Head-to-head study shows non-allergists perform comparably in low-risk penicillin allergy

Published: February 18, 2024

Penicillin "allergy" labels are common but often misdiagnosed – with up to 90% of labels found to be incorrect after evaluation. Correcting incorrect allergy labels (known as “delabeling”) can allow patients to re-use life-saving penicillin antibiotics, which has been shown to improve outcomes and reduce the development of multidrug-resistant organisms.

Given the overwhelming number of mislabeled penicillin allergy labels and relative lack of allergists, evaluations by non-allergists have been advocated for low-risk patients. One example was the Hong Kong Drug Allergy Delabeling Initiative (HK-DADI), which was a previous pilot study demonstrating the effectiveness of a nurse-led penicillin allergy delabeling initiative. However, more definitive evidence on the effectiveness, safety, and impact of such non-allergist initiatives were previously lacking.

Mak et al. report findings from a prospective, multi-center study performed between four centers in Hong Kong – HK-DADI2, published in The Journal of Allergy and Clinical Immunology: In Practice. This study directly compared the outcomes, safety, and impact on quality of life of more than 220 patients undergoing penicillin allergy evaluation over 2-years. Regardless of evaluation by allergists or non-allergists, the majority (>93%) of penicillin allergy labels could be safely delabeled with significant improvements in patient quality-of-life. There were no significant differences between evaluations conducted by allergists and non-allergists. However, non-allergist evaluations had shorter waiting times, while allergists required fewer consultations and were more likely to complete evaluation within one single visit.   

With proper training and support, non-allergists can independently conduct penicillin allergy evaluation among low-risk individuals. Compared to allergists, evaluation of low-risk penicillin allergy by non-allergists can be comparably effective, safe, and impactful on quality-of-life. Effective strategies for fostering long-term, interdisciplinary collaborations between allergists and non-allergists should be further encouraged.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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