Penicillin Allergy Management in India and Sri Lanka: Current Challenges

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Pharmacology

Background:

• Data on Penicillin Allergy Labels (PALs) in India and Sri Lanka is limited.
• While unverified PAL prevalence (1%-4%) is lower than in high-income countries (15%-20%), the absolute number is significant given the region's population (25% of global).
• A substantial gap exists in allergy specialists and structured penicillin allergy management protocols in these regions.

Purpose of the Study:

• To review the current burden and challenges of Penicillin Allergy Labels (PALs) in India and Sri Lanka.
• To identify gaps in the literature and health service frameworks related to drug allergy management.
• To propose a pragmatic approach for improving antimicrobial stewardship concerning PALs.

Main Methods:

• Narrative review of existing literature on Penicillin Allergy Labels in India and Sri Lanka.
• Analysis of challenges including lack of specialists, diagnostic reagents, training, and standardized protocols.
• Examination of the impact on antimicrobial stewardship for critical infections.

Main Results:

• Lower reported prevalence of unverified PALs in India and Sri Lanka compared to high-income countries.
• Significant unmet needs for allergy specialists and formal drug allergy training.
• Compromised penicillin allergy management due to resource limitations and unregulated practices.
• Adverse effects on antimicrobial stewardship for conditions like rheumatic fever and syphilis.

Conclusions:

• Despite lower reported rates, Penicillin Allergy Labels pose a significant challenge in India and Sri Lanka.
• Addressing the lack of specialists, training, and standardized protocols is essential.
• Implementing a staged, pragmatic approach is necessary to improve penicillin allergy management and antimicrobial stewardship, aligning with WHO AWaRe guidance.