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The global prevalence of reported penicillin allergy: A systematic review and meta-analysis

Akish Luintel1, Joseph Healy2, Michael Blank2

  • 1Institute of Global Health Innovation, Imperial College London, UK.

The Journal of Infection
|January 28, 2025
PubMed
Abstract

Insights

Globally, 9.4% of adults are labeled with penicillin allergy (PenA), a condition often misdiagnosed. This prevalence varies significantly by country income, highlighting the need for broader data collection to support penicillin de-labeling initiatives.

Area of Science:

  • Clinical Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Penicillin allergy (PenA) labels lead to broad-spectrum antibiotic use, increasing antimicrobial resistance and adverse outcomes.
  • Approximately 95% of patients with a PenA label are likely misdiagnosed.
  • Penicillin de-labeling programs are emerging but are currently limited in scope.

Purpose of the Study:

  • To determine the global prevalence of penicillin allergy (PenA) labels.
  • To inform the potential impact and scope of penicillin de-labeling programs worldwide.

Main Methods:

  • Systematic review and meta-analysis of adult PenA prevalence studies.
  • Inclusion criteria: studies published between January 2003 and June 2023.
  • Data extracted: PenA prevalence, allergy recording methods, healthcare setting, country income.

Main Results:

  • 174 studies from 28 countries were analyzed, encompassing 18,352 patients.
  • Global PenA prevalence was 9.4% (95% CI 8.4-10.4%).
  • High-income countries (HICs) reported higher PenA prevalence (9.9%) compared to middle-income countries (MICs) (4.4%).
  • Studies were heavily skewed towards HICs (92%) and secondary care settings.
  • Allergy recording methods significantly impacted reported prevalence.

Conclusions:

  • PenA prevalence data is concentrated in HICs and secondary care, with limited representation from Africa, Asia, and South America.
  • There is a critical need for expanded epidemiological research in under-represented global regions.
  • Addressing data gaps is essential for effective global penicillin de-labeling strategies.
Keywords:
AMRAMSAntibiotic resistanceAntimicrobial resistanceAntimicrobial stewardshipBeta-lactam allergyDrug allergyPenicillin allergyWHO policy

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