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Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber
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Amoxicillin Direct Oral Challenge in Hospitalized Patients With High-Risk Allergic Reactions, in a
Bryan Le1, Shyam Joshi2, Kendall Tucker1
1Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA.
Open Forum Infectious Diseases
|June 22, 2026
Summary
Direct oral amoxicillin challenges safely delabeled 94.1% of adults with remote penicillin allergy histories. This approach, led by non-allergy specialists, shows promise for improving antibiotic stewardship and reducing healthcare costs.
Area of Science:
- Clinical Medicine
- Allergy and Immunology
- Infectious Diseases
Background:
- Penicillin allergy is frequently reported but often unconfirmed.
- Unverified penicillin allergy leads to broad-spectrum antibiotic use, increasing resistance and costs.
Purpose of the Study:
- To evaluate the safety and efficacy of direct oral amoxicillin challenge for penicillin allergy delabeling in hospitalized adults.
- To assess the feasibility of this approach managed by non-allergy specialists.
Main Methods:
- 169 hospitalized adults with a history of penicillin allergy (urticaria, angioedema, anaphylaxis, shortness of breath) at least 10 years prior were included.
- A direct oral amoxicillin challenge was administered and supervised by non-allergy specialists.
- Patient tolerance and any adverse reactions were closely monitored.
Main Results:
- 94.1% of participants tolerated the amoxicillin challenge and were successfully delabeled.
- Mild reactions were observed in 5.9% of patients.
- No severe allergic reactions occurred during the challenge.
Conclusions:
- Direct oral amoxicillin challenge is a safe and effective strategy for penicillin allergy delabeling in adults with remote allergy histories.
- This method, managed by non-allergy specialists, offers an alternative to penicillin skin testing.
- Implementing this approach can enhance antibiotic stewardship, reduce healthcare expenditures, and improve patient care.
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