Published on
A large international study found that direct oral challenge (DOC) can be a safe and effective strategy for identifying patients who have a true penicillin allergy. Researchers evaluated hospitalized adults who self-reported a penicillin allergy—a label that historically is attached to about 10% of patients, according to the study presented in Clinical Infectious Diseases. Among the 5,121 patients assessed, 30.7% underwent DOC; of these, 95.5% (95% confidence interval, 94.3%–96.5%) were safely “delabeled,” after assessing and confirming that the patients did not have a true penicillin allergy. Only 4.5% had a positive reaction, and serious adverse events were rare (0.4%) with no cases of anaphylaxis or death. After a patient was assessed for penicillin allergy during their hospital stay, researchers looked forward 90 days and found patients who underwent DOC were more likely to receive penicillin (risk ratio, 13.25) during that subsequent period. In all, a total of 2,415 (47.2%) participants were delabeled for penicillin allergy throughout the study period by either DOC (1,502) or direct delabeling (913) following assessment.
On second thought: The bottom line is that most self-reported penicillin allergies were inaccurate, and structured assessment with DOC was found to be a safe way to confirm the allergy. The findings may help improve routine care if clinicians can create protocols to reconsider patient-reported penicillin allergies.