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Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber

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Penicillin Allergy Testing with Direct Oral Challenge in Primary Care.

Siddharth Madapoosi¹, Julio Garcia-Castro², Nadia Ilhardt²

¹From the Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI (SM, EW); Department of Family Medicine, Michigan Medicine, Ann Arbor, MI (JGC, AME); ACCESS Madison Family Health Center, Chicago, IL (NI); Division of Allergy and Clinical Immunology, Department of Internal Medicine, Michigan Medicine, Ann Arbor MI (RR). madapoos@umich.edu.

Journal of the American Board of Family Medicine : JABFM

|March 21, 2025

Summary

Direct oral challenge (DOC) safely delabeled penicillin allergies in low-risk patients within primary care settings. This penicillin allergy testing approach can improve antibiotic stewardship and patient outcomes.

Keywords:

Allergy and Immunology Electronic Health Records Follow-Up Studies Hypersensitivity Michigan Penicillin Allergy Primary Health Care

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Area of Science:

Clinical Medicine
Allergy and Immunology
Primary Care

Background:

Approximately 10% of the US population reports a penicillin allergy.
Many patients with reported penicillin allergies lack true IgE-mediated allergy.
Alternative antibiotic use in these patients increases risks of adverse outcomes.

Purpose of the Study:

To establish a protocol for direct oral challenge (DOC) in a primary care setting.
To evaluate the efficacy and safety of DOC for penicillin allergy delabeling.
To assess the feasibility of implementing DOC in primary care.

Main Methods:

A standardized DOC protocol was implemented at two primary care sites.
Forty-nine patients with very low-risk penicillin allergies underwent DOC.
Patient outcomes were monitored via phone calls at 1 week and 6 months post-DOC.

Main Results:

All 49 patients successfully passed DOC and had their penicillin allergy delabeled.
No severe adverse reactions were reported following DOC.
At 6 months, all contacted patients were willing to take penicillin and believed their allergy was resolved.

Conclusions:

Direct oral challenge (DOC) is an effective and safe method for delabeling penicillin allergies in low-risk primary care patients.
This protocol can serve as a model to expand access to penicillin allergy testing, especially for underserved populations.
Implementing DOC in primary care can improve antibiotic stewardship and reduce reliance on alternative antibiotics.