ArticleAsia Pacific allergy2023
APAAACI clinical pathway on direct provocation testing for penicillin allergy delabeling.
Article in Asia Pacific allergy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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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.
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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.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Pooled it
- Impact of a drug allergy education course for non-specialists: Findings from ADAPT-A randomized crossover trial.Allergy · 2025Trial
- Penicillin Allergy Delabeling: Bridging the Evidence-Practice Gap in Antimicrobial Stewardship.Journal of general internal medicine · 2026Review
- Direct Oral Challenge for Penicillin Allergy: The International Network of Antibiotic Allergy Nations (iNAAN) Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Observational
- Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.Allergy, asthma & immunology research · 2026Article
- Performance of PEN-FAST and CEPH-FAST for Cephalosporin Allergy Delabeling.Clinical and translational allergy · 2026Article
- Bridging Global Disparities in Drug Allergy Through AI-Assisted Training for Non-Specialists: Findings From the Multinational ADAPT-2 Course.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Article
- Penicillin allergy documentation in the UAE: 10-year trends and stewardship implications.Frontiers in medicine · 2026Article
- The impact of drug allergy on planetary health and sustainability.Asia Pacific allergy · 2025Article
- Hereditary Angioedema (HAE) in China: Advancing Awareness, Access, Advocacy and Alliances From the Greater Bay Area to the Global HAE Community.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2025Review
- Penicillin Allergy in China: Consequences of Inappropriate Skin Testing Practices and Policies.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2025Review
- Article
- Review
- Article
- Comparing pharmacists versus allergists in low-risk penicillin allergy delabelling: The Hong Kong Penicillin Allergy Pharmacist Initiative (HK-PAPI).The World Allergy Organization journal · 2024Article
- Bibliometric analysis of the trends and evolution in β-lactam allergy research.The journal of allergy and clinical immunology. Global · 2024Article
- Narrative review of recent developments and the future of penicillin allergy de-labelling by non-allergists.npj antimicrobials and resistance · 2024Review
Corrections and comments
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Authors and funding
18 authors at 17 institutions in 15 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Allergy to penicillin is commonly reported in many countries and is an overwhelming global public health concern. Penicillin allergy labels can lead to the use of less effective antibiotics and can be associated with antimicrobial resistance. Appropriate assessment of suspected penicillin allergy (often including skin testing, followed by drug provocation testing [DPT] performed by allergists) can prevent the unnecessary restriction of penicillin or delabelling. Many countries in the Asia Pacific (AP) have very limited access to allergy services, and there are significant disparities in the methods of evaluating penicillin allergy. Therefore, a clinical pathway for the management of penicillin allergy is essential. Objectives: To develop a risk-stratified clinical pathway for delabeling penicillin allergy, taking into account the distinct epidemiology, patient/sensitization profiles, and disparities of allergy services or facilities within the AP. Methods: A risk-stratified penicillin allergy delabeling clinical pathway was formulated by the Drug Allergy Committee of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. and members of the Penicillin Allergy Disparities survey in AP each representing one country/region of the AP. The clinical pathway was tested based on a database of anonymized patients who were sequentially referred for and completed penicillin allergy evaluation in Hong Kong. Results: The clinical pathway was piloted employing a "hub-and-spoke" approach to foster multidisciplinary collaboration between allergists and nonallergists. A simulation run of the algorithm on a retrospective Hong Kong cohort of 439 patients was performed. Overall, 367 (84%) of patients were suitable for direct DPT and reduced the need for skin testing or specialist's care for 357 (97%) skin test-negative individuals. Out of the skin test-negative patients, 345 (94%) patients had a negative DPT. Conclusions: This risk-stratification strategy for direct oral DPT can reduce the need for unnecessary skin testing in patients with low-risk penicillin allergy histories. The hub and spoke model of care may be considered for further piloting and validation in other AP populations that lack adequately trained allergists.
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