ReviewJAC-antimicrobial resistance2021
Safety and efficacy of de-labelling penicillin allergy in adults using direct oral challenge: a systematic review.
Review in JAC-antimicrobial resistance, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- The effectiveness of interventions that support penicillin allergy assessment and delabeling of adult and pediatric patients by nonallergy specialists: a systematic review and meta-analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Pooled it
- The Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels (PROPEL) Trial: A Randomized Clinical Trial.The journal of allergy and clinical immunology. In practice · 2025Trial
- Guidelines for the management of adult penicillin allergy in community and specialist settings in Australia and New Zealand: An AGREE II and Delphi-based approach.The journal of allergy and clinical immunology. Global · 2026Article
- Standards for practical management of drug hypersensitivity reactions to intravenous drugs and proactive early allergy involvement before referral: A WAO Statement.The World Allergy Organization journal · 2026Review
- The prevalence and risk factors of drug allergy in Sri Lanka-a multi-centre cross-sectional observational study (2024-2025).The Lancet regional health. Southeast Asia · 2026Article
- Penicillin Allergy, Really?-A Cross-Sectional Mixed-Methods Study in Baden-Württemberg, Germany, to Explore General Practitioner Perspectives on Delabeling Potential in Primary Care.Antibiotics (Basel, Switzerland) · 2026Article
- What are patients' and healthcare professionals' views on managing penicillin allergy? A qualitative evidence synthesis.JAC-antimicrobial resistance · 2026Review
- Impact of a Pharmacist-Driven Penicillin Allergy De-Labeling Service (PADLS) on Hospitalized Patients.Pharmacy (Basel, Switzerland) · 2026Article
- Patients' experiences of penicillin allergy evaluation: a qualitative study.JAC-antimicrobial resistance · 2026Article
- Penicillin allergy documentation in the UAE: 10-year trends and stewardship implications.Frontiers in medicine · 2026Article
- Evaluation of the Allergy Fact Checker, a clinical decision support system for non-invasive beta-lactam delabeling: a mixed-methods study.NPJ digital medicine · 2025Article
- Non-β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections.JAMA surgery · 2025Article
- Time to challenge penicillin allergy labels.Canadian family physician Medecin de famille canadien · 2025Article
- Evaluation of cephalosporin allergy: Survey of drug allergy experts.The journal of allergy and clinical immunology. Global · 2025Article
- Clearance of penicillin allergies via direct oral provocation testing (DOPT): a systematic review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Developing and disseminating an electronic penicillin allergy de-labelling tool using the model for improvement framework.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2024Article
- Reliability and validation of an electronic penicillin allergy risk-assessment tool in a pregnant population.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2024Article
- Protocol for a systematic review and meta-analysis of interventions aimed at delabeling low-risk penicillin allergies with consideration for sex and gender.Systematic reviews · 2024Article
- A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling 'low risk' patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems.The Journal of infection · 2024Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundApproximately 10% of people have an unverified penicillin allergy, with multiple personal and public health consequences.
objectivesTo assess the efficacy and safety of direct oral challenge, without prior skin testing, in this population.
methodsMEDLINE, EMBASE, CINAHL, the Cochrane Library and Google Scholar were searched from inception to 28 June 2020 (updated November 2020) to find published and unpublished studies that reported direct oral challenge for the purpose of removal of penicillin allergy labels. Population weighted mean was used to calculate the proportion of patients who developed an immediate or delayed reaction to direct oral challenge across the studies.
resultsThirteen studies were included in the review, with a sample size of 1202 (range 7-328). Studies included inpatient and outpatient cohorts assessed as low risk for true allergy. In pooled analysis of all 13 studies there were 41/1202 (3.41%) mild immediate or delayed reactions to direct oral challenge. The population-weighted mean incidence of immediate or delayed reaction to an oral challenge across studies was also 3.41% (95% CI: 2.38%-4.43%). There were no reports of serious adverse reactions, 96.5% of patients could be de-labelled and many were subsequently successfully treated with penicillin.
conclusionsDirect oral challenge is safe and effective for de-labelling patients assessed as low risk for true allergy. Non-specialist clinicians competent in using an assessment algorithm can offer evaluation of penicillin allergy labels using direct oral challenge in appropriate patients. These measures will facilitate optimal infection treatment for patients, support antimicrobial stewardship, and minimize antimicrobial resistance.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.