[Work-up of penicillin allergy]

Area of Science:

• Clinical immunology
• Pharmacology
• Infectious diseases

Background:

• Penicillin allergy is overdiagnosed, with up to 10% of hospitalized patients labeled as allergic.
• However, 80-90% of these patients can tolerate penicillin upon proper evaluation.
• Accurate identification of true penicillin allergy is crucial to avoid unnecessary avoidance of this vital antibiotic.

Purpose of the Study:

• To review new Danish guidelines for evaluating patients with suspected penicillin allergy.
• To provide criteria for risk stratification based on index reaction severity.
• To guide the appropriate management and potential removal of the penicillin allergy label.

Main Methods:

• Review of new Danish guidelines for penicillin allergy evaluation.
• Risk stratification based on the severity of the initial reaction to penicillin.
• Criteria for immediate removal of the allergy label versus referral for specialist evaluation.

Main Results:

• Guidelines enable immediate removal of the penicillin allergy label if criteria are met, ruling out allergy.
• Patients not meeting criteria require referral to a specialist allergy department.
• Specific IgE testing is recommended only for adult patients with immediate reactions or urticaria.

Conclusions:

• Implementation of these guidelines can safely de-label a significant proportion of patients with penicillin allergy.
• Appropriate patient selection for allergy testing and specialist referral is emphasized.
• Reducing the penicillin allergy label improves antibiotic stewardship and patient care.