The effectiveness of interventions that support penicillin allergy assessment and delabeling of adult and pediatric patients by nonallergy specialists: a systematic review and meta-analysis

Direct oral challenge for immediate and non‐immediate beta‐lactam allergy in children: A real‐world multicenter study

“…Very few reactions were severe, but all resolved adequately with the treatment administered, and only one required overnight hospitalization. These results open the door to considering performance of DODPT in non‐specialized and primary care settings in most patients without risk factors, which would facilitate the delabeling of BLA allergy in a larger number of children, with important benefits for patients, their families, and health systems 63,64 …”

Is penicillin allergy de-labelling about to find its place in UK antimicrobial stewardship strategy?

“…A new systematic review of the literature included 69 studies from around the world, with the majority from the USA (70%) and Australia / New Zealand (16%) and relatively few from Europe (5.8%) and the UK (2.9%). 4 The dominance of USA and Australian studies may be due to the early recognition of penicillin allergy de-labelling as an antibiotic stewardship priority by authorities in these countries and subsequent publication of guidelines for Authors: A consultant antimicrobial scientist, Royal Cornwall Hospital, Truro, UK; B professor of medical microbiology, University of Plymouth, Plymouth, UK; C professor of leadership nursing, University of Plymouth, Plymouth, UK; D health psychologist, University of Oxford, Oxford, UK; E consultant medical microbiologist, Leeds General Infirmary, Leeds, UK non-allergists to deliver penicillin allergy assessment services. 1,5 In 2021 the World Health Organization published their endorsement of antibiotic allergy assessment as an effective antimicrobial stewardship strategy providing a global position statement for other countries to follow.…”

Delabelling penicillin allergy revisited

“…The British Society for Allergy and Clinical Immunology (BSACI) guideline includes a checklist to identify patients at low risk of allergy and a framework for drug provocation testing by non-allergists 5. A systematic review of 69 studies reporting on the successful delabelling of 5019 patients delivered by non-allergists provides further evidence for this intervention 8. In the review, the methods of delabelling included direct delabel (removal of allergy record on history alone), direct drug provocation testing (most often using a single dose of oral amoxicillin) and skin testing followed by direct drug provocation testing 8.…”

“…A systematic review of 69 studies reporting on the successful delabelling of 5019 patients delivered by non-allergists provides further evidence for this intervention 8. In the review, the methods of delabelling included direct delabel (removal of allergy record on history alone), direct drug provocation testing (most often using a single dose of oral amoxicillin) and skin testing followed by direct drug provocation testing 8. These were delivered, mainly in inpatient settings, by pharmacists, doctors, nurses, physician associates, medical students and pharmacy students.…”

“…Rates of allergy delabelling varied from 14% to 41% depending on the method of assessment. Once assessed as suitable for testing, 95% or more of patients tested were successfully delabelled with only 1.7% reporting harm (non-serious) 8…”