 hour after ingesting amoxicillin. These reactions do not involve antibodies and instead occur due to the drug antigens activating T cells, which are part of the immune system.
The development of amoxicillin rash without any additional symptoms may indicate that the person does not have a true allergy.
As such, it may be helpful for a person to see an allergy specialist, who may recommend skin testing or penicillin challenge to evaluate for a true penicillin allergy.
In other cases, a person may instead develop a rash due to a viral infection. For example, individuals with the condition known as mononucleosis, or mono, who take amoxicillin, are more likely to develop a rash.
Some FAQs about allergic reactions to amoxicillin and amoxicillin rashes can include:
What does amoxicillin rash look like?The rash can vary in appearance depending on a person's reaction. A maculopapular rash will resemble small, flat, symmetrical pink spots. However, hives will typically appear as raised, red bumps that may be itchy.
Should I stop taking amoxicillin after developing a rash?If a person notices a rash after taking amoxicillin, it is advisable they consult a doctor. They will be able to advise whether a person should continue taking the course of medication or whether they should stop.
How do you treat an amoxicillin rash?Treatment will depend on the symptoms a person experiences. If a doctor advises a person to stop taking amoxicillin, the rash will usually disappear. If the rash is itchy, a person can try remedies such as OTC allergy medication or a lukewarm oatmeal bath.
If a person experiences a severe reaction, they should call emergency services immediately.
Treatment for amoxicillin rash depends on whether the rash is due to an allergic reaction.
In mild cases with no additional symptoms, a doctor may not prescribe any treatment. However, they may advise that a person stops taking amoxicillin. The rash may disappear a few days after a person stops taking the medication.
A person can consider multiple remedies, such as topical anesthetics and a lukewarm oatmeal baths to help manage itchy skin.
If a person develops hives, or experiences any other symptoms associated with an allergic reaction, they should seek immediate medical advice. They may need other treatments to help stop the reaction.
AAAAI Roundup: Perioperative Assessment Of Antibiotic Allergy With A Mobile App
WASHINGTON -- Posters at the American Academy of Allergy, Asthma & Immunology annual meeting provided data about an antibiotic allergy assessment tool via a smartphone app, a direct oral challenge (DOC) for assessing low-risk penicillin allergy labels, and a digital self-assessment tool for the identification of low-risk penicillin and sulfa antibiotic allergies in adults amenable to DOC.
Perioperative Antibiotic Allergy Assessment and Testing
Assessment of antibiotic allergy via a smartphone app by anesthesiologists was safe in delabeling adults with beta-lactam antibiotic allergy labels undergoing planned elective surgery, a pilot randomized controlled trial showed.
The incidence of any kind of adverse event within 90 days was observed in 5.4% of the intervention group compared with 0% of those who received standard of care (P=0.057), reported Joseph De Luca, MBBS, of the University of Melbourne in Australia.
Adverse events in the intervention group included facial numbness/chest pain (2.7%), immune-mediated diffuse rash (1.4%), non-immune-mediated thrush (1.4%), and vocal cord dysfunction (1.4%). As for management, 4% either required no management or self-resolved and 1.4% required use of an oral antihistamine.
Patients with allergy labels for beta-lactams such as penicillin or cephalosporin have worse outcomes in surgery, De Luca told MedPage Today, including more surgical site infections and a higher likelihood of being admitted to the ICU or even death during their admission. "It costs both patients and healthcare services more," he added.
The intervention consisted of an anaesthesiologist assessment via a smartphone app that had been adapted from a previously validated antibiotic allergy assessment tool, followed by directed allergy testing. Drug provocation was conducted in an outpatient clinic with a single dose of either oral amoxicillin 250 mg or phenoxymethylpenicillin 250 mg or cephalexin 250 mg, depending on the index allergy label.
Of the antibiotics used for surgical prophylaxis, 2% of both the intervention and control groups received any form of penicillin, 86% and 82% received any cephalosporin, 11% and 18% received any restricted antibiotic, 7% and 9% received metronidazole, and 4% of both groups received gentamicin.
