ArticleAllergy, asthma & immunology research2026
Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.
Article in Allergy, asthma & immunology research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAlthough around 90% of penicillin allergies are mislabelled, delabeling initiatives have been hindered by limited access to drug allergy services. Asia Pacific Association of Allergy, Asthma, and Clinical Immunology (APAAACI) and PENFAST risk-stratification tools can facilitate non-allergist delabeling, but their comparative real-world performance remains unknown. The purpose of this study was to prospectively evaluate APAAACI and PENFAST against allergist assessment and drug provocation testing (DPT) outcomes.
methodsIn a blinded, head-to-head study, 103 adults with penicillin allergy labels underwent independent risk stratification using both APAAACI and PENFAST tools, followed by allergist evaluation and allergy testing (skin tests,
resultsOverall, allergist assessment demonstrated the highest AUC of 0.82 (95% confidence interval [CI], 0.69-0.95), outperforming APAAACI (AUC, 0.79; 95% CI, 0.66-0.92;
conclusionsAPAAACI and PENFAST can both effectively identify low-risk patients labelled with penicillin allergy when used by non-allergists, with comparable sensitivity to allergist assessment. APAAACI's stronger agreement with allergist assessment may suggest particular utility in Asian populations. These tools can significantly improve access to delabeling in settings lacking specialist allergy services.
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