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Creating a Feasible, Safe and Sustainable Penicillin Oral Challenge Program in a Rural Health Service.

Jaclyn Bishop¹, Jane Miller¹, Sue McAdie¹

¹East Grampians Health Service, Ararat, Australia.

The Australian Journal of Rural Health

|March 8, 2026

Summary

This summary is machine-generated.

A rural health service successfully implemented a penicillin oral challenge program for low-risk penicillin allergies. This initiative enabled over 25% of eligible inpatients to safely delabel their allergy.

Keywords:

allergy antibiotic assessment health service. quality improvement

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Area of Science:

Clinical Allergy and Immunology
Rural Health Services Research
Medication Safety

Background:

Penicillin allergy delabeling programs are typically based in tertiary centers.
Limited data exists on implementing these programs in resource-constrained rural settings.

Purpose of the Study:

To describe the development and outcomes of a penicillin oral challenge program in a rural Australian health service.
To assess the feasibility of safely delabeling low-risk penicillin allergies in a rural inpatient population.

Main Methods:

A penicillin oral challenge program was developed and implemented in a medium-sized rural health service.
Key workflows included allergy assessment, patient identification and recruitment, challenge supervision, and outcome communication.
The program utilized Plan-Do-Study-Act (PDSA) cycles for iterative improvement.

Main Results:

Fifteen out of 23 completed allergy assessments identified patients with low-risk penicillin allergy (PEN-FAST score 0-2).
Of the eligible patients, four completed the oral challenge, representing 27% of those assessed.
The program demonstrated successful implementation within a rural healthcare context.

Conclusions:

Rural generalist staff and teamwork can facilitate penicillin oral challenge programs.
Over 25% of inpatients with low-risk penicillin allergy were safely delabeled in this rural setting.
This study highlights the adaptability of allergy delabeling strategies for rural healthcare.