A total of 150 participants were enrolled in the study, 74 of whom were assigned to the intervention group (median age 67, 49% women, 85% white) and 76 to the standard-of-care control group (median age 67.5, 55% women, 88% white). Sixty-one percent of intervention patients had a form of immunocompromise compared with 43% of control patients.
Among the intervention group, 41% were determined to be very low/low-risk and 59% were determined to be medium/high-risk following assessment. In the control group, 54% of patients were determined to be very low/low-risk, while 46% were medium/high-risk.
All patients included in the study were contacted at 30 and 90 days following their elective surgery at one of three hospital centers in Melbourne to assess for adverse events.
DOC for Assessing Low-Risk Penicillin Allergy Labels
Data from the ORACLE randomized controlled trial showed that DOC can be a safe way to assess low-risk penicillin allergies in critically ill patients and can lead to improved in-hospital antibiotic prescribing.
Among 40 patients in the intervention group, first penicillin DOC outcomes were negative in 98%, reported Morgan Rose, MBBS, of the National Centre for Infections in Cancer at Peter MacCallum Cancer Centre in Melbourne.
DOCs were deemed feasible with a 130/533 eligibility-to-screened ratio, an 80/130 recruitment-to-eligibility ratio, and an 80% protocol compliance.
DOCs also had high validity, with second DOC outcomes also negative in 96.9% of patients.
Critically ill patients are vulnerable to penicillin allergy labels, but are underrepresented in allergy assessment literature, the researchers noted.
"Given that that burden of allergy labels is in that low-risk group, it would be ideal to have a dedicated low-risk clinic that only saw those patients -- you wouldn't need the cost of all the extra training for the time needed for skin testing," Rose told MedPage Today. "You could just have a clinic that was specifically focused on direct oral challenge."
"The problem, though, is that triage step to identify who is low-risk upfront," Rose added. "To then direct them into our clinic is relatively time-consuming. So, I was looking for a way to try and streamline that process to support a dedicated low-risk clinic."
For DOC patients, penicillin utilization increased from 10% pre-intervention to 32% post-intervention compared with an increase of 8% to 10% for patients who received routine care (P=0.019). No significant differences between groups were observed when it came to use of narrow-spectrum penicillin, use of restricted antibiotics, or any antibiotic use.
This open-label study was conducted across four teaching hospital ICUs in Melbourne. Participants with a Penicillin Allergy Decision Rule (PEN-FAST) score <3 were randomized 1:1 to receive DOC with 250 mg of the implicated penicillin versus routine care. Both groups were directly observed for 2 hours after randomization. A repeat DOC was performed in the intervention arm following ICU discharge and >48 hours after first DOC.
A total of 80 patients were included in the trial. Median age was 62.5 in the intervention group, 57% were women, and 80% were white; median Charlson Comorbidity Index was 3 and 30% had obesity. Median age in the control group was 67 years, 42% were women, and 95% were white; median Charlson Comorbidity Index was 4 and 46% had obesity.
Digital Self-Assessment Tool for Identifying Low-Risk Penicillin, Sulfa Allergies
Rose also presented data from a study that showed that digital self-assessment tools may be useful in identifying which patients with low-risk penicillin and sulfa allergies would be amenable to DOC.
Adapted from the PEN-FAST and Trimethoprim-Sulfamethoxazole Allergy Clinical Decision Rule (SULF-FAST) tools, the self-assessment tool had a low-risk positive predictive value of 92.2%, a low-risk negative predictive value of 67.4%, a low-risk sensitivity of 80.4%, and a low-risk specificity of 85.7%.
"The main thing that we've seen is that there is no additional benefit for skin-prick testing in individuals who've been appropriately assessed as low risk," Rose told MedPage Today. "And so in fact, jumping straight to that challenge did not put you at risk of increased positive tests and increased reactions from the testing."
Describing how this process may add to delays for patients, Rose noted that "really all you're doing is you're potentially exposing them to the risks of skin testing, which are small, I absolutely acknowledge, but the challenge there is that you're limited ... If you're relying on skin testing first, then everyone has to be cycling through a clinic."
