Amoxicillin and penicillin allergy direct oral challenge in a campus health clinic

Introduction: Although 9.4% of patients globally report a penicillin allergy, the vast majority are not truly allergic and needlessly avoid penicillin and other beta-lactam antibiotics when these drugs are clinically indicated. Such patients are more likely to be exposed to broad-spectrum antibiotics, which can negatively impact their quality of care and contribute to antibiotic resistance. Direct amoxicillin oral challenge (DOC) in low-risk patients reporting penicillin or amoxicillin allergy is safe and effective in the outpatient and inpatient setting. Methods: Direct oral challenge for penicillin and amoxicillin allergies was offered in the college health clinics of a large, public 4-year university and a medium, private 4-year university. Results: During the study period at the two colleges, a total of 2,436 patients had penicillin allergy noted in their medical record. A total of 102 patients completed DOC; 101 (99%) experienced no adverse reaction and none experienced severe allergic reaction. Discussion: College health clinics are highly accessible, cost-effective, and regularly collect drug allergy information during routine care. With nearly a third of young adults in the U.S. attending higher education, the college health clinic is an ideal setting for amoxicillin DOC.