The democratization of de-labeling: a review of direct oral challenge in adults with low-risk penicillin allergy

ABSTRACT

Introduction

Penicillin antibiotic allergy labels (AALs) are common and lead to significant negative health and health system outcomes. Direct oral challenge offers a rapid and cost-effective way of removing inaccurate AALs and improving outcomes.

Areas covered

A narrative review (Medline, May 2020) of direct oral challenge in low-risk penicillin allergy in adults is described, and the evidence for the safety and efficacy of this approach in inpatients, outpatients, and special patient groups is presented.

Expert opinion

Whilst the current literature demonstrates the safety and efficacy of direct oral challenge in de-labeling low-risk penicillin allergy in adults, novel approaches are needed to improve access to antibiotic allergy assessment and address the growing global need.

KEYWORDS:

• Allergy
• antibiotic
• beta-lactam
• de-labeling
• oral challenge
• penicillin

Article highlights

• Direct oral challenge is effective in de-labeling low-risk penicillin AALs and can be safely applied in both an outpatient and hospital setting.

• Direct oral challenge can be safely undertaken within the patient’s routine care setting.

• Validated allergy phenotyping tools can be used to safely identify low-risk allergy and facilitate rapid de-labeling or referral to specialist allergy services.

• Early data supports oral challenge in de-labelling immunocompromised and critically ill patients although access remains limited in these settings

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Two reviewers on this manuscript have disclosed receiving grant funding from ALK Abello, a manufacturer of a penicillin skin test product. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.