Patients who were referred to an outpatient antibiotic allergy clinic with a penicillin or sulfa allergy from January to October 2023 were invited to complete the self-assessment via a personalized web link.
A total of 357 participants were included in the study; 66.9% were women, and the median age was 55. Of these participants, 82.3% were allergic to penicillin, 5.9% were allergic to sulfa, and 11.8% were allergic to both.
Of the participants, 63.3% completed the self-assessment, and user satisfaction was 93.1% among those who provided feedback.
Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Primary Source
American Academy of Allergy, Asthma & Immunology
Source Reference: De Luca J, et al "PREPARE: A pilot RCT in perioperative penicillin and cephalosporin antibiotic allergy assessment and testing" AAAAI 2024; Abstract L11.
Secondary Source
American Academy of Allergy, Asthma & Immunology
Source Reference: Rose M "A pilot RCT of direct oral challenge (DOC) vs routine care for low-risk penicillin allergy in critical illness: the ORACLE study" AAAAI 2024; Abstract L46.
Additional Source
American Academy of Allergy, Asthma & Immunology
Source Reference: Rose M "Validation of a digital self-assessment to identify low-risk penicillin and sulfa antibiotic allergies in adults" AAAAI 2024; Abstract L47.
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Meet The Top TikTok Allergy Influencers
Whether you experience the congestion of seasonal allergies or deal with food allergies in your daily life, there's a TikTok influencer for you.
The social media platform has sprouted numerous doctor and patient influencers across countless diseases and specialties, including a handful of allergists who are also making a name for themselves serving as experts on the platform.
There are also plenty of patient influencers who guide their audiences through their daily life of managing food or seasonal allergies.
Here are some of the top allergy influencers on TikTok.
Dr. Zachary RubinWhen searching for "allergy" or "allergist" on TikTok, almost all of the initial videos that pop up fall under one name: Dr. Rubin, or @rubin_allergy, as he calls himself on the site.
Dr. Zachary Rubin is perhaps the most notable allergy influencer on TikTok.
He's a pediatrician, allergist and immunologist who built a large following of more than 1 million followers during the COVID-19 pandemic, when he began posting videos debunking myths and misinformation around the virus.
Now, he provides expert commentary on various health trends and questions that circulate on the site — while also finding ways to incorporate as much allergy information as he can.
In one video, Rubin breaks down his least favorite allergy medications, while in another, he explains how not everyone who thinks they may have a penicillin allergy actually has one.
Wearing colorful bowties and glasses, Rubin has a signature look in his videos as he breaks down medical information for his audience.
It's part of his goal to help doctors be more relatable to their audiences, he said in an interview with the American Academy of Allergy, Asthma and Immunology (AAAAI).
"It feels good to share information that members of the public may not know," Rubin told AAAAI. "While I posted that video about how most people with a penicillin allergy label are not truly allergic on National Penicillin Allergy Day, the video is still watched daily. It's funny how social media can work, and that important information can continue to be viewed and shared for a long time to help educate the public."
Dr. Amiirah AujnarainDr. Amiirah Aujnarain is another physician influencer who specializes in allergy and immunology. As a pediatrician at Kindercare Pediatrics, Aujnarain brings her perspective to her more than 70,000 followers on TikTok, where she goes by the handle @doctoramiirah.
In one video, Aujnarain breaks down "what to expect" during an allergy skin test, when a doctor places small samples of different allergens onto a patient's skin to examine possible reactions.
"The way it works is, initially we're applying that in order to put droplets of everything you're allergic to," she explained in the video. "After that they're going to test whatever things you're curious about. For example, if you have anaphylactic food allergies, you might test something like peanuts, eggs, fish. If you're more interested to see if you have environmental allergies, [that would be] like grass, trees, dust, cats, dogs."
https://www.Tiktok.Com/@doctoramiirah/video/7338669304050863366
Aujnarain also makes content about how she has suffered from allergies herself, and offers relatable advice to her followers.
Aspire AllergyWhile Aspire Allergy may not be an individual doctor influencer — they're an allergy clinic with multiple team members posting videos — they have built up a following with the goal of "helping allergy sufferers."
In one video, a physician with Aspire Allergy breaks down the differences between common colds and allergies. "Number one, aches and pains and fever are never allergies," he explains. "We don't see those symptoms with allergies — only with infections. Number two, infections last about seven to 10 days. Allergies can last for weeks and months. Number three, itchy and watery eyes are much more common for allergies compared to infections."
The doctor then adds that antihistamines don't always work for everyone — but there are other options that work, like allergy drops and shots.
In another video, Aspire Allergy explains some of the side effects of antihistamines.
Finally, Aspire Allergy tackles the questions that really matter — such as whether hypoallergenic dogs exist and what breeds are the best?
Shiv SewlalIn September, TikToker Shiv Sewlal posted a video that went viral.
She showed herself developing a severe allergic reaction to something that had resulted in her eyes swelling up. In the video, she films herself going to the doctor as her face gets puffier and redder. The doctor then advises her to use an adrenaline pen.
After getting treated, Sewlal recovered — but the video gained more than 26 million views, 2.2 million likes and more than 20,000 comments on TikTok. One commenter encapsulated the main takeaway: "Please never delay going to the hospital or using your epi pen!"
Since then, Sewlal has been documenting her journey with allergies, eczema and asthma, posting videos about what she eats in a day with plenty of food allergies.
In one video, she points out that she has over 40 allergies that she has to keep in mind when eating. In another, she shows how she has to bring her allergy-friendly food to the club in case she stays over at her friend's place overnight.
Megan LavinIf you want to learn allergy-friendly recipes and to "live an awesome life with multiple food allergies," Megan Lavin, who goes by @allergyawesomeness on TikTok, is the influencer to follow.
Lavin has gathered more than 23,000 followers posting about dairy- and gluten-free meals, as well as showing what it's like to be the parent of a child with allergies.
@allergyawesomeness⚠️HUGE WHEAT ALLERGY WARNING! ⚠️ I noticed several years ago European flours, like Antimo Caputo, found a way to still use wheat starch, AND still be considered gluten free! That's great for people ONLY avoiding gluten. For people like my son that have a wheat allergy, this really muddies the water. I just found out King Arthur is now offering this same type of technique in their Bread Flour. As this becomes more main stream we need to be careful and aware and really ask questions to ensure "gluten free" is actually safe for our wheat allergies and individual diets. . #glutenfree#wheatfree #kingarthur #foodallergy #foodallergymom #wheatallergy #wheatfoodallergy
♬ original sound – Megan Lavin Mia, the "allergic girl"If you thought 40 food allergies was a lot, enter Mia — who has 50. Known as @theallergicgirl on TikTok, Mia has built up an audience giving glimpses into her daily life of managing all her allergies.
Sometimes, she'll post her skincare routine — curated to avoid any potential allergens — or film her process in the grocery store to find allergy-safe snacks.
@theallergicgirlReplying to @Amanda #ad #sponsored Dr. Anjuli, board-certified allergist, created the Evme allergy-friendly skincare routine! It's clinically proven to be safe for sensitive and allergic skin. Their vetting process called "The Evme Method" removes thousands of known allergens and irritants commonly found even in "hypo-allergenic" formulas. You can use the discount code MIAEVME10 to get 10% off your order at evme.Com. #EvmePartner #foodallergies #skincare #allergicskin #eczema sensitiveskin.
♬ Lofi – Domknowz Danielle PriceDanielle Price has several severe food allergies, including peanuts and hazelnuts. However, that hasn't stopped her from seeking treatment for the issue.
In a viral video posted last year, Price noted that it was her first day of severe peanut allergy desensitization — a therapy that involves exposing people with allergies to extremely tiny amounts of the allergen so their immune systems can learn to handle them over time.
Price takes her viewers into the doctor's office with her while she asks questions, offering a close-up view of living with — and treating — a severe food allergy.
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